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I step through the sliding glass doors of my hospital’s emergency department and immediately look for the paper bag with my name scribbled on the outside. It contains my previously used surgical mask. I put it on, breathe deeply, and wrinkle my nose at the smell. It’s a stale, tired scent, unrecognizable and unpleasant.

Hellos from the triage nurses behind makeshift plexiglass distract me from the smell. I greet the other docs, nurses, physician assistants, techs, unit secretaries, social workers, interpreters, housekeepers, and the others I’ve worked alongside for years. When they notice my clean-shaven face — I shaved my beard the night before for the first time in 30 years to make a tight seal with the N95 mask — I hear a few cutting barbs and dramatic gasps.

I smile. The mask smell, high in my nostrils, is washed away by the banter with these people. I’m at considerable risk for being exposed to and infected by the coronavirus in the emergency department, but somehow I feel most at ease about Covid-19 when I’m at work, among people I trust.

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Sure, I’m worried. And I’m vigilant. I follow this tyrannical infection as it wreaks havoc around the globe and closer to home. It’s relentless, but mappable.

What I can’t track or make sense of is the response from leaders who should be bastions of guidance and support. One day we’re told that providers must scrupulously don an N95 mask, face shield, portable gown, and gloves. Then the shortage of personal protective equipment somehow alters scientific evidence, and the Centers for Disease Control and Prevention now believes that surgical masks, which fit like a pair of old khakis, should be more than adequate.

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And we can reuse the N95 and surgical masks which, after a day or two, take on a mysterious odor.

I know what that smell is now. It’s mistrust.

I feel abandoned by U.S. leaders who appear to be bungling through a national catastrophe with unearned bravado. When stockpiles of personal protection equipment resemble the toilet paper aisle in grocery stores, I anticipate a declarative announcement from them and the CDC that they have good evidence, excellent evidence, the best evidence ever, that taking a marker and drawing an N95 mask on your face is just as effective as a surgical mask. But you must use a permanent marker, preferably a Sharpie.

In a time of crisis, transparency and trust are essential. But trust has become a resource as scarce as personal protective equipment, and it can’t be manufactured, even as an afterthought. Which explains why I feel comforted when I’m working in the emergency department. Being exposed to Covid-19 also means being surrounded by people I trust inherently.

There is a moral mission to emergency medicine. The sliding glass doors open to anyone and everyone. Our practice is a dance, sometimes a race, and on occasion an arm-wrestle with the unexpected. Fortunately, I work hand-in-glove with dedicated and passionate folks who have big personalities, bigger hearts, and the resilience of Gumby. We’re used to diagnostic uncertainty, responding to desperation, to bodies and lives in crises. We’re trained to respond quickly based on limited information. Since testing for Covid-19 is as scarce as personal protective equipment, we know our foe but can’t always see it. Caring for our patients will require caring for each other to ensure that we stay safe and healthy.

Emergency departments have been described as quasi-public spaces situated between the community and the hospital itself. Even before Covid-19, this space buckles from the strain of serving two masters: meeting the growing needs of communities in crisis while satisfying the demands and working within a stressed hospital. Emergency staff are practiced in doing more with less.

In the midst of a pandemic, it might sound counterintuitive to confess that I feel most in control in the very space where there’s a lack of personal protective equipment. My emergency department boasts two CT scanners, a cardiac catheterization lab, an MRI suite, and now resembles an elementary school lunchroom with reused masks in paper bags propped on shelves.

Covid-19 poses a challenge on a magnitude that will destabilize us in a manner we’ve never before experienced. Luckily, protection comes in the form of the talented, tenacious, and compassionate people who make the emergency department hum. I cherish my colleagues more than ever because we’ve been through so much together, albeit on a much smaller scale. We’re practiced at personal risk and having each other’s back, being frequently on the receiving end of violence, verbal abuse, and infection.

We’ve endured troubles, shared triumphs, and exposed our vulnerabilities. I’ve been at my worst and at my best with my colleagues. Because of them, I’ve grown into a better doctor and hopefully a better person. These are the people I trust most in this crisis.

Emergency doctors everywhere in this country are doing the same thing I’m doing: caring for patients, huddling with amazing nurses to make sure we’re all on the same page, swapping stories with crackerjack techs, and maybe ribbing the indispensable unit secretary about her overhead call for the owner of the red Toyota to please move their “cah.”

