In May 2020, Sean Creegan, OMS III, sat down (virtually) with Dr. Stephanie Davis, DO, and asked about her work on the front lines of the COVID-19 pandemic. This is a transcript of some of the interview. Be sure to listen to the audio version for the complete interview, including our discussion on what changes students can expect when they return to the Emergency Department.
To begin with, do you mind telling us a little bit about yourself and your background?
Dr. Davis: So, I have been an ER physician for 15 years. I graduated from Henry Ford residency in 2005, and graduated from KCUMB in 2001. [I was] born and raised in Kansas City, and actually decided to go to med school when I was 15 and in high school. We basically drew out the cardiovascular system and I was hooked. That’s what I was going to do for the rest of my career. So, I still blame Mr. McCullough for my $276,000 in student loan debt, but never mind that. I’m actively involved in ACOEP. I have been a stroke director and created a stroke program. I am an EMS medical director for about seven different ambulance departments and have been for about 12 years, and I have been really involved with mass casualty incident training for ACOEP for physicians across the nation. It’s been a busy 15 years.
That’s awesome. So then, jumping to today, as someone who grew up in Kansas City, do you notice a change in the general atmosphere right now? I’ve been away in California on clinical rotations and I’ve been pretty curious what things are like back home right now. On the west coast right now, I can definitely tell you that there is this weird weight in the air.
Yeah, that’s a really good way to describe it, and the atmosphere is totally different now than it was two months ago. I think there is this constant weight on all of us of just what is going to be next, on what is this going to evolve to, on what is life after COVID-19 going to be like. Now, I feel like we have this sense of sitting and just waiting. We have all the processes in place, we’ve tested everything from our drive-throughs, to set-ups for ER’s to be prepared for mass amount of patients. I’ve sat on an ethics committee where we determine, if there should be a shortage of supplies, what do we do? [What if] there’s a shortage of ventilators? So now, I feel like it’s this watch-and-wait mentality that we have, and as we have started the phases of opening up the world and the economy again, I think a lot of us in medicine are sitting back going “OK – what is this going to do? How is this virus going to react? What is it going to do?”
As a physician in the emergency room over the past two months, it was tense the first few weeks. I mean, I compared the first seven days of the pandemic…it gives me the chills, sorry. I was trying to work full time, I was trying to be a mom, and I was trying to absorb the amount of information that I had absorbed in medical school all at the same time. I could not read enough, absorb enough, process enough, and by the time I would process all the information and gain all the knowledge I felt like I needed to care for patients and know who to test, and know how to do my PPE, twelve hours later it would change, and I felt like I would have to learn it all over again, and it’s still evolving. I feel like our care is still evolving, but it’s definitely at least slowed down to an absorbable rate. At first you just couldn’t. I feel like I didn’t do anything else. I didn’t read anything else. I didn’t do anything else except read about COVID-19. Where it was, where it was going, how to take care of it, how to prepare for it.
My background with mass casualty has been fabulous for preparing for it. I always pictured mass casualty training as being catastrophic injuries, like accidents, natural disasters. I never put into the category of natural disaster, a global pandemic from an infectious process. That completely changed my mindset on the approach to mass casualty. Then when I realized that, it let me play a huge role in our health system with setting up triage tents, patient flow, separating PUI’s (Patients Under Investigation) from people who are sick versus not-sick. It let me work with the health system to help set up our drive-throughs so we could keep testing people but not have to bring them into our system so they were exposing anybody. So, it’s been an extremely interesting learning experience just for myself of realizing how I could apply all of that to this.
I would say now that the atmosphere is, what is the right word to describe it…cautious. I think cautious is the right description. I think if you ask anybody in medicine how they feel about counties and states and countries opening back up, we would all say we know it has to happen, but we want to see it happen in stages so the exposures are not all at once. Because I think until we get herd immunity or get a vaccine, you still have a high risk. My only thing would be…I feel cautious. That’s the best way to describe it, I think.
So in addition to all that reading you’ve had to do to stay up to date with COVID and its treatment, are there any new skills you’ve had to pick up along the way? Or things that you’ve had to develop even more?
