A physician waits in uncertainty


It started with diarrhea.  Then fever before the patient sought care.  The infiltrates were impressive.  A dry cough with paroxysms that were sometimes uncontrollable.   The rapid test came back negative, as did the send out PCR.  The patient returned from international travel two days before admission.  My index of suspicion was extremely high.  Yes, please keep the patient on enhanced respiratory droplet precautions because her viral load in the nasopharynx may be too low for detection at the time of testing, given her presenting symptoms were diarrhea.  Sent the IgG, and of course, positive.  Grateful that all health care workers who interacted with her remained in full PPE, including myself. But after day two of taking care of her, I developed a slight sore throat.

Slight sore throat which, in the past, I would not have blinked at.  I would have gargled with saltwater and went on my merry way, living life as per usual.  Was I overly cautious? Perhaps, but it’s the caution for self and others that will help end this pandemic.  Hunkered down in my master bedroom, grateful my father lives next door so my children can stay with him while I got tested and awaited results.  The only other human in the home, my husband, in case I started getting more ill. Door side drop-offs of food and even mail.  Feeling just a bit guilty that I enjoyed my solitude, knowing my nature as an introvert required some seclusion for recharging.

The appointment time came for the drive-through testing. “No pictures or videos!” the signs read.  There were blue canopies, each with a number on them atop parking spaces next to each other, a larger tent, and a mobile trailer to the left where the staff remained.  At my designated time, I was to call a phone number and was given instructions to pull up in my car under tent number three. A friendly health care worker approached me in full PPE, asking me to unroll my window.  This was my second COVID-19 test during this pandemic, the first of which occurred in the ED several months prior.  This was much more efficient and less perturbing than the brain biopsy swab I had been subjected to earlier.  He swabbed the back of my oropharynx, making me gag and cough.  Results would be back tomorrow as opposed to the 48 to 72 hours from prior. I was in and out in less than five minutes, without leaving my car.

Hunkering back down in my room, the silence deafening, waiting.  We’ve been eight months now into this pandemic, and this new “normal” remains disconcerting, albeit a bit more controlled where I practice pulmonary medicine.  Now having seen countless survivors of COVID-19 from the extremely aged, doing just fine to the young adults with no co-morbidities who continue to suffer.  What am I noticing? This virus is unpredictable.  We know that, as expected, those with chronic lung disease are more likely to have severe complications from COVID-19, except in asthma, interestingly.  The young adult with no co-morbidities who convalesced at home now has depression, PTSD, and ongoing dyspnea. The senior underwent some PT and is living their best life.  Has the expected prognosis of communicable disease flipped? Where age is proportionate to worse prognosis is no longer true.  Seeing a few survivors post-intubation, fully recovered, yet some with mild disease debilitated, as yet for an unknown duration.

Noticing the discomfort in uncertainty.  Developing some comfort with discomfort.  Knowing that the certainty of this disease is that it is unpredictable. Perhaps this is an opportunity to test our profound capacity for human resiliency to tolerate the unknown.  Pushing humanity to grow, and at the same time, learning to trust ourselves, our intuition, and each other.  While it’s impossible to predict the future, the longer we are immersed in living during the pandemic, the closer we get to some resolution- a cure, a vaccine, a return to pre-pandemic “normalcy,” whatever that will look like.  Look how far we’ve come.  Despite forces not within our control, namely the thoughts and actions of others, headway has been made in my local practice area:  the decline in mortality, the advances in clinical knowledge about the pathophysiology, more efficient testing, more PPE, an uprooting and great revealing of the need for prioritization of health care worker wellness, the impact of stress and isolation on health, the magnification of health care disparities, racism, and sexism, an opportunity for the interweaving connection of humanity for some, along with the stark divisiveness that continues to exist.  But we get to choose how this pandemic plays out for us.  I choose extreme caution, gratitude for this opportunity for temporary seclusion, an opportunity to recharge while reconnecting.  I wait in the uncertainty.

Ni-Cheng Liang is a pulmonary physician and founder, the Mindful Healthcare Collective.

Image credit: Shutterstock.com


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