We’ll talk about what this cough means or whether that patient with diarrhea might be harboring Covid-19. We’ll gown up, mask up. We’ll secure and tie the backs of each other’s gowns and diligently check for gaps in protection that’s more permeable than we’d like. We’ll remind each other to drink enough fluids. And don’t forget to eat, too. We’ll check in and ask how we’re doing.

We’ll struggle through decisions based on guidelines that have a whiff of fiction to them and aren’t completely helpful: When there are not enough tests for SARS-CoV-2, the criteria of “prolonged, unprotected close contact with a patient with symptomatic, confirmed Covid-19” has limited utility.

The masks I’m expected to wear take on a gamey odor with too much use. Luckily, I’m vitalized by the camaraderie, strength, and dash of humor from these extraordinary people.

Everyone should be practicing social distancing. Health care providers, especially those who work in emergency departments, can’t do that. The only way they will make it through this difficult time is through trust and coming together. Fortunately, that’s something we’ve been working on for years.

Jay Baruch, M.D., is associate professor of emergency medicine and director of the medical humanities and bioethics scholarly concentration at the Alpert Medical School of Brown University.

  • You captured the Orange Buffoon’s style nicely.
    (I watched Rick Steve’s “Fascism” not long ago and was struck by the similarities between Mussolini ‘s and Trumps visual styles–neither at all like Hitler’s or Franco’s, BTW.)

  • Conservatives have been not trusting or relying on federal “leaders” for decades, and the current situation sure seems to validate that lack of trust. What boggles my mind is that often, the very same people who are complaining loudest about their federal leaders’ incompetence are the same ones who want to give federal leaders yet more power and authority.

    • Amen! So true. And those who have been wailing that Trump planned to seize power and take over the government are now insisting he should use the NDA to take over businesses and force them to make supplies. Please people – find an ideology and stick to it. Don’t waffle when you’re scared.

  • I trust you will level much of your criticism at the previous administration for emptying and failing to replenish the stockpile.

  • As soon as possible we need to test a representative random sample of the population to see how many already have antibodies and are immune. These could be on the frontlines without getting sick and without infecting others. I am sure many brave souls would volunteer to be tested and be first immune responders.

  • Leaders have abandoned us on all levels. Required PPE changes daily. One day we’re told there isn’t enough but we are not allowed to source our own privately. Then patients that were on isolation are suddenly off isolation. Management is seen gathering up all the PPE and leaving the floor to “keep it safe”. Then we’re told it’s ok to go out and buy our own PPE for work use. The thermometer to screen everyone consistently give a forehead reading of 94-95f. It is supposed to make skin contact but the supervisors refuse to do it because it will be contaminated. I’m on my 3rd day of body aches, chills, cough, and a fever of 101.6 taken by contacting the same thermometer to the skin by my ear. On showing this to the House Sup, I was told that it’s a false high because my hair was down (because I had chills) and only forehead temps taken by the Supervisor are valid. This is a loosing battle.

  • I just wanted to say Thank You for all you are doing. As a layman I do not understand the problems in supply chain which seem almost bizarre – if there were enough masks for everyone to change frequently before, and about the same number of doctors and nurses working, then shouldn’t there be enough to continue like that? I understand there is hoarding but one would have thought the hospitals ordered X masks based on how many staff they have and those X masks are spoken for, and therefore will not be vulnerable, like toilet paper is, to someone going into Costco and buying a flatcar full of it. These medical supplies are clearly something the Feds needed to take control of some time back, but did not.

  • I’m curious – which “leaders” are you speaking of and how have they abandoned you? This is a crisis that was many administrations in the making. There has also been (and continues to be) a lot of bungling and foot-dragging by the CDC and the FDA – these are government entities, not leaders. In fact, leaders are supposed to be able to rely on these departments, not second-guess them. Yes, President Trump continually downplayed the severity of the crisis but there is still a lot that is unknown, including how many of our citizens have already been exposed, and what sort of national security concerns might be involved. If we learn anything from this pandemic, it’s that it’s a test run. Hopefully we will be better prepared for the next one. Praying for your safety. I have healthcare workers in my own family, and it is a very scary situation.

    • Yes, “we have no idea how many of our citizens have been exposed” because there has been a massive shortage of tests and testing – even the ER staff can’t get tested without symptoms.
      “What sort of national security concerns might be involved”
      It’s a VIRUS it has NO POLITICS. This is not some deep-state conspiracy.

