I’ve Had It

It started with a young couple who had just come off a cruise from Mexico with an awful cough they couldn’t shake. They coughed all over me. I saw several more patients with similar illnesses coming back from cruises to Jamaica, the Caribbean, South America…

But no one from China.

That was near the end of February.

The first day of March I started with a bit of hoarseness. It lasted for a few days. I didn’t feel bad at all but I sounded awful, barely able to croak out a whisper.

Then there was a tickle in the back of my throat.

Sometimes the tickle would trigger a coughing fit… a coughing fit so bad I would have to excuse myself from a patient room to grab a drink of water. The cough was always nonproductive. No nasal congestion. No runny nose. No postnasal drip. On the plus side, my voice was back. I’d had this happen before with spring allergies, given the fact I probably had a mild case of seasonal asthma, but oddly, the cough went on for well over a week. I really didn’t feel bad per se. It was just that silly cough. I still didn’t think I was sick.

Until the fevers started.

The fevers came and went and they went on and on. 101. 102. Down again to 100.4. Early morning and late evening seemed to be the common times it would spike. Fatigue. Shortness of breath. I got an inhaler and started using it. I took a steroid pack and an antibiotic. Cough pills. Allergy meds. I took a second antibiotic. I got a chest X-ray.

Nothing seemed to help.

I stayed home for a couple of days when the fevers started but after that, I felt I had to go back to work. Tons of pressure to work. Pressure from corporate, the clinic staff, my office manager, patients, myself. I didn’t want to be called lazy. Or a wimp. Or a malingerer.

So I wore a mask. We had a stash of N95’s and I wore one the whole time I was working. I felt OK with that until one day I started the morning with a patient on oxygen, the next patient had lung cancer and was getting chemo, the next was a frail 90 year old. It spooked me.

What if I make all of these people sick?

What if I killed them by being in the same room with them?

I called the local health department to ask if I could be tested for coronavirus. They were the only ones with tests at this point. My hands were shaking as I made the call. I was terrified of the medical and social implications. A doctor testing positive would no doubt make the evening news. Stigma. The answer from the health department though? Absolutely not. No testing for me. I couldn’t possibly be infected, they said. No exposure to someone recently returning from China and no exposure to a known positive COVID patient.

Corporate, though, got worried and forced me to go home. Honestly, I have worked while I was much, much sicker. During residency it was always emphasized that we had better be present at the hospital rounding on patients unless we were the patient being rounded on. Or dead. We could be dead and that would be a reasonable excuse…

The following weekend, still running fevers, I had a spell where my heart felt like it was racing out of my chest and I dang near passed out. I had to call out to my husband to keep me from falling over onto my face. It passed after a minute or two and I successfully talked myself and him out of a trip to the ER. The whole spell was probably just my imagination going crazy, right?

Interestingly, food did not taste right at all. I felt like that was probably due to all of the medications I was taking. This was before smell and taste changes were identified as part of Coronavirus.

The fevers finally stopped after 10 days. All said I had been acutely ill for over three weeks. I was finally allowed to go back to the clinic. The first thing I did was to call all of the patients I had seen while I was ill to make sure they were OK. They were. Thank God for N95 masks. I still had a cough, though. I still had to use my inhaler. Walking up even a low, gentle hill was just not possible. It took a few more weeks to have all of THAT pass. I have never had something like this hang on for so long. In some ways, I felt more debilitated after the fevers were gone than I did during the acute phase. The whole episode had felt so strange, not like any illness I’d had before.

By then, my clinic was turned into a respiratory clinic. People suspected of COVID were sent to me for testing. My mind would go to dark places almost every day. What if what I’d had was NOT actually coronavirus? Would I get sick? Was I going to die? BUT then I felt that if anyone had a chance to have immunity, it was me even if we didn’t know positively. So I made sure I was the only one doing all of the testing, keeping my staff away from being exposed to patients who were ill.

All the time, I wondered. I have wondered for over five months as I have watched some of my patients die or end up in ICU as they fell ill.

Yesterday, I was told that I AM positive for the antibodies. Testing was performed as part of a healthcare worker research study. I don’t know how high my antibody levels are, only that I have them. No one else in my clinic has antibodies. Is it possible that I had an asymptomatic case later? Sure. But I believe I was one of the first in my area in early March with COVID-19.

There is a huge weight off of my shoulders, now. I did not realize how much the fear and doubt were weighing on me until it was gone. How much immunity I will actually have, especially at this point, I don’t know. But I do know this:

I survived COVID.

And?

If I did it once, I can do it again.

Long Distance

“I had lunch with your dad a couple of days before he died.”

“What?”

We were talking about the logistics of his own grandfather transferring to another facility so he could be with his wife.

“Yeah. When I’m in town I always have lunch with my grandpa. He and your dad were lunch buddies.”

