The following week after I saw my first COVID-19 related patient encounter with a smiling baby, I started to become more apprehensive about certain triage complaints, like "fever" or "cough" or "shortness of breath."
I went to see a patient who was short of breath, although he didn't clearly have symptoms of an infection, and I didn't wear any special personal protective equipment. By the guidelines, I had no reason to do so - the patient had no travel history and likely didn't even have an infection. But it nagged at me for the rest of the week. He had low oxygen levels and I hadn't determined why to my satisfaction, so it nagged at me.
At another shift, a resident blithely strode out of the room of a patient with one of the ominous chief complaints. I had glanced over his chart and seen that he had a fairly high fever and a cough that had been worsening for the prior several days despite being started on antibiotics. "Does this patient have COVID, or what?" I asked the resident, excitedly, but she just looked at me confusedly. "He doesn't have a travel history!" "I'm not sure that matters anymore." I spent some time digging up a disposable stethoscope and went into the room, ensuring that this time I wore a mask and gloves. I quizzed the patient extensively, but could not determine any way to connect him with a situation in which he might have been exposed. He had been in his hometown, period, and so had everyone he had been in contact with, he told me. Why were his oxygen levels so low? It seemed worse than a typical pneumonia. I thought about him each day that week, even on my days off.
Despite my apprehension each night as I went in to work, I found the waiting room surprisingly devoid of patients. People were actually listening to the guidance not to come to the emergency department. It truly surprised me. Even the usual homeless patients didn't want to come in. Near the end of the night, a patient was brought in by the paramedics gasping for air, accompanied by a friend. She had been picked up on the porch of her house after trying to refuse to be transported. "She didn't want to come, I called 911 and made her do it," the friend confessed. "She was trying to stay home, could hardly get the words out but she was just saying 'no! no! Corona! no!'"
I went to see a patient who was short of breath, although he didn't clearly have symptoms of an infection, and I didn't wear any special personal protective equipment. By the guidelines, I had no reason to do so - the patient had no travel history and likely didn't even have an infection. But it nagged at me for the rest of the week. He had low oxygen levels and I hadn't determined why to my satisfaction, so it nagged at me.
At another shift, a resident blithely strode out of the room of a patient with one of the ominous chief complaints. I had glanced over his chart and seen that he had a fairly high fever and a cough that had been worsening for the prior several days despite being started on antibiotics. "Does this patient have COVID, or what?" I asked the resident, excitedly, but she just looked at me confusedly. "He doesn't have a travel history!" "I'm not sure that matters anymore." I spent some time digging up a disposable stethoscope and went into the room, ensuring that this time I wore a mask and gloves. I quizzed the patient extensively, but could not determine any way to connect him with a situation in which he might have been exposed. He had been in his hometown, period, and so had everyone he had been in contact with, he told me. Why were his oxygen levels so low? It seemed worse than a typical pneumonia. I thought about him each day that week, even on my days off.
Despite my apprehension each night as I went in to work, I found the waiting room surprisingly devoid of patients. People were actually listening to the guidance not to come to the emergency department. It truly surprised me. Even the usual homeless patients didn't want to come in. Near the end of the night, a patient was brought in by the paramedics gasping for air, accompanied by a friend. She had been picked up on the porch of her house after trying to refuse to be transported. "She didn't want to come, I called 911 and made her do it," the friend confessed. "She was trying to stay home, could hardly get the words out but she was just saying 'no! no! Corona! no!'"
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