A Front-Line Healthcare Worker's Rant

January 6, 2021

The Monday after Christmas 2020 was the busiest day I've seen so far in the emergency room where I work. There was a point where there were more than fifty people in our waiting room, the longest wait time about nine hours, and eight or nine ambulance crews lined up down the hallway with patients on their gurneys because there were no beds and nowhere to put the patients.

The reason for the unavailability of ER beds? Because the ER has been taken over by the ICU. When the ICU is full, those patients have to stay in the ER; and when a large percentage of your ER beds are filled with ICU patients, it's impossible to get your actual ER patients through in a timely manner, resulting in ridiculous wait times and overcrowded waiting rooms.

We've even had some trauma holds recently. We're a pretty large ER, with about 100 beds total, but we still only have four beds in our trauma bay. This usually isn't a problem because trauma patients tend to get admitted quickly, so there's a fast turnaround and the beds are made available again in case of another trauma. But when they can't get admitted and are held in our trauma bay, that could result in those beds being unavailable to others if there's an accident of some kind, a cardiac arrest, or a physical assault resulting in serious injury.

This is what flattening the curve was about: keeping the entire city from getting sick all at the same time and overwhelming the hospitals. Remember that phrase, flatten the curve? Funny how I haven't heard it for several months now, despite currently being at a peak far worse than the last one.

Somewhere along the line -- which, by memory, seemed to be just a couple of months into the pandemic -- everyone forgot all about flattening the curve, and decided that they were just going to live their lives like they usually do instead. Opening schools and lifting restrictions on restaurants, despite knowing that a second wave was due in the fall... what could possibly go wrong, right?

If things get much worse, COVID-19 will soon begin to kill people who don't even have COVID-19. Because when there are no hospital beds, ridiculous wait times, and no available first responders, people with all kinds of emergencies will suffer and die.

It's so easy to pretend things are normal if you aren't seeing it first-hand. But let's hope and pray that you or your loved ones don't have to see it first-hand. Let's hope you aren't in a severe car accident, or that a parent doesn't have a heart attack or cardiac arrest, or one of your kids doesn't wind up in a dangerous situation and get shot or stabbed. If they do, would you want to take the chance of one of those four beds in the trauma bay being empty? Sure, there are other hospitals, but the longer drive could mean the difference between life and death. Would you want to be in the ambulance that's forced to drive an hour to the only hospital with vacant beds, despite being only ten minutes from a more appropriate trauma center? Would you want to be sitting in the waiting room for six hours with chest pain? None of our patients do, I can tell you that.

What if it gets to the point where emergency rooms and ambulances are allowed to refuse patients based on how full they are? To turn them away at the doors, and just let patients die at home with no help, because they're too busy with everyone who's in the hospital already dying? What if the ER doors were locked and they weren't allowed to take any more people? I'm sure it would start with the simple things, the things that can be taken care of at an urgent care, or maybe even with over-the-counter meds, but what if it eventually spread to include all patients, no matter how serious the emergency?

I'm already hearing reports from Los Angeles about them running out of oxygen, and ambulances being instructed to declare people dead on the scene instead of bringing them to the hospital if there's little chance of survival. We're probably close to that here in the Phoenix area, as well, considering most of our hospitals have been on divert (having to turn away ambulance traffic due to no space in the ER). We're completely out of propofol, a type of drug we use frequently to sedate people. Apparently there's a national shortage. What other things will we run out of? I'm reminded of the scene in Gone With the Wind where doctors have to amputate a man's leg without any drugs, and Scarlett, working as a Civil War nurse, runs away and abandons her duties because she simply can't take any more of the horrors she's witnessing.

There is a finite amount of resources out there. Whether it's beds, staff, or medications. When those resources run out, we're screwed. Patients are screwed, staff members are screwed, we're all screwed.

The amount of people who don't think something is a problem because it hasn't affected them personally is so telling.

It does affect me in a way, even though I'm not sick and haven't lost any loved ones myself. As a healthcare worker, it affects me, because of the things I've seen and done since the pandemic began, and because of the mental toll it takes.

