COVID. What is it to me? A sense of growing dread for primary care providers everywhere, whose patient panels read like a list of future dead. Diabetes, obesity, heart disease, emphysema. The reality is most people have no idea how close to devastation our medical system is at most times. How many times was the hospital of my residency on diversion due to staffing or available beds? How many times have ERs overflowed into hallways with nowhere for patients to go? Without COVID. Without a flu pandemic. Just the heavy burden of chronic disease that America carries. The heavy burden of inflicted illness that America encourages.
Our food system is a joke; the access to fresh food in urban centers is the punchline. Minimal PE in schools, let alone exercise in the real world. Addiction to food, let alone tobacco, medications, or drugs, is killing us. A workaholic culture is taking our stress levels through the roof. Our “living wage” is but a poverty wage in many densely populated areas. And we continue to make changes that disenfranchise the poor, that limit health care access, that promote processed foods, that incarcerate many of certain categories of people while ignoring others. Everywhere you look, there is inequity waiting to be addressed.
The COVID effect. A sense of growing dread, a terror is spreading from my heart to my hands as I treat those who I know would never make it, if it came to it. As I watch the map go from green to red one county at a time. They’ll die alone in a hospital, if they’re unlucky. If they’re lucky, hospice will be available to comfort them – but we all know that service is limited, now far outpaced. And this is just the COVID group. What about those who need an ICU bed that doesn’t exist? What do we do when hospitals are full?
I hope that the rest of the medical field can be as creative as my facility has been. More so even. Home infusions so infections can stay home to get fluid and IV antibiotics, floor beds converted to ICU beds, elective surgeries halted so every ventilator can save a life, telemedicine and drive-up pharmacy and mail order pharmacy to keep people from coming inside a building previously seen as a haven for the medically needy, now an enormous potential fomite. So many changes to medicine in so little time. I worry for those who fall through the cracks.
And my peers. My weary, burned out, numb peers with face sores and a fear of being around the very family that could comfort them. I fear for them. Because medicine is hard to begin with. Sometimes just emotional and sometimes truly traumatizing. I filled out a will this year at thirty-five years old, never believed that would be needed as a physician. I just got married last year. I haven’t had kids. My mom lives in a different state. I never thought that the last time I saw her might be the last time. How do we process this in the middle of all that medicine is? Medicine is asking others to share their emotions while we bury our own. I can’t help but look to the universe to beg and plead that these beautiful, caring people reach out before hurting themselves in ways we cannot fix. Comfort them in their times of need and sorrow. Please don’t break their will to live by breaking the living.
And for the rest of us, the families and the friends, the loved ones, the single people living alone whose isolation is of the truest sense. May our hearts bear the burden well. May our actions reflect our love for neighbors. May our pride take a back seat to life. May our time of isolation lead to positive changes in our hopes and desires for our lives. May we be able to see the value amidst the fear, to highlight our true desires as we recognize their current limitations.
I look forward to a life without or past or through COVID. To blue skies and the sounds of children running down the halls, to full hospitals bustling with family and flowers, to tears around a bed with hands held and goodbyes said. To the moment when connection doesn’t mean infection. In the meantime, I will do everything I can to keep my community safe. From me, an enormous potential fomite.
M. Michelle McClelland is a family medicine physician.
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