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What Lies Beneath

What Lies Beneath

How to be EPIC (in the COVID-19 Era)

Johnston, Michelle MBBS

doi: 10.1097/01.EEM.0000695604.62857.1b
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    PPE, COVID-19
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    Evolution is afoot. It's entirely possible you have noticed somewhat of an alteration in the world around us. A pandemic—the downwind effect of a miniscule strand of RNA and its lollipop-studded shell, a savage little virus that took a wrong turn out of a market somewhere—has uprooted all we know, and everything is awash with change.

    So too our role. A few years ago, I wrote a piece on how to be EPIC, the emergency physician in charge in our ED. (EMN. 2017;39[9]:3; https://bit.ly/2A4dXcd.) Well, we've had a makeover. Where we used to dress like obedient socialists, now we are wrapped in layers, rendering us even more carbon-copied, anonymous, and sweatier than ever before.

    Like most hospitals, we've divided our ED into two streams: dirty/clean, COVID-suspect/non. Ours is called ARIZe. This makes it sound like a resurrection or the denouement of a Joel Osteen TV segment, but really it just stands for Acute Respiratory Infection Zone. And, of course, a stream needs a leader. Sound the horns, unfurl the standards, may I introduce to you our updated EPIC, the APIC—the ARIZe physician in charge. I voted for calling us APHIDS, after the scurrying little sapsuckers, but, as is wearyingly routine, my suggestion was overruled.

    We are not attractive. Covered from head to toe in PPE, our gowns are bile yellow and made from polysynthetic material designed to prevent the ingress of foul liquids and humors but also not to let them out. Our mouths are enclosed in beaks, our eyes shielded with fog-fancying plastic. No jewelry, no distinguishing features. Hair in the worst bun our unhairdressered hair can form and shoes so ugly that even they are embarrassed to go out in public. Ugly shoes are hose-downable; that is the sorry mantra we now live by. I still wear mascara, but that is because I am vain. We will probably discover the coronavirus is attracted to cheap Maybelline products, and I will be the first against the wall.

    Rolling Eyes

    We have been issued radios to wear around our waists like truckers; putting phones up to our ear is a Bad Idea (also nearly impossible among the strata of PPE). I am immature and like to say “niner” a lot into my radio, which has amused absolutely nobody. There is a pattern here.

    We are connoisseurs of alcohol hand-wash. Like sanitizer sommeliers, we can distinguish between a fine aged Aquim gel and the bootleg fluid delivered round the back of the hospital in unmarked trucks. My hands are cracked and flaking, Cinderella hands before she was rescued. No amount of moisturizer or wallops of steroid cream will transform them, fairy-tale style.

    As bosses, we have not adapted well to some things. We cannot type efficiently on the wipeable keyboards, and it takes me half a day to type, with a single gloved finger, a typo-sodden letter to a GP. We complain about compromises to patient care—“Oh, I remember the days pre-BiPAP,” we moan, “and we used rotating tourniquets for pulmonary edema.” The trainees roll their eyes, and we listen to our crusty selves, wishing this were not true. We fumble taking blood, forgetting the correct order to fill the bottles and which are the right bags to place them in. We are consultants! What are we doing venesecting like peasants again? (Working is the answer, we know.) The hierarchy is now so flat we are mistaken for residents, only with wrinkles and creaking joints and a junkie's reliance on coffee.

    Sweaty but Grateful

    But I digress. What complaints! What a whine! We, of course, are fortunate beyond measure, working in a public hospital down the dowdy, unfashionable end of the world. A gobsmackingly obedient and sparse population has seen Australia's curve not so much flatten as disintegrate. Our COVID-19 numbers, as this goes to print, are in single figures. Not happy to celebrate, though, we all mooch around with survivor's guilt, glued to the news of our northern brothers and sisters, and wait for the flares.

    We study like mad the daily accretion of knowledge, the coinage of terms, the innovative, novel trails being blazed by those who are swimming in the floodwaters of presentations elsewhere so we will be able to do things just right exactly when we need to.

    We may be unattractive and slow and torn from the known soil by our complacent roots, but we have, in the wake of a tiny sequence of ribonucleic acids, discovered what it means to live in the very now. Nobody can predict the future; it may be horrifying or it may rise like a beautiful dawn, so all we have is the best we can be today.

    A bit sweaty, hard of hearing, lines across our cheeks like buried worms, dehydrated, and flaky but in possession of a deep, unending well of love and gratitude for what we have on this shift, in this place, in this world, among these people. You. Our critical care family, our patients, our own loved ones. A Physician In Company. That's what we are now, and long may that last, long after the coronavirus has perished.

    Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novel Dustfall, available on her website,http://michellejohnston.com.au/. She also contributes regularly to the blog, Life in the Fast Lane,https://lifeinthefastlane.com. Follow her on Twitter@Eleytherius, and read her past columns athttp://bit.ly/EMN-WhatLiesBeneath.

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