Month: March 2020

The Lord Thy Surgeon

Shutdown Angst

It has been a tumultuous 24-48 hours in the coronavirus epic. The past 2 days have been filled with ups and downs.  I feel like I oscillate between “we’ve got this” and full angst about the future of our country.  The coronavirus continues to take its toll on us.  As an emergency physician, I feel like it’s my duty to serve on the front lines. I’m not sure I have ever felt like I could be in the infantry and fight in a war. Somehow getting bullets shot at you doesn’t seem like the best place to be in.  However, my job as an emergency doc faces similar difficult situations that soldiers face. I’ve never really panicked or worried about accidentally going into a room that a patient had tuberculosis.  I’ve never panicked about accidently not wearing a mask in a room with a positive flu patient. Why is it now that I feel intermittently worried about possibly walking into a coronavirus (COVID-19) positive patient without the proper personal protective equipment (PPE)? On the other hand, I feel mostly that it’s my duty and I know the risks and am comfortable doing what is necessary to serve others.  It’s a known hazard of the job.

For the past 10 days, we have had twice daily briefing with my hospital system.  Intermixed in this, there have been additional daily meetings to plan for clinical care, hospital flow and human resources issues.  Meanwhile, we’ve been asked to work from home as much as possible.  For an extrovert like me, it has been an exhausting 10 days, mostly stuck in my house.  Nothing seems normal. We can’t leave our house. I’m helping plan for terrible devastation. The economy is in getting crushed.  Every day has been mentally exhausting. The most normal part of my job is getting in the car driving to work in the ED and getting into my car driving home.  Everything else seems odd.  At home, I’m stuck. At work, I’m waiting for the worst.

Every day I seem to talk to one colleague that says, “It’s HERE!” and “It’s gonna be bad!” However, I feel like our emergency departments in rural Illinois have been less than full. I have no problems transferring patients for admission. We have additional worries about infectious disease when transferring but generally, it is much better than it was even 1 month ago (during our winter busy time).  We were boarding patients in the tertiary care center hospital. Sometimes 10-30 patients sit in the emergency department at the “big house” (or more affectionately “the mother-ship”) waiting for admission. This leads to 24-hour+ delays in transferring some patients for admissions from the smaller hospitals that I work at.  That is all gone. We have cleared out “unnecessary” surgeries and people have seemingly stopped coming for “unnecessary” medical care.  I’m not saying that the “social distancing” is not necessary. I’m not even saying that it may not get much, much worse.  However, right now, besides the media/social media induced panic and fever pitch, the actual landscape in my ED seems better than it’s been in a few years. This is not to say that places like Italy and elsewhere are not experiencing devastation on all sides and facing difficult, if not impossible, ethical decisions with regards to who to save.

I say all of this because I am worried about the impending exploding powder keg of shutting down the economy for such a long time. I believe in the social distancing, the need for more PPE, the need for more testing, the need for better treatments, the need for more capacity and the need to preserve our healthcare community.  However, I am worried about the toll that the economic shutdown is taking on our communities and our general well-being.  When we encounter crisis and stress, our natural tendency as humans is to come together for comfort and counseling. We go to social gatherings, sports, churches, school, bars, dinners, and etc.  At this point, the coronavirus has effectively cancelled all events for the next 2-18 weeks.  Some might shrug at shutting a church down for a weekend or perhaps even 2 weeks.  But these are the foundational groups of our communities.  We might be able to “survive” on Netflix and Door Dash, but where will our mental health be after not meeting together for Alcoholics Anonymous, psych counseling, after school programs, and in bars and restaurants?

We talk about the possibility of this virus killing 1% of the US population and that is downright scary.  1.5-2 million people may die, “if nothing is done.” But are we not already doing things to raise awareness? We are still allowed to go to “essential” activities such as pick-up food and getting gas.  Can we not trust people to continue with improved hygiene practices at places like cheerleading practice and baseball games? I am happy that we have decided to take action to address all the needs for treating the virus. But when will we go back to our lives and continue treating disease like we always have?

Many want to focus on all the lives saved by “shutting down” everything for time periods of up to 4-6 months.  “We will save 1.5 million lives,” they say. Others predict that many will eventually get the disease.  I am increasingly worried about the general health of  people who have no job, can’t buy their medicines, and can’t feed their kids.  Economic well-being (i.e. having money) is not totally divorced from general health.  Economic stress leads to social unrest which leads to physical deterioration. We, as ED docs, see this in the form of suicide, homicide, heart attacks, stroke, and delayed cancer diagnoses to name a few.  The longer everything is shut down, the more I worry that we will not have an “immediate” recovery to the economy.  Our goal is a “V-shaped” or “U-shaped” recovery. (i.e. Everything returns after the virus goes away.)

Many things were going very well for us in January. The stock market was as good as it ever was.  I am blessed to have job security as a physician in this difficult time. I worry about all those people out there that are not as fortunate.  I worry about the food service worker who is not getting tips. I worry about the airline pilots and attendants that are impacted. I worry about all the jobs connected to professional sports, entertainment, and travel.  Will these bounce back? Will people immediately go back to traveling in the summer? Will small businesses that operate on thin margins still exist after this shutdown? Am I wrong to even question that this shutdown might be too much?

I am encouraged that we are receiving more testing. We are looking at promising treatments. The summer is coming and that is good for decreasing spread of the virus. One of the strangest and most positive things about the virus is that no one under 10 has died from infection with COVID-19.  I find that very odd.  Even the flu kills many infants and children every year.  Why are young people not dying? It is a good thing, praise God. But why are they not getting as ill as the older generations? I hope that this event in our lives serves as a springboard for more disaster planning.  I pray that churches will see how important their connections are with the world. I pray that we will all take care of each other by giving from what we have and taking care of those who are in desperate need.

I am hopeful that there may be a plan to go back to “life as usual.” I’m sure that this virus will take some long-term effect on our lives and there will be a permanent new “life as usual.” I only hope that we preserve our freedoms that make America the best country on the planet.  I pray that we will continue to prosper and that we will continue to support one another.  We WILL overcome. This too shall pass. Wherever you are, I pray that God will continue to bless you and that He will keep you safe.

“If my people who are called by my name will humble themselves, pray and seek my face and turn from their wicked ways, then I will hear from heaven, and will forgive their sin and heal their land.” 2 Chronicles 7:14

May God heal our land.