A Charlotte Doctor on the Day-to-Day Reality of COVID-19
A glimpse inside Carolinas Medical Center with a three-time Top Doctor
Dr. Erika Myers, DO, specializes in the acute care of adult patients at Carolinas Medical Center. She’s been in practice for 17 years and currently works at CMC’s main campus, where she’s treated COVID-19 patients since late March. In April, we caught up with Myers, a three-time Charlotte magazine Top Doctor, to discuss the day-to-day reality of the outbreak at a major hospital: the physical and emotional strain on her team, the surge of patients, and what remains true about the doctors and nurses she counts as colleagues. Her responses have been edited for clarity and space.
Working in an acute care hospital is challenging under the best of circumstances—emotionally, intellectually, physically. We have to share a new diagnosis of metastatic cancer to someone in the prime of their life. We guide families through a loved one’s terminal illness, describing the process of the body shutting down. We’re at the forefront of the opioid crisis. The days are long, and the workload feels unmanageable at times. But what keeps us going is the support of our partners. Each of us helps when someone is down.
When the coronavirus pandemic began overseas, we watched from afar and thought that something of this magnitude would likely never affect us in the same way. I’m in a Facebook group for Charlotte-area physician moms, and toward mid-February, we were starting to hear accounts from Italy, and local physicians were posting interviews with different doctors in Europe. Our hearts ached as we read the words of the exhausted physicians in Italy. And then their reality began to close in on our lives. First in Washington state, then New York—those were the hot spots. Locally, schools began to close, businesses shut down, and before we knew it, we were at the center of a medical crisis.
We didn’t plan for anything like this in medical school. In the ER, we plan for catastrophes like a plane crash or a mass shooting and simulate what we would do in situations with mass casualties coming in. But no one was ready for anything of this scale. I really grasped the weight of this crisis in Charlotte when the hospital closed down anything that was elective to focus on the surge of patients coming in for COVID-19 symptoms.
If a patient tests positive for COVID-19, they go to the COVID unit to be seen by our COVID team, which is made up of hospitalists like me. Now we’re seeing them with advanced technology, or virtual care, so the physical exam and all discussion, even with specialists, is held via computer, and a doctor is behind a camera to minimize the risk of contracting COVID-19.
When we first started seeing cases, we looked for fever, shortness of breath, and cough. We’d ask if they’d recently traveled to areas that were high-risk. But it’s evolved to include other symptoms we’ve learned about over time, like lack of smell or taste, COVID toes in kids (painful red or purple lesions on a child’s feet that resemble frostbite), strokes, and cardiac effects. This virus can affect almost every aspect of your body.
Typically it’s the end of the first week that someone with COVID-19 gets sicker very quickly. So we’re careful to be ready on days five to seven for any change in their condition. We watch for worsening inflammation and see if the patient needs more oxygen. If a patient suddenly gets worse and requires a ventilator, the ICU team takes over. When they improve, they become our patients again.
Although there’s still so much we don’t know, many think this rapid decline is due to a cytokine storm, which gets active when your body knows it has to fight something and your immune system overreacts. (Ed.: Cytokines are proteins that immune system cells produce, and scientists believe overproduction in response to the virus causes lung inflammation and fluid buildup that can lead to death in COVID-19 cases.) Why it happens to one patient and not another, no one knows yet. With a COVID-19-related cytokine storm, you can have swelling of airways and severe damage to the lungs.
Our infectious disease specialists decide when a COVID-19 patient gets treatments; each one is on a case-by-case basis. Remdesivir is a drug we use for a cytokine storm. If you can prevent that, you can stop the progression (of COVID-19). Other options are Tocilizumab, which works to block the immune reaction, and we started convalescent serum this week. (Ed.: Convalescent serum is plasma from recovered COVID-19 patients that contains antibodies to fight the virus.)
When you’re in hospital-based medicine, you don’t have a long-term relationship with patients, so it’s about helping to build a system that can attack this disease better. If I were in private practice, I’d get to know the patient and their family. But right now, I’m helping to put a system in place. I do think the system at CMC was prepared in a sense—not for a pandemic—but we’ve already been doing lots of virtual care. That was already set up, and it allows resources to get to people who live further out. Other cities didn’t have as much time to prepare, but we had time to ramp up—more so than cities like New York or Seattle. So far, we’ve had enough beds and test kits.