    • Think about it. National security – perhaps we don’t want to broadcast to other countries what our situation is. We are so transparent, it makes us sitting ducks. There is a lot that our President CAN’T tell us.

  • I’m curious – which “leaders” are you speaking of and how have they abandoned you? This is a crisis that was many administrations in the making. There has also been (and continues to be) a lot of bungling and foot-dragging by the CDC and the FDA – these are government entities, not leaders. In fact, leaders are supposed to be able to rely on these departments, not second-guess them. Yes, President Trump continually downplayed the severity of the crisis but there is still a lot that is unknown, including how many of our citizens have already been exposed, and what sort of national security concerns might be involved. If we learn anything from this pandemic, it’s that it’s a test run. Hopefully we will be better prepared for the next one. Praying for your safety. I have healthcare workers in my own family, and it is a v

  • Doctor, I totally sympathize with you (I hear the same from my colleagues still in the ED. I am retired from the ED but I follow EM closely). But you do not understand anything about the history of such disasters as that which we face now. No one was prepared, least of all our CDC that bungled the testing, our media that told us we were xenophobic to stop travel from China, our civic leaders (see NYC) who told us to mingle freely. But really it’s not their fault; there was no leadership at the international level: the WHO parroted China in stating the virus was not transmitted person to person and that the Chinese were doing an admirable job (they hid the outbreak, threatened the doctors, destroyed the isolated virus, etc, etc)

    So here we are as we were at the outbreak of the Civil War and WWII – unprepared and bungling our way through. Have you studied the “bungling” of Churchill and Roosevelt and Lincoln? How many lives were lost by these good and great men who did the best they could? How long did it take until they could marshal the resources of a great nation?

    Are you so naive as to think the Federal Government can push bottoms and create PPE or ventilators? Do you understand the role of States in a Federal System? Tell me how well your Hospital Administrators understand your work in the ED and how responsive they are to your requests?

    The President is faced with a challenge near that of Roosevelt or Kennedy. In this case he must seek the balance between protecting the health of our citizens vs. the destruction of our society. He must be optimistic or we are lost.

    • Dr. Edward,
      I agree no one leader can be blamed completely for not being prepared, and I agree the media to some extent criticized Trump wrongly, but Trump is also failing on an ongoing basis – as the writer pointed out “unearned bravado” can not earn trust. Talking about reopening the country by Easter -and I understand the President needs to think about the economy, he is not wrong to do so – but talking about reopening the country when the epidemic will, if the shutdown has worked, be at it’s peak, is not inspiring any trust among knowledgeable realistic people, instead, it is creating a lot more fear that our top leadership has lost it.

    • Compounded fear took the economy from the crash of ’29 into the GREAT Depression. Only WWII really took us out. I am concerned that if our economy is allowed to crumble to its knees, or worse yet, be laid out on the pavement, it won’t regain its health in my lifetime (I’m 70 but planning on making 100). I work in maternal-child health, and am doing the best I can to protect myself, my co-workers, my family, and my patients (the newest of the new), and I’m trying to keep up with the science of this thing and not join the lemmings. I would like more info on the co-morbidities, particularly as the death rate being highest in the “elderly” may well be greatly related to the typical history of many people in that age group being former smokers or heavy passive smokers (or even today be among those sitting outside hospitals with their IV poles while they smoke). I have not seen or heard ANY mention of this, but it seems a likely contributing factor, world wide. Smoking rates are still very high in the countries hit hardest so far. Is it the virus, or the damaged human organism with one too many straws on its back, that leads to death? The other factor that gets some press but not enough is the comparison with “plain-old-generic” flu? I’d really like to see more comparative numbers. Are we killing our society economically because we’re more afraid of this bug than of the various “normal” flu deaths each year, in the many, many thousands worldwide, that are just pretty much accepted? Why? Too many unknowns, not enough visionaries, too much focus on “treatment” healthcare and not nearly enough on “preventive” with a ratio of nearly 50 to 1 in dollars spent. If there’s no profit today, but huge health savings (in human or dollar costs) down the road, we’ve kicked the can down the road for someone to deal with later. Maybe now it’s “tag, we’re it” Thank you Dr. Edwards for your viewpoint. I totally agree.

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