The Reality of Health Care During COVID-19, by Nicole Evelina

 


In the Trenches and Behind the Scenes:
The Reality of Health Care During COVID-19

By Nicole Evelina

“When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’” - Mr. Rogers

There are those who run away from disaster and those who run toward it. Most of us, myself included, are staying as far away from the COVID-19 pandemic as possible. However, others are voluntarily in the thick of it—doctors, nurses, respiratory techs, and caregivers of every specialty. If, as many have said, this is a war, they are its heroes. They work not only because it is their job, but because they are called to serve. Yes, some choose a career in health care for the salary, but by and large, if you ask a health care professional why they picked their profession, they will tell you it was because they wanted to help others. And good thing, too. Because now our future is very much in their compassionate, gloved hands. 

While the history books will someday debate the response of the government and theorize over what could have or should have been done differently, these people will fade into oblivion, just like they have after every other major event in history. Who but their family members and friends can recall the names of the first responders on and immediately following 9/11? And that is still within living memory. 

We can’t allow that to happen this time. It is important to remember those who are saving lives through their everyday work. We must understand and support those who toil away in hospitals and clinics in every city and town across the world, caring for the sick, trying to educate the public to stop the spread of COVID-19, and putting their very lives at risk so the rest of us don’t have to.

The People Behind the Masks

When you imagine a doctor during this pandemic, what comes to mind? If you’ve paid attention to the news, you might see in your mind’s eye a person dressed in a white hazmat suit or a urine-colored protective gown, face covered by a plastic shield and goggles or blue N95 mask. These people are very much in action in our Emergency Departments, Intensive Care Units and isolation wards, working long hours with inadequate supplies and equipment to save lives and keep this deadly virus from spreading. But so is your family doctor. He or she is likely still seeing patients who need ongoing care and testing people with symptoms. Or they might be analyzing the results of online risk assessments or conducting phone or video/online visits with patients who think they might be ill with COVID-19. 

What you don’t see in the media is what takes place behind the scenes: the intensivist storing away her face shield for re-use, praying it will be enough to keep her from getting infected and thus be unable to continue working. Or the physician carefully peeling off an N95 mask by its straps and wondering how long it will be before he runs out of these valuable resources and has to make due with lower quality masks that don’t offer enough protection. 

Picture the person next to that doctor in the locker room, a nurse on her third 12-hour shift in a row, head bent low and gritty eyes closed, trying to catch a moment’s rest before attending to another coughing patient or one delirious with fever. It wasn’t enough that earlier she sat with a dying woman so she wouldn’t be alone in her final moments or that just before going on break she had to calm an outraged visitor who insisted on being allowed to see his hospitalized father, despite the no-visitor policy in place for everyone’s protection. There truly is no rest for the weary; soon she will be called back into battle. 

Imagine the respiratory therapist who trudges home at night not to his warm bed, but to a tent in his backyard so he doesn’t unwittingly expose his wife and child to the virus he’s spent all day battling. As he climbs into his sleeping bag and tries to get comfortable on an air mattress, he says a prayer for the little girl on oxygen who is scared and alone in the pediatric ICU. He knows he will dream of the elderly man who just a few hours ago held what could be his final conversation with his wife before being intubated and breathing with the aid of a ventilator.

Envision, too, the ethicist called in to consult with a doctor in an overcrowded hospital. Each room is filled to capacity and beds line the hallways leading to her office. Their hospital is officially in crisis containment status, meaning they don’t have enough manpower or supplies to meet demand. 

That’s why the doctor has come to her for advice. He took an oath to never willingly harm a patient, but the protocol they are bound to follow states they must ration their supplies according to the ability of a patient to benefit from them. That means some, such as the elderly or those with conditions that make healing more difficult, may have to continue their treatment without potentially life-saving equipment and be given palliative care in hopes they can survive on their own. 

He rubs his temples and asks her the impossible question, “How does one begin to make that decision?”

