Emergency physicians are so much alike. We are brothers and sisters in an elite and still relatively small specialty. Our training is generally similar. So are our experiences of daily life in the departments where we work. Change the names to protect the innocent, but meth is meth, heart attacks look like heart attacks, and overnight exhaustion feels the same regardless of latitude or longitude.
Most of us feel a deep revulsion at being chained to an EMR, and all too many feel objectified and commoditized by administrators and corporatism. When we go to conferences and have coffee or dinner together, we nod in agreement and sympathy at the trials of others.
But now things are different. As the COVID-19 pandemic sweeps across the land and crushes large urban areas, many of our treasured colleagues are locked in a life-and-death battle. They're trying to save as many as possible, fully aware that their own lives are on the line. Some have lost the fight and will be forever remembered with honor.
This isn't the same as working in the aftermath of a tornado or even an explosion or a mass shooting. Physicians and others labor in the thick smoke of the unknown. This miserable virus is new to us, in terrifying ways that leave even our most brilliant physicians improvising against an unpredictable pathophysiology. That, of course, makes their courage even more remarkable.
Across much of America, however, COVID-19 is a distant thunder. My county in South Carolina has eight confirmed cases as of press time. While there are many more across the state, we have nothing like the deluge of death and suffering that larger cities have suffered. I am not alone. Many friends are watching the news, reading posts online about the disease, refreshing their memories on how to manage ventilators, scrounging for PPE, and just waiting. Waiting for the Sword of Damocles to fall. Wondering if they will have the courage, the insight, the skill to manage this if it lands squarely in their departments.
In short, many of us feel a strange mixture of guilt and relief. We write consolations to our friends in the hotspots. We hope for them. We pray for them. And we try to find reassuring numbers that say this plague will slow down or miss us entirely. This is especially true for those of us in rural America, who are simultaneously safer from infection and less prepared if it comes.
No Good Answers
Some are volunteering to go to New York, to New Orleans, to Detroit. Others consider it and make the calculation that it's better to stay home, to prepare for the local disaster when it comes, to be available when friends and family are stricken. There are no good answers. We are a tribe of people who run headlong into danger every single day. We rush to the airway, stop the bleeding, get the lines, face down the violent, try the Hail Mary therapy, heedless and fearless. But those who choose not to go should be consoled that their time, our time, will come.
It is certainly in the realm of possibility that our current pandemic will be cyclic. Those of us who were not involved this time around may find ourselves knee-deep in the coronavirus in a few months. Even if the COVID-19 pandemic is solved tomorrow or a vaccine suddenly appears in the next month or two, the aftermath of this nightmare will take months or years to resolve.
We will face those who have neglected very real health issues for fear of being infected. It is likely that the vast number of people who lost their jobs and insurance will have no option but to return to the emergency department. Rates of depression, PTSD, addiction, and abuse may well rise and pose new challenges.
We have no idea what subsequent health issues may result in those recently infected, especially those critically ill victims who survive. Will their risk of heart disease go up? Will they have chronic lung disease or neurologic issues? There's simply no way of knowing. The tangential and indirect effects of the pandemic are going to be complex, and they will require all of us to be diligent and ready to adapt.
While emergency department volumes are generally down for now and physicians are losing hours and income, that's unlikely to be a permanent condition. It's more like the way the beach is empty when the tide goes out, right before a tidal wave, one full of sick, recovering, frightened patients, desperate for reassurance.
Stand and Wait
Those who bore the brunt of this first round will need the help of those of us who watch with bated breath. We should already be setting up the requisite counseling they'll need, offering sabbaticals, stepping into their place so that they can rest, weep, and recover. Or, in some cases, take over when they've simply had enough and have to change careers. Who could blame them?
COVID-19 is a test for an entire generation of physicians. Everyone in our specialty will feel its effects, and, in some way or another, have to pay a price. Maybe not now, not yet, but it will come.
The sonnet “On His Blindness” by John Milton closes with this line: “They also serve who only stand and wait.” Many of us now stand and wait, questioning our worth, frustrated and hoping to be useful when the need arises, broken for our colleagues who have braved the storm.
Be assured, the guilt-ridden, the relieved, those of us outside the worst of it will have a turn. Until then, we can only rest, learn, and be ready.
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Dr. Leappractices emergency medicine in rural South Carolina, is a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available atwww.nursingcenter.com, and Working Knights, Cats Don't Hike, and The Practice Test, all available atwww.booklocker.com, and of a blog, http://edwinleap.com/. Follow him on Twitter@edwinleap, and read his past columns athttp://bit.ly/EMN-Emergistan.