Do You Remember Why You’re Here?

“I’m thinking of picking up more shifts.”

“Yeah?”

“Yeah.”

Scanning for J’s expression on my screen, all I could make out was the pixelated outline of his face.  His iPhone 6 camera was so old, even in the best light his face was grainy.  But I didn’t need to see his face to know he was not pleased.

At this point, he’s probably not happy with any of the decisions you’ve made in the last 48 hours, M.  

Letting the silence stretch out, I waited for him to break it.

48 hours ago

Hiding away in my Las Vegas hotel room to practice social distancing, my husband waited out my stretch of silence over FaceTime while I collected my thoughts. 

The world had changed rapidly from the time I stepped foot on a plane to head to the White Coat Investor Conference as a panelist to now.  Over the span of a few days, going about my business with extra caution had turned into sitting on the edge of my seat waiting for a national state of emergency declaration.

But nothing prepared me for the bombshell my husband just threw my way:

“I’ve had a low grade fever for the last day.  And some nausea and diarrhea too.”

Immediately my mind exploded into a thousand directions. 

Does J have coronavirus?  Do I need to rush home?  What about our trip we have planned with our parents who are flying in tomorrow?  Am I going to hang out with my in-laws by myself?  What if our parents get infected on the way out here?

Wrangling my wayward thoughts back in, I defaulted into doctor mode.

“Any cough or difficulty breathing?”

“No… I feel fine otherwise.  M, my flight’s at 10 tomorrow morning.”

Squeezing my temples, I mulled over his unspoken question.  This decision was being placed in my lap.  An overwhelming sense of dread consumed me.  The research I had done on Coronavirus until 4:30 am the previous night combined with my lack of sleep felt like a tsunami about to hit.

Letting out a huge sigh, I finally gave him the answer he knew was coming.

“You can’t come.  You need to quarantine yourself.”

All the months of planning.  All the arguments about whether or not J and I could hike the 17 miles down and out of the south rim of the Grand Canyon in a single day.  All the workout updates my dad gave me so he could keep up on our long hikes, conversations about trekking poles and sock liners so his eczema didn’t flare from wool socks.

All for nothing.

“J, I’m cancelling the trip.  I’ll call your parents and my dad up to let them know, but I just don’t think this is a good idea.”

It was now his turn to sigh.

“Okay.”

Back to the present

Staring at J’s outline on Facetime, all I could make out was the reflection of his phone’s screen in his glasses.  This was how we’d been communicating while he was in quarantine – in the same house but never physically crossing paths.

To J’s credit, as soon as I instructed him to self-isolate, he transformed our master bedroom into a little apartment, complete with a kitchenette and command center so he could continue to work remotely/play FIFA on Xbox without leaving the bed.  Since I arrived home, I’d been placing meals outside the slider to our bedroom and waving at him through windows or from 12 feet away.  

Not a single complaint.  Not one effort to “break” any rules.  He had been a perfect, 100% compliant patient.  

But the cracks were starting to show.

“Why do you feel like you need to go back in?  You quit that job.”

“Because… if you follow the numbers and if this social distancing thing doesn’t work, shit’s going to hit the fan next week.  And they’re going to need people.”

“And so you’ll take care of coronavirus patients?”

“Yes, it’s possible that could happen.

…

And that means we would have to continue living like this until… this blows over.”

“Like this?”

“Yeah… once you’re out of quarantine, we can clean down the bedroom, I’ll just live in it like you’ve been doing and you can have the rest of the house.”

“And how long is that going to be for?”

“I don’t know.  A few weeks?  Maybe months.”

“Months!?  Why do you feel the need to go back?  Why can’t you just start your new job sooner?  Have you even asked if that’s a possibility?”

Frustration oozed through the screen, leaving a heavy shroud.

Why?

Why did I feel the need to run straight back to the hospital?

Why, when just 3 weeks ago I had been counting down the days til my last hospitalist shift?  Waiting for the day I could leave all this death and futility behind?

Why, when my anxiety had turned me into one of those annoying Facebook “warriors” after years of silence, spamming my feed with cautionary tales from Italy and China, pleading with my very small personal network to take this COVID pandemic seriously?  

Why, when I was already feeling overwhelmed by the fact that hospital systems were going to run out of essential masks, gowns and gloves for those of us on the front line?  The daily emailed instructions to put our contaminated masks into brown paper bags for reuse did nothing to reassure me.

Why, when emerging data was showing that younger people, people my age were getting critically ill and requiring hospitalization, or even worse, ICU care?  Even more terrifying, reports coming out of young healthcare workers barely making it out of this alive if they required ventilation tore away at the perceived safety of my youth.

And now I was telling my husband I was going to run straight back but at higher personal stakes.

“What could you do, M?  You already said there’s nothing you can do for this infection.”

