When Covid arrived the health system shut down. The hospital stopped admitting patients, except for those with Covid-19 who couldn’t breathe, and the most seriously ill. Mammograms, colonoscopies, biopsies, bunion surgeries, tonsillectomies, sinus surgeries, barium swallows, MRIs, CTs, x-rays—all elective surgeries and procedures, discretionary studies of all kinds, and non-essential imaging were canceled until further notice. People were told to stop coming to the hospital. Stay home and hunker down was the message. Everyone bought toilet paper and face masks and hand sanitizer and bottled water and waited.
Only the sickest of the sick, those who were having heart attacks and strokes, who suffered traumatic injuries or aneurysms or severe infections, the most life-threatening conditions, those whose bodies did not get the message to stay home and continued to get sick regardless of the zeitgeist, dared venture to the Emergency Department. To do so was to put yourself at risk of contracting the virus, to put yourself at risk of death.
The shutdown extended to private doctor’s offices, the health system’s ambulatory centers, and specialty clinics. People stopped coming to these places as well. Illnesses were not treated, diagnoses not made, prescriptions left unfilled.
My office, an ambulatory medical center, part of the hospital system, also closed its doors. Physical therapy, the outpatient lab, the imaging suite, the satellite oncology office—all closed until further notice. Only primary care and women’s health stayed open for patients who absolutely had to be seen. A schedule was developed whereby a primary care doctor was assigned to be in the office one day a week to see these patients—patients with urinary tract infections and chest pain and pneumonia—those sick but not sick enough to hazard a trip to the Emergency Room. Those doctors not scheduled to be in the office were to do what they could with patients over the phone until telemedicine and video could be brought online.
The hospital distributed placards for us to hang from our rearview mirrors that said we were essential personnel, in case we were pulled over by the police on the way to work.
This was the morass in which I found myself in March of 2020, a primary care trained osteopathic doctor who, after fifteen years in practice was disillusioned with medicine and looking to get out but, either out of loyalty to my patients, or age, or inertia, or the fact that no employer wished to entertain the yearnings of a fifty-two-year-old doctor looking to switch careers, I felt stuck. I was stuck. But what would it say about me if I suddenly left just when the pandemic was beginning in the United States? How could I leave when my inpatient colleagues were risking their lives every day?
I thought about my maternal grandfather, Scotty, a World War II veteran who passed away years ago. In the war he was an enlisted man—he made the rank of sergeant—whose job it was to drive around a colonel in an army jeep that my grandfather named Mim and Cin, a nod to my grandmother, Mimi, and my mother, Cindy, who was two years old at the time. My mother has an old, creased, black-and-white photograph of him in France standing next to the hand-painted names on the side of the jeep’s hood, his right combat boot, fatigues draped neatly, standing on the driver’s side running board, his right forearm balanced on his thigh, looking at the camera and smiling. I once asked him if he participated in D-Day and he said, proudly, he went over to France on D-Day plus 2, two days after the initial invasion to secure the beachheads in Normandy. That’s how I felt about my role in the pandemic—I didn’t go in with the first wave, but I did my part, however reluctantly.
Every Tuesday I dutifully donned two surgical masks and safety goggles (when N-95s were in short supply and reserved for inpatient staff who were instructed to store their masks in brown paper bags between shifts) and swathed my hands with Purell and prayed to a God I wasn’t sure I believed in to protect me from the virus and intubation and death and went about seeing patients.
At first, I saw two or three sick patients a day. All masked up and safety glassed, I kept them at least a stethoscope’s distance away.
The hospital administration held weekly conference calls to buck up morale and praise the hard work of everyone and tell us they were working to get more PPE and to ask for volunteers to work inpatient if needed. On the hospital website the infection control section maintained a page of statistics, starkly laid out in numbers and graphs, of how many patients were suspected to have Covid, how many were tested, and how many were positive. It also included the number of Covid patients on the medical floors and in the ICUs, how many ventilators were being used by Covid patients and how many were still available, the number of discharges, the number waiting for beds. I checked this site daily, looking for some sign in the numbers, a downward trend in the graphs and bars, showing that things were improving, that there was a light at the end of this horrid tunnel. Instead, I saw only upward trends: growing numbers, ascending slopes, rising bars.
Then my patients started to call. In addition to my training in internal medicine and pediatrics, I am a trained osteopath. I work with my hands on my patients to heal them, to make their dysfunctions functional and alleviate their pain, often when conventional medicine has failed them. While the office was closed, my patients waited patiently for two months to be seen, but could wait no longer. Their back pain was acting up. Their neck and hip pain, too. Their headaches and plantar fasciitis and sacroiliac dysfunction and whatever else it was they saw me for.
“When can we come in?” they asked. “We are hurting.”
