From Dawn Adams
A few weeks ago, the cases started hitting our area, and it felt as if everything changed overnight. Once word got on the street about coronavirus, more and more patients began walking into the emergency room, and it got quite chaotic. But at that time, during the early days in the beginning of March, we were testing only people who had a history of travel to China. So even if they had fever, cough, upper-respiratory symptoms and exposure but hadn’t been to China, we didn’t test them. The next direction was to test them if they had symptoms, had exposure and had traveled either to China or Italy. That made some sense for us. We are a military facility with an international presence, and our biggest component is active-duty military people, retirees and their dependents, who tend to travel.
During that time, with that old protocol in place, one of my colleagues was working at another E.R. and saw a 50-year-old patient who had a cough and a fever and was in severe respiratory distress, but had no travel history or close contacts who had been exposed. Though that patient was very sick and needed treatment, according to our screening criteria, he wasn’t tested at the time. At that point, because his patient wasn’t high-risk, my colleague didn’t have a mask on and was exposed. He was placed on quarantine and couldn’t work.
I ended up working for him, and other people have picked up his shifts as well. In the past week, I worked a 25-hour shift and two 12-hour shifts — and I’m about to start another 12-hour shift. I know my colleague feels bad, because the E.R. culture is really not to miss work. We know that if we don’t work, somebody else is going to have to work for us. I can count on one hand the number of days of work I’ve ever missed — when my mother was sick, and then when she died. Being sick means you’re off your game; that’s what’s been ingrained in us. But it’s also understood that if someone steps out, you step in.
The same week my colleague was exposed and went on quarantine, we had our first positive case. Since then, one of our colleagues tested positive. And another doctor has had to step back. She’s the caretaker for her mother, who has been ill and is in very fragile health, and my colleague is worried about exposing her. I understand deeply that people must make personal choices, but I am also very, very afraid of losing more doctors while cases are rising so fast. Our facility now has three confirmed cases. And those numbers will only continue to compound. About the time that first colleague was exposed, we think around the weekend of March 11, the D.C. area had something like 60 cases. Now we’re up to more than 1,600.
As each week, each day, brings a new surprise, it has become very clear to us that we have to really protect ourselves, because we don’t have enough physicians to lose. We have N95 masks but not an abundance of them, and we were recently told to ration protective gear. We were already using masks to go into rooms of people we thought were suspected cases, but then we were told to wear a surgical mask to go into every patient room. As things have escalated, we have now been directed to wear a mask all the time for the entire shift.
I think one of the other hardest parts for us is the conflicting information from government officials, saying there are enough tests for everybody and everyone can be tested. That is not the guidance we’ve been given, and it has caused a problem with people demanding a test, and they have to be turned away if they aren’t symptomatic or have no exposure. I’ve had colleagues who’ve been cursed out by patients who couldn’t get tested. As a woman of color, I am used to being second-guessed or having patients ask me, “When am I going to get to see a doctor?” When I walk into a patient room, I automatically say, “Hi, I’m Dr. Adams.” But I get that people are desperate and want answers and help, so I try to bring in understanding. Our E.R. has only so much capacity, and people use us for their primary care. So in the midst of all that’s going on, we’re still treating people with everything from sore throats to asthma, chest pains and strokes. But these people are sort of commingled with patients who might have Covid-19, as well as those who are coming in wanting to get tested.
You often have only a thin curtain separating our examining rooms. Our facility has only one negative-pressure room, a separate facility where the air doesn’t circulate around to other areas, where you put somebody with a high-risk respiratory disease. We thought the negative-pressure room would be a place where we could separate out people who were really high-risk, but with so many potential cases and so many people, that is not going to work out. So it has been hard to figure out. How are we separating all these people so that we’re not increasing their risk and we’re not increasing our own health care providers’ risks? To manage this problem with the testing, our facility now has set up a tent outside the E.R. to prescreen people before they come inside the doors.
The culture of the E.R. is that we don’t stop. That’s part of the reason I went into emergency medicine. I’m a hands-on person and find that being on the front line, the first person to lay hands on a patient, to get them stabilized — that’s what’s rewarding to me. In my job, we don’t have designated breaks; there’s no lunch. You do your work. You eat at your desk as you’re seeing patients. You try to take your water break, and if you’re really not slammed, you hope to get to the bathroom. It’s the same but more intense now, so that doesn’t really give me time for paralyzing fear when I have a job to do.
My real fear and my main concern is my son. I’m the sole caretaker of a 10-year-old child, and his school just let out. School was my child care, so I’ve had to scramble, especially because I frequently have to travel between facilities. I have two child care providers, and I don’t know what I’d do if there is some kind of lockdown and they couldn’t get to him. I also don’t want to endanger him or his caregivers. Increasing evidence suggests that they may have underestimated the risk of younger people getting Covid-19. That means that I have to balance family and work in a way I’ve never had to before. It is a lot of stress. I know I’m really putting myself out there, and I’ve read about health care providers who have gotten sick and died. So I try to do the best to protect myself. I’m washing my hands like 5,000 times a day, cleaning everything and wearing the mask. But I also know what I signed up for.
Linda Villarosa is a contributing writer for the magazine. She directs the journalism program at the City College of New York in Harlem.