“You’re right – there is no treatment right now, but that doesn’t mean we can’t help support people’s bodies as they fight the infection.”

“So why does that have to be you?  You can help people from your new job with telemedicine!  You don’t have to be the one in the hospital.”

Nodding my head, my rational mind shook me by the shoulders yelling,

Listen to him!!  This is what I’ve been trying to tell you!

And yet, I couldn’t bring myself to deviate from what I felt in my core to be right.

“I’d be lightening the load, J.  I can’t leave my colleagues short staffed, not when we anticipate that shit will hit the fan in the next 1-2 weeks. 

I just can’t.  I won’t.”

J threw up his hands and looked up.  The wheels turned as he wrestled with the thing he simultaneously loves and hates about me:

You always do what you want, M.

What is “right”, anyway?

My compass has never steered me wrong. 

But there’s a first time for everything.

The doubt creeps in when I see reports of people not taking social distancing seriously, living out their lives as if their denial is a cloak of invincibility.  Why should I put myself at risk when they’re not even trying to help themselves?

The second guessing starts when I see more and more reports of hospitals threatening fines and punishments for healthcare workers who bring in their own personal protective equipment because they’ve lost faith in the system’s desire and/or ability to secure their workers’ and patients’ safety.

The dissonance between claims of being the “greatest country on earth” during press conferences while nurses and doctors cry out on social media to get them essential supplies is difficult for my mind to wrap around.

Disappointment settles deep in the pit of my stomach at the debacle of ineffective leadership on so many levels across the nation.  How easily science and evidence is ignored in favor of fluffing up appearances and fragile egos.  Lives discarded weeks in advance, the sheer absolute numbers minimized to mortality percentages to make their losses seem more palatable.

Then I look at my emergency fund and know we’ll be able to ride this out for several months.  I’m unable to find any logical reason to put myself in harm’s way for what appears to be minimal gain the longer this plays out.

People will die regardless of what I do, for reasons out of my control. 

Is this not just futility medicine but on a larger scale? 

I can accept the outcome sooner rather than later, for much less emotional and personal cost.  Indeed, this appears to be the philosophy our leadership is inadvertently sprinting toward due to its incompetence – just let this pandemic run its course and pick up the pieces afterward. 

We will mourn our losses, but life will go on.  A monument or two may go up to commemorate our war against this invisible enemy.  There may even be a moment of silence we’ll observe for a few years.  And within 1-2 generations, all of this will be but a distant memory, a blurb in our history books that will remain unread until the next pandemic.  

I see this pattern of human behaviour laid out in front me – we experience such emotional anguish over events and crises that are largely temporary.  But time marches forward and eventually we forget and move on. 

The way to play this game is to outlast the crisis, and the way to do that in this scenario is to not participate.

But that is not who I am.

Even after years of wading through the cynicism and emotional shallows of burnout and moral injury – I haven’t surrendered this part of me yet.

The part that still sees value in a single person’s life.  That is still moved to action by another’s suffering.  That still clings on to the hope that there must be a better way.

There is still a little bit left of this candle to burn until I reach that state of detachment.

Until then, I simply refuse to watch people walk off a cliff like lemmings while we yell at the grand masters to do something, ANYTHING, to minimize the amount of people lost.

I will store my rage at how the system counts on and leverages our caring natures against us, sending altruistic healthcare workers into battle with a whittled shank while its inept generals act like they’re playing a leisurely game of Risk from a place of safety.  

I’ll embrace my perfected INFJ emotional off switch, divorcing myself from the horrible decisions I may have to make and deal with the fallout later.

But when later comes, you’d better believe there will be a reckoning. 

Life, as we know it, will have changed.

Medicine, as we practice it, will have changed.

Most importantly, those of us on the front lines will forever be changed. 

We will no longer be content to stare down the gaping wounds of our healthcare system while our overlords tell us they have it all under control. 

We will mobilize and tear down this whole damn thing with a righteous fury, never forgetting how they abandoned us and our patients in the face of this pandemic while reminding us it was our duty as they ran away to their panic rooms.

Today, we’ll make our personal sacrifices.  We’ll continue to be grateful for the people who love and support us.  We’ll take care of people to the best of our abilities, knowing with that comes significant calculated risk.

And when this is all done, we’ll leverage our unprecedented collaboration, our pent up frustration, anger and disappointment and flood medical societies, organizations and legislation with a force that’s never been seen.

Our work is just getting started, my friends.

***

Photo taken of a tree practicing social distancing in the Columbia River Gorge.

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If you’re not following me on Instagram already, join the conversation! 

I’ve been sharing in my stories about my husband’s quarantine, my positive COVID exposure, thoughts on that NP swab getting jammed up my nose and more!  I’ve even posted some videos of me playing piano – if you missed them, you can find it on my highlights.  

In this time of social distancing, it’s never been more important to stay connected.  Talk soon!