The Invisible Front Line

2020’s trials seem to have come on like a freight train; full steam ahead with no signs of stopping. Australia was still burning when we first heard stories of a novel virus with pandemic potential in Wuhan, China. Numbers and other details seemed to change daily. Weeks went by as we watched world news intently, taking note of the infection rate and death toll, all the while steeling ourselves for a possible outbreak at home. As much as we tried to go about our daily lives, Wuhan and the virus was never too far from our minds. Was this virus airborne? There were still so many unanswered questions, but one thing was certain; COVID-19 was spreading like wildfire and it was only a matter of time now before we would be on our own front line.Huang

Sonographers and other medical professionals soon began deployment into COVID wards in our own hospitals: areas that had been sealed off and outfitted as negative pressure cohort units to treat the infected patients. Then the deluge of daily updates and dizzying policy changes began as we tried to keep up with CDC guidelines. Rumors surfaced of limited PPE (personal protective equipment) supplies. Only doctors and nurses needed n95s? Regular procedure masks were fine for everyone else? Surely that was incorrect. Surely they knew what kind of prolonged contact sonographers have with our patients? X-ray was making contact with every patient under investigation (PUI). CT was scanning countless chests. Worries intensified as we all tried to navigate this new reality.

I’ll never forget my first assignment in the cohort. Only one other sonographer in my department had gone into the cohort at that time. He relayed seeing 3 morgue carts lining a hallway on his first trip inside. I thought about that often in the days that followed and I knew my turn was coming. How would I handle that? Some of our respiratory therapy (RT) and interventional radiology (IR) colleagues had tested positive by this time. I thought about my little boy. I saw news coverage of doctors and nurses who were self-quarantining after their shifts to decrease the potential spread to their families. I didn’t have that option as a single mother.

Finally, it came: my first COVID+ request. I told myself it would be fine. I just needed to be brave, be safe, and stay alert. I’ve never been to battle but having the media images in my mind and knowing the death toll numbers, I imagined this is what it might feel like on some small level. I thought about the PPE shortage and the rumors that we wouldn’t have access to n95s. I steeled my nerves and walked one foot in front of the other with Apollo (my LOGIQ E10). I arrived outside the cohort and was immediately greeted by the plastic sheeting that sealed off the unit. I found an anteroom with shelves overflowing with supplies. A lovely volunteer helped outfit me with everything I needed: a fresh n95, a surgical mask to go on top, a contact gown, shoe covers, eye protection, and a scrub hat. We exchanged nervous chatter for a moment as she gave me a once over to make sure I was ready. She opened the door and I exhaled as I walked inside.

As I made my way to my first patient, I noticed things were definitely different. Physicians and nurses donned full respirator masks, patient information was written on the room windows so staff could see information such as code status from the hallway, and iv poles with extra tubing sat outside of patient rooms so nurses could adjust pumps without going inside. I also learned that doctors were either doing virtual or modified rounds with one MD per team going into the patient’s room while the rest stayed outside. One came in during my 30-minute exam. As I stood hip-to-hip with my patient, he stood at the foot of the bed, asked the patient a few questions, and was gone in about 2 minutes. It struck me how much extra caution was being taken for doctors and nurses to limit their exposure times.

Some other things in the cohort looked like business as usual. I saw radiographers and cardiac sonographers going about their usual work. I saw food service delivering meals. I saw housekeeping working to stay on top of the mountains of doffed contact gowns and other garbage. Everyone was working individually on this front line for a common goal: our patients. Yet, as I arrived home that day and turned on the news, I was once again told by the media that nurses and doctors are the essential workers in this pandemic. While I absolutely believe nurses and doctors deserve every ounce of recognition they receive, I sometimes think people forget that it takes a team to deliver excellent patient care. I was fortunate enough to be able to share my experiences with Alison Bowen of the Chicago Tribune recently in the hopes of illuminating just some of what we do in a day as Diagnostic Medical Sonographers.

My first patient had a seizure during my exam that day. As I approached my second patient’s room to perform a liver Doppler, a doctor sitting outside of the room informed me the patient had just passed away. My third patient was about to receive a Foley catheter and was extremely nervous. Her nurse asked me to help assist before I started my ultrasound. The patient was still very nervous so I went to the hallway to find extra help. I asked an employee there if she wouldn’t mind coming in and holding the patient’s hand. She looked behind herself and then back at me before stating, “I’m just EVS [environmental services] but I’m happy to help if it’s OK.” She donned a gown and jumped right in.

 

Angela Huang, BS, RDMS (AB,OB/GYN,PS), RVT, is a Diagnostic Medical Sonographer for a large research hospital in Chicago. She attended DePaul University for undergraduate studies where she majored in Biology. Huang went on to Sonography school at El Centro College in Dallas, Texas. Now, she has a 10-year-old son who keeps her laughing and they love to travel and explore.

Interested in learning more about COVID-19? Check out the following posts from the Scan:

 

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