They are physicians, mentors, partners, mothers, sisters, friends, colleagues – but most evidently at the moment, they are heroes. I (virtually) sat down with five women physicians, at all points in their medical careers, who are working in several of the largest Emergency Departments in Texas, to talk about their experiences with the COVID-19 pandemic. What I thought I was going to walk away with was a better understanding of how the Emergency Departments were handling the largest health crisis in a decade; however, what I didn’t expect were these stories of extreme resilience.

One of the themes that I heard from each of these physicians was that the inevitable weakening of the patient connection is one of the hardest things about practicing during this pandemic. Due to the six-foot rule and the safety precautions now in place, the doctors take the patients’ history standing at the foot of the bed, do as little physical exam maneuvers as clinically necessary, and are unable to allow family members past the waiting room. But if anyone knows that medicine is a team sport, it’s EM physicians. Keeping family involved and updated is something these doctors are not willing to sacrifice, so despite these physical challenges, they are finding a way. Whether through Facetiming or calling the family/caregiver, or de-gowning and going into the waiting room to speak with them, they are still doing their best to make their patient care family-centered.

Doctors are finding that on top of dealing with the medical symptoms of COVID, they also have social obstacles causing ethical dilemmas in the care of their patients specifically. All of these physicians I spoke with are practicing at county hospitals, meaning they are the primary caregivers for these large cities’ homeless, uninsured, undocumented, and underserved. Each of them specifically brought up the difficulty with patients experiencing homelessness. Discharging someone who is unable to self-isolate for the recommended fourteen days brings an ethical challenge. Another physician spoke on how she personally was pushing for COVID-testing in patients who were being medically cleared for jail, as sending an asymptomatic carrier to such a crowded population would put hundreds at risk. Even for many patients who do have a home to quarantine in, taking two weeks off of work is not an option. However, it is important to remember that these challenges are not specific to this pandemic, did not begin with this pandemic, and will not end with this pandemic. Systemic inequalities and disparities due to social determinants already existed in the medical system but are being especially highlighted by this pandemic. “Our population doesn’t have any particular challenges that are specific to COVID, but COVID has just shined a brighter light on them – whether its access to care or being able to follow up.”

Unfortunately, all of these aspects of life during COVID are interconnected – medical, social, financial, and psychological. We have all been feeling the effects of social isolation, uncertainty, fear of infection, losing loved ones, the abundant media coverage, etc. Combine that with the lack of access to mental health services in these underserved communities, and the psychological impact is amplified even more. Each physician noted that they have seen an increase in patients visiting the ED with psychiatric symptoms, in particular, anxiety and panic attacks. Emergency departments are also seeing increased rates of decompensated chronic psychiatric illness like dementia, bipolar disorder, and schizophrenia, due to issues accessing care or paying for medications. It was obvious before the pandemic that America has a mental health crisis on our hands, and this fire is only fueled by this novel global situation (1).

One cannot talk about mental health during COVID pandemic without mentioning the sector of society that is perhaps experiencing the most trauma – our healthcare workers. One of the residents I spoke with said that the death of Dr. Lorna Breen, an EM physician in New York who tragically died by suicide in April after treating patients with COVID (2) “was huge on us. That was a wake-up call that we need to check up on ourselves”. Dr. Breen’s tragic death is just even more evidence to highlight the mental health risks faced by physicians. Physicians already die by suicide at twice the rate of the general population, with women physicians being at an even higher risk than men physicians (2). Residency is an infamously challenging time in the career of a physician, even without a global pandemic occurring. They are workers who, some even less than one year ago, went from “student” to “doctor”, and in this current situation they are now being thrust onto the front lines of the largest health crisis in over 100 years. This particular woman, who is two years into her residency, stated, “There were times before going to work that I sat in my car terrified, on the verge of crying. I was scared for my life; I was scared for anybody around me.”. However, she also described bonding with her colleagues about these shared emotional experiences and feeling very supported by the attendings at her hospital as well. 

Two of the women I spoke with are mothers of young children, which comes with its own challenges during this time. One of them who has two daughters both under the age of two stated, “It’s hard to not hug them when you first walk in the door before you shower, especially when they are super excited that you’re home, but it’s the new normal, so you get used to it and it becomes just another day.” Another mother and physician talked about the obstacle she has had with keeping her elementary school-aged children focused on their class Zoom meetings while she and her husband, who is also a physician, continue to go in to work. Like many people across America, their home lives look quite different than they did even at the beginning of this year, but they cannot let it affect their work lives.

After the few hours I spent talking with these women, it was evident that flexibility is key. New information is coming out daily, protocols are updated and changed every few hours, and these doctors must be in the know and adapt. One of the physicians I interviewed serves as an educator for the Ultrasound fellowship at her hospital, and their fellowship program was able to obtain ultrasound probes that can attach to a cell phone for all of their fellows during this pandemic. Now these learners can perform scans on themselves or family members at home and send those to their professors to continue their practice and education. Another aspect of medical education that this pandemic has affected is the learning material. In residency, you learn from your patients. One resident I spoke with mentioned that this pandemic has affected her educational experience in that she has learned much more about acute resuscitation of emergently decompensating patients. Though there may be occasional slow moments in the ED due to low volumes, there are also more high-intensity experiences handling critically ill patients with COVID. As an Emergency Medicine physician, these are skills that are essential to build in your residency, and it is safe to say that they are training a new generation of experts in emergent situations.

After speaking with these women, for me to use the word “inspired” is an understatement. As one physician put it, “We have stuff that we have to deal with on a daily basis and then be able to go home to our families and act like it is business as usual, go on with your day, and start over the next day. Like seeing people have to die without any family members there. I always knew EM docs were resilient, but now even more so.”. When it comes to medical specialties, Emergency Medicine physicians have always been the definition of the “front line”. They are classically the first physician to see or touch a sick patient. There is no doubt that the highest risk of exposure to COVID is placed on Emergency Medicine staff.  The resiliency that has been shown by physicians all across Emergency Medicine is undeniable. As one physician I had the privilege of speaking with told me, “You are often helping someone on the worst day of their life. It’s scary, but at the end of the day, it is what you signed up for when you went to medical school, and when you chose Emergency Medicine. I love Emergency Medicine. I would never want to do anything else in my life.” These are the doctors under the PPE.

Sources:

1. Wan, William. “The Coronavirus Pandemic Is Pushing America into a Mental Health Crisis.” The Washington Post, WP Company, 4 May 2020.
2. Watkins, Ali, et al. “Top E.R. Doctor Who Treated Virus Patients Dies by Suicide.” The New York Times, The New York Times, 27 Apr. 2020, .