Coronavirus: Call to Duty

I got the email from my boss on Tuesday:

“You are receiving this message because you have been scheduled to staff an inpatient COVID-19 surge team…”

What followed was a really long, dense list of critically important logistical/ workflow/ orientation information, replete with links to even more critically important clinical information, all intended to prepare an outpatient doctor for an inpatient role.

I stared at that email for a good long while before I could move. Yes, I volunteered for the job. Yes, I’m weirdly excited about it. I’m anxious, too.

It makes sense that I was “activated” to inpatient: Right now, almost 40% of our admitted inpatients are Latino and Spanish-speaking. Around Boston, the hardest-hit areas have been those where Latino immigrants tend to live, sometimes many in an apartment, and unable to stop working or socially distance themselves. Life is hard, so hard, for so many, and COVID-19 has made it harder. I am Latina, I speak Spanish, and I can help, so I will.

It’s another clinical role to learn. For the past month, my colleagues in primary care and I have been working a mishmash of newly-defined clinical roles. Many of us have been staffing the outpatient Maybe-It’s-COVID Clinic, figuring out fevers and coughs and any other symptoms that might be COVID, like diarrhea, or even an odd lightheadedness. (And it was.) Then we’ve all been fitting in telemedicine visits for our own patients, trying to manage anything and everything WITHOUT vitals signs, physical exam, labs or imaging. We doctors are all hesitant and hedging– “Well, MAYBE it’s allergies, it could be COVID, but we can TRY Allegra and Flonase, if you’re comfortable with that…“– meantime patients are extremely grateful, and this is going to change the way we practice forever. Then, and this one was a doozy, we’ve all had these absolutely essential (and also hospital-mandated) serious illness conversations with our most fragile patients. Basically this virus has forced us to actually talk to our patients, or at least some of them, about death. Like, we’ve had to ask if they have their affairs in order, and can they please fax us those papers. We’ve had to discuss how, really, they’d like to die: Peacefully, comfortably, with the help of hospice and a lot of morphine? Or coldly and all alone, on a ventilator in an ICU? That all sounds very awful and dreadful, but, it’s also very very real and now. Soooo I was handed a list of my most at-risk patients, determined by some equation including age and infirmity, and asked to call every single one within one business week please, and update the chart.

I had been spacing those calls out pretty widely, until I got the email from my boss. And, I’d been writing. Up to that moment I’d been working on three different blog posts, with the idea that I would finally get on top of my blogging shit and compose solid pieces that could be scheduled ahead of time so that there wouldn’t be such long pauses between posts. Like that will ever happen.

But the email… and I realized I had very little time to get all those calls in. And they’re important, it’s true. I get it. So the rest of the week was spent calling those folks and then some, having predictably extremely heavy conversations with them and their healthcare proxies or powers of attorney, then documenting it up the wazoo. Sigh.

Today, Saturday, was my last shift in Maybe-It’s-COVID clinic, and now I’m studying up for inpatient. Cramming, really. It’s been awhile since I’ve worked inpatient. I was a badass hospitalist moonlighter once, pulling 24-hour shifts covering whole floors solo in a certain downtown Baltimore hospital. Baltimore is a tough town. I was a tough cookie… as well as young, single, and childless.

But I have some inspiration: Our niece is a badass ICU nurse who signed up to help where she is most needed– New York City. She left her home hospital and her kids and traveled hundreds of miles away to fill a desperate need for good RNs, for twenty-one days straight. She’s right now living in a hotel, and every morning at 5 am she has to be down in the lobby, dressed and prepared for a long shift in any one of a number of hospitals, and in any role. “We could be assigned to a position at the top of our license, or mopping floors, and that’s okay. We’re here to help and we’ll do whatever needs to be done for patient care,” she explained in a recent video post. (You go, Jen! So proud of you!)

So, I got this. Today in clinic, in any free moment, I was reading up on anything and everything inpatient COVID-19. I can do it, it’ll be fine, I’m actually looking forward it. I start Wednesday. Meantime, I promise, I will get to those posts I’ve been working on and schedule them. And when I hit the floors, I will tell you all about it. (In a HIPAA-compliant way, and always pointing out that my posts reflect my opinion and not that of my employer, ever, of course.)