In a span of just three years, I’ve transitioned from a young and, in my opinion, hip attending to an undeniably old and salty one. I now say things like “back in the good old days,” “when I was an intern,” and “there was a better time.” I teach my residents about relics, like how hospitals used to be staffed with non-traveling, permanent nurses, CT techs, respiratory therapists, phlebotomists, etc., and how these people used to be part of your team, ready to pitch in when the going got tough. As always, I preface this with some explanation of how things were different before the mass resignation. But perhaps the biggest tell of all is that I have stopped complaining. I trained and spent the early, we’ll call them the “golden years,” of my attending life during an era when understaffed hospitals were simply unacceptable, when the pharmacy could provide any medication you wanted instantaneously if you called directly, and when the ICU charge nurse functioned as your secret eyes and ears, keeping track of not only your patients, but also the movements of fresh residents still gaining their ICU footing.
But this is not the world I work in anymore. It’s not the world anyone works in anymore. I learned this lesson the hard way: I got a little heated when the blood bank refused to provide blood for a young gunshot wound patient of mine. My patient, a teenager, had been shot while trying to sell his Xbox to help his family through dire financial straits. Most notable among his many injuries were bullet tracks through his superior mesenteric artery and vein, which were bleeding like mad. He arrived right around shift change, which worked in his favor since my outgoing partner was able to assist me with the case. Working together, we were able to stop the hemorrhage more quickly than would have been possible for one surgeon alone.
But as often happens after massive blood loss from severe trauma, our patient developed a profound coagulopathy and needed many, many blood products. When the blood bank rejected our request for blood, I assumed it was a result of miscommunication. We had achieved surgical hemostasis in the OR, and no one says “no” when asked for blood to save the life of a 17-year-old. Sure, we had burned through a lot of blood already (if my recollection serves it was at least a few dozen units at this point), but that’s not so uncommon in trauma. To my surprise, blood bank continued to say no, even after I laid out the extreme circumstances we were under. To my even deeper surprise, so did the administration. I would like to say I remained professional that night, but that would be stretching the truth a bit. I called everyone. I called them repeatedly. I invited people to the patient’s bedside to explain to the family why their loved one was going to die, despite having had his injuries fixed. (No one accepted my invitation.) I explained that we are a trauma center, and that we don’t let people bleed to death in trauma centers. Through some magic, the blood bank was able to get another shipment of a few blood products; it wasn’t what I had asked for, but I certainly wasn’t going to turn it down. It was enough, barely, and our patient survived.
The next morning, I was informed that the issue was not that the people I had harassed all night long didn’t want to help me. The issue was that the American Red Cross was out of blood! Unbelievable. My analysis of potential points of failure the night before had not even considered this possibility. Over the following weeks, I would see email after email and article after article about the nationwide blood shortage crisis and the measures various trauma centers were taking to minimize blood product usage during this critical time. Some even suggested halting efforts to save a patient after a certain transfusion threshold. Under those guidelines, we would have had to walk away and let our young patient die.
Eventually, the Red Cross changed their post-COVID blood donation algorithm, made a full recovery, and no one is talking about transfusion mitigation anymore. I’d like to say that was the one big COVID-related hurdle that our U.S. health care system had to overcome. But soon after this unprecedented disruption, we experienced a nationwide critical shortage of baby formula — something so fundamental to the health of our country that it seemed impossible at the time. It was just as real as the blood shortage. And after this, infant’s and children’s antipyretics were similarly unavailable. I’d like to tell myself that we are basking in the light at the end of the COVID tunnel, but the truth is that I am just waiting for the next shoe to drop.
I’ve spent many sleepless nights since my young gunshot wound patient arrived pondering why our system is falling apart at the seams. We really did have an excellent health care system back in the good old pre-COVID days. We all expected COVID to come and go, rather than linger for years, and so I can’t even claim that things clearly could or should have been done differently in the months leading up to these sequential crises.
What I do know is that we need to learn from this and do things differently moving forward. I don’t know if the answers lie in reducing reliance on overseas manufacturing, in incentivizing businesses to transition from a just-in-time inventory model to a safety-stock model for key health essentials, or in some other regulatory or structural change that is above my pay grade. What is certain is that we can do better. And we have to. The U.S. health care system has been struggling with long COVID for a while now, and it’s time to recover.
How have changes since the start of the COVID-19 pandemic affected your work? Share your experiences in the comment section.
Dr. Danielle Pigneri is a trauma and acute care surgeon practicing in the Dallas-Fort Worth metroplex. When not working, she enjoys her other job, being a mom to two sweet young children. Dr. Pigneri is a 2022-2023 Doximity Op-Med Fellow.
