EM Mindset: COVID-19 Edition – Shahriar Zehtabchi

Author: Shahriar Zehtabchi, MD (@SZehtabchi, Attending EM Physician, SUNY Downstate Medical center/Kings County Hospital, Editor-in-Chief at theNNT.com (@thenntgroup), Academic Emergency Medicine Associate Editor) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Manny Singh, MD (@MPrizzleER); and Brit Long, MD (@long_brit)

If you would like to contribute to the EM Mindset series, please feel free to reach out to us. For this edition of the EM Mindset series, Shahriar Zehtabchi from New York provides some perspectives on COVID-19.

My Children

I have two children. Well, I thought I had two. I’ll get to that later.

Just like any other parent, my heart skips a beat every time I feel my children are in danger: when they fall off their bicycle; when they get too close to the street; when they run too fast down the stairs. No surprise there, right? It’s my job as a parent to keep my children safe and to teach them to make good choices. Skipping a heartbeat from time to time comes with the territory. It’s an occupational hazard. Even so, I have been managing. I have had it under control.

Until now.

With the COVID-19 pandemic, my heart has been skipping many beats many times, at home and now at work. I am an emergency medicine physician. I work in an academic emergency residency program with close to 100 residents and fellows. Lately, during my “COVID shifts,” I have come to realize that I am stressing out over the safety of those residents and fellows just like I do my children at home. Each time they examine a patient with respiratory problems; each time they enter the room of a COVID-19 patient; each time they intubate someone, and so on, I fear for their lives. Yes, they are adults who have been trained to make the rights choices. But they work under my supervision. They are my responsibility. They are, in these times, my children….

We work in two affiliated hospitals serving a very underserved population in Brooklyn, New York. The community looks to us for their care of all kinds of ailments, as there’s often nowhere else to go. With this backdrop, we are always busy with many sick patients. Those who pick our program for residency training know this and undergo years of intense, boot camp-like training. Our residents are often in high demand after graduation, as they are known for having seen and done almost everything. They are like the “Special Forces” of doctors.

Our residents, like brave soldiers, are always ready to pull up their sleeves and jump into battle, no matter the danger. The COVID-19 crisis is just another shift, albeit with unprecedented challenges and risks, but also crucial learning experiences. They show up early, leave late, and volunteer to work on their days off. They run toward the ambulance-loads of COVID patients like army medics, remaining in front and never hesitating or stepping back. They use their hard-earned training to make difficult choices.

I know all this. I know they know the risks. And yet, I still worry. In fact, their fearlessness, all-too-willingness, and positive-mindedness make me even more worried.

I worry that I did not prepare them adequately for this crisis; that they might be scarred by this experience; that will get infected and lose their health while trying to restore others’. I also worry about how worried their parents and loved ones are right now.

Indeed, when I meet my residents at the beginning of a shift and we start wrapping ourselves in gowns and masks, I can’t help but think of all the mothers and fathers who watch their army sons and daughters leave for battle. The residents are my brave soldiers during this COVID crisis, walking the frontlines with the huge disadvantage of not knowing much about their ruthless enemy. I am in this fight with them, feeling more like their concerned parent than their experienced “captain.” I keep one eye on the patients, and one eye on the residents (which I can do because I grew eyes on the back of my head when my twins were born!).

So, like an over-protective parent, I annoy the residents as I watch them like a hawk: “Don’t leave your phone on the counter!” “Don’t touch your gown!” “Go wash your hands!” I sometimes follow them into the patients’ rooms to make sure they follow the protocols at a minimum. I need to make sure that, in the midst of this overwhelming conflict, my exhausted soldiers do not cut corners in protecting themselves. That cannot happen on my watch. It’s literally a matter of life and death.

With age comes wisdom, and with wisdom comes a more relaxed state of parenthood, right? That was my belief, that fatherhood would get easier as my kids get older. What a naïve fool I was! COVID-19 has reminded me that, when I leave my young twins at home to go to work, I have another 100 children, adopted by profession, to look after.

I came home from work today after an 8-hour COVID shift. I quickly showered, then headed outside to ride around the block with my children in our quiet neighborhood. They had been inside all day listening to their new teacher, Mrs. Mommy. Once outside, the worries begin. “Watch the bump!” “Look both ways!” “Slow down!” And so it continues….

Shahriar Zehtabchi, MD