What It’s Like For An ER Doc During The Coronavirus Outbreak

Photo: Courtesy of Dr. Jill Lauren.
As the novel coronavirus continues to spread, more and more people are being directly affected by the disease. At least 412,500 people across 168 countries have contracted the virus, and roughly 18,482 have died. But the pandemic impacts more than our health. Our careers, our social lives, and the global economy have been upended since people diagnosed with the virus began falling ill in China last December. And on the front lines of it all sits healthcare professionals, like Jill Lauren, MD, a board-certified emergency medicine doctor and attending physician at Palo Alto Medical Foundation Urgent Care in Santa Cruz, California.
In the last month, Dr. Lauren has helped dozens of patients who thought they might have coronavirus, and she waited out an exposure scare herself in self-quarantine. She’s brainstormed ways to conserve her facility’s dwindling supply of protective masks and gear and treated patients from their vehicles.
As the confirmed COVID-19 infections continue to rise, and shelter-in-place orders continue to go into effect in multiple states across the U.S., Dr. Lauren is trying to help people every day as best she can. This is what she wants you to know about being an urgent care doctor during the pandemic.
Refinery29: I know California went on an official lockdown last week. People are being told to stay inside, unless they’re heading out for certain jobs, to buy food, or for other 'essential' purposes. As an urgent care doctor — perhaps one of the most essential jobs right now — what does that mean for you? 
Dr. Jill Lauren: "As a medical provider, it doesn't change much for me. We still go to work. Construction sites are shutting down, all restaurants, anything where you can work from home. The streets are silent. It's empty and quiet out there. But my routine is the same."
Is it odd for you to have to have to take this 'business as usual' approach while the rest of the world is hitting pause? 
"Well, it’s 'business as usual' routine-wise, but not work-wise. We instituted a change in the way we see patients about two weeks ago. When this really started to pop, we stopped seeing patients in the clinic who had any respiratory symptoms at all — any cough, any fever, any shortness of breath. If they had any risk factors, they actually had to stay in their car and could not come into the building. In the midst of that, I personally had to quarantine."
"On March 4, I took care of a patient whose test returned positive for COVID-19 several days after I interacted with them. I was in full protective gear when I saw the patient, and they remained in their car, masked. The contact was extremely low risk — it's as safe as you can get. There was no change in my life until [March 11]. That's when I woke up with a fever, some aches, and some vomiting, and some diarrhea.
"So I called into my office, and obviously told them what was going on. They did a COVID-19 test for me that day and left me home on quarantine until my test came back [on the 15] and I was symptom-free. Luckily it was negative."
Thank goodness.
"Yeah. So there was a five-day window where I was home and out of the loop. Everything at work changes so dramatically that by the time I got back five days later, things were already being run really differently. So I'm still trying to get my bearings, because I only returned to work [on March 16]."
What were you thinking while you were waiting for your test to come back?
"When they ran my test, they were really only testing high risk exposures. I really felt like I was at very low risk. I had a low-grade fever and I had no respiratory symptoms, so quite honestly I wasn't afraid. I didn’t think I had it, because I didn’t believe I had symptoms.
"As we're learning now, there's so many more ways that COVID-19 can present. But at the time, from what we knew, I really wasn't worried that I actually had the virus. If I did, I believed I was going to have a really mild case. I had a fever for 24 hours and it was only like 100.7."
You’re a pro, I would have been a nervous wreck.
"I wasn’t actually anxious. I think I felt more frustrated that I was stuck at home once my symptoms fully resolved, waiting to get my test results. It took a lot to get those. I was calling the county public health department, calling a lab every day, trying to track down answers. It took five days just to find them."
Right, that would definitely be tough. Did you worry about your family during that time? 
"I have two girls at home, they’re 18 and 20 years old. And I mean, in some ways you're always worried about bringing home some kind of illness. Now I come home and I do things a little differently than I used to. Instead of walking in my front door, and hanging out with my kids, I go through my back door, immediately throw my scrubs into my laundry and then change before I see my family. It's a small difference, but it's really all I can do, and as long as I'm following my precautions at work, I’m hoping that that keeps me and them safe."
When you came back to work after your self-quarantine, how had things changed? 
"Everything's happening so quickly, and things have changed dramatically since the beginning of the month. Now the waiting room in the building is completely empty. We’re functioning in this really alternative way. 
"Before my self-quarantine, there was one employee manning the parking lot, who would stop cars to find out why they were here. If they had respiratory symptoms, they’d be handed a business card with a phone number on it, call the receptionist, and then a provider would come out to them from inside the building to limit contact. That was before my self-quarantine.
"When I tested negative for COVID, I came back to work to find that we had a full respiratory clinic being run in the parking lot. Almost no patients were coming inside the building. Now we have one provider in the building and all the other providers are outside under a tent wearing full protective gear seeing everyone outside in their cars. The transition has really just followed the curve we've been seeing."
Are patients panicking? 
"I mean, they’re more on edge compared to several weeks ago. Before California instituted 'shelter in place,' there was a little bit of a hysteria. Before my self-quarantine, people were coming in and saying, 'I know a friend who knows a friend whose sister has a fever.' We had to tell them, 'We don't have enough tests.'"
Why do you think there’s a natural inclination to run to the doctor and get a test, even before you show symptoms? 
"People are just trying to get some reassurance, and there was a lot of frustration for patients because everybody just wanted to be screened.

