This is Part III in our “Front Lines” series with Dr. Will Dabbs. Be sure to check out Part I “What’s It’s Really Like on the Front Lines Fighting COVID-19” and Part II “One Week Into COVID-19 and the Wretched N95 Face Mask” before reading on about the age of the drive-thru doctor.
What’s the most interesting thing you’ve ever done in an automobile? Don’t answer that out loud just in case the kids are within earshot. Today I diagnosed and treated gout; that was a first for me. The exigencies that drove me to practice medicine through a rolled-down car window represent some radical American medical paradigm-shifting.
Meeting the Monster
COVID-19 is a fairly indiscriminate beast. SARS-CoV-2 doesn’t care what color you are, how much money you have, or how many people follow you on Instagram. It attacks the homeless and heads of state with comparable enthusiasm. For every hundred folks this virus meets, it’s going to kill about three of them. Those sordid odds changed absolutely everything.
The positive cases I have seen thus far could all trace their exposures back to some discrete moment. As this disease really finds its legs and the virus becomes a more common fixture in public spaces, this will no longer be the case. For now, however, I got to hear the stories about how these normal everyday people met a real-live monster.
The meeting place was typically someplace enclosed. A vehicle, a classroom, and offices comprise the short list thus far. Somebody else in attendance had a little cough, even if they were across the room, and the virus made a new pal.
SARS-CoV-2 is legit terrifying. In two decades of medical practice I’ve certainly never seen anything like it. It’s every bit as nasty as the news makes it out to be.
We’ve got to avoid cramming people together, particularly if they’re sick. Considering cramming sick people together is pretty much the purpose of every medical waiting room on the planet, that required some fundamental restructuring. The end result would have been unthinkable a mere 10 days ago.
Health Care Reimagined
At first we just binned the magazines, burned through a lot of Lysol, and designated one-third of the waiting area for folks not terrifically sick. A medical clinic without magazines is like a day without sunshine, but desperate times demand desperate measures. The ubiquitous free reading material is a splendid disease vector. For this reason, the printed matter had to go. Sorry, Ballistic Magazine.
It soon became obvious that whoever felt they warranted the nominally cootie-free space was an overly subjective determination. I can’t blame them. Who would voluntarily join a room full of the virulent snot-spewing condemned? You recall that this novel new disease carries a 3 percent mortality. It required more radical thinking.
Everybody has a cell phone these days. Backwoods folk I see in clinic who can remember riding to church in a buggy behind a mule will typically still have a smartphone poking out of the top left pocket of their overalls. As such, we locked the front door to the clinic and posted a prominent sign.
Patients now give us a jingle when they arrive, and we take their pertinent information over the phone. Insurance cards and identification documents can be photographed and texted to the receptionists safely ensconced within the building. My staff then takes a quick telephonic history, updates the medications, and gets the ball rolling, all without bringing the patient inside the clinic.
The Drive-Thru Doctor
My nurse takes vitals through the car window and makes a quick assessment of whether or not this person is trying actively to die. On occasion, some are, and that takes us down a different more vigorous path. She typically then enters all of this stuff into the EMR (Electronic Medical Record). The EMR is a cumbersome computerized Obamacare-inspired abomination designed by Satan himself to make guys like me die both embittered and young. Now, it is my turn.
I amble out into the parking lot adorned like Fizzbit the Insect King. We are all wearing N95 masks, oversized goggles, and rubber gloves. If there is anything more innately deleterious to the doctor-patient relationship I cannot imagine it. Perhaps my wearing a chartreuse beret and a Speedo, but even then I might seem at least a bit more approachable.
I then lean through the open window of the car, inquire as to a patient’s medical problems, and do my utmost to resolve them. My lab techs have mastered flu tests, COVID swabs, and blood draws while a patient remains comfortably ensconced in their adjustable reclining buckets. They’ve even done this in the rain. I know it’s not supposed to be a competition but, to all the other medical clinics out there, my lab techs can beat up your lab techs. I do work with some truly awesome folks.
Patients needing an EKG or X-Ray are carefully escorted in the side door of the clinic. Also, anyone wishing to talk about or show me anything embarrassing gets the same discreet treatment. We’ve done this for a week now and, cumbersome and frustrating as it inevitably has been, I get to sleep soundly knowing I have done my utmost to minimize the risk to my patients and staff.
Some piece of this likely violates HIPAA. HIPAA stands for the Health Insurance Portability and Accountability Act. HIPAA was a gift from President Bill Clinton to America’s health care providers that introduces yet another volume to the ever-growing list of reasons why we in the medical field can be fined, sued, or arrested. I honestly never really forgave Bill Clinton for depriving our boys in Mogadishu of the tanks they requested.
I recently arrived at work to find a goody box from Home Depot at the back door. The box contained Tyvek suits and four industrial reusable respirators. Amidst a veritable sea of darkness and chaos let me assure you that Home Depot is just freaking awesome.
Closing down the clinic and seeing patients in their cars may seem like overkill at this point in the epidemic. However, my overarching goal is to get through this thing without killing anybody. The tales I am now hearing from the hardest hit ICU’s seem absolutely medieval. It may be time for a little overkill.