My friends and family check in with me to ask what the Yale New Haven Hospital Emergency Department (ED), where I work as a physician, is like these days. I think they are expecting to hear gory details, as if a train wrecked right in the middle of the place.
Occasionally, we get a flurry of activity all at once, but as adrenaline junkies, we have trained for this. One of the reasons I chose emergency medicine is the teamwork involved, so even when it gets chaotic, it is a controlled chaos with everyone using their skills and working together to help the patients who arrive scared, sick, or both.
But mostly these days, the ED is a wee bit eerie. Before the pandemic, our ED was almost always crowded, with patients packed end to end on stretchers in the hallways, with friends and family scrunched in. Now visitors are banned and overall volume is down.
I wonder about all of the patients who usually roll into the ED all day and night. In addition to the usual abdominal pain, headache, back pain, and chest pain, where are the patients with psychic pain? Where are the family violence survivors, and where are the patients seeking treatment for heroin or alcohol use disorder? We miss you!
People are afraid of getting exposed to Covid-19, and are avoiding us, even though, paradoxically, we now often have more open beds and space to see patients than usual. One of the Yale neurologists noticed that we are even seeing 80 – 90 percent fewer patients coming in with strokes. YIKES!
My friends and family also check in frequently to make sure that I am OK. They probably had more to worry about when, as a pregnant woman with small children at home and a novice practitioner of medicine, I performed invasive procedures in patients with AIDS before post-exposure prophylaxis and effective treatments were available. These days, I am fortunate to work at a place where we have adequate PPE and my access to testing and healthcare is better than so many others who are also on the frontlines in New Haven. Those other essential workers, many from vulnerable communities, who work in the police, EMS, and fire departments, hospice, nursing and group homes, corrections, and retail/food/delivery, all do their work in less visible ways and with fewer PPE resources.
Many of the patients brought to the ED have been really sick. We are seeing a flood of elderly people from nursing homes, and I suspect it is only the tip of the iceberg.
Last shift, in the middle of the night, I called three families in an hour to tell them that their loved one was ill from Covid-19 and not likely to survive. It is tragic that many nursing home residents are seeing their roommates “get moved to a different room” (ie, die), and many of them will spend their last few weeks on earth without visitors, even if they do not get covid themselves, so that fewer of their fellow residents might die. That is true sacrifice for both the patients and their families.
As I was leaving a recent shift in the ED, I saw firsthand what distinguishes someone as a truly exceptional nurse.
I make a point to learn about these patients’ lives when I speak to family members; I hope it is helpful for them to get to tell us a bit about their Nana.
Although it was well after her shift had ended, I found one of our new nurses sitting by the side of a patient who had been brought to the ED in a condition beyond salvation; she was holding his hand and speaking softly to him.
Although he had not graduated high school, he was now her professor. I knew that as much as she was giving, she was also getting the privilege of being present with him as he inched along on his final journey.
Karen Jubanyik is an emergency medicine physician at Yale New Haven Hospital and a faculty member at the Yale School of Medicine. Do you have a story to tell about what life is like for you during the Covid-19 pandemic? .(JavaScript must be enabled to view this email address).
Thank you Dr. Jubanyik.