I am sitting on my living room floor, my back to the living room sofa, a sense of dread overcoming me as I realize that my call to 911 may be too late. I hear her muted voice with periodic pauses that allow her to catch her breath. All I can do is say, “I am still here with you. They will get to you soon.” And then I hear, “Mommy the ambulance here,” followed by footsteps running across the floor, and the voices become distant. Then, the phone disconnects. I call back, and as the phone rings, I think about her: She has COVID-19 infection; she is a marathon runner. She has two kids and a husband; she is the primary caregiver of her elderly mother. She is afraid of going to the hospital and dying alone. I try calling her repeatedly until her husband finally answers; by then, they have already whisked her away on a stretcher.
Hearing someone struggle to breathe is gruesome. Over the last few months, the frequency with which my colleagues and I have heard these struggles is one too many. While the intense conditions in hospitals, ICUs, and emergency centers have been widely publicized, it is equally important to consider the struggles of primary care clinicians during COVID-19.
As the COVID-19 crisis gripped my New York Community, primary care clinicians stepped forward to fulfill two primary roles: caring for patients at home and staffing COVID-19 care units. Many of my colleagues were re-assigned challenging roles in hospitals, emergency rooms, and urgent treatment centers. Others remained in our primary practice sites. This was a difficult transition on both sides – my colleagues went back to the hospital wards after up to a decade of practicing longitudinal, holistic care in their offices. They transitioned to new workflows, treatment protocols, team-mates, and of course, new electronic medical records. A transition that usually is given many weeks, occurred almost overnight, and that too amidst the most uncertain times for their families and loved ones.
For those of us remaining in the primary care practices, we transitioned to patient panels that were exponentially larger than what we previously accommodated. In addition, we accommodated limited staffing, with new workflows, telehealth technology, policies for infection control in our offices, and management for an illness without a management strategy,
We also adopted new roles. We became the cheerleaders for our practice staff and mentors for our junior (and sometimes senior) colleagues. We were the voice of support for our patients isolated at home with tremendous fear and anxiety. We were a source of comfort for patients who have lost parents, children, homes, jobs, and means to support their families. We were also the keeper of our own uncertainty and fear.
Primary care clinicians are proficient jugglers of patient needs and public health needs. And in this crisis, we readily balanced the needs. We readily became the source of stability, teamwork, hope, and dedication. Yet, spirit, teamwork, and dedication, cannot overcome the sense of defeat from the death of a patient. And, in this crisis, clinicians have experienced death in a magnitude that remains unprecedented.
When I ask my colleagues, they all share similar sentiments: COVID-19 is a monster. We have lost patients that were new to us and those well known to us; patients we have seen through the best of times and through life’s many setbacks; patients who were family members of our colleagues and teams, and patients who became a part of our own lives. For me, the loss has been just short of devastating. I have lost patients that I have known longer than I have known my husband. Imagine losing a patient who precedes my most integral adult relationship.
Each patient’s death was equally as difficult and disheartening because we were not prepared to say goodbye. Circumstances force us to transition our focus from a patient’s death to the care of their loved ones. We change roles from holding the patients’ hands to holding those of their loved ones. We witness as families mourn a future that ended too soon and cope with goodbyes that remain incomplete. We offer reassurance as loved ones struggle with guilt that they may have been the source of COVID infection. And we continue to do this for many months after the loss. Saving souls from eternal guilt is my newest responsibility as a primary care physician.
For clinicians, the time to reflect upon the brutality of COVID-19 is limited. And the time to cope is almost negligible. Yet, we must not underestimate the sorrow that has permeated our profession – it is profound.
It is time to ask how we, as a profession, transition from loss to healing? And, what does this path to recovery entail? It is time to ask and accept support in the healing process. It is time to ask what we can do to support our patients and our colleagues. And, the time is now. Our personal and professional paths to healing are intertwined. And our ability to heal depends upon our profession’s readiness to forge the way.
I am sitting on my living room floor, my back to the living room sofa; a sense of hope rekindles as I speak to her on video chat and welcome her back to her home. I talk to her about healing from COVID-19 and resuming her activities with her two kids, her husband and her mother, who lives in the Bronx. The phone unexpectedly disconnects. This time, she calls me back.
Ankita Sagar is an internal medicine physician.
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