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Guest Opinion: Emergency depts: It's NOT normal now

by Nick Gorton

Dr. Nick Gorton. Photo: Courtesy Twitter
Dr. Nick Gorton. Photo: Courtesy Twitter  

It is no secret that many hospital emergency departments are struggling. I recently tweeted some tips about how to access care during this overwhelming wave of COVID-19 in the U.S. These aren't ideas I ever thought I would suggest to anyone outside of Mass Casualty Incidents (MCIs), where need for care greatly exceeds the ability of the involved health care systems to provide care. However, millions of Americans decided seeing Granny for the holidays was more important than a functional health care system. So here we are: the U.S. COVID-19 clusterfuck is a nationwide MCI.

For those considering a trip to the ED during the pandemic, here are a few suggestions:

1. Ask yourself: is this something that really needs an ED visit? If you have access to other care, and your local EDs are overwhelmed, maybe this isn't the time to go for a sprained finger. If you can, call an advice nurse before you go or try one of those fancy new telemedicine apps. If you have a serious emergency, we will try our best to be there for you, but we can treat more serious emergencies better if we keep the flow manageable.

2. If you think you have COVID and aren't either very sick or high risk, don't come "just to get a test." Waiting rooms may be full and you could quite literally kill someone by breathing on them. If you have red flag symptoms like shortness of breath, bad chest pain, or confusion, please come. But if your roommate has COVID-19 and you have mild flu-like symptoms and can't smell anything, you have COVID-19. I don't need a test to tell you that: so please stay home and save lives.

3. If you think you need specialty care pick your ED wisely. If you had surgery at hospital X and come to hospital Y, we probably can't transfer you to your surgeon at hospital X because NO ONE has beds. If possible go where your specialist is. If you come to a small hospital with a heart attack, it may be impossible to transfer you to see a cardiologist. Sometimes choosing the best hospital isn't possible if you live in the middle of nowhere. But if you live in a city and usually go to the small private ED with the better wait times and nicer rooms, maybe now is the time to think more about what services the hospital has instead.

4. Expect a wait. We always say this, but we like really, really, REALLY mean it this time. Also expect not to see your family. Bring everything you may need (including a cellphone charger). Expect to sit in the ED and maybe not go up to a room on the floor. For days. Or possibly to be sent to a tent or a field hospital in a stadium or parking garage. It's not going to be nice.

5. Be kind to the nurses. These amazing professionals have the highest exposure risk to COVID-19 and are not just risking their lives, but their families' lives to help you. Show them the goddamn respect they deserve and if they get upset, or are exhausted, or gruff, or curt with you, the correct response is "THANK YOU FOR RISKING YOUR LIFE FOR ME."

6. If you or your family get COVID-19, talk early about what level of care you want. Grandpa is 98, has diabetes, kidney failure, and told you he doesn't want heroics: RESPECT HIS WISHES. Even if you aren't high risk, tell your family before you go what you want if you get really sick. If you can do so without infecting someone, hug them and tell them how much you love them like it is the last time. Because it might be the last time.

7. Be realistic and remember you probably won't get the level of care we usually expect in the U.S. It won't be fast and we probably can't transfer you for the lifesaving care we usually can: no one is accepting transfers. A transfer center nurse told me recently that last month they got transfer requests from Idaho and Colorado. We work in California. With a few notable exceptions like pediatrics (since kids get seriously ill from COVID-19 less frequently than adults) and major trauma (because Level 1 Trauma Centers always accept trauma) you may only get the specialty care, which may be limited, available at the hospital you walk into.

8. Realize none of us want this. We want to provide the best care possible to every patient, but the resources just aren't there. This is what Americans chose when we decided that we couldn't skip one Christmas or Thanksgiving. And as bad as it got after Thanksgiving, it's going to be astronomically worse in January when we start to see the infections and deaths from Christmas.

9. This is going to be the reality in the U.S. until we either get herd immunity through vaccination OR Americans grow up, break their addiction to science denialism and conspiracy theories, start wearing masks, socially distance, and follow basic public health guidance. We're so damn close. If every American changed nothing else and just wore a mask 100% of the time while outside of their home, we could beat this back and keep 2021 from being 2020 part 2 — COVID-19: The Reckoning.

Dr. Nick Gorton is a gay and transgender physician. He volunteers weekly as a primary care provider focusing on transgender patients at Lyon-Martin Health Services. He serves on the executive committee and is an instructor and medical consultant for Project HEALTH in San Francisco. He has worked as a medical consultant for the Transgender Law Center, the Sylvia Rivera Law Project, and the National Center for Lesbian Rights and is an active member of the World Professional Association for Transgender Health.

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