Crozet Annals of Medicine: COVID-19

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ER personnel and first responders are a superstitious lot. Certain words are taboo, never to be uttered in an ER. The Q word is the most strongly and widely held taboo in the ERs of America. We do not say it. It is believed that if anyone says the Q word in the ER, we will be suddenly overwhelmed with a catastrophic number of patients all at once. We all have qualms about the quagmire that might represent. 

The Q word is not quarantine. The Q word is not quinine, the precursor to chloroquine, which has been much in the news lately as a potential COVID treatment. This treatment is questionable, but that is also not the Q word. You may wait in a queue to get in and see us these days, but that is also not the Q word. 

The Q word is quiet. There, I said it. The ER in Charlottesville has been eerily quiet over the past few weeks. This mirrors a nationwide trend. While the ERs in New York City, New Orleans, Seattle and Detroit are overrun with COVID patients, the majority of the ERs in the rest of the country have seen a drop in patient visits by as much as 40-50 percent. This is good for now. It is part of social distancing and self-isolation. It is working to slow the spread of COVID. Good job!

Don’t get me wrong, we are seeing a lot of potential COVID patients, some of them quite sick and we are carefully donning and doffing PPE all day. And yes, we are looking at shortages of appropriate masks already, just like the rest of the U.S. healthcare system. But while we have more COVID patients, we have far fewer routine ER patients. Earaches and sore throats are staying home, back pain and sprained ankles are being managed at home with Advil and rest. I know much of this is driven by the not unreasonable fear of catching COVID in the ER, but whatever the cause, it is helping our community slow the spread of this virulent disease. 

A quiet ER is a novelty these days, and the staff has used this time to more thoroughly prepare for the COVID pandemic. We are ready, as ready as we can be in the face of shortages of PPE and COVID tests.

But the eerie quiet works on the nerves of the care providers. We know what is coming; we maintain high alertness, only to stand down every day as the storm is delayed by another day.

Despite the uncertainty and anxiety and even frank fear that the hospital staff is facing, staff morale is high. We are all in this together. When I enter a COVID patient’s room, there is a tech or nurse assigned to watch me don and doff my protective gear. Their job is to make sure I get it right, each and every time and correct me if I don’t. They have my back, and I have theirs. 

When a COVID patient leaves the room, environmental services gears up and goes in and cleans and disinfects it. We would be out of business if these guys stopped showing up. 

Nurses and respiratory therapists go in the COVID patients’ rooms with us to assist us when we intubate. Intubation carries the highest risk of COVID infection in the ER for everyone in the room. Yet, go in we must.

Pharmacists and social workers, chaplains and physical therapists, dietary services, unit clerks and security officers— everyone is showing up on the front lines and standing a post.

And of course, most of all the residents. They work the longest hours, see the most patients, bear the brunt of most of the patient contact. I have taught residents for thirty years. I know their minds. They think they are immortal. Not this time. This has them rattled. And it should. But they not only show up, they pitch in and push forward. Even the non-ER residents, the consulting residents, do not hesitate to come to the ER and do what needs to be done.

This is going to be a special generation of physicians. They are being tested and they are rising to the call. I am proud of them and honored to have been able to teach them. 

Rest easy Crozet, we are in good hands.    

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