Dr. Parimal Bharucha is a pulmonologist for Dignity Health in Sacramento. He has spent the last year working in a makeshift COVID-19 ICU at Mercy Hospital of Folsom. (Lesley McClurg/KQED)
It’s one thing to write about COVID-19 from home. It's another to see it, to hear it.
In early March, KQED health reporters April Dembosky and Lesley McClurg visited two hospitals near Sacramento: Mercy Hospital of Folsom and Mercy San Juan Medical Center in Carmichael. One year into the pandemic, it was clear the clinicians there were not celebrating any anniversaries.
Doctors and nurses have seen too much. Too much has changed. With the virus mutating and a threat of a fourth surge of infections, for them, there is no post-COVID world.
“This is going to be the steady state,” said emergency medicine physician Nicole Braxley, comparing the 2020 pandemic to the 1918 influenza pandemic. “We’re going to have good COVID years and bad COVID years."
Read on and tap the play button above to listen to The California Report Magazine's half-hour radio documentary exploring the big ways, little ways and surprising ways COVID has changed the way doctors do their jobs.
Bedside care during a pandemic is devoid of all intimacy. The two practitioners above check on a COVID patient in the intensive care unit inside Mercy Hospital of Folsom. Everyone is yelling because the room is very loud. It’s difficult for practitioners to hear inside layers of protective plastic. Plus, a negative pressure fan sucks air out of the room. No one is touching.
“The problem is that ... is very, very, very isolating. And there's nothing you can do about it, unfortunately,” said Dr. Parimal Bharucha, a pulmonologist. “Sitting all by themselves 24 hours a day, day in and day out, sometimes for five days, six days, seven days. You are locked in a cell, in a prison.”
For the past year, Bharucha has had to zip open makeshift white plastic walls to enter the COVID-19 ICU at Mercy Hospital of Folsom. Blue and red tape stitch the enclosure together. The space used to be a labor and delivery unit, ushering in the beginning of life. Today nurses use baby monitors to communicate with very sick and dying COVID patients.
Bharucha has seen so much death in the ICU this year.
“It was like a war zone. Doing it day in, day out, seeing so many patients not doing well or crashing in front of your eyes. You become fatigued. Emotionally. Mentally,” he said.
“You are a patient advocate, you are their family, which is a lot of burden to be somebody's family, to hold their hands when they are dying. That's very hard.”
Bharucha used to come to work wearing a shirt and tie underneath his white coat. Now he spends much of his day dressed like a Martian.
It takes about five minutes to pull on two pairs of gloves, pull a blue plastic gown over scrubs and connect a white hooded contraption called a PAPR to a battery pack. Earlier this year, Bharucha developed cystic acne from wearing a mask for so many hours a day.
COVID has changed the way doctors dress. When the pandemic hit, Dr. Nicole Braxley, medical director of the Mercy San Juan Medical Center Emergency Department, stopped wearing her white coat because it dangled over the bedside and could brush a patient’s arm or face.
It was a potential source of infection. Now, she carries her trauma shears and pulse oximeter in a sequined fanny pack instead.
“Little bit of bling,” she said with a smile.
Braxley tracks about 18 patients during her shift. She is triple-tasking every moment of her day: checking EKG results for one patient, consulting with the neurologist about another, then dictating a note for a third.
She said her brain is naturally wired for keeping track of all these details.
“I see people in the grocery store and I'm like, ‘I don't know your name, but you had chest pain and your right leg hurt and you were in Room 3. How are you?’ ” she said.
As busy as ER doctors are, the pandemic has actually slowed things down. When stay-at-home orders were issued last spring, Braxley said the ER was a ghost town.
People weren’t getting into car crashes. There were no football injuries. Even people who thought they were having a heart attack stayed home because they were afraid of getting COVID in the hospital.
Trips to the ER dropped by half, and less work forced doctors to take pay cuts. But COVID was still a threat.
“We continued to show up to work everyday, despite any risk to ourselves and our family,” Braxley said. Normally, “You'd actually get a pay raise because you're showing up to this possibly dangerous job. And instead, we all saw the opposite.”
Erin Wemmer, a palliative care coordinator at Mercy Hospital of Folsom, said her caseload has dramatically increased recently, but it’s not just driven by COVID deaths.
“I'm starting to see a lot of late-stage cancer diagnoses,” said Wemmer. “I think it’s a result of delayed exams that are routine, that just did not get done.”
People avoided the hospital during the pandemic. They didn’t want to catch the virus at a cancer screening, so they skipped crucial preventative care. That’s taken a toll. Wemmer is now transitioning a much larger percentage of her patients to hospice than before the pandemic.
“It's been a huge shift,” she said. “Almost all of the patients I'm seeing are now at the end of life.”
Dr. Nate Beckerman went to medical school on a military scholarship, worked abroad for four years as an Army doctor, then landed at Mercy San Juan’s ER in 2013.
Like a lot of ER docs, he wants to be where the action is and he wants to be of service. He flew to New York last spring to help with the first COVID surge.
Many doctors have likened the pandemic to a war. And in many ways, doctors are like soldiers. Even when they feel exhausted, depressed, frustrated or angry, they march on. Even when people refuse to wear masks or take other precautions, causing more casualties to land in the ER or ICU.
So where does that leave the doctors who are left to pick up the pieces?
“That leaves me where I've always been,” Beckerman said. "Right here in the emergency room, waiting for what's next. We take care of everybody. Any time, any problem, we're here."