I’m a primary care physician at the VA, and I have about 1,000 patients. Maybe I was in denial, or just too much of an optimist, but it took me awhile to realize that COVID-19 was going to hit the United States so hard. I came to this realization about a month ago, when I started comparing the trajectories of the curves in Italy vs. the United States, and it was around that time that I started to lose sleep.
Technically, my shift (“tour” at the VA) is 8 to 4:30 p.m., Monday through Friday, 40 hours per week. Of course, I pay no attention to that, because my guys are my guys all the time, and they’re my responsibility 24/7. (I do have a few female patients, about 10, but 99.9 percent of them are men, so I refer to them collectively as “my guys,” it’s an affectionate term and isn’t meant to minimize the service of female veterans in the least.) I never really “clock out,” and am generally processing clinical data for my patients in the back of my head most of the time – I’ll get ideas about diagnosis or treatment for a particular patient while I’m eating breakfast, driving on the interstate, in the middle of the night.
In the middle of one night about a month ago, I was thinking about the range of mortality rates, from South Korea to Italy, and I multiplied those by 1,000, and I started thinking about the number of patients that I’m going to lose to this virus, just going straight by the statistics. And given the age distribution of my patients, and the fact that most of them have at least one chronic medical condition, it will likely be even higher. And I felt like someone had just punched me in the abdomen. There was one month last year when I lost five of my guys – none of them were unexpected, all were in the terminal stages of chronic illnesses from cancer to COPD – but five was a lot for one month, and I really did grieve. So did my RN. Losing five of our vets in one month really, really hurt. After being there a few years, I’ve gotten a little attached to many of my patients. They ask about my kids and bring them little trinkets and “doodads.” They bring me honey from their beehives and tomatoes from their gardens. They tell me corny jokes. They tell me they pray for me. And I work long, long, long hours for them. And it really is an honor to do so. But I cannot protect them from this virus. I need everyone else to protect them by staying home, practicing social distancing, and stopping the spread. There’s simply no other way to do it. If I could do it myself for my guys, I would.
I had a patient a couple of years ago that became quite special to me. He was already so sick and just kept getting new diagnoses, each more serious than the last – but he had the best attitude, and I always looked forward to seeing him. Shortly after I came back from maternity leave when my son was born, my RN got a call from the patient’s wife to tell us that they were going to stop invasive measures like dialysis and do comfort care only. And she also told my RN that she herself had recently been diagnosed with metastatic cancer with a poor prognosis, and that she had found herself making end of life plans for both of them. My RN asked if there was anything at all that they needed, anything we could do for them. And the patient’s wife said, “We would love to see a picture of Dr. Day’s baby.” I can’t even type that without tears flowing. At an earlier visit, that patient had given me some candy, Werthers Originals and Smarties, and it was still in my desk drawer. (I am not great at cleaning out my desk.) After that phone call, I simply could not throw it away. It has moved with me to three different offices.
So I’m asking everyone to please observe the stay at home orders, the social distancing recommendations. I need you to help me protect my guys. If everyone stays home and away from people for a little longer, my team and I won’t lose as many of our vets. Please.
Kimberly A. Lucas Day is an internal medicine physician.
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