By Matt Razon
Before I get to telling you all about my experience as a frontliner in the fight against COVID-19, let me tell you a little about myself. I am a Physician Assistant and have been practicing in Emergency Medicine for almost 20 years. I currently work in several locations. I work in a Level I Trauma Center, a Critical Access hospital and an Urgent Care Clinic. Therefore, what I have seen varies greatly.
I have to say however, I have been extremely lucky that all my locations have supplied me with great PPE (Personal Protective Equipment). Some better than others, but nonetheless, I have been extremely well protected and I feel for those that haven’t been. My PPE has varied from N95 masks and Tyvek suits, and helmet and face shields to N95, paper gowns and plastic shields.
I think the best way to share and paint this crazy picture is to separate my clinical settings. My main clinical setting is an inter-city Level I Trauma Center Emergency Department. Sometimes here it feels like anger painting. Things are just insane and all over the place as we see about 135,000 patients per year. Oddly enough, until recently our numbers have been down. I think people were and still are just afraid to come into the department. This is a “be careful what you wish for” type scenario. At times, we have hoped that some people wouldn’t come to the ER. The runny noses, belly pain for a year, and hangnails. However, now the folks that aren’t coming are the chest pains, facial droops, and appendicitis that has been going on for four days and now has burst. I worry what the long term ramifications of COVID-19 will be for these patients.
Now, what you have all been waiting for. What about the COVID-19 patients? They are sick!!!! Intubated (on breathing machines), proned (on their stomach), and on high-flow oxygen. Now we have all heard that the old and people with pre-existing conditions are at most risk, but everyone is sick. Young and healthy are sick as well. People are dying that shouldn’t be.
It has changed the way things are done. Rooms are closed with signs not to go in without PPE. No one is in the hallway anymore. They are holding ICU (Intensive Care Unit) patients in the ED because there isn’t room for them upstairs. Everyone has a mask on. Who do we test? Do we have tests? Will we have tests tomorrow?
Things are a bit different in the other hospital. It is on an island that is primarily a vacation destination with 20,000 full time residents. In the summertime the population is almost 250,000. The number of COVID-19-positive patients when I was last there was 12.
They were incredibly well prepared and had an infectious disease specialist with Ebola experience help prepare them. Tyvek suits, PAPRs (protective breathing apparatus) N95 masks, separate areas to take on and off your PPE, a place to get out of your hospital supplied scrubs, shower, and get back into your street clothes.
On the island there is a tent set up outside the hospital, staffed with a nurse and a provider. We triage people as COVID vs non-COVID risks. The COVID risk patients are walked through the ambulance bay and into the “dirty” side of the department. Some who are young, healthy and not acutely ill are tested and sent home to quarantine with a seven plus page document on how to do that correctly.
After the patient leaves the tent, everything is wiped and sprayed down with a bleach solution. It is then not used for at least 10 minutes and another cubicle is utilized. Once the nurse or other clinician is finished in the tent they undergo a 10-15 minute rigorous sanitizing process which includes being sprayed down with a bleach solution.
Lastly, is the Urgent Care Center. I never thought when I chose a career in medicine that it would be hard to find work. The Urgent Cares were hit hard and many closed their doors. It wasn’t until recently that I returned to work there.
Many Urgent Cares are again starting to see an uptick in volume. Many are offering drive through COVID-19 swabbing, and where I work they offer bloodwork for antibody testing. It has become our bread and butter. I am starting to see the simple things again. For example, sprains/strains, lacerations, pink eye, etc.
I have seen a lot of interesting, crazy, and amazing things over the last 20 years. Nothing at all compares to what I have seen since the beginning of the COVID-19 Pandemic. In an ever-changing world, I am grateful that one thing hasn’t changed. Every day that I go to work, regardless of where, I am able to put my PPE and do my best to make a difference in people’s lives. This is more important to me than ever, as patients are not allowed family or friends to accompany them. We will get through this but we have to do it together. Stay safe!!!
Matt Razon PA-C is a Physician Assistant with 20 years of experience in Emergency Medicine. He currently works in a Level I Trauma Center, a Critical Access Hospital and Urgent Care Clinics throughout Massachusetts and Connecticut. Matt also has experience and expertise in Wilderness Medicine and is part of Wild Med Adventures, www.wildmedadventures.com.