My Experience Working in the Emergency Room During COVID-19

The story of COVID-19 in the emergency department is a study in teamwork, tenacity and resourcefulness.

We knew very little about the disease when it first emerged. We knew it was a real threat, based on the experience of China, Italy and other hard-hit regions.

But MedStar Washington Hospital Center has always taken disaster preparedness very seriously, fostering a true culture of readiness where every member of the team knows what to do when it counts. In the face of this new pandemic, the entire Hospital Center went to work, quickly and efficiently.

We had to prepare for every imaginable contingency—and even for those we could not imagine. We planned for staffing, for ICU overflow, and for managing the supply of PPE, which is personal protective equipment. We put up and equipped tents to handle a potential surge. If anything, we were over-prepared. Thankfully, we never even needed to utilize the tent on our campus or alternate care site at the Walter E. Washington Convention Center.

We moved mountains to make all this happen. That level of preparedness really paid off. The team came together like clockwork, each contributing to a whole far greater than the sum of its parts. We kept at it, did what had to be done, and were never overwhelmed. Plus, all the plans are still in place, so we’ll be ready in the event of another outbreak. We continue to stay the course. That’s what I am most proud of.

Approaching a New Normal

In 15 years as an emergency physician, I can honestly say I have never seen anything quite like this virus. It is strange, unpredictable, sometimes surreal. Our ER team had to learn a completely new disease process. Up for the challenge, we overcame apprehension and uncertainty, navigating a path that sometimes changed by the hour. With each case we treated, we learned from the experience and emerged even better, faster and more effective.

At the start of the pandemic, just about everyone who arrived at the ER came for coronavirus symptoms. Thankfully, we are now past that stage. As cases trend downward and society begins the reopening process, we are seeing more typical cases returning.

One of the strange things about this pandemic was the way so many formerly routine issues slowed to a trickle. Thanks to stay-at-home orders, for example, there were fewer auto accidents, and so fewer associated injuries.

But concerning to our doctors was the absence from the ER of the most potentially serious conditions, like heart attack or stroke. The worry among healthcare professionals is that some of those people chose to stay home out of fear of the disease, instead of getting the life-sustaining treatment they needed. That could lead to long-term health effects for years to come.

If you are injured or showing signs of serious illness, there is no reason to be nervous about coming to the Hospital Center. We apply every precaution, including personal protective equipment like masks for both patient and provider, restricted visitation, isolation of critical patients, minimizing both wait times and the number of providers with whom each patient comes in contact, and expanded availability of MedStar Health eVisit and Video Visit.

Don’t avoid treatment for a serious problem. With telemedicine more available than ever, make sure to reach out to us if you have any health concerns.

The Beginning: Uncertainty

Although nothing in our training or experience prepared us specifically for this virus, emergency medicine personnel excel at expecting the unexpected. After all, it’s what we do, every day.

Psychologically, those first few weeks were very challenging. The fear of the unknown was, by far, the hardest part. Could we manage the surge? Would we be overwhelmed, stressed to the breaking point—like some of our colleagues in New York?

The challenges were many. We didn’t know exactly how the disease would present or progress. Nationwide, healthcare professionals were in a steep learning curve, having zero experience with this brand-new disease state. There was no reliable test for the virus. There were no medications to combat it.

However, we did have knowledge, shared by health professionals in other parts of the world. With guidelines from the Centers for Disease Control, the American College of Emergency Physicians and others, we understood that the virus is a variation of severe acute respiratory syndrome (SARS). We knew lung health would be key to beating the disease, and we focused our efforts on oxygen.

Throwing Out the Old Playbook

Although mild cases of this new virus act like the flu, what we’ve seen in the emergency room is nothing like flu. It’s very unusual for flu victims to have severe hypoxia—low blood oxygen. At most, we see one or two cases of that each season. Yet, with this disease, it’s the norm in the sickest patients—and often presents without the usual symptoms. We were often surprised to see how low blood oxygen levels had dropped without the patient even reporting much discomfort.

COVID-19 presents a cascade of potentially life-threatening problems, like blood clots and a massive immune response. Blood oxygen is priority one, two and three. But although we quickly learned to be very aggressive with oxygen, it’s a balancing act. Too much oxygen can be harmful. So we were careful to be aggressive when needed, while also knowing when to use a lighter touch.

All Over the Map

Since we first heard about this virus, we’ve become practiced at recognizing the classic presentation—respiratory distress, elevated heart rate, low oxygen. Yet over time, we saw that it represents only a portion of those infected.

This disease can manifest very differently depending on the individual. We now know that some people can have it without a single symptom, and some simply have a mild flu-like reaction. Others become gravely ill and need the aggressive oxygen therapy and, potentially, ventilator treatment.

This was very tricky in the early days, before we had reliable testing. But we knew who was at greatest risk—the elderly and those with underlying chronic disease. Quite often, patients told us they just didn’t feel quite right. Later, when we started testing, our instincts were confirmed. Many who report such nebulous symptoms do indeed test positive.

Testing: The Game Changer

Testing has made all the difference. As testing protocols have advanced, accuracy and speed have improved. In the ED, we have several versions of the test available and can get results within a few hours. That’s a positive development, but more widespread testing and a reliable supply of reagents and other supplies will be key to battling the virus successfully.

Along with testing, experience has driven clear protocols for the disease and strict PPE requirements. The masks, gowns and gloves can be challenging, but we have all become very adept at getting the gear on quickly when seconds count.

A Cloud With a Silver Lining

Working in emergency medicine these past few months has been stressful and sometimes frightening. But the crisis has also brought out the best in both the healthcare system and the communities we serve.

I can’t emphasize enough the importance of the team. The doctor is only one part. We evaluate, test and make a treatment plan. Others put the plan into action, and they are the true heroes in this pandemic. Everyone stepped up: nurses, techs, EMTs, radiology technicians, respiratory therapists, infection control, security and environmental services, to name a few. Our hospital leadership also worked tirelessly to make sure we had the resources we needed to provide life-saving care for these patients.

The community has shown an unprecedented outpouring of warmth and support—even those who have lost loved ones. It’s gratifying to see people acknowledge the hard work of first responders.

The ER is a very social atmosphere—one of the many things I love about the job. Even with all the challenges, we are privileged to be working, compared to many who have been forced to isolate themselves. I feel it on my days off as well. Front-line workers must take care to stay safely distant from others, so I am grateful for my cats, dog, and Zoom meetings with my extended family.

At MedStar Washington Hospital Center, I am surrounded by caring, smart, resourceful and exemplary professionals in every discipline.

That keeps us going, every day. It is a true inspiration.