ER Goddess: Bailing Out the COVID-19 Tidal Wave : Emergency Medicine News – LWW Journals

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Simons, Sandra Scott MD
It’s Christmas Day. I sent my fiancé Matt to work with Bojangles fried chicken and a chocolate cake, but our brief afternoon phone conversation made clear that none of his ED staff will have time to eat it. “Sandy, people are coming in by the carloads. I just had a family of five, all asymptomatic, all wanting COVID tests. On Christmas.”
He pulls a jumbo whiskey ice ball out of the freezer when he gets home Christmas night. “You wouldn’t believe the incredulousness of some of the unvaccinated patients with COVID symptoms when I told them they have COVID. What did they expect?”
He pours two fingers of scotch. “Others are rushing to the ED with minimal symptoms after positive home COVID tests because they are anxious, want confirmation, or just need a work note.”
Matt sees 60 patients in a 12-hour shift the day after Christmas. He comes home two hours late and pours three fingers of scotch. “I had critically ill patients, but the noncritical people with COVID fears were jamming up our department. The press has scared people. I told one 12-year-old girl she had COVID, and she burst into tears and asked if she was going to die.”
A few days later, while procrastinating my pre-nightshift shower, I see a social media post from Matt’s hospital system telling the public that hospitals are not COVID testing locations. Things are serious when a for-profit system posts anything that could deter patients. I head into my nightshift anticipating a crap show.
I try to bail a tidal wave of patients out of my waiting room with my one single bucket for 12 hours. Juan in the lab tells us that results will be delayed because the lab is inundated and he is the only tech. COVID swabs are so backed up that we can no longer tell patients to expect results within 24 hours. They are now taking several days.
I see yet another patient with fever, COVID symptoms, and a known exposure. I explain that we are going to treat her illness as COVID; a test won’t change what we do in the ED, and she vehemently demands a swab. “Last time I was here they sent the test.”
“Ma’am, last time you were here our labs and waiting rooms weren’t overwhelmed,” I say.
It’s hard not to upset people when they expect a test because that’s what we’ve been doing up until now, when numbers allowed. She stomps out.
By the time my relief arrives, I’ve seen more patients than I’ve ever seen in a single night. My Fitbit tells me that I’ve done more than two miles of scurrying around the department.
Twelve hours later, after my less-than-restful daytime sleep, I’m back to do it all again. This time I instruct the triage nurse, “Please tell patients they will be seen by the clinician. A COVID test is at their clinician’s discretion because this is not a testing center. If they ask, give them a list of testing centers.” I don’t want anyone waiting hours to see me only to be disappointed.
My first patient, refreshingly, is a laceration. She tells me about her three hours in our waiting room. “Everyone wants a COVID test. I told one man who looked completely fine that instead of further backing up the ED, he could go to a testing center or get an at-home test. He took my advice.” I would high-five her, but I’m sterile.
Unfortunately, not everyone is as reasonable as my laceration patient and the patient she redirected. The crammed waiting room feels like dynamite sticks with unlit fuses. Then one explodes. The triage nurse flees triage and grabs our department police officer, explaining that a patient called her a “little white b—-,” and began punching the wall. When the officer gets to him, he is throwing chairs and escalating his complaint from COVID symptoms to chest pain, demanding to be seen. After a nonischemic ECG and attention from the officer, two nurses, and me, his fury burns out. He’s ultimately diagnosed with COVID, like so many others.
In the wee hours, a dialysis patient with a GI bleed, whose transfer to a higher level of care was arranged by the day doctor the day before, is still awaiting transport. Transfers are usually waylaid because there are no beds or available EMS crews. Surprisingly, this patient has a bed and a crew to take her. And the bed she’s going to is empty, but only two housekeepers are working in the referral hospital, and they just can’t get around to cleaning it. When angry patients become verbally and physically violent with hospital workers, is it any wonder hospitals are short-staffed? And we haven’t even hit the peak of this Omicron surge.
Fast forward to the first Monday in January. I sit down to write this article about our shifts-from-hell over Christmas, and Matt bursts into my office thrusting his phone toward me. “Look at this email I just got!”
All the 9-5 administrators who enjoyed their holidays off are back to work, and they have emailed Matt to let him know how many of his charts from December did not contain enough documentation. One would think they might thank him for working over the holidays or for charting as much as he could while seeing ridiculous volumes of patients in the middle of a surge with no scribe. No, COVID surge or not, they just keep cracking the whip. The already-demoralized troops are becoming further demoralized by the day. I’m afraid for the next few months.
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Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns athttp://bit.ly/EMN-ERGoddess.
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