Gasping for breath
Emergency room physician associate works at the front lines of COVID-19 pandemic.
By Emily Rossing
The case count doesn’t stop rising. Greta Sowles has been watching it slow down over the past six months, but it still rises. Ebbs and flows, like the waves on a heart monitor, but always there. In the summer, when the Fairview South emergency room fills with chest pains, headaches and massive cuts, Sowles is also dealing with sick patients from a now preventable disease.
In late July, the healthcare provider has her back to the wall of the ER hallway, willing herself to hold tears in. Sixteen patients. Thirty-minute appointments. No lunch break. The shifts have been flying by. She hasn’t had more than one consecutive day off in weeks. The bubbling feeling in her chest won’t disappear. Another COVID-19 patient. Another patient yelled at her for not being able to cure them. She walks past the lobby full of desperate people who might have to wait overnight to be seen due to staff shortages.
There’s only so much she can take, and she’s been past her limits for a while now. Her N95 mask hides her face slightly, but not enough to hide her exhaustion. The dark circles under her eyes are highlighted by the tears that slowly drip down her face. A coworker leads her out of the main hallway and around the corner.
“Hey, you’re doing a great job,” he says.
Sowles wants to hear it, but she can’t. Not now. She feels like the 30-year-old patient she had who contracted the virus and had a tube breathing for him. Sowles is gasping for breath too, in a different way. She’s drowning. And no one she’s serving seems to care.
Greta Sowles’ life includes holidays and family gatherings spent outdoors, because she can’t risk contracting a deadly virus and bringing it to work. It includes treating patients who incessantly complain. It includes going days without speaking to her husband, because she’s always working. It includes spending Wednesday night with seventh grade girls, after working with angry patients for hours on end. It includes heart attacks. It includes legos lodged in kids’ noses. It includes burnout. It includes perseverance. It includes the discovery that giving more, might mean doing less.
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As a five-year-old, Greta looked at pictures in anatomy books, not Dr. Seuss. Growing up with three sisters, Sowles learned to forge her own path. She was always interested in medicine, but she liked words too. So she did both. In college, she was Editor-in-chief of the school paper while balancing reactions in organic chemistry. When it came time to think about post-undergrad, she originally thought about attending medical school.
“That’s what the smart girls did,” Sowles said.
Without studying for the MCAT, she thought she’d just apply to become a physician associate, or PA, first. Getting it would mean only two years of school and about half the amount of debt that med school would bring, with a large amount of the same medical freedom. To her surprise, she was accepted. She finished her undergrad at Bethel University May 16, 2015, and enrolled in PA classes just two weeks later.
Naturally, Sowles picked the area of medicine that many consider to be the most challenging. Her first job out of school was working in the emergency room. The learning curve was uncomfortable, involving trial and error every day. Her husband, Jared Nelson, has never seen her at work but was there to help her process during her first year on the job. Nelson recalls what Sowles was like during the first year of her career, while the two were engaged.
“[She] would come home and just be in a rough state because [she] felt incapable or incompetent,” Nelson said.
But she wouldn’t let herself stay there. As time went on, so did Sowles’s confidence in herself. For three years, she worked in three different Twin Cities emergency rooms as a physician associate. In that time, she grew proficient in diagnosing patients, prescribing medications and dealing with the stress of work in a healthy way.
Sowles and Nelson got married in 2018, and both picked up running as a way to exercise and connect. In their first year of marriage, they ran the Twin Cities marathon together, finishing in step. The couple also got involved at their church by being youth mentors for middle schoolers. By the beginning of 2020, Sowles actually felt like she had the work-life balance down.
Then, on a grey March day, everything she knew flatlined.
On day one of the stay-at-home order, Sowles was almost eager to go to work. A brand new virus, and not one she had learned about in school. She watched the movie Contagion to get in the spirit and was surprised to find the set very familiar. She spied the name of her emergency room on a badge of one of the doctors in the film. Little did she know, she would be fighting a real life contagion in that very ER for months following.
“I went into healthcare to do exciting things, like help people to fight pandemics,” Sowles said.
Enthusiasm wore off quickly as reality took its place. With a new dress code including a full gown, gloves, face shield and N95 mask, Sowles encountered those most sick with COVID-19 who needed emergency assistance. For the first few months, ERs were relatively slow because people who would normally come in feared the new virus covering every surface of a hospital. By winter, the disease was so widespread in Minnesota that ERs didn’t have enough beds for the sick.
