As part of my work as an emergency medicine resident, I began a rotation in the second week of March as the physician charged with telling patients about their lab results. That once meant calling people to let them know about positive urine cultures or incidental findings on imaging.
The emergence of Covid-19 dramatically changed what I do. I now call 10 to 20 patients a day to inform them of their positive Covid-19 test results. It isn’t a one-way flow of information. The patients almost always tell me about themselves and ask questions, some that are difficult to answer.
In the span of two weeks, I’d called more than 60 patients. By the end of March that represented almost 10% of the Covid-19 patients in Washington, D.C., where I work. I’ve met these patients in a starkly different way than I would have during face-to-face encounters in the emergency department.
I’ve called people from all walks of life, from highly paid executives to minimum-wage workers and the unemployed. The responses to the news I deliver is as varied as they are.
After spending hours on the phone delivering Covid-19 results and answering questions about them, I realized that the pandemic has led to a unique intersection between the law, medical problems, and preexisting social conditions.
At the beginning, there was no system for managing questions from the general public about Covid-19. Calls about it to the emergency department were routed to me. The hospital and the city quickly built the infrastructure to tackle these difficult inquiries. Within days, our faculty practice had partnered with the city to create a hotline that referred patients to a telemedicine consultation that would result in a test for Covid-19 when appropriate.
My focus then shifted to managing the flow of information to patients who had been treated and released from the emergency department with “suspicion of Covid-19.” At this time, the hospital was sending these tests to a commercial lab with a turnaround of five to eight days, what I’m sure felt like an eternity to those who were waiting for their results.
Here are several stories of my discussions with patients. The names, genders and other demographic information have been changed to protect their privacy.
John works at a local hospital. He was at a party when I reached him. He came to the emergency department a week before my call because he was feeling sick. Back in his apartment, as he began to feel worse, his elderly parent moved in with him to care for him during his illness. Once he started to feel better, he resumed his social life. As I delivered the news that he was positive for Covid-19, he cried so hard that it took more than 10 minutes to calm him down enough to be able to provide information about isolation precautions.
Erik lives with his entire family in a one-room rental house with eight other occupants. He didn’t understand the precautions for preventing the spread of Covid-19 and had regularly been socializing in the apartment. He kept asking how to file for unemployment and how to isolate the household when the house itself could barely hold those living in it.
Jeff lives alone. He has a chronic blood condition and is struggling to get by. A few hours before we talked, he had resumed his job as a ride share driver because he needed to make ends meet.
Jason lives in a city hostel established for homeless individuals who are in quarantine and isolation. He told me that the rules are strict and that all of his needs are being met without him having any problem adhering to isolation. Before getting sick, he had found freelance work and was living in a shelter. I came away from that conversation amazed to hear how people can thrive when their basic needs are met.
Angela is 40 years old and has one of the preexisting conditions that put people at high risk for serious complications of Covid-19. When we spoke, she told me that she was feeling better, but that her home life was difficult. Her children had returned home after Mayor Muriel Bowser issued a stay-at-home order for the District of Columbia. She asked her kids to take precautions, but they continued to leave the house often. One son brought home his girlfriend, who had a cough, and displaced Angela from her room. She was unable to make an appointment with her primary doctor and couldn’t afford her medical supplies because of insurance issues. When I spoke with her, she sounded well and had no classic symptoms, but something didn’t sound right. I arranged a televisit that afternoon to have her evaluated more closely. By the time she got the call two hours later, she was so short of breath she could barely speak. When an ambulance arrived to take her to the hospital, her oxygen levels were dangerously low.
I tried to reach Sarah several times one day. She didn’t answer, and my voicemails went unreturned. I finally called her husband, who was listed as her emergency contact. He answered, and sounded devastated. “She’s on a ventilator in the ICU at another hospital,” he told me. Her symptoms had gotten worse after her emergency department visit. Sarah is in her 50s with no preexisting medical conditions. During her initial visit to the emergency department, she had complained of diarrhea but had no breathing problems. The recording on her voicemail was exceptionally cheerful — you could practically hear the smile in her voice — and she ended it with, “Have a blessed day.” I can still hear it.
I called Annette three times and finally called her teenage child to ask her to text her mother and advise her to take my call. When she answered, she was sitting without a mask in the waiting room of a community emergency department because the sore throat that sent her to our emergency department hadn’t gone away. She said that her dog had chewed up the mask she had been given in our emergency department. I suggested that she ask someone to give her a mask and that she tell a nurse or doctor that her test for Covid-19 was positive. She choked up as she began to understand that she could have been spreading the virus to others.
Mike and Jessica were relieved to have an answer — Covid-19 — for what was causing their symptoms. They asked how they could donate serum once they were well enough, with the hope of being able to help others who are infected.
I have a script of questions for every patient I call, asking whether they are willing to receive future calls for research purposes. All reply with an emphatic, “Yes, anything I can do to help.”
Each time I called someone who was having trouble making ends meet, or finding safe shelter, or desperate for answers I didn’t have, I wanted to find a way to help. Sadly, the resources to do that are few and far between. As I pleaded with one social worker about obtaining resources for a low-income Covid-19 patient, she told me, “We don’t have these resources on a good day.”
My work is made personal in the daily calls I make to Beatrice, who lives in New York state, to check on her symptoms. She doesn’t yet qualify to be tested for Covid-19, though she has had a fever and a cough for 10 days. At age 70, she is in the high-risk category for Covid-19 complications. Current estimates from the Centers for Disease Control and Prevention give her a 30% to 50% chance of needing to be hospitalized with Covid-19 and a 10% chance of dying from it. She had been social distancing for more than a week when the symptoms started. Beatrice is my mother.
Caroline Schulman, M.D., is a third-year resident in emergency medicine at George Washington University in Washington, D.C. She is grateful for the help that Robert Shesser, M.D., professor and chair of the Department of Emergency Medicine at George Washington University School of Medicine and Health Sciences, provided for this essay.