Virginia Commonwealth University, a large state-funded Level 1 Trauma center where I practice, is rarely below 95% occupancy and usually, we are at or over 100% capacity.
While it is nice to be busy, recently I have considered this situation a worrisome liability. With the threat of COVID-19 looming, our anesthesiologists are soon to be inundated with patients in a way that will likely overrun resources at all of our facilities, including equipment, drugs, supplies and personnel.
By the time you read this article you may already be at that point. However, I believe we are ready to meet the challenge and will demonstrate our reliability and outstanding value to the healthcare system.
The impact of the COVID-19 crisis on anesthesiologists cannot be overstated. It is likely that we will never encounter a global event like this again in our careers. How we respond to the crisis will reflect our training and preparedness in our discipline.
Anesthesiologists are uniquely trained to rescue and manage the respiratory impairment and critical organ dysfunction that COVID-19 patients will demonstrate. Anesthesiologists are experts in respiratory physiology and management, in critical care procedures such as intubation and intravenous access, and in the rapid response and triage of many critical patients in a multi-casualty event.
Many years of stressful operating room and strenuous ICU practice aids our resilience. As has always been the case in my 25 years of anesthesia experience, we rise to the occasion despite any personal or professional barriers to ensure our patients have the care they need.
There is a cost to what we do. Though not surprising, anesthesiologists rank high on the burnout and physician suicide rates among professionals. We internalize and absorb the suffering that our patients experience as part of delivering their care and treatment. I personally believe it is innate compassion and empathy that draws us to become physicians; though, this later contributes to the moral injury we endure while we treat illness.
The stress and significance of what we see and do on a daily basis is enough to push any of us to the edge or over it. Although the physical risk of what we do is low, the emotional and psychological impact is real.
I have noticed the anxiety and stress in the voices of the surgeons, nurses, and anesthesiologist colleagues over the last couple of weeks due to the uncertainty of the crisis. This is an expected and understandable human reaction to an unpredictable situation.
However, as it becomes clearer that we are faced with an unprecedented public health crisis, we must meet the onerous task with resolve. We must support each other and look for signs of fatigue and stress in our colleagues. We must remind each other to protect our families and ourselves first.
We must heed the warnings of officials to stay home, isolate, and help to “flatten the curve.” We must help elderly relatives and neighbors obtain food, supplies, and prescription medicines. We must read accounts from our colleagues in Italy and Seattle, and learn the lessons gained from their experience.
We must use our creativity and thoughtfulness when resources such as N95 masks, PAPRs, and negative pressure ICU rooms are exhausted. We must educate ourselves on how to treat, transport, intubate, and ventilate COVID-19 patients. We must support our colleagues in quarantine or those who become infected, by making sure they stay home in isolation or receive the medical care they need.
We must be willing to use our training and experience to the highest degree possible since our normal role as anesthesiologists likely will change temporarily in the coming weeks.
These times ahead will be a trying for all of us. Now more than ever, we should help, support, and protect one another as much as possible, physically as well as mentally, and emotionally.
Both the VSA and ASA are here for you. There is information available for anesthesiologists to help understand how to manage COVID-19 patients at www.asahq.org. There are recommendations for how to protect yourself and your family from the risk of infection.
A resource I have found personally helpful is the private group called “Anesthesiologist Group” on Facebook. A great deal of information sharing and helpful posts can be found with timely and relevant information for anesthesiologists. I would encourage you to read and share stories and tips related to your experience during this pandemic.
In addition, please reach out to your local VSA contact or to me personally at Jeffrey.green@vcuhealth.org if there is anything the VSA can do to help you through this crisis. Despite all of the “doom and gloom” we hear related to the worsening crisis, I believe we are stronger and more resilient working through this together.
To quote Gene Krantz, NASA Apollo 13 Flight Director, “I believe this is going to be our finest hour.”