Powering a Pandemic Response

Behind all those troops in the trenches are people whose work is rarely seen by the public and isn’t nearly as dramatic but is needed all the same. These leaders and tactical specialists provide vital background support that enables caregivers to do their jobs. 

Think of a health care executive like a general in a war. Exempt from the isolation that keeps many people safe, she attends meetings with her counterparts, just like military in their war councils, to study trends and predictive models in an effort to understand when the surge of cases will hit her area so her people don’t face the worse-case scenario that other hospitals have experienced. In between meetings, she is glued to her phone, consulting with local and national experts to understand constantly evolving best practices for treating the virus and conserving and sanitizing protective equipment for reuse in the face of a national shortage. She yawns and yearns for the days when she was able to sleep a full eight hours; but if her troops can do without personal time and rest for the greater good, so can she. 

Remember that doctor with the N95 mask? He is also an administrator. So, when he finishes his shift he doesn’t return home, or if he does, it is to do more work online or on a conference call. He spends his nights and weekends working with others like himself to establish the most streamlined and effective courses of care for treating COVID-19. When he’s not thinking about his patients, he’s trying to figure out the best ways to change traditional triage and care practices to adapt to the needs of this unprecedented time. Then he catches a few hours of sleep, only to get up and do it all over again.

Across town, a supply chain manager lies awake in the middle of the night mentally mapping routes from one facility to another and calculating inventory. If a surge of patients maxes out ventilator capacity in one hospital, what other locations can spare a few to help? And what is the fastest way to get them from the places they are to the place they are needed? She grabs her phone and dictates a quick reminder to call the CDC and her list of private suppliers again; her health system is desperate for more COVID-19 tests. Their lab partner said they can manufacture the tests themselves, but she can’t find the correct type of nasal swab anywhere—that hunt is another to-do for the next day. 

The next morning a communicator is on a conference call with hospital administration; she’s going to have to find a way to tell doctors and nurses that they are running dangerously low on one size of N95 mask and try to provide them with safe alternatives. When the call ends, she flips on the television to see how well the hospital representative took her coaching for the press conference to assure the community they have the capacity to handle a surge in cases. She breathes a sigh of relief. He did well. But her calm is short-lived. Her phone pings with a Facebook notification she needs to respond to before she writes the communication about the masks; there is no end to the misinformation spread online.

Enabling all these people to do their work—whether they are at a hospital or working from home—is the information technology co-worker holed up at a data center, and a team of others like him. He just restored an outage that was affecting caregivers’ ability to document patient progress in their electronic medical record. Now he needs to figure out why one of their video visit connections isn’t providing sound. Then he will return the call from a co-worker working remotely who is having problems accessing her files. The aphorism “technology is great when it works” is certainly true, but in an age when hospitals are reliant on it to power all aspects of care from programming Smart IV Pumps to helping providers follow proper care protocols, disaster can result when it doesn’t. There’s a reason he’s always on call.

Unsung Service

All of the people described above are real, as are the situations they are facing. So please, before you post on social media that you are bored during the quarantine, say a prayer for those who don’t have that luxury. Whether in patient care or in support roles behind the scenes, they are working 24-hours a day, seven days a week to keep you informed and ensure that should you contract COVID-19, you’ll have the best care possible. And they will continue doing so until this strange period of history is over and we can all return to whatever the “new normal” is. If that isn’t the definition of a hero, I don’t know what is.

Nicole Evelina is an author whose day job for the last seventeen years has been in health care communications. She is in the unique position of seeing how COVID-19 is affecting all aspects of health care. This essay reflects the experiences of actual health care professionals from across the United States. 

Nicole is no stranger to TaleFlick, achieving Top Pick status with her novel Camelot's QueenTaleFlick Pick status with Madame Presidentess, and having listed novels Daughter of Destiny, Mistress of Legend, and Been Searching for You on the platform.