Two different aspects of my life I think significantly changed. One, in the way I obtain information. When it was at its worst, I completely stayed off social media, which sounds crazy because it has always been a good source for me for contact and feeling connected to other ER physicians, but I found it to be exhausting, too emotional, and too overwhelming. I cut a lot of that out when it was first happening, and only turned to competent resources I could trust, and that’s because social media is filled with…someone copy-pastes and posts something and you think it’s from them, and then you realize it’s from an incompetent source. So I learned really quickly to kind of shut that aspect off.
I think the procedural or ER portion that I’ve changed so much is this whole concept of not aerosolizing the virus. [It’s] completely changed the way I take care of a patient in respiratory distress, and that’s been the hardest thing. So normally, if someone came in, and they were an asthmatic, or a COPD patient, you might give them a neb treatment, I might put them on bipap. I can’t do any of that now. It aerosolizes the virus too much, you don’t know if someone with those underlying lung conditions has it. I would stand at the door, watch a patient short of breath or wheezing, hand them their own inhaler to take four puffs off like they can do at home, and then watch them to see how they did. After so many years – and you’ll learn – you clinically learn how to look at a patient and go “they’re going to tire out and they need to be intubated.” So you learn that process, and now I’ve had to change my approach because there is no in-between now, right? I’ve always had that middle stage of “oh, I can put them on a ventimask or a bipap,” and now I have to look at them and go “tube or no tube.” There’s no in-between. That has been the biggest internal struggle for me. I’ve always felt like I’ve been clinically astute and I feel like I’m just standing there watching them, waiting, and can’t do anything to intervene, because I have to protect myself, and I have to protect my staff first, and giving a neb treatment or putting a patient on bipap exposes too many people, and I can’t take that risk for me or for my nurses.
The fact that anyone who walks through the door could have this seems like such a confounding element of care, especially with the varying presentations. How has it affected your approach to patients with non-respiratory or non-febrile complaints?
So, in the beginning, I felt like I was really clear. Before all the information came out, you were like “OK, fevers, chills, cough, shortness of breath, you have this ‘sort-of-like-flu’, but not completely. You ask all the right questions, but then I realized that not everyone had every consistent symptom. A chest pain would tell you that they had chest pain, and if you didn’t go in prepared that they might start telling you that they had shortness of breath or cough, you were caught off guard. Then one of the biggest things I advocated for at our facility was that if anybody had any complaint that was even slightly suspicious, they were all considered a PUI, they were all considered a person-under-investigation. And that meant that you were whatever the max PPE was at the time, since it has evolved, but the way I explained it to everyone was that you should never up your PPE. I should never start at one level and up the amount. I should always start higher and downgrade it so that I’m safe and you’re safe from the beginning.
And I’ve have been amazed at the complaints that I have had, like chief medical complaints, that have evolved into a positive COVID patient. I mean, things that you think would be really clear to walk in and clinically diagnose, but it’s not. It’s become so difficult. The perfect example is, I had this pregnant patient in with a miscarriage. “Do you have fevers? Do have chills? Do you have a cough? Do you have shortness of breath?” “Nope.” “Do you have a sore throat?” “Nope.” “Body aches? ” “Nope.” And so I did the whole work up, and then at the end, when she is getting ready to be discharged, she said “well what about that loss of taste and smell I’ve had for like a week?” I don’t ask that question. I would think that would be something that patients would offer up. And I learned really quickly not to depend on the patient to tell me what symptoms they might have, but to ask them specifically. I mean, you sound like an idiot when you ask that question out loud: “have you had any loss of taste or smell?,” but I added it to my [list]. You’ll learn, you have this little dialogue you go through when you ask people questions, and I’ve added to the front of mine “fevers, chills, cough, shortness of breath, body aches?” “Nope.” Then I go through their chief complaint, then at the end I go “so no fevers, no chills, no cough, no body aches?” And just for completion, any loss of taste or smell?” I’ll get smirks out of it, but it’s a unique symptom of it, and with that one patient I caught [it] because she happened to mention it and I did not ask. It’s been interesting to say the least. I still can’t look at a patient and go “you’re definitely COVID positive.”