From the Frontline: Life as an Emergency Physician During a Pandemic

I’m ready to be back blogging and am excited about a brand new year. I’m excited to bring you new recipes and talk about food and lifestyle, and Holly plans on joining us just as soon as her schedule allows. But first: a little reality. This pandemic is a large part of why we were not blogging as usual this summer (along with my medication misadventures: see post here). We need to acknowledge the elephant in the room. The weight that made my heart too heavy to sit down and concentrate on editing food photos and testing recipes. I felt like my mind was constantly whirling…which to be fair, I guess it was. So maybe we should talk about it. We should talk about life as an emergency physician during a pandemic (which is almost identical to the life of any healthcare professional-from the nurses to the techs to the pharmacists to the social workers to the EMS providers).

Trigger warning: This post talks about my experiences as an Emergency Physician during the pandemic. Writing has been healing for me, and as one of my friends recently said “thank you for using your platform for good.” So this is for you Nathan, hopefully it will help more people understand what we as healthcare workers have been through since the pandemic started…

I’m also writing this post in honor of every life that has been lost.

It started as barely a glance at a TV screen while standing in the San Francisco airport. Holly and Kelly and I were returning from a medical conference in Napa. The voice reporting the news droned on “passengers incoming from China now quarantined at Travis Air Force Base”. Barely a blip on the radar. Nothing to worry about. We boarded the plane and flew back to Minneapolis.

Fast forward another month and there was a hushed pall over the nation. Coronavirus. Covid-19. A novel virus quickly spreading across China and parts of Italy. Not much was known about it, other than it seemed virulent and more deadly than the viruses we normally had circulating. But China was far away. We live in the United States. Safe and sound.

And then Seattle happened. Multiple people infected at a nursing home. Sick. Dying. The country was starting to take notice. And the fear was setting in. It was here. Coronavirus in the United States. When would we see this virus in Minneapolis? How would we know? How could we protect ourselves?

Being a doctor in normal times is a difficult job. We carry a tremendous amount of responsibility and we don’t take that responsibility lightly. We always want the best for our patients and we try to give them exactly that. But no matter what you do, someone out there is ready and waiting to second guess your decisions. In the end you have to make the decisions you think are best. The decisions that allow you to sleep at night. This was a novel virus. We were quickly trying to integrate any information that was being published and everyone was sharing as much clinical detail as they possibly could, but we were still working with a lot of unknowns. Most people have no idea how much time I spend thinking about my patients- I’m still thinking about them long after I’m no longer the one caring for them, long after the decisions have made. Long after they’ve left the emergency department. Long after they’ve left the hospital. This responsibility gets even more weighty in a pandemic. The thought burden becomes even greater.

Nationally the response was confusing. Minneapolis shut down fairly quickly, but in Florida, spring break celebrations continued, business as usual. Schools in Minnesota were closed, everyone who could work from home did, and the streets were eerily quiet. At the hospital we stopped seeing all but the sickest of people, they just stopped coming to the emergency department, afraid of leaving their homes. Afraid of getting infected. The fear intensified. Were these sick people we were treating in the Emergency Department infected? How would we know? How could we protect ourselves?

Testing was atrocious. We didn’t have the access we needed, no one did. Statewide we were short of testing solutions and then short of the swabs to get the samples. No one knew how accurate the testing was anyway. Testing was only available to the sickest of the sick. Worst of all, it took days to get results. Days in which people went on infecting others. The fear built. Was it like the flu? How would we know? How could we protect ourselves?

Our hospital was quick to impose rules regarding personal protective equipment (PPE). We were required to wear surgical masks and eye protection at all times within the walls of the hospital. We did have access to N95 masks, the ones thought to offer the most protection-and many of us wore these from the time we entered the hospital to the time we exited the hospital. But we were to reuse each mask 5-10 times before getting a new one, in order to ensure an adequate supply for everyone. We knew they broke down over time. We knew they didn’t keep their seal reliably after some number of uses, but what was that number? No one knew, but we sure hoped it was more than the times we were being asked to reuse them. What else could we do, there were no N95 masks available to buy. Hospitals were holding city wide drives trying to source as many masks as they could. Every governor was pitted against every other governor in a strange Hunger Games like bid to get equipment for their states-ventilators, masks, gowns, gloves. All were suddenly scarce. And yet the worst of the pandemic was still yet to come.

