Emergency physician Emily (who asked us to not use her last name) was knee-deep in flu season in Texas when the initial reports of coronavirus began surfacing."I was highly skeptical. It sounded very similar to the flu," the 36-year-old Air Force veteran shared with We Are The Mighty. "Information out of China was obviously pretty filtered and somewhat difficult to interpret. Once I began hearing reports from physicians in Italy, this was probably late February, I started to become a bit alarmed. This was not the flu. It was much, much worse. It was going to be bad."
Emily at work.
In early March, Texas hospitals began preparations for the anticipated surge of COVID patients.
"PPE [personal protective equipment] shortages were rapidly apparent, and the supply seemed to change daily, making our personnel protection protocols constant moving targets," Emily explained. "Testing capabilities also fluctuated wildly, again making for daily -- sometimes hourly -- changes in how we performed testing. Going into work was a completely different experience every day. We had to quickly adapt to being comfortable with extreme flexibility."
As the days passed, extreme flexibility would be crucial.
"When shelter-in-place orders took effect in our area [and] as people began staying home and elective hospital procedures were cancelled, emergency department volumes plummeted, as did hospital revenues," she explained. "This led to drastic changes in how emergency departments were staffed. Down-staffing was warranted, because there just weren't as many patients to see, but it was - and is - still having significant effects on the pay for these frontline workers."
Emily, who works in three different hospitals across three different healthcare systems on a PRN [as needed] basis, typically works "at least full-time, some months even more so." With low emergency room volumes, she expressed feeling underutilized.
"The PRN employees have been the first to go," she shared. "My shifts have been cut back drastically. I have cherished the extra time with my family and my children, even as I am itching to go back to work. To have the skills to be of use and not have the opportunity to use them has been an unusual form of torture."
Emily with her family.
She adds that COVID-19 has put a spotlight on the state of the U.S. healthcare system.
"Our healthcare system has been teetering on the verge of collapse for a long time," she said. "The people who profit from our for-profit healthcare system are neither the doctors nor the patients. As I saw our system straining under the weight of COVID, I had hoped that it might finally break and give way to real and lasting reform. Instead, I have seen physicians losing their jobs for speaking out about their lack of PPE. I have seen physicians experiencing pay cuts, even as they work more, work harder, and in a more dangerous environment. When administrators who sit behind a desk feel empowered to dictate to their healthcare workers how often they have to reuse PPE, all the while handing out pay cuts to those exposing themselves to the greatest degree of risk, we have a serious problem."
Through it all, and despite the gravity of the situation, Emily shares that coronavirus has provided her with professional clarity.
"COVID has been something of a crucible, reinforcing for me that emergency medicine is more of a calling than a job," she said. "I have been fearful for my own personal safety as I have heard accounts of physicians falling ill, and even dying from complications of coronavirus. As a combat veteran, facing peril while in the line of duty is not foreign to me, but COVID has felt different -- I never expected to be in danger while working in a stateside ER as a civilian. Despite the risk, I have felt an undeniable pull toward the Emergency Department, to use the skills I have spent years developing and the expertise I have gained from thousands of patient encounters to try and do some good. It has been good to feel like I can be of some use."
Like Pat Sheehan in Louisiana, Emily stated that in the ER, healthcare workers are always on the front lines.
"The only difference now is that the world is finally paying attention."