A Day in the Emergency Department
Stacy Kovacs is one of the most high-energy people, ever, anywhere. She leads Fogo Azul, the all-women’s Brazilian percussion corps that performs all over New York and internationally, at parades and public events. Her day job is a “PA,” a physicians’ assistant in one of the New York’s largest hospitals.
I hope this story is a wake-up call to people who aren’t taking the threat seriously enough. And it’s a tribute to Stacy and all the other fearless professionals on the front lines.
“People are asking me how I’m doing. I’m fine. They want to know what it’s like. I’ve worked three days in a row for 13-hour shifts. I’ve been re-deployed from my happy little outpatient procedural department to covering “boarders” admitted to the ED, the emergency department. These are the people stuck waiting for open beds upstairs — which means that someone else has to be discharged or die for them to get a bed.
My assignment is to cover eight patients in the ED.
All my patients are Covid+, which means they tested positive. In fact, I don’t think anyone in the ED is not Covid+.
I’d never been to the ED in my hospital… Where is it? Oh, more than a block away in another building. I go there and meet the doctor and the other PAs I will be working with, for the first time. Okay, everyone is super-nice. I learn that one of my patients is on “comfort care,” meaning that the family withdrew extraordinary measures. We are to pump comfort care patients with morphine, not give oxygen, and let them slowly die with so much morphine in their systems they don’t know they’re dying — passive euthanasia. It takes about 45 minutes for the man’s heart to stop.
I learn how to write death notes and was refreshed on how to “call death,” which means how to note the time of death and begin the process of paperwork required by New York State.
Keep them alive!
My other patients are in their 60s with NRBs (non-rebreather face masks) at full oxygen level — as much oxygen as they can get. They are now considered “stable,” which one month ago would have been criteria for admission to the ICU. Not any more. 15 LPM (liters per minute) on NRB is the new stable. Fine. Our job to watch them, wait for a change, or wait for them to get a bed upstairs. Our mantra is: “keep them alive, keep them alive.”
Then I help another PA get the necessary people and equipment to intubate her patient, which is the process of inserting an ET (endotracheal tube) through the mouth into the airway. Not easy. The patient is in his 50s with high blood pressure and uncontrolled diabetes. After being intubated, he is fortunate to get an ICU bed in one of our ORICUs — the operating rooms that have been turned into ICUs for three to four patients at a time. Entering that room is a strange, movie-like scene with patients under the OR bright lights. So surreal.
Next, the ICU triage team puts one of my patients on Bipap (usually used only for sleep apnea). Her roommate is on comfort care. Their stretchers are literally three feet apart. It takes the roommate about an hour to die. I need to go into that room and do a blood gas, a special blood draw from an artery in the wrist, on my patient. A PA colleague goes in with me to help, but try to picture me bumping my ass against the stretcher with the dead woman on it every time I move. And my patient knows that the woman next to her is dead from the same virus she has.
The rest of the day is a blur. The following two days are similar.
We discharge six people from the ED who got better, and the rest go upstairs to rooms.
This is far from normal. We may usually have more deaths from the flu, stroke, heart attacks, suicide or cancer, but we don’t get 150 flu patients in each of the emergency rooms every day for two weeks straight. The usual flu deaths are spread over the entire country over 365 days a year.
Please stay home and just chill.
I would do anything right now to stay home and chill. I envy all of you.”
Hey Stacy, thank you, thank you… and take good care.