Estimated read time: 5 minutes
Julian Ferris, MD, Cerner Physician Executive, who practices at a hospital in northern Vermont, provides insight into his life as an emergency physician before and during the COVID-19 outbreak.
As a physician, I’ve known about the COVID-19 virus since December when it first appeared in China. As time progressed, I learned of its potential risk to the community and the patient population I serve. Since then, I’ve seen and felt different levels of caution, as well as the reality of our “new normal” as health care professionals. As I’ve encountered more patients with the virus, I’ve documented these experiences and phases in hopes that it will showcase how quickly life changed.
The calm before the COVID-19 storm
Mid-late February 2020
I had little concern about the virus. In fact, I was admitted to the hospital for a surgery and there were no special precautions in place, besides being asked about my travel. The surgery went well without complications. I wasn’t supposed to travel for three weeks after surgery, so after a week of laying low, I got back into my regular work-from-home mode, connecting with clients and team members.
Once I was ready to travel, the restrictions were in place, so I began spending most of my time rescheduling and canceling previously planned trips. In the meantime, one of my fellow hospitalists called and told me he had a cough and felt feverish. This was the same week my hospital started to address contingency plans related to COVID-19. I covered two shifts for my sick colleague as our care team and hospital administration discussed how to deal with providers who had symptoms of the virus.
It was eerie to see how quiet the hospital and emergency department (ED) were at that time. It was the quietest two nights in March that I can remember. Locally we’d had our first cases, but none were reported in the county where my hospital is located or where my colleague lived. We thought it was unlikely he’d contracted the virus, but when he came back to work, he wore a mask just in case.
COVID-19 testing, cases increase
We ramped up testing and had our first community case. I decided to get into the new habit of arriving at the hospital dressed in fresh scrubs and changing into street clothes before leaving at the end of my shift. At first, I felt silly doing it because the hospital was so quiet, and our group had not yet cared for any COVID-19 patients. On my second morning of work though, I was called at 2 a.m. to admit an elderly gentleman who reported feeling weak with shortness of breath and a low-grade fever. Everyone in his three-generation household was also sick but doing well at home. Although we didn’t think he had COVID-19, we tested him because we were starting to see more cases.
When I went to see him, he was in a temporary negative pressure room in the ED. Since I still had my full beard and couldn’t be fitted for an N-95 mask, I wore a hooded powered air-purifying respirator unit (PAPR), which I hadn’t needed to wear in years. Even though I didn’t think the patient had COVID-19, I was acutely aware of how close I was to him. I paid attention to how much my wrists were exposed because the typical bedside gloves aren’t long enough to stay over disposable gown sleeves. I removed all the gear while still in the room behind a curtain and cleaned the PAPR unit for the next person. The patient ended up testing positive and from then on, I was forced to rethink how I interacted with each patient and how I used my personal protection equipment (PPE).
Adapting to the new normal, preparing for more COVID-19 patients
Since mid-March, the hospital had two or three COVID-19-positive patients and two or three patients awaiting results at any given time. Our organization did a tremendous job preparing for the pandemic. There are multiple protocols in place to address the safety of our health care providers, patients and community. I’ve shaved my beard to save our PAPR units for my colleagues who can’t wear the N-95 masks with an appropriate seal. We’re also screened daily when we arrive at the hospital, which includes a temperature check and going through a list of symptoms.
We have nurses who act as spotters, carefully watching us put on and take off our PPE to ensure we’re doing it correctly. Compared to several weeks ago, this process feels much different. The spotter helps me don PPE in the appropriate sequence, double gloving so I can go from COVID-19 room to COVID-19 room without changing to preserve our gown supply. The spotter also helps me ungown in sequence in order to preserve the gown for the next time I need to see one of those patients. They also make sure my wrists aren’t exposed.
As a physician, I feel as though I’ve had it easy, but I’ve watched one of our top-performing nurses go in and out of a room multiple times to care for a COVID-19 positive patient on a ventilator. Beads of perspiration sat on her forehead as she donned and removed in sequence layers of PPE each time. Throughout this outbreak, several caregivers at my hospital have tested positive ─ likely from community exposure ─ and one patient turned positive while being cared for in the hospital despite having no symptoms. These are hard pills to swallow.
We go to work every day waiting for the other shoe to drop as our long-term care facilities and prisons are seeing more cases and our at-risk populations are becoming increasingly exposed. As we fight this pandemic, it’s amazing to think about how much has changed in two months. Health care, and the world at large, will likely never be the same.
As the world responds to the COVID-19 pandemic, Cerner’s work continues to support health care providers and communities across the globe. Learn more here.
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