University of Kentucky
Department of Emergency Medicine, PGI
Intern year had started out how most of us had imagined. Bumbling through the ED, second guessing every order for Tylenol, just trying to get comfortable with the idea that I am responsible for someone’s medical care. Our program switches between off-service rotations and ED months every other month. Finally, around February I was at a point where I felt comfortable with the flow of the department and found myself stepping out of my comfort zone more often to challenge myself. At this point we had heard about this virus that was sweeping around the world at a rate no one could quite understand. They had shut down entire cities in China and the first few cases in the US had arrived by the end of the month. Meanwhile, we were still trying to carry on business as usual and come up with plans to handle what would come. By March, Kentucky had its first case and it was full hands on deck. We were seeing countries like Italy and Spain be decimated by this terrible disease.
Early on throughout the disease progression, we thought we were going to be overrun. PPE supply was in constant question, and hospital policies were changing from almost shift to shift. We had expected to see a large surge in patients. So much so that UK had an expanded hospital in the football fieldhouse to accommodate for this. We were coming home from shifts to go through various “decon” procedures just to be able to interact with our families. In the beginning we didn’t have many tests available, and most of them were being shipped out to Frankfort who had the capabilities.
I was hearing stories from my friends in NYC and in New Orleans whose cities were getting crushed and absolutely overrun. Stories of residents contracting the disease were circling around. Throughout all of this chaos and confusion I’m still just trying to figure out how to be a doctor. I had just gotten use to the old system. I had just gotten confident in my abilities to see more patients and work on my efficiency. How was I expected to deal with a pandemic on top of all of this?
We had thought initially that the less urgent cases would be the ones who didn’t show up during this time, but what we found was not even those who truly needed to come were not coming through our doors. The surge we had expected never came and instead of our normally full 80+ bed ED, we had nights where there were less than 5 patients in rooms. Off service rotations were not letting us rotate through their departments trying to decrease overall exposure. Though this was frustrating at times, this where I found the true importance of our specialty.
When other departments were shutting down and limiting their practices to telehealth, we continued to show up day in and day out. While sometimes this was a little daunting and constantly changing, we supported each other in the best way we knew how. Our specialty doesn’t allow us to take a back seat and slow things down. We show up every single day for each and every one of our patients. Our ED is setup where all of the providers can sit together throughout the shift. On some of these long slow nights that was one of the things that made it so much easier to carry on, knowing that we weren’t alone. We all figured things out together, another quality our specialty is great at doing. We adapt. We never know what challenges we may face from shift to shift, yet we show up and do the best we can with the resources we have. We are in such a unique field where we are able to see the vast variety of what medicine has to offer. We don’t only have to know what is changing in our field, but also in the management of others as well and make sure to change our practice appropriately.
Slowly our volume started to increase, and cases began to rise, but we had prepared appropriately and, so far, have been able to handle what has come our way. Of course, there have been small hiccups and curves along the way, but we have been able to handle them throughout. Even though my clinical learning may have gone through a small slump during all of this, what I was able to learn is a deep appreciation for this specialty. I was able to see our physicians, nurses, and techs work together to keep everyone as safe as we could with the information and equipment we had available.
Lastly, what I have been able to appreciate is the love and dedication of our families and friends. I can only imagine the fear that they all must have when we’re going into shift while constantly hearing of PPE shortages and people dying in hallways on the television. Not only concerned for our safety, but their own safety. They did not sign up for this job, nor its risks, but they have had to live with them every day for the past few months. They have had to live with all of these changes along with changes of their own. I will forever be in awe of my wife continuing to take care of her children in speech therapy using telehealth resources she had no prior experience with before the crisis. There are many more stories like that and as much as we have had to deal with in medicine, those around us deserve to be recognized as well.
We will continue to go along this ride together and it will seemingly get worse before it gets better, but I believe we will continue to adapt and change as needed like we always have and will continue to do so.