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About the Author: Dr. Koenig is a 2014 graduate of the College of Osteopathic Medicine. Prior to medical school she worked in international animal welfare and holds a Masters of Public Health from Tufts University and a Masters of Science from the Tufts Veterinary School. She currently works as an Emergency Physician in the Phoenix, Arizona area primarily in emergency departments catering to the medically underserved. Her passions include global health and medical education which she pursues through positions at Creighton University and the Maricopa Emergency Medicine Residency Program.
We let You down
By B. Witkind (Davis) Koenig, DO ‘14, MPH, FACEP
The triage nurse grabs me from a patient’s room for the third time tonight. A patient just walked into our Phoenix emergency department with an oxygen saturation of 60% on room air, working hard to breath.
Before entering the room, I am confident of what I will find. The patient will be between 50 and 70 years old. They or their spouse will be an “essential worker,” leaving the home every day to work in a grocery store, construction, or healthcare. If they ever had access to medical care in the past they have been told that they have high blood pressure or diabetes. And of course, I will most likely require an interpreter to gather the rest of the history.
Throughout the COVID outbreak in Arizona, I have seen patients whose symptoms range from mild to critically ill. They spanned all races and classes. This catchment aligned with the message broadcast across the world: “This can affect You.” Yet somehow, on days when I was going room to room, intubating or trying to temporize the sickest patients with non-invasive measures, I felt like I was seeing the same patient over and over. Mostly they were Spanish speaking. Occasionally Arabic. Most of the speakers of Native American languages did not personally walk into my emergency department. The inpatient beds were already filled with them as direct transfers from reservation hospitals. The association between higher levels of melanin and ventilator use in Phoenix seemed to disproportionately shift in a matter of weeks. The English speaking, Caucasian patients often had milder symptoms, if they needed to come to my department at all.
But why?
I almost always wanted to ask the patient questions to educate myself on why or how they were so much sicker than the white patient in the low acuity zone down the hall. Why did their family bring them to the hospital today rather than calling the ambulance days ago like their white and English speaking counterparts? But between the rhythmic growls of the CPAP machine, my voice shrill behind a P100 mask and thick face shield, the conversation was typically limited to an interpreter repeating over the speaker phone, “I couldn’t understand
“ The association between higher levels of melanin and ventilator use in Phoenix seemed to disproportionately shift in a matter of weeks.