We watched in horror as our colleagues in New York tried to stem the tide of the sick and dying. The testing remained inadequate long after it should have been abundant. Our treatment strategies were labor intensive and we were quickly running out of health care professionals as they started becoming sick themselves. Brave health care workers from less affected areas of the country flew to New York to lend a helping hand. Several incredible nurses I knew, Jay and Cassie, quickly volunteered. Without looking back, they each went to a hospital in New York, where they were desperately needed. Teams that had met each other that day were taking care of sick patients in make shift units, cafeterias, hallways. It seemed like the beginnings of a science fiction movie I never would have volunteered to watch.

Meanwhile in Minneapolis our numbers rose. We were now seeing more of this odd virus. Consistent only in its inconsistency, we were frantically trying to figure out how to best treat it. How best to protect our staff. How best to protect the public. How best to offer comfort to those who were now isolated in rooms far away from family and friends. Terrified, alone, and sick, we struggled to remember the humanity of the patients we were caring for, their individuality. And as we continued to watch with fear and trepidation, many parts of the country went on with their lives, routine in their dealings, nothing to see here.

Masks, those simple pieces of cloth trying to keep respiratory droplets contained, suddenly became a hot button topic. “But our freedom” they cried. As healthcare workers trudged back to work, swathed in layers of hot and stifling masks, hoods, goggles, gowns, and gloves, tending to the sick, trying to reassure the well, all while trying to protect ourselves from that which we could not see. The masks wreaked havoc on the sensitive skin of our faces. Yet we wore those masks for hours on end, grateful to have them. “What about us?” we wondered. “Who will help protect us?”

The months marched on and the deluge continued. The striking trend being the fact that people of color seemed to be so much more affected. Was it the comorbidities? The uncontrolled diabetes, high blood pressure, and obesity, that ran rampant through communities? Was it cultural where many generations may be living under the same roof? Was it the simple fact that these were the people who were largely the true front line workers, still providing our daily services-and not from the comfort of their homes. The people working in grocery stores and pharmacies, driving our buses and cleaning our buildings, working as PCAs and aids in nursing homes, often with inadequate PPE.

And still the political games continued. There was no national guidance. No national mask mandate. No national testing strategy. No national effort to get supplies to where they needed to go. Only governor v. governor in a battle that would prove brutal for the nation, and would ultimately brand everyone a loser, as state lines do not function to keep out viruses.

We watched in amazement as people continued vacationing and attending crowded gatherings. We couldn’t believe what we were hearing as we treated patient after patient who had been exposed while attending weddings and other large family gatherings. Exposed while hanging out in crowded bars. We can debate whether we can even blame those who chose the narrative that caused the least disruption to their lifestyles. After all, there were two clear narratives being touted by our media. One based in science and one not. But it’s hard when your leader is holding crowded mask optional rallies, after all, he wouldn’t put himself or his staff at risk, would he? And America is all about freedom of choice. If you were worried, you could stay home, problem solved. Except for the healthcare workers who did not have that same choice, and instead got left to pick up the pieces.

So time went on. We became more and more disillusioned. Help wasn’t coming, not in any meaningful way. We were exhausted, emotional, overwrought. We couldn’t unsee what we had seen. We’d all held the hands of someone who had died alone. We all witnessed the fear and the discomfort and the inequity, yet we could only do so much. Turns out we weren’t really the front lines after all, more like the last line of defense. We relied on each other and tried to shore each other up as we faced another day of the same grim realities.

I give the hospital I work for credit. They acted quickly and decisively making it clear that safety was a priority. Their quick actions likely saved a lot of staff exposure while on the job. They tried valiantly to keep communication flowing, whether about PPE or new treatment protocols or even what the models were predicting for volumes of disease. They changed workflows to keep patients safe (and yes, you can absolutely come safely to our emergency department). They tried to be as transparent as they could be about what we were going to get, and more importantly what we weren’t going to get. Several of my colleagues stepped up in major ways both to staff the incident command center and to lead our emergency department to make sure that things went as smoothly as possible. Their voices were invaluable and I’m so proud to say, many lives were saved as we were able to continue providing excellent care.

