COVID Diary: Love, Loss and Hope

Life in our small ASC is different from most hospitals in our area. We've traded responding to emergency codes in ICUs for the pleasure of spending holidays with loved ones, and the hustle and bustle of ERs for focused one-on-one care. We're a small enough group that our surgeons know our stories, our bosses know our concerns and our patients know our names. We love it here, and most days feel luckier than other healthcare providers.

Our experiences aren't like the ones you see during social media scrolls that include posts of brave nurses donned in full PPE treating seas of patients on death's dark doorstep. Yet COVID-19 has forever changed our center, and brought extreme challenges that were often difficult to meet.

We don't have HR specialists or multidisciplinary committees instructing us on what we can and cannot do. Our COVID-19 information comes from Google research that starts from the CDC and filters down through various governing bodies and ASC message boards. At times, the ever-changing COVID-19 recommendations feel overwhelming. CDC recommendations become state mandates that become city mandates that are then labeled and enforced as "strongly recommended." We have to do our homework, write our policies and perpetually stay up to date.

Despite our city's presence on lists of most highly infected areas in the nation, a significant segment of our community sees masking as a violation of their civil rights. This has made what had traditionally been a very happy and easy-going environment at our center a more confrontational and stressful one. We've strictly enforced our mask-wearing policy since March. To alleviate some of the patient pushback, we've posted multiple signs that are easy to read, fun in their approach and clear in our expectation that a mask must be worn — and worn correctly — in our facility. We're also clear in our expectations during pre-op calls and while screening patients before they enter our facility. Yet, mask-wearing is an ongoing issue that we have to police.

Staffing has been a constant concern. Unlike large hospitals, if three or four of our staff members test positive at one time for COVID-19, we have no resource pool to pull from or FEMA workers to step in to take their place. We have to cancel surgeries and postpone treatments that are often time sensitive. Since March, we have required and enforced our staff to wear a mask at all times while working. We've stressed ad nauseum the importance of social distancing and masking when they're away from our center, and remind them to be hypervigilant about reporting new-onset changes in their health. But even the most well-thought-out policies cannot prevent exposure outside our facility or unintended exposures in our facility.

In November, we lost Janine Jones, a 58-year-old nurse, to COVID (see "Major Milestone" on page 16). The effect on our staff has been humbling, scary and overwhelmingly heartbreaking. She was an inspiring presence here for five years, a favorite of patients and staff. The incredible void she has left among our tight-knit team is felt daily.

Our CEO is not seen as a suit who passes through to make an appearance. Rather, he's a leader who stops by often, knows our names, shares our concerns, our laughs and our triumphs. Because of this, his decisions and responsibilities are not weighted by the bottom line but by a deep obligation of doing right by the people who depend on him for a paycheck. In April, when even a masked exposure meant 14 days of mandatory quarantine for everyone involved, he chose to split our staff and providers into two groups working opposite weeks of each other, hoping to keep a large group exposure a less likely occurrence. Instead of cutting our paychecks in half or furloughing staff, he continued to pay us even when they were home. ?We were fortunate to have such a situation but, with medical facilities furloughing staff everywhere around us, we recognized how tenuous even the best situation can be.

To those who are on the front lines of the COVID-19 fight, our worries might seem inconsequential and unimportant. By no means do we think our situation is awful. But for our patients who have bladder cancer, testicular cancer or even a kidney stone, our center offers them a place to be treated quickly and with less worry of being exposed to the many COVID-19 patients currently overwhelming larger hospitals. And, in addition to reducing the risk of COVID-19 exposure to our patients and visitors, our center also serves to reduce the burden on area hospitals and emergency centers.

Like most small businesses during the COVID era, our center looks much different than it did a year ago. Many things remain beyond our control, which is a heavy weight to bear. Our story will continue to be told as we remain committed to delivering safe, efficient, patient-centered care each day. OSM