Written by Nathan Dow ’23
Many universities across the country have a student-run emergency medical service, ranging from students first responding on bikes to transporting patients on ambulances. The University of Vermont is a rarity in that it is one of the few universities in the country that fields an undergraduate-run, 911 ambulance operating at the Advanced Life Support (ALS) level. After joining at the beginning of my sophomore year, I was hooked. I quickly became an EMT, then an advanced-EMT, and medicine became my passion. After graduation I was hired full-time in the emergency department at UVM and continued to pick up work on local ambulances. I spent five years working in the emergency room, during which time I also worked in trauma research and pursued a master’s in medical science. Those years were an incredible period of both professional and personal growth, but with the beginning of medical school the time came to ride off into the sunset, leave the emergency room, and put myself 100 percent into my studies.
With clinical time suspended for medical students, many of my classmates have jumped in to help respond to the COVID-19 pandemic. I’ve watched peers organize PPE drives, assist with childcare and meals for healthcare workers and of course, physically distance. I’ve sought a different way to contribute. The staff in the ER here are like family to me, and it felt wrong to sit on the sidelines while they geared up for a frontline fight, especially when I knew I had skills that could help. Staffing during COVID-19 faces a double whammy: more patients require more staff, but fewer staff are available if they also get sick. Joking with one of my old managers about coming back quickly became more serious, and shortly after I was in the ER again.
It’s both strange and exciting to be back. Strange because we have prepared for a surge which has yet to come. COVID-19 in Vermont has been well mitigated by our rural nature, by strong public health planning and response, and by the discipline of individual Vermonters. At the same time, getting my hands dirty in emergency medicine again is an exciting opportunity. In the last few weeks I’ve been reminded that I find my highest meaning while taking care of the sickest of patients. It’s wild to self-reflect and realize that even only a partial medical education has completely changed my understanding of patient assessment and management. Nothing is a stronger motivator to study hard than to see patients, realize the gaps in my knowledge, and leave a shift with questions that I want to answer.
A challenging aspect of this pandemic is that the symptoms are so variable and the agent is widespread. As we began to see cases in low numbers, I was uneasy about which ambulance calls were appropriate for full PPE. In early March, it felt silly to hop out of the ambulance in all this gear, but now many EMS services have made this their standard on all calls, regardless of the dispatch. Being generous with the PPE is especially important on the pre-hospital side, as you’re essentially trapped in a box with your patient. You can take gear off if you’ve overdone it, but it’s a little too late to put more on after the initial encounter.
In or out of the hospital, patients are the common theme. Some patients are remarkably stoic, but in others you see the panic in their eyes, both from air-hunger and from fear of how their symptoms might progress. In the past I’ve cared for sedated, intubated patients, and at times struggled to see their humanity beneath the mess of lines, drains and wires. I imagine that these COVID-19 patients now might see us in the same way, hidden behind our gowns, respirators, eye protection and face shields. When I see these patients, I apologize for my full hood PAPR, tell them that they’re in the right place for help, and remind them that they’re in good hands. I’m proud of my co-workers for the resolve they’ve shown facing this pandemic head-on every shift. For me, this opportunity to come back is a privilege afforded by past skills and connections, and I’m thankful to be able to serve the community in this way during a time of such great need.