Dr. Stephanie Brenman ’09 was member of MIT’s women’s soccer, lacrosse, and ice hockey teams and graduated with a degree in brain and cognitive sciences. She went on to receive her M.D. from Stanford University School of Medicine and then completed the UCLA Emergency Medicine Residency Program. Brenman is currently an emergency medicine physician Kaiser Permanente, St. Francis (Vituity), and Providence St. John's Hospitals in the Greater Los Angeles Area. In her own words, she shares how the COVID-19 pandemic has impacted her professional and personal life.
We are doing OK right now in Los Angeles but preparing for the worst. Our overall volumes in the Emergency Department (ED) have been cut in half for the last few weeks due to the stay-at-home order and people wanting to avoid going to the hospital due to concerns about exposure to COVID-19. Though the volume is down, the acuity is up. Most patients who do come into the ED truly need to be there and overall are a little sicker than usual. Because volumes are down so significantly, two of my three hospitals have had to cut the number of physician shifts in order to sustain finances, so I've been doing telemedicine on days when I otherwise would have been working.
So far, we are doing OK with resources. At a couple of the hospitals where I work, we are running very low on gowns, but most other personal protective equipment is only slightly low or adequate. We are sterilizing and reusing equipment that previously was supposed to be one-time use, given there is a lot of fear of running out. However, we have been able to do this in a safe manner and I personally still feel adequately protected.
In general, anxiety amongst all medical staff is much higher than usual. The extra precautions are both uncomfortable and time consuming, and definitely impact the usual flow of the day. Even with protective equipment there's still the constant worry that you are still being exposed to infection. It is easy to make a mistake while doffing (taking protective gear off), and it is so easy to touch your face accidentally, especially when you're wearing an uncomfortable mask all day.
Every day we get an N95 mask to last us for the day. The N95 mask used to be a one-time use mask that we would throw away immediately after leaving a patient's room. Now we are wearing/reusing one for an entire day. We have recently started a process for mask sterilization so at the end of the day. We can write our name on the mask, turn it in to be sterilized, and then the charge nurse will return the clean mask to you on your next shift. The mask is very tight fitting, and it becomes uncomfortable after continuous use even for a few hours.
You can’t eat or drink with an N95 on, so you have to be very careful when you take it off in order to not contaminate yourself. After I take it off, I put it in a brown paper bag to keep the inside portion from being contaminated and to keep the outside portion from contaminating other things in my work area. After taking off the N95 mask, I put on a regular surgical mask. One surgical mask is given to every employee (and patient) when they enter the hospital. I try to just use one for the whole day, but most days I have to use two or three because it’s no longer good once it gets wet, and if you talk a lot in them they will eventually become wet.
In the ED, we are used to grabbing a bite to eat whenever we get a second and I personally carry a water bottle with me so I can stay hydrated on the go, but now eating and drinking on shift is fraught with the possibility of self-contamination. Then there's the worry you are bringing the virus home from the hospital. I now leave my work bag in my car, and I've set up a decontamination area in my garage where I strip when I get home and put my clothes into a separate laundry bin in the garage. I leave my shoes in the garage and use hand sanitizer before walking in the house, and then try to shower right after the shift. No one cares about wearing a white coat anymore, so I wear a different white coat or a zip-up track jacket each day and it goes in the laundry bin after my shift. I used to re-wear the same white coat 1-2 weeks at a time!
One of the more exhausting parts of the pandemic is keeping up with the constantly changing protocols. It has impacted everything from which entrance we use to enter the hospital, to the most advanced airway management protocols. What you learn one week has been tweaked or even completely turned on its head by the next week. Things that used to be standards of care are now things that are advised against, and vice versa. Luckily the lower patient volumes are giving us more time to adapt to the constantly changing recommendations, but it still is exhausting.
Anyway, we are fortunate that we are not seeing a surge like New York City, and predictions are showing that we will remain within our surge capacity if social distancing measures continue, so we are just bracing for the long haul. Flattening the curve also means lengthening it, so mentally I am preparing for life without my usual outlets (hockey has been cancelled, most outdoor trails are closed) for the next year or two.