Notes from the Front Line: Rapid Response in L.A.

Michael Ohkura, M.D.'18
Michael Ohkura, M.D.’18

Written by Michael Ohkura, M.D.’18

The initial surge of coronavirus patients never quite slammed us in Los Angeles the way that we were expecting. We watched as NYC struggled to cope and wondered if we would be next. The U.S. Navy ship, “Mercy,” was deployed to dock in our harbor, and we raced to plan.

As a second-year resident in the UCLA Family Medicine Residency Program, I was on the family medicine inpatient service in the hospital when COVID-19 started becoming a very real concern. As the code blue and rapid response team in the hospital, we were very involved with planning how to run respiratory codes in a way that would minimize staff exposure. We laid out plans for the minimal number of people and what meds/initial equipment are needed, how to keep the door closed as much as possible yet still communicate with the rest of the team outside, what level of PPE to use depending on the situation, and more. While managing our full inpatient service, we had multiple mock codes per day to practice. It was mentally exhausting never knowing whether we were running to a real or mock code.

I then transitioned to working in the county ED of one of the large Los Angeles Department of Public Health safety net hospitals. There, volume was actually low initially due to many patients staying away. However, those that did come in were much sicker, and toward the end of April things started picking back up again due to many of these patients lacking any other regular access to medical care. In the meantime, I helped to mobilize 20 different 3D printers through the Los Angeles Public Library system to help print and distribute face shields where needed.

Throughout all of this, I’ve also been trying to take care of my patients in my two busy family medicine continuity clinics and nursing homes via telemedicine. I “see” my patients independently, order labs/diagnostics, plan follow up, and periodically check-in with my attendings who are also working remotely. We have limited in-office visits for issues that need to be evaluated in person, and limited procedural appointments for time-sensitive things.

For the duration of this month, I remain the “jeopardy” resident, on-call anytime to be deployed to help fill in any service (labor & delivery, ED, adult inpatient service, pediatric wards, clinics) as my co-residents get pulled for testing or others are out sick. It really puts our jack-of-all-trades skillset to use, which is cool. But this has made for some long days as I finish a busy day’s worth of clinic visits, only to be called to help cover the overnight pediatric ward, as was the case last week.

My husband is also a critical care nurse in our hospital’s ICU, directly caring for many COVID positive patients. I guess there’s no avoiding that risk in our household, so we’ve taken to being reasonable with our precautions, but also coming to terms with the idea that it may just be a matter of time before one of us tests positive.

California was very early to start stay-at-home orders, which undoubtedly helped flatten our curve, but as Los Angeles extends its lockdown for another three months until August, I can feel people getting antsy. Cases continue to rise, and we still have a steady stream of patients gradually filling up the hospital. Only time will tell how things settle out. Since other outlets like laying out at the beach with friends or a night out dancing don’t look like they’re happening anytime soon, we try our best to commiserate with each other and reconnect with the little things we can enjoy (the garden is looking wonderful!).

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