Chris Hutchinson worked back-to-back 10-hour shifts as a doctor in the Beaumont Royal Oak emergency room over the weekend and worked another on Tuesday.
The days are long and the COVID-19 patients seemingly endless.
But on the front lines of this pandemic that has gripped the nation and world, there are no breaks.
Hutchinson was a Michigan football player, a captain, the Big Ten Defensive Lineman of the year in 1992 and an All-American that same season. He perhaps is better known now as the father of Aidan Hutchinson, the Wolverines’ fiery defensive end, whose spring practice has been postponed, like all college athletics across the country.
His playing days long gone, Chris Hutchinson is an emergency room physician whose work has put him at the heart of the COVID-19 outbreak locally.
“You just have to put your head down. This is my job, and this is what we’ve got to do,” Hutchinson said in a telephone interview with The Detroit News this week. “It just is what it is. When you sign up for emergency medicine, part of our curriculum is disaster management, but who sees this? Nobody. Nobody sees this and hopefully won’t go through this again.
“It’s just what you do. You’ve got to do it. It’s part of the job. I’ve got to do my job. I can’t not come to work. Somebody’s got to do this, and this is my role here. Put your mask on and have at it. Is it fun? Absolutely not, but somebody has to do it.”
As doctors across the country are coping with limited protective gear, particularly masks, while caring for a growing number of patients, Hutchinson’s message is clear to everyone.
“Just assume you’ve got it,” Hutchinson said. “Quarantine yourself.”
He has over the last couple of weeks repeatedly said this situation will get worse before it gets better. There is no vaccine or cure yet for the coronavirus, and they're a long way off. The medical community is working to find ways to get a handle on this situation that has already led to more than three dozen deaths and more than 2,000 confirmed cases in Michigan.
“We’re not close to being plateaued,” he said. “We’re still in the steep, upward curve. We’re still in that phase. I don’t know how long that’s going to be.”
'Everything has changed'
The availability of single-use masks has become an issue across the country, and Beaumont Royal Oak is no different. He used the same mask for his Saturday and Sunday shifts.
“It’s all pretty much on lockdown,” Hutchinson said. “You have to sign one out for our N95 mask. Ideally, they were supposed to be single-use, but under restrictions, they’ve expanded so now that masks last one day or more.
“The infectious disease doctors tell us they use them for a week at a time. As long as they’re not grossly soiled, we use them for a week. We’ll put another chintzy surgical mask over them when it’s more heavily contaminated. But we have to assume even if somebody comes in for belly pain, just about everybody coming in has got (the virus).”
Patients are evaluated and treated in negative-pressure rooms, which are on suction so that all the air exits through a special vent that heats the air from the room and kills all bacteria before it is released. Beaumont has an entire area with multiple rooms, so the entire unit is negative pressure. Medical personnel must enter wearing masks and shields.
If a patient is in serious enough condition to be intubated and placed on a ventilator, the medical personnel must double everything from gowns to gloves. Hutchinson said anesthesiologists who typically would be working with elective cases have handled all the intubations.
To reduce the possibility of cross-contamination, medical personnel at Beaumont are coming up with different ways to reduce the amount of contact with patients.
“We’re actually trying other things,” Hutchinson said. “We all have their phone numbers in their rooms, so other than the assessment when we have to lay hands on them, we’ll actually talk to them on the phone, call into their room, ‘Hey, this is Dr. Hutchinson, I’m your doctor, we’re gonna do this, that and once this is fine, we’re going to get you out of here. You have any questions?’ So we limit our contact and limit the amount of (protective wear) we use.”
While there has been considerable conversation nationally about a shortage of ventilators, Hutchinson said that while Beaumont Royal Oak might be getting thin on ventilators, the hospital has a large number of BiPap machines that can act as ventilators. There are ventilators in the operating rooms, but those must be manually operated.
He said because so much is in flux, the hospital staff has four or five meetings a week. Once the doctors and nurses get used to one process, there's another.
“Everything has changed,” Hutchinson said. "Everything changes almost every day. You just don’t know."
'Just assume you've got it'
The emergency room is typically jammed with patients complaining of chest pains, or someone arrives with a gash that needs stitches or maybe another has a badly sprained ankle.
But this is a new world and the coronavirus has been the primary focus of ERs.
“The struggle from a diagnostic standpoint, you have to keep asking yourself, ‘What is this other than COVID?’ Because it’s all COVID, so you’re just trying not to miss something else because it’s seemingly everybody you walk into,” Hutchinson said. “And you just don all your (protective equipment), because even if they say sprained ankle, in a second they’re going to tell you, ‘Oh by the way, I’ve been coughing for a week.’
“Everybody here is gowned up and say, ‘Hey, another COVID, hey another COVID.’ Of the 20 I saw (Sunday), maybe four had nothing to do with COVID. That’s the amazing thing to us — where are the people we normally see 120,000 of? Where are they? They must have their chest pain and belly pain at home. How can this be? It’s scary. Now it’s none of that, it’s all COVID. That’s, to me, the most staggering part of it, almost everything else has gone away, and it’s just COVID every single day. Where are all those people who cut their fingers?”
Hutchinson laughed for a moment. Yes, where are those normal days when people would come into the ER with a mixed bag of typical ER complaints? Now, COVID-19 is the norm, and gradually, he said, people are understanding there’s only so much that can be done in the ER for those who aren’t presenting symptoms. Testing is limited and results do not come back immediately.
“Part of it now is just education,” Hutchinson said. “People say, ‘We want to know the diagnosis.’ Well, it’s so rampant in the community, just assume you’ve got it. ‘Well, I want the test.’ Just assume you’ve got it. We keep telling people that over and over again — just assume you’ve got it. If you get worse, come back.
“The less ill ones are starting to not come in because they’ve come in already or they’re realizing there’s nothing we can do for you. We have those experimental treatments with the erythromycin and the hydroxychloroquine but we’re only doing those for inpatients. And that’s a study of like 40 people so we don’t really know if that really works, but we’ve got to try something.”
Hutchinson, 50, has treated H1N1 and West Nile virus patients during the height of those illnesses. The volume, though, was much less, nothing like what he is seeing now.
“No one in my generation has been through a health-care issue like this,” Hutchinson said. “I tell the younger residents, the only thing I can equate this to was in the late 1970s and the oil shortage. I remember waiting in line with my dad to get gas for 2½ hours. That’s the only thing that everything shut down, and I lived in Texas at the time, so it was a really big deal.”
COVID-19 is clearly a big deal as evidenced by state-by-state and federal responses. Hutchinson said younger people need to be vigilant, as well.
“They don’t get it to the same frequency, yes, but that doesn’t mean they can’t get sick from it,” he said. “In general, the younger you are with less medical problems, the better you do. But that doesn’t mean it’s a free pass to go the beach and still do your beer bongs on spring break. You’re still at risk.
“And even if you don’t get very sick from it, you’re now a vector to give it to the 55-year-old who has lung disease. It’s about reducing that transmission to everybody because 30-40% of people aren’t even symptomatic. And I know people are like, ‘I want to live my life.’ OK, but don’t get my grandmother sick, don’t get your mom sick. You’ll kill them.”