Multiple times a week, I get messages asking some variation of, “How are you holding up?” I am neither an anesthesiologist, critical care, or ER physician, so I’m not three inches away from exposure while intubating patients with coronavirus. I am also not a nurse or respiratory therapist in a room dozen of times a day administering life-saving medications, performing vital assessments, or carefully managing the oxygen lifeline. I’m certainly not someone in charge of the hospital operations, and no one relies on me to prepare food, ensure security, or clean the work environment. Finally, I’m not working in places that look like war-zones (Bergamo or New York City). I guess I’m doing fine. However, as a hospitalist, I do take care of patients with COVID-19 who are too sick to be discharged. My days have blended together into an eight-week block. I arrive at the hospital in scrubs (new for me), review labs and diagnostics, and start rounding with a N95 mask, face shield, gown, and gloves. I finish after a few hours and am relieved to temporarily remove all the garb. My time spent documenting in the EHR is frequently longer than the time I have spent with patients. In the afternoon, I update families via telephone because no visitors are allowed, and I go back to the wards to evaluate the sickest patients. My day is punctuated by notifications about rapid responses; my patients being upgraded to ICU or by the need for me to pronounce a deceased patient. Overall, I’m tired from the never-ending cycle of despair. On further reflection, I find myself shifting between these states: Fear Anger Courage Transformation Stress Fear Statistics don’t help me. My mind doesn’t take solace in the fact that the case fatality rate is “likely less than 5 percent” or that “elderly patients are more at risk.” All I see scattered over social media, and the news are images of young healthcare professionals succumbing to the virus. In my own patients – mainly those from nursing homes – I see the lonely death without family or friends at the bedside. I also witness the obliteration of their decades of experiences. Horrifying doesn’t begin to explain the spectacle. I am hypervigilant and do things like wipe down every keyboard or phone I touch, open door handles with tissues, I religiously put on and take off my PPE, and I come home and strip down in my garage and immediately shower. Yet still, I worry that I inevitably must mess up somewhere along my day, and I wonder if I will fall sick or whether I will expose my family to the virus. Anger The target of my anger shifts between inept government officials, healthcare middlemen who have bled our healthcare system dry, a world that thrives on inequality, and some health system administrators who don’t seem to prioritize the safety of frontline healthcare workers. My anger quickly abates, though, since I don’t have time to focus on the past at this moment. Courage I wish I had more. Up until now, I thought I had an iron stomach and steady hands. Until a few years ago, I rarely thought much before jumping into experiences; I traveled carefree (sometimes carelessly) across the world, participated in medical relief work abroad, and worked across the country without thinking twice about uprooting my life. I now worry constantly about the consequences. Turns out, having young children changes your risk tolerance; the thought of your family fills your heart with love and nourishes your soul but also tests your stomach. During some particularly difficult moments in the hospital, I can feel a fluttering for what feels like an eternity before I manage to get my bearings. Seeing all the other hospital staff turning up every day to fulfill their duty gives me courage and inspiration. I, too, put one foot in front of the other and stride through the sliding doors of the hospital. Transformation Besides the obvious fact that the pandemic has upended our daily lives – something else feels different. Our society cannot go back to business as usual, and I certainly can’t. Up until now, as a physician, I’ve taken care of one patient at a time in front of me. I’ve fought to ensure that whatever is medically necessary gets done for my patients while they are hospitalized. However, after they have been discharged – I have been largely absent in their care and wellbeing. I definitely haven’t made myself an activist in any greater cause, and essentially I’ve been reactive rather than transformative. Going forward, I now see that I must personally do much more to become involved in activism to fix our broken system. If healthcare professionals continue to stand silently and just “do their jobs” – nothing will change about the inherently unjust and flawed healthcare system, we have allowed to exist. The existing sick-care-system has allowed the proliferation of chronic diseases, the neglect of the vulnerable, the metastasis of profits over patients’ ethos, and a complete break down of the doctor-patient relationship. Stress Unfortunately, stress seems inevitable for all of us at this time – whether you’re an essential worker or whether you’re at home protecting against the spread. We each must execute strategies to manage stress, so it doesn’t conquer us. In my own experience, step 1 has been to accept things as they are. After this, I’ve made it a point to carve out some time for myself and be thankful. Finally, I’ve tried to just be present with my family. I’ve managed to turn off the news and put down social media. Like many have reminded us – the present moment is the only one we have to lose – and rehashing the past or fretting about the future is futile. Varun Verma is an internal medicine physician who blogs at his self-titled site, Varun Verma, M.D. He can be reached on Twitter @VarunVermaMD. Source
