Torree McGowan, MD
I wear a bracelet on my left wrist. It’s a terrible fashion choice. It used to be red, made out of thin metal. The red has now faded to just an occasional suggestion, but you can faintly make out the words on the band: SSGT Warren Newton. I have worn this band since 2000, over 20 years of a forgotten hero’s legacy. It’s a POW/MIA bracelet, carrying the name of an American warrior who never came home. I have worn it on my left wrist, just down from my watch, for these many years. It has never come off.
Blurry images taken through a ziploc bag to protect my phone.
Today, I’m thinking about taking it off for the first time.The fusillade of coronavirus patients is just starting to hit my hometown. I’ve already seen a few that I’m pretty sure have it, but the tense uncertainty of days of waiting for diagnosis leave me in limbo about how worried to be.
The sanitizer I compulsively smooth over my hands has left a raw area under my wedding ring, so last night I left the platinum band in a little dish in my bathroom. As I sit here in the quiet night, I contemplate what my next step needs to be to try to be just a little safer.
There is so much uncertainty about who may have it, and what they present with, and how to watch for them, you start seeing virions in every shadow these days. The headlines blare each day about a nurse dying, a doctor on a ventilator, a patient who presented with a ruptured ectopic pregnancy and happened to have coronavirus as well. The most terrifying stories are the doctors, nurses, and other frontline caregivers who are being asked to come to work to battle this disease with bandanas and trash bags for safety.
The idea of sending caregivers into patient rooms without appropriate protection is such an anathema to me, I can only glance at it out of the corner of my eye. The first thing we learn in any tactical medicine course or first responder training is the idea of scene safety. It’s a mantra drilled into so many of the servant occupations: military, firefighting, police, medicine. You don’t risk your own life until you’re safe. Dead doctors can’t save anyone.
Those of us who wade into these battlefields many places are being asked to do so without any protection. This feels like sending soldiers to a gun battle in flip-flops and a bathrobe. Doctors are being told not to wear masks because it might scare patients. I’m scared. I’m scared I will bring this home to my husband, who is immunosuppressed. I’m terrified my dad will get it. I’m okay if my patients get a little more scared from me. Maybe they will stay home, and help us get ahead of this exponential juggernaut.
Many places are asking nurses and doctors to continue seeing patients despite what we know is ineffective protective equipment. The Oregon Board of Nursing even came out with a statement that nurses couldn’t refuse an assignment for a COVID patient if the facility follows Oregon Health Authority guidelines, even if those were not as stringent as the CDC and WHO guidelines. They are being told that not running into the cannon fire is patient abandonment.
I am deeply troubled by the blatant disregard that many hospitals are showing for the safety of their staff. The basic tenet of scene safety appears to be forgotten in many places, and administrators are asking others to take unacceptable risks when they ask us to work with inadequate equipment. I feel incredibly lucky that my hospital has continued to support us, but many are not so fortunate.
Aaron Mischler reflected on his time treating Ebola patients in West Africa several years ago - link. His words echo in my mind as I think about the risks we are asking of our caregivers: “Who is the most important person on the Ebola Treatment Unit? I am. There is no emergency in a pandemic.” His words are some of the most important I’ve read during these troubled times. He is right; people are going to die in this outbreak. Many of them, we can’t save. But for the ones we could save, if all of the doctors and nurses are sick or dead because of inadequate protection, we won’t be able to save the heart attacks, the appendicitis, the salvageable COVID patients.
If the barrage of patients continues to increase and is not mirrored by increasing amounts of personal protective equipment, the doctors and nurses caring for this country will be asked to make a soul rending choice: do we rush in to save the one patient in front of us without any armor, or do we preserve the precious resource that is our medical workforce to be able to care for the next patient and the ones after that? Tremendous efforts are being made to get us safety gear, but for many, it may come too late.
Waiting for the next skirmish
Every one of us who cares for these patients is doing every tiny thing we can to protect ourselves and our patients. Beards are disappearing. Previously unused hospital showers now have frequent visitors as shifts change and people begin their weary trips home. Fear makes glances slippery, and feet skitter around to try to keep appropriate social distancing in our close quarters.
I doubt there will be bracelets like the one I wear to commemorate the physicians and nurses we lose in this battle. I promised SSGT Newton that I would never take his bracelet off until he came home to his family. I’m afraid today that I will break that promise for the first time in 20 years. That bracelet and my watch will join my wedding ring, one more offering in a desperate prayer to keep this infection away from my door. I’m doing everything I can to secure the scene so I can keep helping patients. I’ll continue to do so, as long as I’m armed enter the war zone safely.