Prepared for This
Kathryn Rouse, MD, was finishing up her residency at a Bronx city hospital emergency department when the Covid-19 Pandemic hit New York City. Her time at the hospital – one of the worst hit in the country – followed by her first year as an attending there, was unforgettable.
“In one sense,” she said, “The pandemic was exactly what we had been preparing for, what residency was training us for. In another sense, it was like finishing a marathon and then being told we needed to sprint a 10K. The best thing about residency was the camaraderie, and, in the face of the pandemic, we were able to band together and strengthen each other as never before.”
She shared a stream of her more prominent memories, but for those interested also recommends “Every Minute is a Day,” written by her residency mentor Dr. Robert Meyer; as well as articles by New York Times’ Nicholas Kristof, including Life and Death in the ‘Hot Zone.’
In her own words
Our Bronx city hospital ED – already overcrowded before COVID – now had hallways filled with people coughing and vomiting, the very first week that the pandemic was suddenly announced, before there was a mask mandate and while n95s were in very limited supply, kept in brown paper bags for when we would go into an isolation room. With only 3 or 4 isolation rooms for the obvious COVID admissions, dozens more patients filled up any available space and we were all quickly exposed and infected one by one. We would soon line up each morning to be given our N95 for the day… then it was one for the week. Then the CDC suggested bandanas if need be.
My co-resident and I worked the same shifts one of the first weekends of the pandemic and we both had fevers a week later. It was so early on that there wasn’t even COVID testing readily available. After my 7-day quarantine, I was, thankfully, ready to go back to work, but my co-resident was now hypoxic in the ICU.
On shift one night, I flooded with terror as I heard a rapid response called to the unit where he was admitted. As I was covering the “fast-track” urgent care section of the ED at the time, I had the freedom to run up to the unit. I looked into each room and found him awake, on oxygen but comfortably texting on his phone, and breathed in relief, only to then notice a crowd gathering two doors down. Looking over the crowd, I saw a 20-something year old young woman with the bluest face I’d ever seen. We were in the pediatric ICU, which was being staffed by pediatric residents overnight and admitting up to 30-year-olds due to space/staffing limitations. They probably had never intubated someone before or managed a ventilator. The scene was chaos. They were scrambling around to find intubation equipment, thinking her ET tube needed to be replaced. There were already far too many people in the room. I helped them find the glidescope and equipment as the critical care team arrived. A pediatric emergency attending showed up and helped bag the patient. I quickly ducked out to let the critical care team take over. I could imagine the degree of anoxic brain injury that had taken place and left the situation in the hands of the critical care team.
There are many moments of COVID that will remain permanently etched my mind, including:
- Consult residents hovering at the door despite wearing full PPE, even for traumas, in fear of exposure.
- The desperate creativity of re-deploying staff
- We finally got a doctors’ lounge, a small spare, bare room down the hall that was a paradise of freedom to lower our masks, eat, and drink. Simple joys we once took for granted.
- Tolerating tachypnea… respiratory rates of 30s… 40s… that once would’ve had us sprinting for the intubation box were ordinary. We became comfortable with the discomfort, always conflicted about intubation. We waited and watched and proned and used bipap and hi-flow, silently hoping they would somehow turn around.
A New Chapter
After an intense first year as an attending in the Bronx, Dr. Rouse and her husband wanted to relocate. They had the freedom to choose the best fit for themselves, wherever they wanted in the country. Dr. Rouse had become acquainted with USACS at ACEP in 2019 and was immediately drawn to how well USACS cares for its people.
“I like that USACS is led by physicians, and that they are large enough and established enough to provide stability, resources, and strong leadership,” she said. “Now, as part of USACS, I have gotten to experience these things firsthand. I’m grateful to be part of an amazing team here in Tulsa.”
Dr. Rouse has worked as an emergency physician for Saint Francis Hospital in Tulsa since October of 2021, and System Medical Director Ryan Parker, MD, said that she has been a wonderful addition.
“It is not an easy time to be an ED physician right now, but she is a natural,” said Dr. Parker. “Kate is a consistent calm and steady force in the ED. She always has a smile on her face and navigates even the toughest circumstances with grace and confidence. She has been such a positive influence for her patients, her physician and APP colleagues, the nurses and the ED as a whole. We are so thankful she is a part of our team!”
Dr. Rouse and her husband are also pleased with the location flexibility of USACS.
“We were looking for cities that are very community-oriented, but still offered a job opportunity for me that would be somewhat comparable to the pace and acuity of the work I was doing in the Bronx. Tulsa was a big city with a small town feel that seemed to fit us both well,” she said. “Saint Francis is a high volume, high acuity facility. My current position is a great fit for me because it’s fast-paced and I have many opportunities to use the skills and training I gained there. The area and hospital network is an epicenter for healthcare in this region.”
Tending to the Suffering
Though there have been COVID surges in Tulsa as well, Dr. Rouse appreciates the differences in how the Saint Francis Hospital system has handled its approach.
“Staffing issues are handled differently here,” she said. “While there are nursing shortages everywhere, here, the 30 patients waiting wait in the waiting room rather than crowding the Emergency Department halls to wait. There’s more space, more rooms here, so even on the busiest days, it still feels less chaotic. Also, in the Bronx, our hospitalists didn’t cover ICU patients, so we would often be caring for boarded ICU patients, sometimes down in the ED for over 24 hours while they waited for a bed, which could be a challenge when we had more critical patients coming in steadily. But while it’s seemingly less chaotic in Tulsa, and it could be easy to think people are struggling less here than in the Bronx, I remind myself that each nurse, tech, APP, environmental services personnel, secretary, transporter has been affected by this pandemic and we all have to look out for each other.”
You are not alone
Looking out for her patients – as well as her colleague team – is something Dr. Rouse takes to heart.
If she has a word of encouragement for her fellow clinicians, it’s this:
“You’re not alone. This pandemic has been very isolating, from literal quarantine to how each of us processes our unique experiences and challenges. Give yourself grace to rest, recover, and find support when you need it.”
Kathryn Rouse, MD, earned her medical degree from Albert Einstein College of Medicine, where she graduated with honors, Alpha Omega Alpha. She completed her residency at Jacobi Medical Center/Montefiore in the Bronx, one of the first established and largest Emergency Medicine Residencies. Before coming to Saint Francis Hospital in Tulsa, she spent a little over a year as an attending at Montefiore Medical Center.