Crozet Annals of Medicine: The Things We Lost in the Fire

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We will find in the ashes.  – Creole Proverb

Fall is in the air. The days are growing shorter and colder and the trees are dropping their leaves in a brilliant display of loss. Soon my lawn will disappear under the matted weight of the rotting dead foliage.   

This fall marks the beginning of the third year of the worldwide Covid pandemic. 47 million Americans have gotten Covid and 766,000 have died. Despite having an effective vaccine, cases and deaths continue, mostly in the voluntarily and often proudly unvaccinated. I see this on a daily basis at work where I am still admitting Covid patients, many of whom are quite sick.

The public awareness of the danger of Covid however has seemingly faded and the cognitive dissonance of what we are seeing and what the public is doing (or not doing) is vexing for my ER staff.

Nevertheless, cases are declining somewhat (although we have seen this trend reversed before) and so perhaps this fall is a good time to reflect on all that we have lost and what we may have gained.

In the beginning I was one of many “Health Care Heroes.” Remember that phrase? Health Care Heroes are people who get paid in pizza. I don’t hear that phrase now so much. Nor do I get any more free pizza. That’s a loss. It’s okay, though. Most of us never really liked the pompous braggadocio of that phrase and the pizza was always cold and who had time to eat it anyway?

But we have also lost actual health care heroes. At least 3,600 healthcare workers have perished in the first year of treating Covid and that is certainly an undercount. Many, many more have retired due to burnout and moral injury.
ER nurses are at the forefront of this exhaustion and they are resigning or moving on to other kinds of nursing in large numbers.

In my 33 years in the ER, I have never witnessed anything like the nursing shortages we are facing. Many places have greater than 50% ER nursing staff vacancies. You can’t run an ER half staffed. It is dangerous and further exhausts the remaining staff. Trying to care for patients in a system that demands concessions due to shortages causes our RN’s moral injury and burnout.

But we have gained something from this I suppose. A whole industry has sprung up to provide “travelers,” i.e. itinerant nurses who move from place to place following the most lucrative jobs. As short-staffed hospitals compete for this scarce resource, traveling nurses’ salaries have skyrocketed to two or three times what they were pre-pandemic. So that is a win for some nurses.

I try to view this development in the best light possible. While I have lost many good nursing colleagues who I have valued for years and whose judgment I could rely on, I now get to make new nursing friends every shift. This is of course problematic if a sudden emergency arises, and I don’t know who I can trust, but they are by and large an energetic bunch with lots of experiences in other ERs.

I have also lost the custom of shaking hands with acquaintances. But I have replaced it with fist bumps or elbow bumps. Way cooler and a kind of secret handshake that says we both are in the know about the dangers of Covid transmission and are standing a post together to defeat this thing.

I have lost shirts and ties and gained the much simpler and more comfortable scrubs for work wear. I also don’t have to comb my hair or shave before work because I am in a surgical cap and mask continuously while at work. Masks work; it is why we will never go without them in the ED again.  I wear a mask most of time outside of the ER as well. Something gained in the ashes; because of my mask I did not get the flu last year. Consider masks something found in the ashes and think about wearing them more often when you are out. It is comforting to protect yourself and it is gratifying to protect others.

Early on in the pandemic we all had to slow way down, stay home as much as possible and really do almost nothing. We gave up a lot; travel and restaurants, parties and family gatherings, movies and shows, live sports events, schools and offices. Now we are beginning to resume some of these vital social interactions, but I am trying to keep some of the quietness as well. It has been very restful and I have been getting plenty of sleep and gentle exercise.

And this year I will leave the fallen leaves on my lawn. They shelter lots of insects and other critters from the winter’s cold and when the spring finally comes, as spring always does, they will decay and nurture new growth. 

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