A Day in the Life in Yale's ER with Thomas McNeely '11
Thomas McNeely '11 is an ER Technician at the York Street campus of Yale New Haven Hospital, fighting against COVID-19. At ND, Tom was a National Honor Society inductee, a Team ND ambassador, and a member of the track and cross country teams. We wish him the best of luck as he prepares to apply to PA school!
"At work, my typical “day” starts at night. I put on my clean blue scrubs, gather my things, and walk out the door. During “normal times”, my 15-minute drive to work allows for only a minute or two thinking of what I may see during the shift ahead…(night time in the Emergency Department of a Level 1 trauma center can go from calm to “Code Blue” with the pull of a trigger or the crash of a car)... the rest of the drive I’ll listen to the radio. But in “COVID times”, the only tune playing during this drive is sweet silence, paired with thoughts of how many “new COVIDs” we’ll treat, or if tonight might be the night that I become one of them. At this time of the year, my drive is accompanied by the last precious minutes of sunshine. I’m grateful now more than ever to see and feel it, knowing that tonight, some may no longer be so fortunate.
I park and walk towards the hospital to start my shift, passing the “day-shifters” who have just ended theirs: techs, food service workers, nurses, maintenance and sanitation workers, doctors, and many more. These people serve as the first indicator of what to expect walking in- even the quickest glance at a pair of tired eyes north of a surgical mask can tell a surprising amount about the quality of the day gone by. This also reminds me to put on my own mask as I walk into the building."
"I clock in at 6:53, then time for “the huddle” at 7:00. The huddle is the pre-shift briefing for the oncoming staff, lead by the charge nurse from the previous shift, and the goings-on from that day: how many patients in the department, who are sickest patients/“ICU players” are, and lately, the state of our PPE supply. Normally this is done in a staff break room full of nurses and techs sitting together around a large table or shoulder to shoulder on the window ledge in the back of the room. But during the pandemic, we conduct the huddle in the much larger ER waiting room (which is empty of patients due to visitor and infection-control restrictions) to allow for a socially distanced update.
After the huddle, I look at the schedule to see my assignment and walk out to the floor to relieve the day-time technician and take their report about the patients in my assignment and the supply stock of their rooms. After this hand-off, I walk over to a metal-grid storage cage and look for my “COVID bag” amongst a sea of other similar brown-paper bags meant to hold the singular N95 respirator, face shield, and other PPE equipment issued at the start of the shift. I feel lucky to now be able to grab a new (or cleaned/recycled) mask for each shift— other hospitals around the country struggling with supplies are still using the same pieces of equipment indefinitely.
From then on, I tend to my duties as an ER technician, assisting the nursing and physician staff in treating and tending to sick patients— everything from stocking rooms and making beds to splinting broken arms to performing CPR or other life-support procedures on people who are engaged in the fight of (for) their lives. When I get the chance, I eat lunch (dinner for most) in the break room sometime during the night; this is one of the few times I can take off the surgical mask that I must wear throughout the whole shift.
Although we still treat all different illnesses and traumatic injuries, the overwhelming number of patients we see nowadays are COVID-19 positive or rule-out patients. They occupy nearly all of our rooms and require any person who enters the room to be fully “gowned up”: N95 respirator, the surgical mask covering it, face shield over both, yellow gown covering the rest of the body, surgical hat. Shoe covers optional but always a good idea. A lot of these patients also require intubation due to respiratory distress, which calls for a small team of doctor, nurse, respiratory therapist, and ER tech members who spring into action to sedate, intubate, stabilize, and mechanically breathe for someone who cannot effectively do so on their own. This task is choreographed, controlled chaos in which every participant knows their role and executes in the best way that a small negative-pressure exam room will allow. Sometimes I am in the room, sometimes my job is just outside the door acting as the “clean tech”, un-gowned and ready to grab any and all items needed by the team inside the room.
The dramatic decline in non-COVID patients has led to extended periods of eerily quiet downtime in our Emergency Department which sometimes lasts most of the shift, although we still get the occasional surge of patients (par for the course in any ER). In periods of downtime when we are not running around doing intubation or tending to sick patients, we wait. I keep busy by stocking. I check and then re-check life-saving equipment to make sure it’s functioning properly. I also use this time to talk and reflect with my fellow techs, nurses, doctors, cleaning, and transport staff. These periods of time provide an escape from our current reality, and a crucial outlet to decompress.
When the shift is over and the day-shifters come to relieve us in the morning, I give my handoff report to the oncoming tech. My used N-95 mask and face shield goes back into my bag, which I return to the cage, to be found for the next shift. Still on the floor, I use sanitizing alcohol wipes to “disinfect” most of my belongings and the equipment that I carry on me (cellphone, stethoscope, trauma shears, badge) before making my way to the locker room to change. I put my used blue tech scrubs carefully into a sealed plastic bag, and put on a clean pair of green scrubs to go home in--COVID stays at the hospital!"
"After clocking out at 7:23 am, I walk outside, take off my mask, and breathe a breath of fresh air as I walk to the car. Once I get home, I strip down to underwear at the front door, throw everything in the laundry machine, and take a hot shower before I go to sleep."