ER Goddess: We Are Laughably Far from Business as Usual: Emergency Medicine News



EP life, COVID-19, Joint Commission


The Joint Commission showed up at my Richmond-area ED this week, as if hospitals were back to business as usual. The Virginia Department of Health also reported that the devastating wave of delta-variant COVID-19 cases is far from over. On the contrary, already overwhelmed hospitals can expect to see continued growth of COVID-19 cases until a peak in two to three weeks. (Sep 29, 2021; The incongruity is comical.

The Joint Commission (JC) was focusing on whether the floors were clean and whether we committed the sin of having coffee while we work, while our nation’s EDs are floundering through a COVID surge in which hospitals were full, staff was short, and ambulances were hard to find. ED volumes are back to pre-COVID numbers, but we no longer have the pre-COVID resources to care for patients.

No rooms are available upstairs, and we can’t transfer patients because we have nowhere to send them. Even when we do find someplace to send them, no ambulance is available to take them there.

The day the JC visited, as Murphy and his darn law would have it, the state of our department was typical ED chaos on anabolic steroids. We had several psych holds due to a shortage of in-patient psych beds. These psych patients repeatedly wandered into the nurses’ station, where JC administrators were trying to focus on their agenda. Our nurses that day were tasked not only with controlling the beefed-up mayhem but also with catering to JC’s bureaucrats and their checklists.

A Farcical Universe

Not surprisingly, veteran and new nurses with potential are saying “enough” and getting out of the ridiculousness transpiring in our EDs. We’re left with traveling nurses, who, though helpful, earn exorbitantly more than regular staff, destroying our regular nurses’ moral. Even more devastating than coworkers resigning are coworkers becoming infected with COVID-19 and dying. Just last month, COVID took the life of Molly, a phenomenal tech who many of us had grown to love over the decades she spent in various area EDs. Now the JC wants to focus on how troublesome the bottles of water on our desk are? Even dear Molly would laugh at that.

When an organization purporting to be expert in patient care ignores the SARS-CoV-2 elephant in the room and expects to carry on business as usual, is it any wonder that the public expects the same? Despite the fact that our ED is busting at the seams with COVID, more patients are back to unrealistic pre-COVID expectations. We’ve had patients leave in a huff because it took too long to get their COVID work notes. One patient, who came in with five chief complaints and a grossly positive review of systems, instructed us to get him out within an hour because he had to get to work. We’re also seeing patients wanting STD checkups and treatment. Patients are tired of the pandemic, no longer willing to be inconvenienced, and returning to the expectation that EDs accommodate them as usual.

We are being held to expectations of high patient satisfaction numbers and low left-without-being-seen numbers as if we aren’t in a pandemic. Making allowances for anything outside of business as usual is not profitable, so the health care machine is returning to its usual expectations of us, pandemic or not. Some days it feels like I’ve slipped through a portal into a farcical universe in which our patients and colleagues continue to die of COVID, but no one acknowledges that we’re in another surge.

Dumpster Fire

The day after the JC appeared in our ED, a box from Christie’s came for my EP fiancé. Inside was a tin of cookies adorned with his employer’s logo plus a note thanking him for caring for patients on the frontline of COVID.

But pizza and cookies are woefully impotent gestures from administration. Instead of treats, we need better staffing, scribes, and a moratorium on physician order entry. I wanted to hate the cookies because they scoff at the depth of our wellness needs, but aside from the fact that they might be the most scrumptiously plump oatmeal raisin masterpieces I’ve ever tasted, I’m too desperate for any morsel of appreciation. Instead, I’m grateful.

I don’t do this job for praise and thanks, but I’m learning I have a limit for what I can give without it. When the health care industry and patients don’t recognize the toll this pandemic is taking on the frontline, it further demoralizes and depletes us. At least cookies are a sweet little reassurance that someone appreciates our struggles.

Our preposterous reality is that, aside from baked goods, fewer and fewer accommodations will be made for our overwhelmed system. We’re back to unrelenting expectations from health care organizations like the Centers for Medicare and Medicaid Services and the JC. My colleagues and I will try in earnest to meet everyone’s expectation for business as usual. Unfortunately, no matter how inconvenient, unprofitable, or unpalatable it may be, we are far from business as usual.

Lately at the end of my shifts, as I remember to remove my untouched caffeine from its JC-approved hiding place before dragging myself home an hour late, I leave with an unsettling awareness that my best effort just couldn’t get it done. I could beat myself up, feel grumpy toward patients, or lash out at bureaucrats, but most days that takes too much energy, so I just snicker at our impossible predicament. Sometimes just shaking my head and laughing at the absurdity of it all is the best thing for my sanity. Expecting pre-COVID medicine in the middle of a COVID dumpster fire is, after all, pretty comical.

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Dr simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at


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