For a while, I would cite the pandemic, the fact that the office was closed, the danger of exposure, as reasons not to schedule.
“Take NSAIDs,” I would say. “Stretch. Exercise. Rest. Heat and ice. I’ll see you in a couple of months.”
But it got to the point where patient demand for treatment outweighed my personal desire for reprieve. I could put them off no longer. My medical assistant, Yarely, first put them between the sick patient appointments on Tuesdays, until my Tuesdays filled with the sick and in pain. Then we added Thursdays. Thursdays filled up. Then Wednesdays. Mondays. Fridays. By late May, my schedule was unrecognizable from what it had been before the pandemic. I was back at work, full-time, while my colleagues continued their one-day-a-week office routine and the rest of the time saw patients safely ensconced in their homes, their hospital-supplied laptops and video feeds providing the reassuring balm of social distance.
Meanwhile, I worked on my patients with my hands, a folded arm’s length away from their bodies. My hands cradled their heads, worked their knotted muscles in necks and backs and arms and legs, loosed tense sinews. Before the advent of masks, I would breathe the air that they breathed, soak in their scents and smells and odors. Often their physical, and emotional, presence saturated my senses. An extra cold or two, an occasional unpleasant scent, tired arms at the end of the day—these were the pre-Covid price I paid to do my job. Now, however, amid the pandemic, a few hundred micrometers of fibrous membrane were all that separated me from the possibility of infection, and death.
Patient resentment and practice fatigue had permeated my being long before the pandemic. Now it was exacerbated by terror: the trepidation of catching the infection from one of my patients, the horror of being intubated and living out the rest of my life on a ventilator, my loved ones out of reach, the dread of dying alone, well before my time. I was, I knew, not the picture of health. At fifty-two years old, I was overweight, with undiagnosed sleep apnea. I had GERD from drinking too many Starbucks dark roasts in a day. I hadn’t been to a doctor in years. Who had time? I was probably diabetic or was at least flirting with that diagnosis. The last time my blood pressure had been checked was during my pre-employment physical. It was high. The examining doctor chalked it off to White Coat syndrome, but it was real, and I ignored it.
That was five years ago. I was a classic case of metabolic syndrome. All of which, I told myself, I had time to contend with. But later. Right now, my patients needed me. My kids still needed me, though I was acutely aware, as they grew in maturity and experience, that that window was rapidly closing. My wife. The dogs. I had Responsibilities. I will exercise, but later. I will eat better, but later. I will go to the doctor, later. Lose weight, clean the house, look for another job, later. Later later later. Before the pandemic, I was living a lifetime of later. But the arrival of Covid-19 changed all that. Suddenly I was faced, perhaps for the first time in my life, with the fact that there might not be a later.
Yet I persisted in my work, my lifestyle habits, my fear. Why? My work was not lifesaving. I treated pain and dysfunctional joints, muscles, fascia. Whether I treated a patient or not, whether I fixed their pain or not, they would still go on living their lives. I was not an emergency or critical care or inpatient physician. I did not intubate patients only to stand by as their lungs deteriorated, helpless to intervene further. I did not hold I-pads up to moribund patients to say their last goodbyes. I was D-Day plus 2.
I recognize now that what I went through during pandemic was burnout, brought about by fear, exhaustion, and overwork. Post-traumatic stress disorder from the fear of dying and poor physical health were in the mix, as well.
***
It has been over two years, two vaccinations, and two boosters since that time. I survived, as did my family. Though some got infected, none, I’m grateful to say, was hospitalized or died. The vaccinations, I think, made that possible, as have genetic mutations that made the virus more transmissible, but rendered it less lethal in the process. That, and enough people have been immunized, exposed, or infected to the point that perhaps we are slowly reaching the elusive goal of herd immunity. But the cost has been dear. Over one million Americans have died that, likely, would otherwise have lived out full lives. The toll on children is just now becoming apparent. The lost time in school has created profound gaps in their education, not to mention socialization and just the joy that comes from being a kid. Vaccine deniers are still a robust force, and people still get infected, hospitalized, and die. But there are fewer, and there are effective medicines for Covid now, and new, targeted vaccines are emerging. People have continued to live their lives and the virus has become one more thing that we have learned to live with.
In the hospital, things are returning to something resembling life before the pandemic. I still wear my mask when I see patients. It’s still health system policy. I’ve gotten used to it, and I haven’t had a cold in two years, which I largely attribute to the mask. But now I feel comfortable leaving my mask in the car when I go into grocery stores or am otherwise out in public.
My attitude toward my work has changed, and I realize how lucky I am to be doing the work that I do. My health is better, too. I’ve lost weight, I eat better, and exercise. I even go to the doctor regularly.
Later is gone. Now, I just get things done.