If it gets to a point where we can't protect ourselves while we take care of people, it's like a suicide mission.

Dr. Jill Lauren
"Now, there isn’t as much panic in our parking lot, but I don’t think it means the panic isn’t there. In some ways, I think the lockdown is causing people more anxiety. They’re just staying in their homes wondering if they have the disease. Very few patients are actually coming in, because they're too anxious to leave their house."
Is there any tension between doctors and the public right now? 
"A little bit. This is our first experience with coronavirus, so we're learning as we go and doing our best to try to allocate resources and move patients through quickly and safely. But some people are like, 'I've been in my car waiting in a parking lot for two hours.' We're having to say, 'You know what, you might not be happy about this but this is the safest way to do it.' It's like drive-through medicine."
That's interesting. Do you worry about getting hit by cars in the parking lot?
"Yeah. Last night we worked until nine o'clock at night, and there's not appropriate lighting, and it's freezing, and nobody can see you." But changes are instituted to address that.
Have you had any bad experiences with patients since coronavirus has become more widespread? 
"Recently I had a patient yelling at me that they had waited in their car for an hour, and they got out of their car without a mask to express their frustration to the whole parking lot — thereby possibly exposing people. We had to say, 'Please get back in your car, put your mask back on.' They were so angry. They said they were going to call the governor. I was like, please call the governor. I've been trying to get in touch with the governor. Call! Get advice, get recommendations. We invite feedback if it's constructive."
So, are you seeing an uptick in coronavirus patients that echoes the numbers we see on the news? 
"I worked last night and I only saw probably eight or nine people for COVID-related [symptoms], and that's not a lot for a usual shift. I mean, on a normal day pre-coronavirus I'd see maybe 20 to 30 patients. So the volume I'm seeing, I think things are going to shift as people get sicker, but I don't think we're seeing any surge right now. We're just seeing so few people leaving their homes. They're really listening to officials who are saying: Don't come out unless you absolutely need to be seen."
What do you wear when you see these patients? 
"When you have direct contact with the patient, you're in full gear. So you're in gloves, a gown, goggles, and a special mask called an N95, which protects you against the virus. We’ve run out of the good gowns we used a few weeks ago. My coworkers and I were just saying this morning that we’re not even sure if the new gowns are adequate. The quality is going down, and they keep getting thinner and thinner."

We need infectious disease doctors, government officials, epidemiologists, priests, and rabbis to all get together in a room and try to span this out as a world community.

