A Coronavirus Clinic Day

This is a play-by-play of my day at work, during the pandemic.

My alarm goes off at 5 a.m. I always get up extra-early for work, mostly because the T is variably reliable, and running late for clinic gives me palpitations. Better to avoid being late in the first place.

But today I’m driving in. I’m aware that of all the people on the train, I’m one of the ones more likely to be infected with COVID19 through my work, so I’m sparing others and keeping to myself. This means I get to listen to NPR on the drive in, for the whole fifteen minute commute anyways: There is NO traffic. All lanes on 93 North wide open, which is CRAZY for a Wednesday morning at 6 a.m.

I enjoy the brisk walk from the Nashua street parking lot to the hospital, except when I get to the door and remember I was supposed to fill out the symptom form on the new COVID Pass app. This is literally an attestation that every single hospital employee is required to complete and then show to the security guards. I open the app on my phone and tap in my responses with very cold fingers: NO new fever, cough, congestion, sore throat, anosmia, shortness of breath.

I get the all-clear:

Every hospital entrance now has a monitored entry point where several things have to happen: Employees have to flash their badge and their Covid Pass. Patients have to explain where they are going and why; No visitors are allowed. Everyone gets a squirt of hand sanitizer and a beautiful, brand new surgical mask. The mask must be worn all day, removed only for eating and drinking. (This is a good thing, and I am thankful, knowing that there are other hospital systems where administrators are literally pulling precious masks off of employee’s faces.)

My shift at the new Respiratory Illness Clinic starts at 7:30 a.m., so I have time to swing by my “old” office and sign a bunch of paperwork, check patient charts, send in a few prescriptions, and most importantly, read the latest COVID19 testing criteria and any updates. These vary almost daily, based on what we’re learning about the virus in real time, as well as testing and personal protective equipment availability.

Just a few weeks ago, I would have been starting my regular clinic morning seeing the patients I’ve known for as long as ten years for their physicals or urgent issues. But so much has changed, and keeps changing.

Our hospital has been very good about sending daily email blasts with tons of information and links to resources. We know that Monday, there were about 200 inpatients with COVID19, and 42 were in intensive care. We know that the outpatient Respiratory Illness Clinic (RIC) has been seeing about 130 patients a day. This clinic, the concept of which opened around mid-March, was originally housed in my own outpatient clinic space, but space limitations and logistics made it necessary to move the whole operation to the Sports Medicine clinic space, a feat that was accomplished in just a few days.

I get to this new RIC in time for orientation. I’ve worked at the RIC several times already, but not yet at this location. And, just as the COVID19 testing criteria and management guidelines are changing frequently, so are new clinical workflows and documentation requirements. I gladly sit through the whole presentation, which is delivered cheerfully and expertly by the director of our Center for Physician Well-Being. She, like so many others here, has had to step into a totally new role, and is excelling.

As soon as I review the ropes, I sanitize my hands again, then don my gear (mask and goggles, gown and gloves) and jump right into an exam room. I see a bunch of patients over the course of the morning shift. Almost everyone who presents to this clinic has a cough, and some are really sick. Most primary care physicians are doing everything they can to manage their patients who are doing OK at home by phone. We do not want patients who may or may not have COVID19 to be exposed to it in the RIC, and so, the ones that do get sent in tend to be doing not great. For this reason, there are two ambulances waiting outside the building, and every exam room sports the direct phone number for summoning the paramedic teams. They can get the patient on oxygen fast and rush them to the emergency room, which is a block away. They’ve been called ten or more times per day, and were definitely called while I was there.

My shift was only five hours. Yes, I could work longer, but they currently have a pool of healthy, energetic volunteers, many of whom request re-orientation to outpatient medicine in addition to COVID19 care orientation. During my shift, we had volunteers from Dermatology and Neurology. I know that they’ve had others from Orthopedic surgery, Endocrinology, Gastroenterology, Ophthalmology… everyone is stepping up to the plate. It makes sense to give short shifts to a large number of people, get them oriented, so that when people start to get sick, there are others already with the skill set.

After my shift, I doff my gear, sanitize my hands again, and head back to my own clinic to make more phone calls, write more prescriptions, read the latest email blasts, and discuss cases with colleagues. We’ve heard that the emergency room is handling an unusually high number of cases of respiratory failure, meaning that patients have had to be intubated and placed on a ventilator right there. The numbers of sick patients requiring ventilators or other high-level support go up and up every day, with the estimated peak still ten days to two weeks from now. We’re hearing the same things from colleagues at other hospitals.

What more can we do? Well, social distancing is still critical. We know that we need to slow the spread of this very catchy virus, and that it takes about 5 to 10 days for people to show symptoms after they catch it, and another week to 10 days until they get really sick. So the measures we take now, right now, we won’t know if they’re working until about two to three weeks from now. It’s hard for folks to be home, either working from home or dealing with their kids or worse, both, or even worse, out of work altogether, and not seeing the results right away.

People are asking, “Is this social distancing thing even working?” I am telling you, it will work, just hang on. We haven’t all been social distancing for that long, folks. Just hang on. Remember: It takes 2 to 3 weeks to see the results of social distancing, and it can mean the difference between overspilling the ERs and ICUs and people needlessly dying, or not.

I leave the hospital at 4:45 pm, and see these signs on the walk back to my car. Didn’t see them in the morning! So uplifting, and appreciated.