I’d had no idea my father was having lunch with one of my patients. And apparently my patient had no idea he was eating lunch with his doctor’s father until the picture was flashed up after he died. He saw the name and realized the man’s daughter who was a doctor was….

Me.

That meal was the beginning of the end. Something happened. That afternoon as I was wrapping up clinic the assisted living facility called to tell me he wasn’t doing well. When I got there he said he had choked then urinated on himself. His blood pressure was dangerously low and he had a terrible headache, severe back pain. He had apparently left the meal without telling anyone at the table what was going on.

My father suffered the indignities of dementia, angry about having his freedoms taken away one by one….. He had already lived through polio. One pandemic should be enough for any human being. I am glad he died before COVID. He would not have done well with quarantine thrown into the mix. His facility on lockdown? He needed family to visit, to keep him sane. Someone to yell at.

I went as often as I could.

It still didn’t feel like enough.

My father, if he were here, would likely subscribe to all of the COVID conspiracy theories. He would have cheered healthcare workers going from heroes in the US to suspect individuals, purveyors of falsehoods to keep the American people under control. I think he would have been one of those that refuses to wear a mask.

Or maybe not?

I didn’t know him that well, after all.

How strange to have a man, halfway around the world, tell you out of the blue that he had lunch with your father a year ago. A man you have never met. If God allows things happen for a reason, what reason for this?

“My grandfather thinks highly of you. He might not put a lot of stock into what other people say, but you? You he listens to.”

And there I was. Sitting at my desk, gooseflesh standing out on my arms. Hot from working outside in the sweltering heat. Tired of telling suspicious people all day that COVID is real and they need to take it seriously.

“Thank you.” Thank you for taking the time to tell me.

It felt like I had just gotten a big hug from my dad.

Maybe he doesn’t hate me after all.

Paradigm

If one could say there is something good coming out of the pandemic it is this:

Medicine has been forced to rethink how it delivers care.

After begging for telemedicine access for years, BOOM! I have it. After being told I cannot see patients in their homes, BOOM! It is not only allowed, it is smiled upon.

I spent most of the day yesterday seeing my patients in their cars. I had regular patients that don’t have access to telemedicine out front in the morning and Covid suspect patients out back for testing in the afternoon so I was not going back and forth putting people at risk. In between I was seeing patients via telemedicine.

It struck me as I stood in the sun for a few hours that I need to start wearing sunblock in my moisturizer or I am going to get a fascinating N-95 tan line on my face if this keeps up. The temperature was close to 90 degrees (that’s 32 degrees to the majority of the non-US world) and I had ice packs in my pockets to try to stay cool in the sun while dressed in a long plastic gown with absolutely no ventilation. Dehydration could be a risk as the summer progresses and temps get up over 100 degrees (37 degrees Celsius). I can’t just take off everything to swig down some water and then pop it all back on.

But I am not complaining! I am getting to be creative, feeling like I am actually doing something productive and meaningful on a level I have not been able to experience since residency. Are there risks? Sure. But that makes it spicy.

I have not been able to respond to comments as I would like and I am sorry for that. I will catch up when this is all over and things have slowed down.

Call of Duty

How do we stay connected as humans beings as we retreat from our patients and from each other behind gloves and masks and face shields?

I have been pondering this.

Back in the day when I was doing inpatient medicine, if I knew someone was dying and there was no one to be there with them, I would go and hold their hand until it was over. The thought of dying alone is very upsetting to me personally. I don’t want to be alone. I don’t want anyone else to be alone.

Hospitals right now are not allowing visitors at all. If your mom or dad or sister or husband gets admitted, no one can come in with them… they are alone.

We have made plans for COVID dedicated hospitals in the area. I am on the list to help out at one should the need arise so I have been brushing up on ventilator management. That part does not scare me. God knows when my time is up. I won’t be reckless. I just know that I could walk through a room full of coughing COVID patients without PPE and if it isn’t my time, it isn’t my time. But knowing that if we are overrun, I may not have the opportunity to linger at the bedsides of those on their way out really bothers me.

I wonder what all of this is going to do to us. What will the world be like in the other side, when the danger has passed? I don’t feel like a hero. It bothers me when people say that I am. This is my job. This is me being human. This is what we are called to do, to care for others. All of us has an opportunity to be a “hero” to someone right now. Whether it is giving food or money or emotional support to those who need it or caring for someone in a hospital bed. They ALL carry risks. It is easy to hide behind a door, a mask… to disappear.

Don’t disappear.

The Shift

Getting ready for work is super easy now. I throw on a pair of scrubs and my tennis shoes, pull back my hair into a ponytail, slap on a smattering of make-up and I am done. No rings or necklaces for germs to hitchhike home on. I kind of feel like I am back in residency but I don’t want my hair getting tangled in the face mask and who needs lipstick when you can’t see it anyway?

