Twenty in the Waiting Room



I think the emergency departments are getting back to normal. At least, the ones I work in seem to be.

For months now while I on duty I waited around aimlessly as occasional patients would trickle in here and there. Apparently, most people were choosing to have their heart attacks and strokes at home rather than come to the hospital and risk contracting the coronaplague. Although at its nadir our volume was literally cut in half, the patients that did show up were generally much further down the illness progression timeline, necessitating much more aggressive actions to stabilize and reverse the disease cascade. Sepsis comes to mind- that state in which an infection spreads like wildfire through the bloodstream so aggressively  that the body's defenses become overwhelmed and circulation collapses from an immune system gone haywire. After one hour of the "sepsis state," survival drops precipitously, often irreversibly. Avoiding the ER for these patients is tantamount to a death sentence.

The walking ill are beginning to once again show up. Those who were deep into their social distancing alcoholic benders are returning in advanced states of withdrawal. The mental health patients off their meds are coming back (at least the ones left who haven't committed suicide while under government-ordered isolation). Women are starting to brave the pandemic to be treated for domestic violence injuries sustained while under lockdown. Pelvic infections from STDs are spiking. Type 2 diabetics, victim to their dietary indiscretions while bored at home, are appearing for intravenous insulin, or to have their ischemic limbs amputated. People who had their scheduled cancer staging biopsies cancelled are now showing up to see us in a more advanced state of their condition. 

Yes, they are all coming back. For the first time since late winter yesterday I walked into a packed department with 20 patients in the waiting room. The ER in March and April had, generally speaking, been a ghost town. People stayed away as they grew steadily more ill, fell deeper into their addictions and destructive behaviors, or let their cancers grow unchecked. At least yesterday we were almost back to pre-COVID volumes. And everyone I treated seemed, sadly, profoundly sicker. I admitted 80% of the patients I saw yesterday to the hospital. That number is usually around 30%. 

But the great news is that they avoided the ‘rona! 

The Legacy of the Plague...



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