EM Mindset: COVID-19 Edition – Turning some of the bad of COVID-19 pandemic into something good

Author: Andrea Wu, MD, MMM, FACEP // Reviewed by: Alex Koyfman, MD (@EMHighAK); Manny Singh, MD (@MPrizzleER); and Brit Long, MD (@long_brit)

For this edition of the EM Mindset series, have thoughts from Dr. Andrea Wu. If you would like to contribute to the EM Mindset series, please feel free to reach out to us.

Feeling frustrated? Me, too! Feeling like you want to leave medicine? Don’t! Healthcare needs us more than ever. Do you know why? Because the EM physician is the best person in a crisis, the best specialty to face it, and the best leader to manage it. But do you know what the problem is? We aren’t in positions of power… yet. This needs to change. Let this pandemic be the fire that ignites our passion to fixing our healthcare system.

To say that this COVID-19 pandemic has caused emotional stress amongst health care workers is an understatement. I am feeling a lot of things right now, and it’s hard to find the right words to describe the breadth of emotions. But perhaps we can take the bad elements of COVID-19 pandemic and turn it into something positive. There is clearly a huge opportunity for improvement for the next wave of COVID-19, for the next pandemic or disaster we face in healthcare.

I feel frustrated about this country’s readiness to address this ongoing COVID-19 pandemic. We need more EM physician leaders throughout healthcare – at a local hospital level, county and state level, and even national level. EM physicians are one of the few specialties that interfaces with so many other specialties and types of staff. We have a unique perspective that understands the needs of various types of patients as well. We are used to being decisive and coordinating many members of a team. Our ‘generalist’ background and ability to collegially work across all kinds of staff makes us the natural leader to organize the chaos of a needs within a hospital, and arguably within a healthcare system. We just need to be part of that important work to get this country ready for this and future pandemics.

I feel disregarded. We work in a unique environment where our patients are undifferentiated, and we never turn people away. Therefore, it can be hard for others to understand our work environment and the challenges we face. We need to position ourselves as strong advocates for our patients and for ourselves. If we get our voices heard, then we can help the non-clinician administrators, or non-EM clinicians make decisions that make sense for us and our patients. We need to be part in the decision making, and get a seat at the table. As an EM specialty, we work hard, we are always there 24/7 when others aren’t, we take care of everyone when others can’t/won’t, and we always do more with less. Because we are adaptable and flexible, we just say yes and take it. But perhaps for once, instead of just burying our heads and doing the work, we should also fight the good fight outside the ED.

I feel scared to be a working mother of two young children. I am scared for my husband who is also an EM physician. We don’t have a way to self-quarantine as a family of two working EM physicians without family nearby to support us. I want to make sure my family is safe. But from this fear, my husband and I have a better appreciation of the quality time we are at home together.

I feel anxious for the safety of the residents, nurses, RTs, radiology techs, EKG techs, social workers, registration staff, pharmacists, environmental service workers, etc. As the medical director of the Adult ED, I want to make sure all ED staff are safe. From this anxiety, we have worked even harder to improve communication and collegiality amongst all the various team members in the ED. We have learned to look out for one another, to make sure that each of us has the correct PPE. We have broken out of our silo mentality.

I feel worried. I worry about whether we will have enough staff, PPE, airway supplies, medications, testing, etc. in our ED, hospital, country, or world as a whole. There’s talk about reopening, and yet many places are still grappling with the first wave of COVID-19 patients. I’m worried about our regular patients that are too scared to come in for their chronic medical conditions. They are slowly deteriorating without access to healthcare and are coming in critically ill. I’m nervous about the second wave of COVID-19 patients, or the winter wave of COVID-19 mixed with influenza and whether we can handle it all. But I have turned my worry into preparedness. I’ve worked with my colleagues on disaster planning, including creating protocols for triage and treatment tents, expanding ED treatment spaces into a pre-op and PACU areas, and making backup staffing plans with EM and non-EM teams. Now we have updated our disaster readiness plans. These efforts have promoted inter-departmental, inter-facility collegiality by working together to prepare for this pandemic.

I feel proud of my colleagues and the work that I have done. I have been a part of countless meetings, worked my shifts alongside all the staff in the ED, and admitted patients to hard working hospitalists and ICU teams. I am impressed by how everyone has stepped up to help us in the ED. Inpatient ICU nurses are coming down to take care of the ICU boarders, surgeons are helping place a-lines in COVID-19 patients, and gynecologist are taking our patients straight from triage. Hospital administration is doing their best to make sure the ED has what it needs. The collegiality seen amongst all my colleagues has been so heart-warming. It takes a huge team to care for our patients. We aren’t running away from the fight, we are walking into it, despite our fears, stress, and worries, to take care of all of our patients.

And yet with all these feelings and thoughts swirling through my mind, I project the calm, collected EM physician, because that is what we have been trained to do. We stay levelheaded in the chaos. Our specialty has never really faced anything like COVID-19 before. I look back to my training at Los Angeles County + University of Southern California Medical Center and remember feeling like residency was so hard and that I made it through because of my work family. We have all gone on to work at many different places all over the world, and are all trying to save a piece of the world in the places we work. Now I have a new work family at Harbor-UCLA. This pandemic is just another challenge that we are all working together to get through, only now it’s higher stakes. Our lives, our families, our patients, are all at stake here. We trained for this. We can make it through this. I have no doubt we will come out the other side, and we will have become stronger for it.

Thank you to my colleagues out there with me on the front lines still trying to make a difference in the ED where sickness doesn’t discriminate. No matter how botched the government has handled it, the lack of testing, and the shortages of PPE, we chose this field because of the need to help greater good. And it takes a special breed of human to willingly be in the middle of a pandemic. Now we just need to take the next step as a specialty to get more involved in leadership positions so we have a stronger voice in the way our healthcare system is run. Stay safe out there.

One thought on “EM Mindset: COVID-19 Edition – Turning some of the bad of COVID-19 pandemic into something good”

  1. Muy buena nota. Gracias Dra por dar esa voz de aliento y energía que necesita mucha gente en las urgencias. Un abrazo y fortaleza.

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