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— Clinical

Fetaulaiga Ala: At a Crossroads

I was in our Hospital Command Center in early February 2020 when we got that first call that U.S. Marshals would be transporting people who were sick and might be infected with a novel coronavirus — evacuees from Wuhan, China being held in federal quarantine at the nearby Marine Corps air base — to our hospital in Hillcrest. Our Incident Commander turned me and said, “Liz, what’s our plan?”

My first thought was “Holy s***, this is real. This is really happening.” Until then, it was all talk, just something we heard about in the news. We’d been through this before. With Ebola, we had prepared, we created a dedicated unit, but the virus never came. It occurred to me in that moment that this time would be different.

“I didn’t know what my plan was, but we obviously needed one — quick.”

It was one patient from Wuhan that day. Then another. Then another. The first thing we needed to do was figure out how to clear and secure the path of patient transport from ambulance to the rooms that had been readied for them. For the first few weeks, we worked closely with the Marshals. Everything was tightly controlled. Then one day the Marshals left, and it was up to us to determine who could go where and when.

Then it all snowballed from there.

After the Wuhan evacuees were released, we were at, well, “fetaulaiga ala.” (That’s “crossroads” in Samoan, which my parents spoke at home while I was growing up in Hawaii and California, and the language in which words still first come to me sometimes.) That’s when our leaders turned to me and said, “Liz, we need to secure every entrance. No one in except staff and patients. No visitors.”

We needed a new plan.

Seemingly overnight we set up a system to screen each person entering our hospitals, and only those with an employee badge or appointment could enter. Those early days were the hardest — processes and requirements were changing every day with the fluid situation. Sometimes mistakes were made simply because a person could show up to work following yesterday’s new protocols, not knowing they had already changed again.

It quickly became clear that our agents couldn’t possibly staff every entrance station, so we worked closely with the health system’s labor pool — a system for re-deploying staff from other units to an area of greatest need. Suddenly, agents weren’t just responsible for themselves, but became team leaders and subject matter experts in a way they never were before.

“At the same time, many of us were worried about our own families. We may have been a little resentful at first of all the people who could do their work from home when we couldn’t.”

I had to show up to work every day, as did my husband, a San Diego Police Department detective. And of course we worried that we could be bringing this mysterious virus home to our family. I’m grateful those fears never materialized and we fortunately have not been affected personally by COVID-19. As we learned more about the virus, and with the tremendous support of UC San Diego Health’s experts and leaders, we were able to take all the right precautions to work comfortably and safely on the front lines.

I cannot tell you how proud I am of my amazingly adaptive team. Whenever the need seemed impossible, we just dug in our heels and said “How can we help?” even if that meant working double-shifts (16-hour days) for seven days straight when we had to. Even when the worst happened — we lost a member of our team to COVID-19 — we came together, and we stepped up our efforts to get everyone vaccinated.

In January 2020, the Security team was again called upon to help make the impossible possible: Work with the County, the City, the San Diego Padres and San Diego Police Department to open the state’s first drive-through Vaccination Super Station at Petco Park. Oh, and do it all in just five days from idea to open gates. Everyone jumped in. It was hard at first, making adjustments every day to traffic flow and maintaining a safe environment for our hundreds of staff and volunteers, as well as the thousands driving in each day to be vaccinated, all in a parking lot downtown. Several days of wild winter storms didn’t make it any easier.

At times the Petco site felt like an episode of M*A*S*H — it was like a medical drama and I found myself in the middle of patient care in a way that I normally don’t. Each day a “doc of the day” was in charge of overseeing medical care, should patients need extra observation for rare allergic reactions after vaccination. I’ll never forget this one day when I was talking to the doc-of-the-day at our onsite command center when a call came through by walkie-talkie for a medic. I basically threw the doctor into a golf cart and drove him to the medical tent. He jumped out and started calling out commands before I’d even rolled to a stop. I’d never seen anything like it before.

I’ll also never forget the gratitude of the people coming in to be vaccinated — even if they had waited for hours, they were thanking us. That was worth all the hours of walking, talking, planning. After the Petco superstation, launching and managing additional vaccination locations was easy by comparison!

Before COVID-19, one of the main things my Security team was focused on was managing workplace violence. Most people would probably be surprised to hear it, but violence is a major issue in health care environments everywhere. So for many years we’ve been developing threat assessments and implementing data-driven programs for conflict management and weapons screening.

A silver lining of the pandemic has been that now, with staff at each hospital entrance to screen for COVID-19 symptoms and compliance with masking and visitor requirements, hospitals everywhere are more secure than they ever have been before. It’s long kept me awake at night that, just by its nature, the hospital is completely open to the public. There wasn’t a way to know who was in the hospital at any given time — who they are, why they are there, where they are going. But now calls to Security to manage unauthorized people, custody and domestic violence issues, vandalism and theft have gone down to practically zero. I can tell you how many people are in the hospital at any given time, and that’s huge from a safety perspective, including in the case of fire. I hope we can keep it that way going forward.

Through all of this, we realized that we are more capable than we ever thought possible — we really can implement totally new systems very quickly when we need to. If you had told us before we’d have to do the things we did, we’d laugh and say we couldn’t do it. But we did it, and we improved every day along the way. I’m grateful to the team for not becoming overwhelmed, but instead realizing that UC San Diego Health, where we are blessed with incredible support and resources, is the best place to be.