‘Things have been very tumultuous’: A family nurse practitioner worries patients could go without care

Rachel Cox shares what it's like to work at a clinic facing staff layoffs

A nurse holds swabs and a test tube to test people for COVID-19 at a drive-through station set up in the parking lot of the Beaumont Hospital in Royal Oak, Mich. PAUL SANCYA / AP

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This story was told by Rachel Cox, a family nurse practitioner and clinical operations associate at Tristan Medical Care Centers, and has been transcribed and edited from a conversation with Kristi Palma.

My name is Rachel Cox. I’m a family nurse practitioner and clinical operations associate at Tristan Medical, which is a collection of small, private family practices in southeastern Massachusetts. We normally do primary care, urgent care, and occupational health. And for the last few weeks we’ve been doing a lot of telehealth, which has been logistically challenging. Things have been very tumultuous here, very scary.

We are very fortunate to have a decent amount of supplies. Our big issue right now is we’ve got all the supplies, we’ve got test kits, but the company has been really struggling. A lot of our business was more elective type stuff like routine wellness visits, occupational health was a big source of income for our clinic. Of course, all of that business has mostly dropped off at this point. So the business has had to make a lot of really difficult decisions. The staff is terrified of catching coronavirus, but they’re also terrified of losing their jobs. We laid off some people this week, which was really, really sad.


Our big concern is we have a lot of patients and if we’re not around to take care of them at this time because we can’t afford to be, then everybody is going to go without care, which is really stressful and scary. I did get a tent this week and I set it up in the parking lot, so that sick people can come and get seen in the tent. That way, the staff don’t have to be exposed in a contained space. One of our clinics hasn’t had any positive cases come back yet, but the other two sites have had plenty of positive tests come back.

My husband is also a nurse practitioner, so the two of us are in the same boat together. He works at a hospital. We have just kind of isolated ourselves off from our respective families. We don’t currently have any children. So it has been tough but we’re very fortunate in that we’re both kind of in the same situation together. It makes it easier. There’s a lot less guilt because we both know that we could be bringing it home to the other person. We miss our families. But they understand. I have had a couple of confirmed exposures and he got quarantined two weeks ago. We had separated a little bit at that point — split the house up, different bedrooms and stuff. We had already prepared a lot of stuff ahead of time, just in case. So it really wasn’t too bad for us, thankfully.


Telehealth allows us to have video visits with patients, but not all of our patients are technologically savvy enough to always make it work consistently. And, to be honest, we didn’t really prepare for something like that. So our internet service isn’t quite good enough. But we do our best. I try to do as many visits as I can. It’s kind of time consuming, but it’s a great service. Patients like not having to leave their house. They are very appreciative that we have something like this, even if it’s not perfect.

I have to say the patients have been very supportive. They are always sending well wishes and calling to check in on us, so it has been really nice having that support from them. They’ve been very understanding and very patient with all the problems we’re having. And the staff is all just trying to be brave now. We’re here as long as we humanely can be. We’re going to try to keep the company open and running for as long as possible, even if we have to make hard decisions. We don’t want our patients to go without care. The rest of their health goes on, even during coronavirus.



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