Life on the Frontlines

A story of emergency medicine healthcare workers and what you can do to help

I am an emergency medicine physician in Houston, working at the frontlines of this terrible COVID-19 pandemic caring for patients from our community day and night. I am an experienced physician who thought I had seen and taken care of patients with every emergency imaginable—until now, with a surge of patients suspected or confirmed to be infected with coronavirus.

I am very fortunate to work alongside the most incredible and dedicated health care providers – nurses, technicians, advanced practice providers, and physicians. Like others around the country, the topic of having the necessary resources and personal protective equipment such as N95 masks, gowns, gloves, ventilators and blood supply is constantly on our minds. And like many health care organizations, we have implemented significant measures to conserve these critical resources at a time when the entire country is in need. Although outwardly brave, my colleagues and I also fear for our own health.

This is our story—what our days are like, how we are coping, and how the community can help us as we work 24/7 to care for this community:

Today I am the rapid treatment physician. My job for the next eight hours is to screen patients with any respiratory illness before they enter the larger ER. My goal is to keep potential COVID-19 patients from infecting other patients and staff. The nurse and I don our gowns, gloves, and surgical masks and bring the patients in one at a time. We will determine whether they have this new disease, need to be tested, need to be hospitalized, or are safe to recover at home. It is not simple with COVID-19, as things are not always how they initially appear.

Our first patient has had a persistent fever and cough for two weeks. The patient’s mask slips below her mouth as she unintentionally coughs directly in my face. She apologizes and adjusts her mask, but it’s too late. Did I just get exposed? Was my mask enough protection or did COVID-19 sneakily slip through the side of it and I can expect to get sick? These thoughts linger as I continue through her history.

Next is a man who appears to be homeless, but he tells me he recently traveled overseas on a cruise ship. We learn he has a history of psychiatric illness. He coughs. I tell him to self-quarantine and then realize: he is homeless. It starts to sink in, just how complex this is going to be.

The process continues for the next six hours. I see patient after patient with respiratory complaints and patients who believe they have been exposed to the virus.

We change our personal protective gear more than 30 times to protect each patient. It seemed that every patient had a fever and a cough, the most common symptoms of the coronavirus. I was 12 inches from them for eight hours and wonder if I inadvertently touched my face or scratched my nose at any time. I’m not sure, but if I had to place a bet, I would say I probably did.

As I observe firsthand the suffering, fear, and panic spreading across our region, I am proud to be a physician with skills that allow me to play an important role in this battle to save lives. But I’d be lying if I told you I wasn’t scared for my own health and the health of my colleagues, my work family, as well as my real family.

I have read multiple stories from around the U.S. about ER doctors stricken with the virus, on ventilators in the ICU. Some emergency providers are resigned to contracting the virus—it’s just a matter of time. Some of my colleagues are sleeping in hotel rooms, away from their families, out of fear of bringing the virus home. My friends who are telecommuting complain about the boredom of being home all the time. Ours is the opposite experience. I am anxious everyday as I change into my scrubs and protective gear that hopefully protect me from this incredibly infectious virus.

It would be easy for my emergency medical team to walk away or back down, but their selflessness and intense sense of duty calls them to meet the challenge—and even use it as an opportunity to innovate. One of my colleagues created a novel telemedicine system in a single week to decrease exposure to the virus. Another has been working with a fire department to create systems to help decrease exposure of our EMS rescuers.

I share our story to underscore that we are all in this together and we will get through this together. The more we work in lock step, the more lives we will save—your family, your friends, my family, my friends.

You too can play your part. There are specific actions each of us must take now to save as many lives as possible. They are not complicated, but you have to do them and you have to start now.

First, stay at home. It won’t be forever but for now you need to follow the stay-at-home orders. Second, wash your hands—more often and more thoroughly than you have ever done before.
Next, please do not hoard surgical masks and other personal protective equipment. Health care providers need these to treat patients. Please, if you or your company have N95 or surgical masks that are unused, donate them to your local hospital, nursing home, or fire department.
Don’t come to the ER unless you are seriously ill, such as having difficulty breathing. Consider using a virtual health care option to speak with a doctor. If you come to the ER, you increase your risk of being exposed to someone with COVID-19 and, unless you need supplemental oxygen, we will most likely send you home to treat your symptoms in order to make room for patients who need oxygen or a breathing machine to live.
Finally, please donate blood. Houston has a dire blood shortage now and you can literally save someone’s life in an hour. It’s safe, it’s easy, and you will have given a small part of your very self to save another person.

I can’t emphasize enough: these things must be done now for us to win the battle against COVID-19.

Houston’s health care providers are doing the best we can—giving our all, one patient at a time, one day at a time. Please help us do our best. We are Houston Strong!

Author:

Salil Bhandari, MD
McGovern Medical School @ UTHealth
Department of Emergency Medicine
Houston, Texas