Crozet Annals of Medicine: The Beginning of the End

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I was walking the lanes of Appomattox Courthouse yesterday and thinking about the national mood and the mood in my hospital.

Appomattox Courthouse is not too far from Charlottesville and is well worth a visit. Much of the small village has been restored to the way it appeared in 1865 when history was made there. 

On a pleasant April day it is easy to picture the historic scene. After four years of brutal civil warfare, top Union General Ulysses S. Grant has finally run top Confederate General Robert E. Lee to earth in Appomattox Court House. It is April of 1865. Starving and surrounded, Lee faced no choice but to surrender the 30,000 men of the Army of Northern Virginia to Grant and his Army of the Potomac. Grant paroled (pardoned) all 30,000 Confederates and allowed them to return peacefully to their homes. 

It wasn’t the end of the Civil War, but it was the beginning of the end of a conflict that took 750,000 American lives. It was a time when Americans could breathe a sigh of relief and imagine an imminent future without the carnage of the past years.

That is how I have been feeling lately.

It was exactly one year ago that my ER saw our first Covid case. It was a terrifying time. The carnage had begun in New York City, after sporadic cases in Seattle. Soon the nation was engulfed. Healthcare workers were being struck down along with the patients. 

At U.Va. we had almost no information about the disease or how to treat it. We faced shortages of PPE, especially the N- 95 masks that could save our lives. Fear and anxiety were palpable all throughout the hospital. And yet, and yet; we showed up, and we figured it out day by terrifying day. 

I am beyond grateful and inordinately proud of the entire hospital team’s response over the last year. Everyone was flexible. For example, as elective surgeries were cancelled to deal with the surge, the OR and floor nurses came to the ER to aid in our PPE donning and doffing procedures, which we were refining every day. The ER was the front line and everyone knew it. Everyone was willing to help in any way they could. 

Our lab worked to develop our own Covid tests so we didn’t have to send them out. Biomedical engineering crafted face shields from 3-D printers for us. Community members donated face masks. (Thanks Lucy, and many others!) Telehealth provided in-room telehealth monitors so we could talk to the patients remotely. The OR team provided surgical scrubs for us. I loved going back into scrubs after all these years. There is a simple elegance to these shapeless, monochromatic, purely functional garments. 

Every day was different as we learned what worked and what didn’t. As an ER group we met twice a week over Zoom to share information, worry, and support. Nationally, we were talking to our ER colleagues to learn from their experience. We were following the copious and mostly erroneous research literature that was being churned out at a frantic pace to try and find some sort of treatment. Remember hydroxychloroquine? Zinc and azithromycin? Bleach?

We closed ranks around our pregnant and immunocompromised partners, relieving them from seeing potential Covid patients, while maintaining their ability to continue working.  

So, we did our best but it was long dark winter. We saw desperately sick patients and lost some of them, and some of us. But no one complained and no one shirked. 

Now it is April and the mood in the hospital has changed dramatically. The end is in sight and we can all feel it. It helps greatly that we are all vaccinated. This was U.Va.’s greatest accomplishment in all of this—the vaccine rollout was amazing and efficient. 

We are much better at treating Covid now, so that helps our moods as well. Although not everyone has been vaccinated yet, the most vulnerable have been vaccinated so the disease is not as deadly as it was in the first months of the pandemic. 

There was one serendipitous bright spot in all of this suffering and disruption. Due to the extensive use of masks we did not see any cases of flu this winter! I think masks are here to stay, at least in the winter months. I know I will be wearing one in the ER.

Abraham Lincoln encouraged the nation, scarcely a month before Appomattox with words that still echo in our present struggle-

“Let us strive on to finish the work we are in, to bind up the nation’s wounds, to care for him who shall have borne the battle.”

Let’s finish this work. Keep wearing your mask. Get vaccinated. And get outside and enjoy this glorious Spring! 

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