There’s always fear that today could be the day we have more patients than beds, though. We fear patients dying. We worry that members of the health care team will get sick. We worry about our critical care colleagues, managing the sickest of the sick. We pray that our nurses and techs, who spend far more face-to-face time with the patients, stay healthy. For the first time in our careers, we worry about our own mortality. We’re terrified we’ll bring it home to our families, our children, our spouses, our fathers who are on chemotherapy. No one went into medicine thinking they were going to give up their lives. You miss out on a lot of things in your 20s when you’re in med school, sure, but you don’t worry that you’ll die at a young age.
The support system we had built in our office has changed. Social distancing means we’re no longer eating lunch as a group in our office. Now we write our daily notes separately, either at home alone or in solitude at an empty nursing station. We’ve lost the ability to bounce ideas off each other or share a complicated case. We line up every morning to answer questions about symptoms we may have and get our temperature taken before we can to walk into our respective units. We strap on one mask, maybe two, grab some goggles, and gown up. Then we grab our list and begin our rounds.
I get ready for work in a different manner now. One set of shoes for home, one for work. No makeup, no jewelry. The wedding ring that’s been on my finger for 12 years stays in the jewelry box. I wear clothes I can wash daily. Coming home should be carefree, but now I have a different routine before dinner. Take my clothes off outside and run to the shower. Is there a small amount of virus on my hair? Did I touch my face? I wipe down the doorknobs at home. And those of us who stay at home are lucky; others live away from their families. Instead of relaxing at night, mindlessly reading or playing with our kids, we watch the news and scour the internet, hoping for a breakthrough.
Treating patients for COVID-19 symptoms makes me nervous, but once I’m caring for them, it’s uplifting because I know I’m making a difference. Bedside manner is so important right now because these patients are scared and completely and utterly alone. We have to be good at explaining their symptoms in a way that makes sense to them. They’re hospitalized and isolated for 14 to 21 days. It’s a long time to be alone and separated from family. I sent a patient to hospice recently and the family couldn’t be there—not because the patient had coronavirus but because it’s everywhere else.
I fear that we won’t get back to what normal was, that we’ll continue to live with trepidation for the foreseeable future, that we can’t just get up and travel to see our loved ones, and we’ll constantly wonder who will get sick and when. It’s hard to know the exact point when you have enough beds and resources in place and you can allow people some freedom. I worry about a second problem for the people with chronic illnesses who couldn’t get their meds while they were at home and out of work. People who can’t afford their blood pressure medicine anymore could have a massive stroke. Someone who needed a hip replaced but postponed surgery during the pandemic could have a fall.
It’s hard to imagine this will fully go away anytime soon. I think the most exciting thing we can hope for is a vaccine. It’s amazing to see scientists all over the world coming together to find this common solution. I think it’s important to listen to what virologists and microbiologists say, not just physicians. Creating a vaccine and understanding how a virus replicates and how to stop it is so important. And using antibody tests could change everything.
A close friend and colleague of mine gives a lecture to our physician’s assistant and nurse practitioner fellows called “Introduction to Antibiotics.” It’s a universally loved talk that ends with each fellow picking the four antibiotics they would choose to help them survive if there was a zombie apocalypse. It’s about understanding what you would need to treat a widespread group of things. A decade later, I would never have imagined that “zombie apocalypse” would be the fight of our career, this battle against a microscopic virus.
In my best-case scenario, we’re able to slowly open up small sectors of our world again. Over the next six months, we’ll figure out better ways to treat the virus and prevent it in the future. A lot of people are willing to help, donate plasma, or be a guinea pig to test vaccines. I hope kids go back to school in fall. When winter comes, I hope we don’t close down the world again. I hope we’re better prepared than we are now. You have to jump-start the economy, but you can’t do it at the risk of your people.
This experience makes me believe in the medical profession more. The majority of people who are in medicine do it because they want to make a difference. Outpatient nurses are rounding in the hospital because they want to help and they care. Others are coming out of retirement or volunteering to go to New York and help. It makes me feel more proud of who we are. One thing I still know to be true about the medical profession is that people really are in it to do good.
It’s a very interesting time in the world, and I think we’ll be better because of it. I’ve felt more like a parent than I ever have after this time at home with my kids, supervising the schoolwork, doing the laundry, cooking the meals. In that way, it’s allowed us all to be truer because we’re not wrapped up in the craziness that we used to live. It’s nice not to be running all the time. I’ve learned that life is sacred. Slow down, spend time with your family. Cherish your elders. Remember all those that were willing to give up their life to save someone they didn’t know. My hope is that this pandemic will help medicine—and society—heal.