I've done chest compressions on COVID-positive patients while wearing an N-95 mask and face shield. If you have so much as taken a CPR class, you know what a workout just two minutes of compressions can be; then try adding a small heater strapped to your face. A couple of these people have lived -- for the time being -- but most have not. I've seen people crash and die within minutes of getting to the hospital. I've watched people break down because their loved one just died, and been yelled at by others for not letting them in to see their family members due to the no-visitor rule. I've seen people coughing up blood, people who couldn't breathe, I've watched people have a piece of metal stuck down their throat. I've seen ER nurses not know what they are doing because they're suddenly ICU nurses but have no ICU training. I recently had to clean up an otherwise-healthy 44-year-old man with diarrhea because COVID had him too weak to get to a toilet. Imagine how embarrassing that was for him. I've seen people brought in with rib pain after a car accident, only to be diagnosed with COVID after the chest X-ray, despite having zero symptoms. I've seen doctors try to prevent a man with dangerously low blood pressure from being admitted to ICU because they were at capacity. I've seen ambulances bring patients from other states because there were no beds there. I've seen fifty people in an emergency room lobby and nine ambulance crews unable to respond to other calls because they were standing in the hallway with their patients, hoping that someone in one of the beds might get discharged soon, or God forbid, go to the morgue so a room would be freed up.

But even if I hadn't seen these things, I'd still like to think that I would listen to the people who have. I'd like to think that I would still have enough compassion to learn about what was going on around me and what I could do to prevent others from getting sick or even dying. I'd like to think that I'd still be able to understand that I don't have to wait for things to affect me personally before I can care about them.

I don't even know why I'm writing this. It's unlikely to change anyone's mind. It's nothing you haven't heard before... and most people haven't listened yet, so why would they listen now?

For a brief period, early in the pandemic, when an actual stay-at-home order was enacted, this same emergency department was actually empty. Back when there was less traffic on the road and things were eerily empty. When people were actually staying home except for essentials. The ER lobby was empty and wait times were short, as well; in fact, I was sent home early from work a lot during this period because the patient census was so low. What does that tell you? That a lot of people go to the ER for things that... maybe could wait. For the same reason, it tends to be slower on weekends and busier early in the week. People don't want to waste their weekend at the ER, but as soon as Monday rolls around, their "emergency" becomes more pressing.

This is nothing new. For years, people have been coming to the ER with problems they've been having for days, weeks, or months. Who knows what makes them decide that today is the day.

It was both amusing and annoying to see how empty the emergency room became when there was a stay-at-home order. We still had our traumas, our heart attacks, our strokes, etc.... but what had happened to all of the lower-acuity patients? It was like everyone finally understood the definition of the word emergency.

But then everyone stopped caring. They'd gotten tired of staying at home and decided to go back to living their lives the way they normally do, as if the pandemic would go away if they just ignored it. Funny how that didn't work, isn't it?

The governor stopped caring, too... or knowing him, he never did anyway. He only put the first order in place because he was being pressured by so many. He seemed to be among the people who thought we should sacrifice our grandparents for the sake of the economy.

And now, even though things are much, much worse than they were during the first wave, there's been no stay-at-home order. I've seen no restaurant or bar closures, no school closures or even movie theaters. Life keeps going on the way it always has... but not for the 352,000 Americans who've died, of course. And that number will be even higher by the time I finish writing and publishing this, because it goes up every single day. But no one is doing anything to slow the spread or flatten the curve.

The pandemic is not going to go away just because you ignore it. It doesn't work like that. Believe me, I want it to go away, too. But pretending it doesn't exist only makes it so much more real.

And other emergencies don't stop just because COVID is spreading, either. Those accidents, assaults, heart attacks, cardiac arrests, anaphylaxes, strokes, overdoses, etc.... they don't know there's a pandemic. They'll keep killing people regardless. People ARE going to die because of this pandemic, even more than already have. Some people of COVID itself. Some people because they couldn't get the medical care they needed for other emergencies. Maybe it will even be you. You might say "I'm healthy, I have nothing to worry about" -- until that unpredictable accident happens. No one is safe.

It isn't just the lack of beds, but the lack of staff, as well. The people who take care of the sick often become the sick. Healthcare workers are contracting COVID themselves, some of them missing weeks or even months of work because of it, some of them dying. At any given time now, there are fewer staff members in the hospital than there were before this began. Not to mention the ones who quit because they just can't take it anymore. And even those of us who don't quit... do you think we are running at 100% battery right now? No. We're tired. We're burned out. Some of us are working extra hours. Some of us are having trouble sleeping because of anxiety or pandemic-induced nightmares. We cry in the bathroom or on our lunch break sometimes. We're overwhelmed. That's what "flattening the curve" was supposed to prevent, but nobody cared enough to actually make a difference.

I've stopped caring, too, but not about you. I'll never stop caring about others, and I'll always do anything in my power to prevent myself from spreading the virus to them. The best ways to do that being to simply stay away from them, and if I have to be around them, to wear a mask.

