Anything but Normal: A Year as a Frontline Healthworker Battling Covid-19
The hospital paging system sounds: “OB Rapid Response to ICU.”
It is the middle of the night in the middle of a pandemic. Our Covid-19-positive patient is on the other side of the hospital, in a separate building, on a different floor. She is having a delayed postpartum hemorrhage after being delivered preterm via c-section due to complications of Covid-19 infection. I sprint.
I have sprinted before. To a different ICU, another patient, this one still pregnant, reminding myself as I race up four flights of stairs that I must reserve enough breath to perform an emergency c-section in full personal protective equipment (PPE) when I arrive.
The new normal is anything but normal.
I was nearing the end of my intern year as a resident doctor in obstetrics and gynecology (OB/GYN) in Atlanta when the Covid-19 pandemic reached crisis levels. Medical and surgical residencies are challenging even in the best circumstances. Needless to say, a raging pandemic compounds the already grueling demands placed upon young doctors.
During the early days of the pandemic, a sense of powerlessness, dread, and frantic uncertainty dominated. PPE was in acutely short supply. Covid-19 policies and protocols differed across the many hospitals at which I worked, changing by the day. Surgeries were canceled. Operating rooms shut down for anything but emergencies. We quickly transitioned to telemedicine, seeing patients remotely for routine care.
But labor and delivery cannot shut down. Babies come at any and all hours of the day. For pregnant women in Georgia, the pandemic threatened to further compromise a state with one of the highest maternal mortality rates in the country.
We know that pregnant patients are at higher risk of complications from Covid-19 infection, with symptomatic pregnant patients at increased risk of ICU admission, mechanical ventilation and ventilatory support, and death, as compared with symptomatic non-pregnant peers. Data suggests that Black and Hispanic pregnant patients are at even higher risk of complications from Covid-19 infection, which compounds existing racial and ethnic disparities in pregnancy-related morbidity and mortality.
These statistics, far from being mere numbers in medical journals or newspapers, have names, faces, and stories. We have performed bedside c-sections in the ICU for pregnant patients too unstable to transfer to fully equipped and sterile operating rooms. We have witnessed moms write letters to their children from ICU beds, unsure if they would ever leave the hospital to see them again. We have comforted those who have never held their newborns and cannot visit them in the neonatal ICUs until they test negative for the virus.
Just when I thought the pandemic had inhabited all of the mental and emotional space in my life that it could, Covid-19 hit even closer to home.
I was infected in July 2020. I thought the extreme fatigue was the result of sleep deprivation from long 24-hour shifts and overnight calls. But when a sore throat and cough developed, I became suspicious. I quickly got tested, and while awaiting results in quarantine I realized I could not smell my morning coffee.
In fact, I could not smell anything. Sure enough, the test came back positive.
We were lucky. My husband never contracted the virus, and my symptoms were limited to extreme fatigue and anosmia (loss of smell). I continued to see patients remotely via telemedicine while I was sick. I recovered quickly and returned to work after 10 days of quarantine, but over six months later, the anosmia persists.
I count my blessings as I mourn healthcare providers who have lost their lives and lost their loved ones. Now, over half a million people have died as a result of Covid-19 across the country. As of March 1, the Centers for Disease Control (CDC) estimates that, among U.S. healthcare personnel, there have been over 400,000 cases and just under 1,500 deaths. The death of a 28-year-old OB/GYN resident in Texas could have been me or any of my co-residents.
Finally, one year into the pandemic, we have seen important progress: adequate PPE, widespread testing, long-awaited vaccines, and newly elected national leadership that will listen to and empower health experts.
However, there is still so much we do not know as well as numerous outstanding challenges and areas where greater attention and focused effort are needed.
Already, demand for vaccines is outpacing supply at the same time that many Americans, healthcare workers included, are making the decision not to get vaccinated.
Already, vaccination patterns by race and ethnicity are at odds with those populations most deeply affected by this virus.
Already, new variants of the virus are emerging, and the evolutionary arms race between human and virus will continue to be a battle fought throughout our lifetime.
I hope that we will look back on this fraught time and be able to point to lessons learned. That our response to this crisis strengthened our healthcare system. That the painful disparities set us on a path toward equitable, compassionate care. That identifying our weaknesses prompted us to empower the CDC to carry out robust disease surveillance and response.
The Covid-19 pandemic threw me and other doctors into a battle against an unknown and unseen threat. It forced us to improvise and adapt in new ways we never imagined. We confronted serious risks to our own health and safety and that of our families—while doing everything we could to protect and care for our patients.
The new normal may be here to stay for some time, particularly if this pandemic lives on in the face of proliferating viral variants.
The fight is not over, but my generation of doctors will carry these experiences forward throughout our careers. We will be better clinicians because of it.
Dr. Alisha Kramer is a OB/GYN resident at the Emory University School of Medicine. She holds an M.Sc. in global health policy from the London School of Economics. Prior to medical school, she was a program manager and research assistant with the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) in Washington, D.C.
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