Waiting

Collateral Consequences in the Time of COVID

Abstract

"Hi, I am so sorry for your wait," had become an essential part of the emergency department staff's greeting. The waiting room was full of frustrated, pale, and tired faces. The lucky patients had waited for 5 hours, others had been waiting for 24 hours or even longer. Then, when they finally got a room in the emergency department, patients would wait for another 24 hours for a bed inpatient. The hospital was gridlocked; half of the emergency department was technically functioning as an inpatient unit.

The emergency department team was coding a 30-year-old woman. The chief resident saw my confused face, and explained, “she was extremely acidotic because of DKA, because she had a 12 hour wait in an ED waiting room”.

“SI” popped on the board. I learned from my upper levels that SI stood for suicidal ideation, however I never expected that I would see this chief complaint this frequently in the children’s emergency department. There was always a resident in the children’s emergency department transcribing a child’s depiction of depression in the corner of the room. We got the same responses when we asked what was going on: “I’m lonely, I have no friends”, “COVID has been hard”, and “I don’t hang out with my friends anymore”. The effect of COVID-19 was further reaching than the pediatricians expected.

A victim of a lethal accident was wheeled in. Normally family members could gather by their loved one around a bed someplace other than in the ED, a place reserved for them where calmness and serenity would ease anguish and suffering. They would be greeted and prepared by caregivers to receive the sad news. The patient’s brain had herniated. “Usually, we would have a bed on the floor for this patient, a quieter space than the emergency department, however because of the limited bed space upstairs we were wondering if we could declare your son brain dead in the ED”.  The devastating news was delivered in the ED among trauma staff busily attending to other patients and in the confusion of screams of psych patients in the background.

The contagion of COVID-19 goes beyond its medical diagnosis. In the emergency department, slashed on the faces of the crowd in the waiting room, you can see a sliver of how COVID-19 expands and devastates countless lives beyond those in the statistics.