Dispatch from the front
‘I do not want to make the soul-killing choice of who will have a chance to live and who won’t’
Editor’s note: For more than 20 years, Dr. Hugh Hill, a resident of Rappahannock County, has been a member of the Emergency Department faculty at Johns Hopkins University School of Medicine. We asked him to comment on his experiences of late with the ongoing coronavirus pandemic.
My next patient has the sniffles, a cough, and reported a fever at home. I suit up. Our screening tent in the parking lot is not yet operating 24/7 so he came directly into my ER. A nurse had obtained the swab from the back of his nose and the test for COVID-19 was being processed. It will come back in 3-24 hours. He isn’t terribly sick and I send him home to wait for the results.
The mood in the ER this morning is dark, grim. We’re not overwhelmed yet; people are staying away when they can, and our volume is down. Usually we try to keep it light until we can’t — or shouldn’t. But today our seriousness of purpose is on obvious display. Another older physician and I tell jokes and stories and some of the tension lifts and the team begins to function more smoothly.
Right now, at Johns Hopkins Bayview in Baltimore, we are still in preparation mode, getting ready. More and more of my hospital and my ER is being adapted and readied to treat COVID cases. We expect the need to peak in a few weeks.
Will it be like NYC? Will it be like Italy? I know from colleagues at hospitals in Virginia that they are also preparing. The president of the Virginia Association of Emergency Physicians is driving through the state delivering equipment.
We watch the data as it comes in, read everything we can, and constantly query colleagues elsewhere. What new information in the last day? How to recognize impending organ failure? Is there anything, anything more we can do for the sickest ones?
The hardest part is worrying about our families. We signed up for this and, it turns out, signed them up too. I was the first physician exposed in my ER and I had to isolate myself from everybody at home. I developed mild symptoms and was tested. It was negative, unfortunately. I would have liked to survive a mild case and develop immunity.
I look at the unsung in my emergency room with new respect: the staff that must clean the rooms of COVID patients, the aides and techs, security and registration. They show up every day, but unlike the nurses and doctors, no one seems to be celebrating them. We all should be.
Some people still ask why we don’t let this one burn itself out, rather than risk the economy just to spread out and delay. For us, that’s easy to answer. If anything like the potential disease burden and critical caseload comes at us all at once, we will not be able to save nearly as many. And I do not want to make the soul-killing choice of who will have a chance to live and who won’t.
This is not the epidemic my colleagues and I have feared for decades. It will take time, but we will crawl out after this one, chastened and — I pray — determined to be prepared for the next one.
Meanwhile, I come home between shifts and isolate myself in this beautiful place. I stay home except to walk and ostentatiously avoid people on the trails or road. My wife Sandy makes the runs to Martins for us and my son to Settles. But the beauties of spring in Rappahannock lift and brighten, and I know, for most of us, it will all be all right.