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ER doctor: Don’t wait or delay coming into hospital

As featured in the Maui News on May 9, 2020...

Since the beginning of COVID-19 and self-quarantine, we have all been looking at ways to get back to a sense of “normal”. One way I find time to ground myself is to walk my dogs, two lovable boxers who have way too much energy. At my neighborhood dog park, I occasionally see my friends and neighbors with their dogs, and we talk about . . . well, everything. They all know I work in the Emergency Department at Maui Memorial Medical Center and some know that I hold a leadership post as co-director as well as being a member of the Medical Executive Committee.

The first and most frequent question I get besides how I am doing, is how is the hospital doing? They have seen the news footage from New York, Italy, etc., and have all read stories on Facebook as well as other social media outlets that have them worried. My neighbor asked me, “What can we do? We only have one hospital on Maui, and I’m afraid to go there because I don’t want to get the coronavirus . . .”

Well, I will tell you what I told her.

The Emergency Department has been doing everything to prevent anyone from contracting or spreading COVID-19 well before many other hospitals in the state or on the Mainland did. We always took precautions, such as wearing masks in suspected patient rooms, washing our hands and thoroughly cleaning the rooms after each visit. We have designated isolation rooms that help contain any airborne contagion and have been doing so for years.

Our community should feel safer coming into our ER than going to the local grocery store. I know I do.

One assumption from my neighbor is that the ER is overloaded, that they need to stay away to protect, well, me as well as themselves, and I have to say that is incorrect. The ER is seeing half of the volume we are prepared to see. Yes, it is true. We are seeing 50 percent less people than we expected to see on a regular basis. It may be that the loss of visitors, and the “stay-at-home” orders are playing a role in keeping visits to the ER down, but it doesn’t explain the consistent and unfortunate rise we have been seeing in both strokes and heart attacks in our community.

I know these patients are still out there in our community, and they are avoiding the emergency room. I know because I see them after they have waited to access care. Last week, I had three days in a row where I saw multiple stroke or heart attack patients come in after waiting at home for more than a few days. That is, sadly, much too late to make a big impact for their long-term outcome. It doesn’t have to be this way.

I have been an ER doctor for over 15 years, and I feel helpless when I can’t offer the best of care because the patient didn’t come in quickly. When patients wait three days to a week after their health crisis, we are left with limited options.

I told my neighbor, “You know the hospital is rated one of the highest in the state for stroke and cardiac care, right?” This was the hard work put forth by the hospital, the Emergency Department, cardiology, neurology, radiology, and many more colleagues. We made that happen, and the hospital supported us making the collaboration successful and bringing the best care to our island. We are still here, and we are waiting to help you.

I know the hospital could have done better. It is easy to play “Monday Morning Quarterback,” but the hospital has adapted and is making the needed changes to address the unusual circumstances of managing a pandemic. I can tell you we made changes quickly and well ahead of other facilities in the state and on the Mainland, including wearing masks in the ER and limiting visitors, and we are still making improvements to stay prepared for whatever comes next.

Please know, we are here for you and above anything else, it is safe to access care at Maui Memorial Medical Center. Do not wait to come see us if you are experiencing an emergency. Please. We have always been here for you and always will be.

Dr. Vijak Ayasanonda
Co-director of the Emergency Department at Maui Memorial Medical Center.