Doctors will die. My friends will die.

I looked at the door.  Standing there, in a paper gown, my hair tucked back into a ponytail, mask, and shield across my face, gloves on, boot covers over my shoes and legs.  Behind that door was a woman I had known for years, whose youngest I had delivered, whose children I still cared for.  And her father had just died.

Under normal circumstances, as her long time family physician, I would have walked through that door and given her a tight, all-encompassing hug as I consoled her on the loss of her dad.  But the circumstances now are anything but normal.  The coronavirus outbreak was gaining momentum, and while our community had not yet seen the local spread of illness when I saw her, she had come from a large city that did.  People had come “from all over” for his funeral, she told me, “and I must have been hugged and kissed by at least 500 people.”  Now she had a high fever and a worsening cough, and she was worried.  While she was healthy, she had a family with chronic illness.  What if she had exposed them?

We talked, I explained everything we knew about coronavirus and how information was changing quickly.  I examined her eyes, ears, nose, mouth, heart, and lungs.  I offered my condolences on the death of her father, and then I shoved two nasal swabs deep into each side of her nose, and another swab down her throat.

As a longtime small-town family physician, this is my new normal.  My practice is filled with members of my community, from newborns just a few days old to feisty grandmothers in their mid-90s.  For years, I’ve tended to them when they are sick and help keep them well.  We’ve always talked and shared stories about life.  My patients have taught me as much as I hope to teach them.  And I’m fiercely protective of every single one of them.

That protectiveness has swung into high gear now as I help navigate my community through this pandemic and public health crisis.  My clinic, along with my regional health care system, has postponed routine care to try and minimize the spread of the virus.  We’re doing as much care as we can through “virtual medicine,” taking care of patients over the phone or through video apps such as Facetime or Zoom.  Emergency measures from the Federal government are allowing this so we can continue to care for our patients when possible while keeping them safe in their homes.  The care and reassurance I can’t give in person I am doing my best to provide over the phone.  Patients are also worried about me, asking how I am doing.  Tired, but OK.  My brother texts me every other day: Are you OK?  Do you have PPE?  Luckily, right now we do.    Being in a state where coronavirus is getting a later start, we had more time to prepare.  Our hospitals took quick action, as did our governor and public health department.   We’re conserving our PPE (personal protective equipment) so that we have it for when we see patients who are sick, and we need to care for them and test them for coronavirus.

Communicating with my physician colleagues across the country, the story is vastly different.  That’s when I get scared.  We are rapidly sharing information on coronavirus and relying heavily on each other for support during this crisis.  And many of my friends are putting their lives on the line as they continue to care for patients while running out of masks, face shields, and gowns, often with no way to replace them.  With the president not directing industries to switch to making the supplies we need to care for coronavirus patients, more people will die than necessary.  Doctors will die.  My friends will die.  And if we run out here, I might die.

The thing I keep struggling with as a family physician and “preventionalist” by training is that much of this could have been avoided. We knew the virus was coming.  We knew what steps had to be taken to prevent it from spreading widely.  But our public health infrastructure is crumbling and needs to be rebuilt.  Our federal government looked the other way early on, and has been haltingly playing catch up ever since.  And now, as a small-town family physician, there’s only so much I can do to reassure patients that ask, “When will this all end?”  “What will happen to my job?”  “Could I die?”  For the first time in my career, nothing in my training, experience, or even my moral compass has prepared me for how to answer these life-changing questions.  And I hate feeling helpless.

Joanna Bisgrove is a family physician.

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