Dr. Jill Lauren
What would happen if you ran out of masks or other gear
"God, that's been the question. I don't have the answer. I mean, if it gets to a point where we can't protect ourselves while we take care of people, it's like a suicide mission. I don't know what moral code or legal code we’ll start to follow at that point."
Speaking of moral codes, I was reading that in Italy, some doctors are having to make decisions about who lives, and who gets what care because resources are so limited. Do you worry that you'll have to make those kinds of decisions?
"Well, that absolutely needs to be addressed, researched, and triaged at a very high level. We need infectious disease doctors, government officials, epidemiologists, priests, and rabbis to all get together in a room and try to figure this out as a world community. How do we want to approach that? I mean, it's really war-time thinking.
"We get trained in residency on how to assess mass casualty events where basically you're going to stick a tag on a toe. It's a black tag if you're dead; it's a red tag if you need to be seen immediately; it's a yellow tag if you can wait. And that's really what we're talking about where we're triaging and deciding who to save. And those kinds of decisions are so above my pay grade. God, I really hope I never have to be the one making that call because I think would be difficult to do that with an individual moral conscience."
Right. Wow, so true. Do you think you and your coworkers have bonded through this experience?
"I really do. I'm hoping every hospital and clinic feels this way, but the camaraderie that we're all going through as the people seeing this on the front lines, it's really — it's almost like you feel safest at work because you know that everybody there is doing the right thing. They're washing their hands, covering their coughs. We know they wouldn't be here if they were sick."
What's the most distressing thing about coronavirus for doctors?
"Through all this, we’re trying to figure out from the [Centers for Disease Control and Prevention] exactly how this transmits and what's the minimum amount of protective wear we need. You always feel, as a doctor: The CDC has got this. They're going to keep an eye on you and make sure that you're always safe and you always have all the information about a disease. But when something is happening this quickly and they're learning it at the same rate as we are, it’s odd. The people that you've always assumed have all the answers — they don’t have all the answers. It’s not their fault, we just don’t know enough about this virus. So that’s a little bit unnerving."
"As doctors, our whole careers, we compartmentalize. I mean, you're taking care of patients, dying babies. You see traumatic car accidents where a whole family gets killed. And then you're going home and hearing about your daughter's soccer game. So you've learned early on that work is work, and then you'd let it go. Otherwise you just get consumed by the death and disease that you see. So I think, if anyone's prepared, honestly — healthcare providers are. We go to work, function through the anxiety and the fears, channel them, and try to be productive. Then, you come home and you live your life."
Right. But does it feel like work is leaking into your home life now? Is it harder to compartmentalize? 
"More than ever, it definitely feels like work's coming home with me, hopefully not literally... Again, some of those compartmentalization tools include mindfulness, being in the present, and focusing on what you have. So, for me personally, it has not been consuming at home. I've just been enjoying my kids and my dog, Maverick, and feeling lucky that I'm healthy, live in a beautiful area and have a beautiful home. I don't feel scared all day."
Wow, I'm glad you have those coping tools. Okay, last question. As a healthcare provider, what do you want the public to know — other than that we should keep washing our hands. I think people have that one. 
"I know, the 'don't touch your face' thing has become such a meme. The first thing we want people to know? Stay home. If you're not sick right now, your best chance of not getting sick is to stay home. If you are sick and you don't know it yet — you're asymptomatic — your best chance of not giving it to someone else is to stay home. If you’re feeling bad but don't feel like you’d need to see a doctor in person to feel better, stay home. Really, the only reason to come to the doctor is if you are very, very sick. Your best chances of not giving your disease to your doctor or other patients is to stay home. All roads lead to: Stay home if you can."
This interview has been condensed for clarity and length.
The coronavirus pandemic, and resulting economic downturn, has disproportionately affected some professions — doctors, nurses, teachers, small business owners, cashiers, and food industry workers are just some of the folks on the front lines. Checking In is an ongoing series where we pass the microphone to workers in industries most impacted, and ask them what they want us to know about their hopes, fears, and needs right now. Click here if you want to participate.
COVID-19 has been declared a global pandemic. Go to the CDC website for the latest information on symptoms, prevention, and other resources.
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