Face mask cons: they cause an increase in zits and blemishes

Face mask pros: they cover said blemishes

Right now I am running a Covid suspect clinic, meaning if you have respiratory symptoms that indicate possible Covid-19, you are sent to me for evaluation and testing. I have a safe harbor letter that allows me to go to and from work in case I am pulled over for being out during lockdown. That sounds weird.

Safe harbor?

This does not feel safe….

My kids are struggling, trying do online school with a grandmother who is not entirely technically savvy or a dad who is having to work from home. They miss their friends. They miss their mom. AND they don’t understand why they cannot use toilet paper for craft projects right now. Everyone started talking about toilet paper shortages and all of a sudden my kids decide it is great for all manner of things beyond wiping your butt.

Go figure.

There are dire predictions abounding everywhere. It is dizzying how much the world has changed in less than a month. BUT humans have a history of facing dire circumstances with ingenuity and sacrifice. Are we scared? Sure. But fear is helpful. It ensures we make safer choices. Will people die? Yes. Many already have. And yet many more will live.

So listen up, people! We are going to make it through this. We are all stronger than we know.

Circumstances Being What They Are….

“I want to say that I am exceedingly upset about getting rescheduled a second time. Do I need to find another doctor?”

I read the message again then typed a response:

“Yes, you probably do….”

For a few seconds I stared at the blinking cursor, waiting for the guilt to overpower my hurt. Finally, I hit the backspace until the words disappeared. I closed out the note and removed it from my tasks box without responding.

I’d spent the weekend on call from my father’s hospital room and I was sleep deprived. He was in excruciating pain, choking on everything he tried to eat or drink. His blood pressure was 88/40. No urine output for almost 24 hours. He wasn’t able to maintain his oxygen levels without supplemental oxygen. And I’d STILL had to fight with the prick of an ER doctor to get him admitted Friday evening.. We’ll just send him out with some codeine cough syrup... until I divulged that I was a physician and knew what he was trying to do was wrong. Codeine cough syrup would not control his pain if 4mg of morphine could not.

Even mean, ugly, crippled people with dementia and a history of leaving the hospital against medical advice deserve compassionate medical care when they are suffering.

Over the next couple of days my father required more and more oxygen and needed my help to use the bathroom.

He stopped eating.

He stopped drinking.

Now it was Monday. I should have been seeing patients.

But I wasn’t.

Because he died...

Instead of seeing patients, I sat in front of my computer in a bare office with no windows. A box of Kleenex waited nearby, ready to catch the unexpected tears that kept sneaking out of my eyeballs. I was there to wrap up loose ends so I could take the next few days to help my mother arrange the funeral, get him buried, and get his stuff moved out of the assisted living facility.

The patients didn’t know this.

No one had any idea that I quit my job of 14 years to move back to my home town because my father’s dementia was worsening. They had no idea that he was in and out of the hospital starting the first day of my new job. At one point he had even barricaded himself in his house for over a week after my mother moved out because she feared for her safety. He would let no one in, not even me, until he finally emailed in a panic because he was hallucinating. He couldn’t remember how to place a phone call. They did not know that I removed 40 guns, some of them loaded, from his house during the subsequent hospitalization or that I helped get him into a memory care unit, that I’d filed for legal guardianship through the courts to make him stay there because he could not understand why he shouldn’t be allowed to drive or own a gun or live on his own.

Over the course of six months a once proud man lost his freedom, his dignity, and his will to live and I’d had no choice but to do it to him.

I still feel so guilty.

In truth, I was not prepared for how much losing a father messes with your head. It came as a surprise that I found myself mourning someone I spent so much of my life hating. Is it easier if you loved them? Yet, seeing someone you hate suffering as he did, trapped in a hell that was not of his choosing… it does something to soften even the hardest of hearts, I think.

It softened mine.

And then there is the guilt, even months later.

I wonder if he understands now… if he forgives me?

So here I am, less than I was in some ways and more than I was in others. I miss my blog. I miss my friends. I miss my old home, my old office with the giant picture window, and I miss my old patients. After almost a year and a half after moving I think I am finally getting past the dysphoria of recognizing bits of my past in the shadows and around the corners of this town.

Progress.

It was unquestionably the right decision making the move, and I would do it again, but it came with costs, some of which are difficult to put into words.

When people ask if I am happy with my new job, I focus on the positives. I don’t want them to know that I am second guessing myself on an almost daily basis. Here, at this place, I can make a difference in a way that I could not before. But I wonder sometimes if I am strong enough to persevere through all of the layers of bureaucracy and politics, things I really suck at, to last any length of time at this. I no longer have the protection that seniority affords and there is such a thing as caring too much. I can feel it eating me alive because I simply cannot let things go and keep my mouth shut. Not when something is clearly wrong or not fair.

Where did all of that outspoken stubbornness came from?