I have stopped caring about getting sick myself, though. I do next to nothing to prevent myself from getting the virus. I don't wear isolation gowns or N-95 masks into COVID rooms anymore. I did for a few months. But then it just became too much. So now I will walk right into a COVID-positive patient's room without any protection. I've adopted the philosophy of "If I die, I die." Just add me to the growing list of unnecessary and completely preventable deaths. I'm too tired to stop and put on a gown and mask and face shield every time. I just can't do it anymore. Just like you got tired of staying at home to protect others, I got tired of making the effort to protect myself. If I die, I die. I'm too exhausted to care.

The only downside to that is that if I get sick, my chances of spreading it to others are higher -- and that's why I always wear my mask and avoid everyone in every scenario I can. I don't socialize anymore. I refuse to accept anyone's invitation to dinner or to hang out in person. I told all of my friends to avoid me like the literal plague, because I am probably carrying the literal plague.

I am not the only one who ignores isolation precautions, either. In fact, it's almost all of us. Very few of my coworkers wear the proper PPE anymore. We are in and out of these patients' rooms, over and over, for hours. We cannot stop and gown up every time. It's unrealistic. Our N-95's -- which are supposed to be thrown away after only one use, but we've now been carrying with us for months -- don't fit us well enough to protect us anymore anyway. So don't hang out with a healthcare worker. Don't hang out with anyone, for that matter, unless you live with them.

No. One. Is. Safe.

And please stop coming in and asking us, "Are there any patients here with Coronavirus?" THE ANSWER IS YES. OF COURSE THERE ARE. THIS IS A HOSPITAL. Approximately half of everybody here has it. And every single staff member you come into contact with has been exposed to it. Some of us might have it too, and just don't know it. We'll do the best we can to keep you safe, but it's everywhere in here. If you come in, you will probably be exposed. Keep that in mind when you're deciding if you have an emergency or not. Obviously, don't let that stop you from coming in if you are having a true emergency; but maybe just take it into consideration.

I have to take Lyft frequently (an unfortunate necessity) and nearly every conversation I've had with a driver recently has been centered around the virus. After they pick me up, they will ask me, "Is there a lot of COVID in there?" Yes... yes there is.

Then they'll ask me, "Do you guys get extra pay or a lot of bonuses for doing what you do?" No... no, we don't. The hospital system I work for did give us one bonus, more than six months ago. But then they, like everyone else, stopped caring.

We've been at this for almost ten months now. And still I'm hearing people say things like, "He always wore a mask, but he still got sick." How are there still people who don't know that a mask doesn't protect you, it protects others FROM you? It will only protect you if you are wearing a well-fitted N-95 with a perfect seal. A regular surgical or cloth mask does not protect the wearer, and nobody is claiming it does.

COVID-19 is spread through respiratory droplets, the moisture that escapes your mouth or nose when you breathe, talk, etc. Imagine it like seeing your breath in the air when it's cold outside. That fog is your respiratory droplets, and it can travel far. Wearing a mask keeps those respiratory droplets to yourself -- to protect others.

If going around without a mask only negatively affected you, no one would care what you do. You have the right to die if you'd rather do that than wear a piece of cloth over your face. But you don't have the right to kill others, which is exactly what you might be doing if you aren't wearing one.

About a week after that one busiest night in the ER, I met an adorable 90-year-old man, whose patient chart read "COVID exposure on Christmas." He was having difficulty breathing and his oxygen saturation was dangerously low on room air. It's obvious how he was exposed. This sweet, gentle grandfather -- who called me a sweetheart because I brought him a warm blanket -- had COVID because his family couldn't give up their holiday celebrations for just one year. What if that man dies? Just add him to the list of unnecessary and completely preventable deaths as well, I suppose.

That's one of the worst things about all of this. It was all preventable. We knew it was coming, we'd seen it happen in other countries -- even earlier in the year in our own country -- and we knew how to prevent it. And yet we did nothing. We, as a society, did nothing.

There are so many people with blood on their hands.

I know I'm not perfect either. Once back in October, when things weren't so bad, my eyebrows were driving me crazy after an entire year without being waxed. Going through this continuously rough time, I felt like I needed a confidence boost, so I went to get them waxed. Just once. Over the course of this entire pandemic, that's the only thing I've done that wasn't essential, or where I would be in close contact with anybody outside of work. Of course I took every precaution I could, and had no symptoms -- I had even been more cautious at work for a while beforehand because I was planning to go and didn't want to pass anything on -- but it still wasn't essential for me to get my eyebrows waxed. And I still feel guilty about it. I wish I hadn't gone. I know that I went during a time when it was relatively safe because it was in between waves of cases, but I can't stop feeling guilty about it.

I don't want anyone's blood on my hands. Some people seem to be okay with it, but I'm not. I don't want to be the reason some sweet old grandfather, or anybody else, dies.

tags: healthcare, ems, covid-19, pandemic, rant