Then the vaccines came.
Finally, a breath of fresh air.
Sowles was among the first to get the vaccine in December 2020, thinking it might finally be a turning point in ending the pandemic. She initially thought everyone would rush to get it so life could return to the way it was. When that didn’t happen, her attitude changed. Sometimes, she finds it hard to not be bitter towards those who refuse the vaccine for non-medical reasons, knowing that they’re a main barrier to ending the stress on the healthcare system right now.
“I never thought it would be such a fight to end this,” Sowles said.
Once the Health Department deemed it safe again to go out in public, Sowles noticed the ER beginning to return to what it was before COVID-19. She began seeing more of the regular stuff, the “bread and butter” of the ER, as her coworker Peggy Heppner calls it.
Abdominal pain. Chest pain. Dizziness. Headaches. Lacerations.
But the COVID-19 cases didn’t stop either. Add a pandemic to a busy ER and you get overworked healthcare providers.
Sowles vividly remembers not being able to take breaks to eat or use the bathroom.
Twelve hour shifts on her feet.
Getting home, exhausted, finding Nelson asleep.
Waking up before him to go to her next shift, and giving him a quick kiss on the cheek before leaving.
“Other than that there was no conversation,” Sowles said.
She missed what she wasn’t doing. She wasn’t indulging in her favorite pastimes, like going to wineries or playing cribbage with her husband. She wasn’t meeting with her mentees from church. She wasn’t going to bar trivia. She wasn’t getting to visit her nieces and nephews as much as she wanted. She wasn’t sleeping well.
But this is the life she chose. The patients come first. Before loved ones, and too often, before mental health.
The atmosphere at work and the public view of healthcare workers didn’t help either, especially when compared to the first half of 2020. From an emphasis on teamwork in the workplace to being short with one another. From being praised as “healthcare heroes” to receiving a slew of expletives from patients who feel their medical freedom is impinged upon when encouraged to get vaccinated. Sowles believes everyone is just tired, but it still makes it hard to do her job well.
“I’ve never had patients be more rude to me than they are now,” Heppner said.
Nearing the end of her rope, Sowles knew something needed to change.
After talking to her sister, Esther O’Donnell, Sowles decided it might be best to give herself more time off. Still, it was hard for her to pull the trigger. Sowles knew that if she cut back her hours, someone else would have to pick them up. Hospitals were already understaffed. She thought of the patients waiting overnight in a lobby to be seen despite an open bed across the hall, but no nurse available to board them. Or the man who waited in the lobby for three hours to be seen while actively having a heart attack.
She didn’t want to contribute to the problem.
“It wouldn’t surprise me if she would pick up shifts when she feels like this … she gets filled by that,” O’Donnell said.
Eventually, Sowles obliged, and so did her supervisors. She cut down to working at 80% of a full-time schedule, giving her another day or two off during the week. Even in the past year, she’s made it a priority to take weekend trips with her husband or visit her nieces and nephews in Waconia. She’s hoping some extra time off will grant her more of these rejuvenating sessions, allowing her to come back to work as a good, positive provider.
She hasn’t seen a drastic change yet, but a small one. The extra days allow her to go for runs and train for marathons like she used to. One Wednesday, she bakes cookies to give away to all the hungry kids at youth group. The slow mornings are starkly contrasted from the work environment she described as sometimes being “toxic.” With even just a little more time away, her hope is to be more present with patients and colleagues while at work, remembering to have more grace for everyone.
One afternoon away from the hospital, Sowles moseys around the kitchen of her home in St. Louis Park. It feels refreshing to move slowly. The glossy white cabinets reflect the sunlight streaming in from the windows. On the opposite wall, there’s a baby grand piano taking up half the room that she hasn’t played in in a while. She used to love playing. Maybe she’ll pick it up again on one of her off days. Nelson sits at the kitchen table near her. They’re discussing the details of an upcoming trip they are taking to Florida. He’s attending a conference there, and Sowles is spending some of her precious days off to join him.
Sowles sets her espresso on a textbook labeled “Advanced Trauma Life Support.” She has a recertification exam on Monday, and begins to justify why she is studying on her day off to her husband. He just laughs and shakes his head.
“She’s gonna pass with flying colors,” Nelson said.
