This king of all viral syndromes is here

We are still in the office.  I go daily, either dressed in scrubs or shirt and tie, in an effort to maintain some sense of normalcy.  I can feel the anguish of staff who themselves are deemed “essential.”  Their apprehension about the possibilities of themselves being infected adds a starchy thickener to the office atmosphere as they answer phone calls, receive medical records via fax, and schedule appointments while postponing others.  This is their usual, but what is rather unusual is that they are doing all of this now in gloves and masks.  It is impossible to feel alone with the accompaniment of such dedicated clinical and non-clinical staff, who overcome their own unease and unrest to wake up each morning in the age of viral pandemic, get dressed, leave their families who they cannot help but think of all day long, and travel once heavily populated streets to work.  They drive to be there to help our patients—to help me.

Yet, although it is seemingly impossible for me to feel alone in still functioning practice space, there are some things only I can do alone.  A once filling schedule of preventive, established patient, new patient, and late afternoon sick visits now face remarkable dwindling to just five or eight a day, with half of those visits being virtual or telephone-based.  It has taken sheer accommodation on all sides, constant impromptu updates from managerial staff on the newest of policies, and we acclimate.  We learn and relearn.  We remain up-to-date as much as possible.  Still trying to reclaim the time of some existence of normalcy of a life and a medical practice that once was not that long before, I cannot help but to think as I shut the door of my office to do a virtual visit with this teleconferencing platform that I am alone in here with no examination bed.  There’s no other physical presence.  There’s no diagnostic equipment other than the stethoscope I drape across my neck to remind the patient that he or she is seeing a physician.  I am behind a desk at a computer, clicking a “start video” button, and then, in the age of pandemic, I am no longer alone.  Then, we talk.

Toward the end of the day, every day, there is a patient or two who comes in.  The appointments are usually scheduled after lunchtime for these types of visits.  “PUI” is the label for “person under investigation,” often nestled gently next to the patient’s name on my schedule.  Other primary care offices close by are closed down for two weeks.  Urgent care just told one of these patients to “just reach out to your PCP” regarding his symptoms.  The emergency physician didn’t test the patient at the time of his or her evaluation of the patient just the day before.  Now, the onus falls upon me.

I’ve never seen one of these patients before.  Granted, some things may have changed since those other physicians’ evaluations of her, and they are too in the fight against this.  The medical assistant assured me that the patient is ready to be seen.  I open the medical record and review the chart.  Documented symptoms rang out like “loss of smell” and “dry cough, muscle aches, and chills,” meeting my eyes as I begin to formulate a plan of care in my mind.  We’ve designated rooms at the office for them—rooms 8 and 9, which are down a long hall’s walk from my personal office.  I stop on the way to don the appropriate PPE.  Fortunately, for now, we have enough.  My gown, my gloves, and then my face mask are in place, and placing them has become somewhat of a ritual.  In the midst of it all, I say a solemn yet brief prayer for protection, and I proceed because that is what I was taught and trained to do.  I remember to grab the appropriate swab kit.  I knock on the door.  I enter alone.  There is usually no response, so I proceed, and I see a patient there alone.  She is often afraid of the possibilities.  He often has a dry cough.  I occasionally see red eyes, and I’m not sure to distinguish that as a manifestation of the disease course in this patient, or if it was just because he or she was crying.  I ask questions and interview to create some sense of normalcy, but it is palpable to both me, and I presume the patient both that this all being normal is so far from the truth.

The late Gospel Alto Gloria Griffin of the Roberta Martin Singers would belt out beautifully with her wonderfully mellifluous voice:

The marketplace is empty.
There’s no traffic in the street.
The builders’ tools are silent.
There’s no time to harvest wheat.

Busy housewives cease their labor.
In the courtroom there’s no debate.
Work on earth has been suspended.
As the King comes through the gate.

I’ve been thinking a lot lately about this song entitled “The King is Coming” and its eschatological verse of providing Christian hope for days to come.  I do not remember when I first heard it, but the allusions to a day when life as we know it all around the world would pause and be altered forever are fiercely reminiscent of our lives in the era of COVID-19.  The Latin student from years ago within me cannot help but remember that corona translates into English as “crown.”  It does not discriminate based on gender, ethnicity, age, or socioeconomic status.  It is making every knee bow.  It is making every tongue confess.  Like the King Mrs. Griffin sang about, this is not a “respecter of persons.”  This king of all viral syndromes is coming and is here.  This is our 1918 flu pandemic.  As I’ve said before to others, I write now:  I never knew my training in medicine would be preparing me for something like this.  I’m intensely grateful it did.

Earl Stewart, Jr. is an internal medicine physician.

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