Emergency room doctor laments personal and professional isolation

Eric Berger, Associate Editor

Dr. Evan Schwarz says he went into emergency medicine because “you got to see people who had no other place to go and help them in that situation. And you had a combination of the intellectual side of medicine, as well as doing as procedures.”

These days, working at Barnes-Jewish Hospital, Schwarz is missing both the intellectual and the personal. 

Due to fears over the coronavirus, there are far fewer people at the hospital “and working with patients is also very different,” said Schwarz, 41, who also runs a toxicology and addiction medicine clinic. 

“We are in [personal protective equipment] all the time when we are in the emergency department. There are more attempts to limit when you are going to the rooms, and at the same time, patients now have another concern when they are going to the hospital” — contracting the coronavirus.

Although the volume of patients he sees is down, “the shifts are just tougher,” he said. “The people that we see are sicker. Working in the PPE all day longit wasn’t really intended for that – also makes things harder. And there are also tests and imaging modalities that we used to have that are either much harder to do or aren’t available in certain situations because of COVID.”

As to the intellectual part of his professional life, Schwarz, who is affiliated with the Washington University School of Medicine, said he misses meeting his colleagues from around the country at conferences and “comparing how things are going in different” areas.

At the hospital here, “when I am in the office, you are trying to limit how often you go out. At the toxicology service, we used to have … a lot of weekly didactic sessions, and that has all changed,” he said.

At the toxicology and addiction clinic earlier this month, Schwarz was still seeing all his patients remotely. He worried about losing “that element of connection, which is really important with these patients, to make sure that they feel comfortable being honest with us. You worry about worsening depression, worsening socioeconomic status and how all that can lead to increased drug use.”

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Still, Schwarz has also had surprisingly easy interactions with some patients sick with COVID-19.

“When you tell patients that are doing OK that you think they are going to be OK and can go home, a lot of them are accepting of it and seem to understand,” said Schwarz, who is Jewish and from Dallas.

Conversely, he said, when “they are getting sick, it’s a lot harder to tell them what is going to happen in the future. With a lot of other things, you can give them a better idea of how long they are going to be in the hospital, how their disease is going to progress, but here it can be really hard to know. 

“They are getting sicker and can’t go home, and in the past, you could have family there to try to support them, and family can’t really go to the hospital anymore, so it makes it even more difficult on that patient who is scared and worried.”