Portal de Periódicos da CAPES

My Family Didn't Sign Up for This

2020; Wiley; Volume: 27; Issue: 8 Linguagem: Inglês

10.1111/acem.14073

1553-2712

Liza Hartofilis,

COVID-19 and healthcare impacts

“Will buddies.” That was an unfortunate phrase a friend of mine and I coined together during a shift early in the pandemic. He was a resident in our program just a couple of years ago and is now one of my attendings. While we were working a shift in the ED swarming with critically ill COVID patients, it came up in the “doc box” that we were both drafting our wills. How's that for a view into the dark places a lot of us have gone during the pandemic … and we're both young and otherwise healthy. We have little kids and wanted our spouses to know we were looking out for them if anything happened to us, despite the little in savings I have still being a resident. One problem was that I couldn't find anyone to notarize mine. He mentioned, “Don't worry. I have someone. We can get them notarized together.” “Great, we can be will buddies,” I replied and we both laughed the cynical laugh a lot of ED docs use to cope in the difficult times we aren't strangers to. Just two weeks before this, COVID cases started to mount in New York City and the feel in the ED changed almost overnight. Within one or two days, the typical mix of urban ED patients—strokes, vasculopaths, heart attacks, gun shot wounds, chronic pain patients, psychiatric patients, GI bleeders—virtually disappeared and was replaced by a flood of hypoxic patients. Every corner of the ED was packed with patients hooked up to oxygen tanks, dispersed among the critically ill on ventilators or those about to be intubated surrounded by a swarm of people donning extra PPE for the high-risk procedure, and the patients just kept coming. As I hurried through the ED to evaluate yet the next patient, I would keep an eye on the pulse ox monitors, seeing confused patients, alone and scared, pulling off nonrebreathers and nasal cannulas with sat's in the 70s and try to redirect them and get them settled in on their oxygen before getting to that next patient. We were all scrambling to titrate pressors, vent settings, oxygen levels, and call families for heartbreaking goals of care conversations or FaceTime them in to see their loved ones for what was often and likely the last time. The tide was unrelenting. During that first week we started seeing COVID cases, I began what has since become a “new normal” decontamination routine when I got home. I'd undress in the garage, put all my clothes in a cloth laundry bag, bound it tightly, immediately shower in the basement and wipe down my glasses and cell phone a second time with Clorox. I was sleeping in that same basement and trying my best to distance myself from my two young boys, Finn (almost 5) and Roan (almost 3). That's a hard thing to even think back on, distancing but still being present with my little guys. I'd sit in the living room or outside while they played but couldn't hug, cuddle, tickle, kiss, wrestle with them, or even prepare their food. I was stricken with anxiety and guilt knowing they were potentially at risk being around me. The same with my husband. I was a pariah in my home. A vector for disease. So when I finished a string of five night shifts that first week, had slept a little and cried a lot, I helped pack up my kids, husband, and in-laws to head to the burbs in New Jersey to keep them safe from me and the explosion of COVID in the city. I drew big crayon notes for each of my kids telling them how much I love them that I tucked in their bags, made sure they had their favorite toys and lovies to sleep with, and gave them each a big hug while fighting back tears and telling them I'd see them real soon. I've never felt my heart break as it did that day because deep down I was fighting back the fear that could be the last time I ever see them again. It feels like I'm being overly dramatic because that couldn't possibly be true. But the sad reality is, it could. None of us know what straw we'll draw if we get infected, and working in the thick of the storm day in and day out makes it difficult to see beyond that reality at times. We treat patient after patient coming in critically ill with COVID: young, old, healthy, and those with any multitude of medical problems. We've watched colleagues fall ill, be intubated and linger in the ICU for weeks. Some get better and a lot don't. And that has shaken me to my core. I think we, as physicians, often put up a mental divide between ourselves and our patients, never letting ourselves believe for too long that we too could fall prey to the sometimes awful things we see our patients afflicted by. But this disease reaffirms in me everyday just how human and vulnerable we all are. I don't let myself linger on these thoughts long though as there is just too much work to do and too many patients to try to help, and I do feel a great privilege and responsibility being among those who can help. This new disease levels the playing field so vastly in health care as we're all learning about it for the first time together, residents and attendings. That's changed the dynamic of the resident experience. I've never been asked to come to the bedside with an attending so often to troubleshoot and think things through together on such an even plane. Sometimes it's crazy to think we both bring the same amount of experience with this disease to the table, having read as much as we can as fast as we can over the past couple of months everywhere we can, from our accrediting body websites to physician group chats on Facebook. We've seen the same numbers of patients with the disease. On second thought, given we spend so much more time in the ED as residents, we've likely seen more patients with this disease. In my first couple of years of residency, I took solace in my training knowing a seasoned attending was often just an arms length away when a patient was crashing and burning and I just couldn't figure out what to do next. I had that sense that thank God there's someone here who really knows what's going on, someone who has seen this or something like this before and has control of what to do when everyone else senses a totally out of control moment. But COVID is utterly different. I don't have that ultimate backstop anymore. On the one hand that feels good and exciting as we all find our confidence in the practice of emergency medicine, and on the other hand it is terrifying knowing we're all to some extent floundering, doing the best we can against a new enemy we admittedly know little about. I chose emergency medicine excited about the thrill and challenge of not knowing what was going to come through the door on any given day or night and the challenge of having truly undifferentiated patients. And I accepted the risks that come with that: violent patients with weapons, patients with toxic or caustic exposures they bring into the ED with them, infectious diseases like TB or measles. But I never contemplated this new paradigm of putting my family in harm's way. Becoming an emergency medicine doctor has been a lifelong dream and I'm humbled to be included in the ranks of such a group of BAFERDs, but my family didn't sign up for this.