A Doctor’s Diary: Health care through the lens of a pandemic

(The eighth installment of a special Efe series featuring the first-hand account of pediatric surgeon Colleen Fitzpatrick, who offered her support to an ICU for adults at a community hospital outside New York City, the global epicenter of the coronavirus)

New York, May 12 (EFE).- Clearly, different hospitals have experienced this pandemic in different ways. I’m grateful that we’ve never had to ration care and never had to decide which patient got a ventilator and which did not.

I think this is largely because, despite our being the global epicenter of the coronavirus, social distancing and preventative public health measures kept us from reaching that “worst case” scenario.

However, the experience of being on the front lines of this pandemic, which has already claimed the lives of 80,000 people in the United States, has helped me better understand the ways in which a hospital system can be overwhelmed and has certainly exposed some of the strengths and weaknesses of health care in America.

Looking at health care through the lens of the pandemic, I began to appreciate complexities I had never considered. Not only is the number of patients an issue, but so is their acuity.

Are the patients at a hospital that is used to seeing such sick patients? Does the hospital have enough staff to provide adequate care for the increased number of patients around the clock? What do you do when staff members get sick and can no longer work, or their family members are sick and care is needed at home? What happens when local schools are canceled and staff now have new constraints related to child care?

And if we talk about resources, there are other more technical, but vital, concerns. Does the hospital have enough ventilators or pumps for tube feedings? Is the oxygen pressure in the hospital high enough to support all of the patients on ventilators and all of the patients who aren’t on ventilators but need oxygen? Does the morgue have sufficient capacity? What happens if a patient who doesn’t have COVID-19 needs an emergency operation?

And, of course, the question that we have all been forced to face: does the hospital have enough personal protective equipment (PPE)?

Fortunately, from a PPE standpoint, I have always felt safe.

I was fit tested for the appropriate N-95 mask (the primary type of mask used by health care workers on the front lines of the Covid-19 pandemic) when I arrived at Syosset Hospital, located on Long Island, east of New York City. We were initially issued a new mask after 48 hours of use. But soon we were issued a new mask daily.

I also wore a surgical mask over my N-95, safety glasses and a head covering. We were provided with face shields, gowns, gloves and shoe coverings.

Thankfully, while our hospital was certainly operating beyond its usual capacity, we were well resourced. That’s not to say there weren’t shortages, or times when supplies ran low, but equipment and supplies were quickly forthcoming.

I think this pandemic is an opportunity for us to re-evaluate the structure and the ways in which we provide care in the overall US health care system. It is imperative that we build on our strengths and address our weaknesses in a truly meaningful way.

I believe our people are our greatest asset and the people I worked with proved this to be true.

But clearly the US health care system was not prepared to handle a disaster on this scale.

Weaknesses in communication, coordination and the supply chain have been exposed at many levels. Adequate testing has been, and continues to be, an issue. Far too many essential workers – both in health care and other professions – have fallen ill, which may be the be the result of inadequate PPE.

We are also seeing this disease disproportionately impact different segments of the population.

While I know at some point we need to resume our normal routines, it’s a little scary to think about what that looks like. Will we be able to do so in a way that doesn’t cause a second surge and what will “normal” look like anyway? EFE

cf/mc