Humility drives physicians in the face of COVID-19

One of the great responsibilities in doctoring is alleviating suffering. That hasn’t changed. But the novelty of COVID-19 makes us uncertain as we care for our patients. Anxious even. We feel helpless watching people get ravaged with SARS-CoV-2. We are all limited in our fund of knowledge.   We know that we aren’t incompetent, but COVID-19 has made us feel impotent.

A hospitalist friend recently broke down in tears after pronouncing the third COVID-19 death of the morning. In providing comfort, I realized that we have to support each other through the many struggles this pandemic is putting us through.

COVID-19 is indeed a terrible illness. That we leave our patients to manage without their families for support, and we leave said families feeling hopeless at home to grieve without a chance of in-person closure is enough trauma as it is. We don’t have a cure. Yet, it is humility that drives us in the continuous pursuit of knowledge.

How much our world has changed in just a few weeks? Before universal masking. Before the closure of hospitals to visitors. Before the sequential conversion of medical floors to COVID-19 units. Before the cancellation of elective procedures. Before having no choice but to attempt to keep one’s medical practice afloat with telemedicine.

Enervated in the very beginning. We could do this. But then the slow realities. The patients would not present neatly tied up as COVID-19 infected. We would have to be super-vigilant. It didn’t matter that it was a motor vehicle accident, best to make sure the patient didn’t have COVID-19 too.

That first-time donning PPE — gown, gloves, N95, face-shield — wondering if this was enough when photos of health care workers in China and Italy showed them in multiple levels of head-to-toe spacesuit protection. Then doffing and making sure not to contaminate self. Wiping down face shields, storing masks in paper bags, wondering what sense our reuse of PPE made when any other day, these would go promptly into the trash.

Overnight, physicians transformed into wearing scrubs. I never thought I would be in scrubs again. Yet, here I am. Do I now re-learn ventilator management as well? How would I fare as a redeployed hospitalist or even yet intensivist? Would surge redeployment be covered by medical malpractice insurance?

One week of taking care of COVID-19 patients was enough. Yet this was just the beginning. The impending sense of doom. The constant worry of contaminating self. Being keenly aware of one’s own health and mortality. Trying not to become patients ourselves. Being committed to daily exercise like never before yet finding comfort in sugary delights.

White coats have essentially disappeared. One less potential fomite. Rings. Gone. Watches. Gone. Phone into Ziploc bag. Stethoscope? What is there to gain from auscultation of a COVID-19 patient except for the increased risk of contamination? If PPE is limited, should we not limit the number of people using them? To that point, as a consultant, what is there to be gained from entering an isolation room? Could I not just speak to the patient on their phone? Examine them from the windowed door?

Physicians changing into street clothes in the hospital parking lot before driving home to family. Others driving home in scrubs to strip naked in the garage and dash for the shower before greeting family. Others renting an apartment, so there’s no chance of becoming a vector of transmission of SARS-CoV-2 to loved ones sheltering in place at home. Wondering if today is the day we have become infected with SARS-CoV-2. Hoping that if we are unfortunate indeed to have COVID-19, it would be mild. Yet to be sure, is there enough disability insurance? Life insurance? An advance directive? A will?

If I were sick enough to need hospitalization, would I go to the nearest or to mine? Or would that be selfish to impose such trauma on my colleagues? If intubated, does my family know that I need at least three blankets in the cold of a hospital room? That the TV should be on the ambient sound of waves crashing on the shore?  If I were to die, would my family know how to access my accounts?

Every day now brings more COVID-19 patients. When we are not taking care of them, we are reading COVID-19 literature, listening to COVID-19 podcasts, writing COVID-19 protocols, and trying to avoid COVID-19 politics.

Lately, some days are worse than others. Some of us are convinced that surely by now, we have been asymptomatically infected and since recovered. Or perhaps that tension headache from the exhaustion of constant vigilance or that seasonal allergy cough is proof we have COVID-19 right now.

Fed up with this our new normal. Waiting for the surge. Frustrated with not having a magic pill to offer. Wondering how much longer we can keep ourselves mentally and emotionally intact. The strain of it all.

It is appalling that we are using garbage bags for protective gowns in the United States. Physicians being fired for raising the alarm over the lack of PPE. Hospitals placing gag orders on health care workers. Residents being put into unfair and unsafe positions. If we fall gravely ill or die from COVID-19 because of our profession, to what purpose? The health care system thinks physicians are expendable. But we are not.

Fear? We all have it. It remains unconscionable that we have to crowd-source our own PPE or reuse the one mask we were assigned a month ago. But here we are. Showing up.  Leaving fear and frustration at the door. Signing up for extra hours at no additional pay or for less because our hospitals say they feel the crunch of the lockdown.

We have to believe we are strong.  To not take the despair of patients home. To ignore the reports of people not social distancing, threatening sooner or later to be patients in our COVID-19 units. Now more than ever, we must show compassion to each other for we are in this together.

Gloria K. Aggrey is an infectious disease physician who blogs at Vexing Microbes. She can be reached on Twitter @gaggreymd.

Image credit: Shutterstock.com

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