From sadness to irresistible laughter, an emergency room doctor describes what it’s like to practice medicine at the epicenter of Australia’s latest outbreak.
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This week’s issue is written by Amalie Loukange, an emergency physician at the Royal Melbourne Hospital.
One of our department’s favorite emergency physicians retired two weeks ago. This was earlier than expected, and given the heightened emotions of Covid and the lockdown, many of us had tears in our eyes – especially as some of us tried to persuade him to stay in the past few weeks. Richard was the first person in Australia to be trained as a specialized emergency physician, and it seems wrong that Covid should end his career. But the work became very stressful, isolating and difficult when age and comorbidities increased his risk of covid. His story is not unique, and plays out across all disciplines in healthcare as COVID takes its relentless impact on our wellbeing and our work force.
Personal Protective Equipment, PPE, is tough. There are times when my glasses are foggy, the shield is dripping with condensation, I feel like ripping it all out and screaming for air. During resuscitation, the normally quiet and controlled room is now noisy as everyone speaks 10 decibels louder only to be heard. Trying to present via PPE breaks down previously easy conversations with patients and makes my tone louder because it’s not my normal range. At the end of a shift, a severe headache and muscle aches are now the norm.
PPE keeps us safe within a silo, unable to reach out, to share jokes with each other, to whisper gossip. Emergency medical care is declining. We try to put the sadness away for later and wonder if it will be the norm for years to come.
Emergency departments are usually open spaces with clear vision, but now our department at the Royal Melbourne Hospital is changing. The cubicles are surrounded by doors, the entire area is closed to house COVID patients, and the department seems to be getting smaller as the patient numbers grow exponentially. The feeling of claustrophobia builds up with each passing change.
The pressure on nursing staff is particularly acute. Before the pandemic, when visitors were allowed, the family provided support, translation and context for the patient’s condition. Now, with visitors severely restricted, the burden of care falls mostly on our nurses. I walk into a cubicle and see a young girl crying, struggling to bear the pain of a leukemia diagnosis—the nurse holds her close, doesn’t allow the family into the department. I ask a nurse if she’s trying to find the pulse of a dying patient and she says in one voice, “No, I’m holding her hand.” The relatives of the patient did not want to come to the hospital due to fear of Kovid.
Then there is the disease. Thankfully, it’s mostly easy to detect – even without a COVID test. Its constellation of symptoms is clear and specific: chest pain with each breath like sharp small stabbing pains, severe headache and muscle pain, dehydration. Patients come to the first diagnosis because they think they are dying. At least for those in my emergency department, it’s definitely not just the flu.
From a purely medical point of view, Covid is fascinating. Being on the front lines, at a time when we are still discovering the nuances of treating a new disease, feels like a privilege. To stay safe, treating these patients with adequate PPE and effective vaccinations, in a hospital that is pivotal to living well ahead of the disease, seems like a miracle. I am thankful every day that the real jump in COVID infections is happening now, not in 2020.
At the moment, most of our patients are not vaccinated. Some of them were too young to be eligible, some do not believe in the disease, and some are waiting for a better vaccine. Many do not speak English and rely on their communities for support. I think we have let them down. We haven’t integrated them well enough to be able to reach them in distress.
For many of them, we are their only support now that they are sick. “They treat me like a leper!” A patient with COVID who was isolated from his unrelated partner and children mournfully tells me. An illiterate woman tells me about her son, whom I have just seen. “Please don’t send him home,” she pleads, “there’s no one to take care of him.” I know she is thinking of the young Covid-positive woman who died alone at home that day. Being able to help these patients at their most vulnerable, facing an illness that fills them with fear, is one of the silver linings of this pandemic.
Another is black humor. Just as we are all close to tears, even the faintest laugh is sometimes irreversible. A patient almost walks into a COVID patient’s room, but, her hand on the door, she hesitates as the nurse screams and lunges at her. Patient safely in his room, we fall into frenzy at the close call and response of the nurse. Within a week, the hospital changes its policy and provides N95 masks to all patients.
The status of the vaccine mandate in the US
- Vaccine Rules. On August 23, the FDA granted full approval to Pfizer-BioNtech’s coronavirus vaccine for people 16 and older, paving the way for mandates in both the public and private sectors. Such a mandate is legally permitted and upheld in court challenges.
- Colleges and Universities. More than 400 colleges and universities require students to be vaccinated against COVID-19. Nearly all are in states that voted for President Biden.
- School. California became the first state to issue a vaccine mandate for all teachers and announced plans to add the COVID-19 vaccine as a requirement to attend school, which could begin as early as next fall. Los Angeles already has a vaccine mandate for public school students ages 12 and older that begins Nov. 21. New York City’s mandate for teachers and staff, which took effect on October 4 after being delayed due to legal challenges, appears to have taken thousands of last-minute shots.
- Hospitals and Medical Centers. Many hospitals and major health systems require staff to be vaccinated. Mandates for health care workers in California and New York state appear to have forced thousands of holdouts to get shots.
- indoor activities. New York City requires workers and customers to show evidence of at least one dose of COVID-19 for indoor dining, gyms, entertainment and performances. 4, Los Angeles will require most people to provide proof of full vaccination to enter a range of indoor businesses, including restaurants, gyms, museums, movie theaters and salons, in one of the nation’s strictest vaccine regulations .
- at the federal level. on 9 september, President Biden announced a vaccine mandate for the vast majority of federal workers. This will apply to the employees of the mandate executive branchincluding members of the White House and all federal agencies and the armed services.
- NSThat private sector. Mr Biden has mandated that all companies with more than 100 workers be required to be vaccinated or tested weekly, helping to push for new corporate vaccination policies. Some companies, such as United Airlines and Tyson Foods, already had mandates in place before Mr Biden’s announcement.
Now that Covid has finally arrived and we are on the verge, the emotions have run rampant. Behind us is the old way of emergency medicine, and ahead is the unfamiliar and unknown.
In the end, we will adapt and find a new way of being. Before that time, we may lose much more than we gain. But against the backdrop of death to the rest of the world, it seems like a small price to pay to defeat the disease that has plagued our very existence for far too long.
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