Physicians For Fair Coverage

Dr. Kate Kohls: I can't remember the first time I heard the word COVID-19

Wednesday, 03/25/20

I can't remember the first time I heard the word COVID 19, nor am I sure when the thought of a pandemic first entered my mind. But I do know that I have been living those two words for every waking hour of the last seven days.

As physicians, we take oaths, we promise, we strive to always put our patients first. As an anesthesiologist, I am an expert at perioperative medicine. That means I evaluate patients before surgery, educate them about their upcoming anesthetics, hold their hands, give medications to make them lose consciousness, place breathing devices, resuscitate traumas, relieve pain, start intravenous lines, and participate in high-risk obstetric cases. In short, I help to keep people alive every day.

We are used to responding quickly, rushing in to breathe for someone when they no longer can. We are vigilant, and we are calm; we are the eye of the hurricane when it surrounds us. But most of all, we are prepared for anything, or at least we thought we were.

As news of a pandemic began to spread, as we watched our medical colleagues in China and Italy respond, I began to educate myself. I knew this was coming, and I knew I would play a vital role in the airway and resuscitation of these patients, but I didn't know how fast it would happen. 

In the early morning hours of March 17th, I was nearing the end of my 16-hour shift at our Level I Trauma Center. We had done two large traumas, both requiring massive transfusion of blood products with extensive resuscitation, and we had done many other small cases throughout the night. When the phone rang, it began as the typical call; a patient needed my help, she wasn't breathing well and needed to have a breathing tube placed to put her on a ventilator. Where the call changed from the routine, was the last line: this is a patient under investigation (PUI) for COVID-19.

In a normal situation, I would proceed to the bedside, check my equipment, don a single pair of gloves, and intubate the patient, something I have done thousands of times. But this was different.

I had watched videos on how to properly place the personal protective equipment (PPE) that I would need to protect myself, but I had not had an opportunity to practice. We knew that resources might become scarce, so using actual protective gear in a simulated situation seemed unwise. This time I was not just wearing my simple pair of gloves. I could not immediately rush in to evaluate the patient.

Instead, I began the process of donning the appropriate protective gear to protect myself and any other patients I would come into contact with afterward. I was lucky to have access to much of what I needed, which included an impermeable gown, a face shield, gloves, a surgical hat, shoe covers, and the most important, an N95 respirator mask that protects me from airborne pathogens.

A process that usually takes 10 seconds has transformed into a multi-minute procedure, and that is in the best-case scenario. While we have continued to have the appropriate PPE at my facility, some healthcare workers have not, and there is fear that this vital resource is running out. We are rationing PPE, and we have to lock it up to keep people from stealing it. We are living in a completely different world.

We are unable to test everyone, and we are concerned that a large number of patients may be asymptomatic and transmitting the virus. All elective surgeries have stopped, to conserve resources and not expose healthy patients. We are facing every patient and every case, not truly knowing the level of our exposure.

My first experience with placing a breathing tube for a COVID patient was a particularly difficult one. As I began to discuss opportunities for improvement with many of my colleagues, we decided to form a COVID Intubation Team. Our goal is to become experts in the airway management of COVID patients consistently following best practices, maximizing patient safety, and minimizing exposure to staff.

We are mere hours away from implementing this team. I will spend 24 hours in the hospital ready and waiting to intubate as many patients as we have. There are 20 physicians from my group that have volunteered to stand with me in these high-risk situations. I have written protocols, guidelines, spoken with physicians all over the country, and spent too many hours to count researching best practices, at a time when those are hard to find. We have worked tirelessly to find a way that we can take care of this high-risk patient population and continue to protect ourselves and our families. 

Now it is time to put the computer down and the pens away. We will don the modified hazmat suit, and we will face whatever there is to come. I feel confident in our profession, in the medical community, and in my fellow healthcare workers that we will be successful in saving many, many lives. In short, we will be helping to keep people alive every day, no matter what the risk.

 Dr. Kate Kohls is an anesthesiologist in Austin, Texas.


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