Our numbers soared in Minneapolis in November. I have never cared for as many critically ill patients at one time during my career. We were struggling to find ICU beds, and if a hospital had one, they were struggling to find a nurse to staff it. Many staff were getting infected from exposures outside of the hospital as our community numbers skyrocketed. We kept heading to work telling ourselves “today will be a better day” even though we knew better. There was always more to do, more issues to address, more problems to stabilize. And so many phone calls to make. When we intubated people, the breathing tube acting as a last resort for oxygenation, we were left to wonder, would ours be the last voice they heard? Did their families understand how sick they were? Were there still words that needed to be said between loved ones? Often there just wasn’t time. And it wasn’t only the patients with coronavirus, when the hospital is full everyone waits. The cancer patient…waits. That surgical patient…waits. We all waited. Would today be the day that something really bad happened? Would we even recognize it as such after all of the months of something bad happening?

Every one of the doctors, nurses, advanced practice providers, techs, pharmacists, EMS personnel, social workers, lab staff, housekeeping staff, kept showing up to do their jobs even when the job seemed like too much to bear. When making one more decision seemed impossible. When the constant fear was that you would get sick, or worse yet, would bring the virus home and get your family sick. But we came back, day after day. We donned and doffed PPE until we had done what we had come to do-which was everything that we could.

The surge has started to dissipate again, and during this breather, I want thank these coworkers, everyone I work with day in and day out, for showing up and always giving their best. Everyone did and continues to do whatever needs to be done. The bad days are made tolerable by being surrounded by amazing people. Our patients can be assured no matter how bad it gets, this team will give you the very best care possible, in the safest manner possible. I have been bolstered by the dedication of everyone that works in our healthcare system. We learned we have each other. We’re flexible and we’re resilient. We’re fighters to the core, we don’t even know how to give up.

We have some light at the end of the tunnel, in the form of the vaccine. I’ve gotten my first dose and I’m a little over a week away from getting my second dose. I’m hoping this will protect us, therefore allowing us to get back to some semblance of normal living. I miss seeing my medically fragile dad. I miss hugging my mom. I want my kids to get back to school. I want a normal college experience for my daughter who has lost her senior year to this virus. I miss traveling and dinner parties and happy hours with friends. I miss the theater and concerts and even medical conferences. But what I miss doesn’t hold a candle to those people who have lost loved ones because we haven’t been able to contain this monster. These losses have left huge holes in our hearts. I’m finally optimistic after months of feeling angry and hollow. Maybe this will be the path out. But this too depends on a strong national leadership and a country willing to listen to science.

As an ER MD I’m used to being strong, stoic, impenetrable. I’m used to denying myself time to feel, and just moving on. There is a job to be done and I’m going to do it. Cold? Maybe. But anything short of getting the job done would be unthinkable. Some days I feel like I can talk freely about what it has felt like to always be living in “fight or flight” mode, what this pandemic has done to us as healthcare workers. Some days I wall it all off in order to go about my daily life. It’s affected us all differently, but there are a few universal truths. So much pain, so much grief, so much fear. So many tears shed in my car, my shower, in my room late at night. So many patient’s faces I remember so very clearly. So many families I’ve met only over the phone as I’ve called to give updates. We’ve all lost so much. We haven’t even begun to see the true fall out from this pandemic. The post traumatic stress we are all carrying.

But along with all of the bad, the great losses and the heartbreak, there have also been beautiful lessons. Things we’ve learned that we are going to need to put first in 2021. Things like family and friends and the beauty of slowing down and the importance of the equality of our fellow human beings. I’ve started posting on social media about THESE things. The good things. Because we all need to remember the good things when the going gets tough, which I anticipate it might again. And we all especially need to remember the most important lesson we’ve learned during this horrible pandemic.

We’ve learned that we are all better when we work together.

Thank you to all of the healthcare workers who shared their deeply personal photos with me to share with you.

-Lane Patten, MD is an Emergency Medicine Physician at a Level 1 Trauma Center in Minneapolis.