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.
I was moved by the humanity of Dr. Caroline Schulman’s experiences. She was genuinly surprised at the people handled the news she was bringing. What I found annoying was the picture of a male doctor, complete with blue and gray striped tie, holding the telephone that, supposedly, made those calls. I like a picture that supports the text, especially when that picture is preceded by a female name without the MD identification. Such carelessness undermines what this lady doctor wrote!
Thank you for sharing your experience., which underscores the lack of a social safety net, the borderline financial viability, and the lack of resources for many people in this country. Your exposure to this in medical training and during your career will make you a better physician, but will also increase your frustration level as you try to be empathetic and caring in an environment that is frequently hostile to these values. You have chosen a difficult and complex calling from which I recently retired. Thank you for your service and may you have good fortune in life and career.
Wonderfully written article,and agree with Joel. Covid is revealing, if not accentuating, weaknesses inherent in our fragile society and its health care delivery system. This high-cost system serves to provide amazing hightech care but fails miserably in low tech public health and primary care. Many lessons to learn and hoping to see changes that improve caring professional’s ability to impove health through trauma-informed care and coordinated wrap-around services to address Social Determinants of Health.
People who are one dimensional – learn one subject all the way develop Domain Specific Intelligence but like this Dr. who also learn about related subjects- law, sociology, culture, etc., acquire Domain General Intelligence(DGI). Without DGI people are in general, ignorant.
get pulse oximetry, if po2 is low, assess for H A pulm edema and get her on
at the high Fio2 on low peep protocol see articles by Dr.
S idell of NY 1 do this asap! sincerely Dr. Day
Breaks my heart.
Thank you for sharing your experiences. Your description of your interactions with patients, and your closing about your personal experience with the virus is very moving and poignant.
I have worked a domestic violence/ rape crisis line and currently work as the initial contact point for individuals seeking services (sometimes insurance covers it, sometimes it doesn’t). All these calls carry a mental weight and the fact that you chose these specific calls to highlight reflect the impact they had on you and that although you end a call there will never be closure bc you don’t know how it ended. It is a tough job to do. I am so sorry that your mother finds herself in with symptoms. I will pray for you and your mother.
To Dr. Schulman, Thank you for helping with COVID19. I though you may find this app helpful to triage your patients. Check it out: https://aicovid19.com/screening-tool-2/.
Medicine is a science as well as art. The art part is where you handle these social and political issues. It seems like you are good at both. Keep up the good work.
A city that allows eight people to live in one room may congratulate itself on being understanding and ‘special’, unlike those nasty rule-bound places.
Thus, they created eight rather than one disease vectors is it’s near certain that anyone else living in that one box of air and surfaces will soon become infected. Multiply by however many hundreds of similar arrangements exist in that city.
New York is known not only for its high density but for the residents attitude towards rules; in NY, rules are for them not for me (I live in NYC).
Singapore is high density, it is also high in law’n’order.
Compare the results.
obviously you don’t understand much about poverty and the impoverished, who can only afford to live with a large group of others in order to have a roof over their heads. Congrats to you for being able to live by the rules, without compassion for those who can’t afford not to
I am an intern in govt. hospital in chennai and i was posted to help out in the corona control room of our state along with my co-interns. On a daily basis, each of us recieved an average of 90 calls a day and the content of the calls varied from clarifying doubts about covid19, helping people get food and medicine, arranging for them to be tested, etc. We were there only for a week and it was an experience that can’t be easily put into words. Everyday it was like getting on a rollercoaster which drifted through mixed feelings from being happy to have helped someone in need to being devastated to know that you coudn’t be of help to someone who needs it just as badly as the previous caller. No matter how much you try it always gets personal. I just wanted to tell you that you’re doing a great job Caroline and hope you help a lot of people in need.
Thank you, Adarsh, for the essential work you are doing. I hope you find moments of hope. The type of work you are doing is mentally exhausting. I hope you are also getting important support and are taking moments for self-care.
Healthcare workers are likely to be in contact with many COVID-19 patients every day.
We must cover our face in public until we get a vaccine, which is a while off, this is going to be our new normal, and we need to adapt and protect ourselves. I got mine here:
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