“Well this was a useless appointment, wasn’t it?”
As I watched W struggle to contain his hostility, I registered the absence of mine.
No rise in heart rate. No sweaty palms in my violet, nitrile gloves. Not even an eyebrow raised in response.
Nothing.
This is it, M. You have officially run out of shits to give.
Maybe it was the previous 15 COVID testing appointments running on 10 minute increments. Perhaps the 3 people who pretended to have symptoms just so they could get a less accurate rapid antigen test to “clear” them from having to do a full quarantine. Or more likely, the 7 people who yelled at me for telling them the PCR turnaround times wouldn’t be back by Christmas.
Whatever the case, I felt myself settling into this familiar space. It was always hard to explain how I could step outside of myself and emotionally detach at will. It was an essential survival skill perfected in residency and used during my hospitalist days.
The problem with getting too comfortable here, though, was I still hadn’t figured out the switch to turn off the depersonalization as quickly. It was a long drawn out process that required me to lock myself away from people for days until I decided it was no longer too “people-y” out there.
In a bizarre, ironic twist, it was the pandemic that taught me this lesson. Quarantine isolation was the thing that was causing and saving me from burnout.
Right on cue, I watched W’s restless fingers rake through perfectly gelled hair, crisp strands bouncing back to an exact, pre-determined location. As he fidgeted, even through my turquoise n95 I could smell that familiar damp woolen pea coat scent, whispering memories of harsh Midwest winters.
He had traveled far to get here.
And I was the one “withholding” permission for him to see his family.
Glancing over at my workstation screen, I reviewed his completed questionnaire – multiple visits to multiple people as he made his way across the US. Now with the onset of cough, fevers and chills, he was sitting in my office for COVID testing.
Somehow this was my fault. I replayed the conversation we’d had just a few moments ago:
“Because you’re within the first 5 days of symptoms, we can do the rapid antigen test and we’ll have results within the next 3 hours. While the rapid antigen test is great at picking up active infection, the false negative rate is 15-20% which means 1 out of 5 times we can’t trust that negative result. This is why I send off a PCR test which is more accurate for confirmation, and that result won’t be back for likely another 4-6 days*.”
“Okay… and assuming the test is negative, what am I supposed to do?!? Christmas is in 3 days!”
“The current CDC recommendation is to quarantine for 10 days once you start having symptoms, so that means you have another 6 days that you need to lay low. This is regardless of whether or not you have a test.”
“…
I don’t have COVID.”
“Sir, even if you don’t have COVID, you certainly have something causing your symptoms. You can still transmit that infection.”
“Well this was a useless appointment, wasn’t it?”
The absurdity of this situation and entire morning struck as I pushed back on the maniacal laugh threatening to bubble up and take over the room.
My fault
It was my fault he visited different people in different states on his way to see his grandma.
My fault he chose not to practice social distancing and not wear a mask.
My fault I couldn’t cater lab turn around times to him in the midst of a testing surge nationwide.
My fault for standing by the guidelines to deter community spread for situations just like this.
The flash of anger was so tempting to grab on to, but instead I breathed 4 seconds in, 4 seconds out to wait it out.
At least he’s here trying to do the right thing, M. He could’ve gone to his family gathering without getting tested. That’s gotta count for something, right?
I don’t know, does it? Or is he just trying to get some absolution for his irresponsible behaviour in the middle of a worldwide pandemic and pass the blame on to someone else?
Choices have consequences.
Yes they do. So choose your words wisely.
Finally turning to W, I took in one last deep breath, unsure if the words to follow would be the right ones.
“W, I want you to be able to make an informed decision with the best information I have right now. I know you’re trying to do the right thing by getting tested and I know this sucks. It all sucks.
I want you to be able to spend time with your family AND I want everyone to be able to walk away healthy. I know I’m asking you to make a really difficult decision, but the safest thing to do right now is to wait another 6 days if you can.
There’s no rule that says you can’t eat ham with your family 6 days after Christmas.”
Searching his eyes, I looked for something, anything that signaled I had won him over.
Wow, M. You really went all in there. Telling him he’s a good person by trying to do the right thing when he was obviously an idiot beforehand. Validating his feelings of conflict – conflict he created for himself, mind you. Then for the final blow, telling him to bend holiday rules while rigidly following yours?
Do the ends justify the means of you flat out lying to his face? That you actually hope he feels so wiped out and awful over the next few days that he can’t even roll out of bed to make it to the dinner table? It doesn’t make you a better person to convince someone to stop spreading the plague when you secretly want them to suffer.
Not a lot… just enough.
W’s cough reverberated in the room, hand coming up to cover it out of habit, hitting his gray mask instead. As I pumped hand sanitizer into his open hands, W finally spoke.
“6 more days?”
“Yes please.”
“I guess… I work remote so I can shuffle things around.”
Nodding my head, I tried to relish this victory.
Nothing.
No relief. No adrenaline rush. No joy.
“I’ll be in touch once I get the lab results back. And… thank you, W. I really appreciate your diligence.”
“Your Mama got another crazy email from someone at church. She’s worried now about microchips in the vaccine and you not being able to give us grandchildren.”
“Mmm… it was Paul**, wasn’t it?”
“Come on now, why does it have to be Paul?”
“Oh, I’m sorry… I forgot he hasn’t operated in the same predictable pattern for the last 20 years, never mind the last 9 months in this pandemic.”
“Yeah… ok fine. It was Paul.”
Shaking my head at my dad during our weekly phone conversation, I resisted the urge to ask why he continued to indulge people entrenched in these conspiracy theories. Maybe his lack of desire to watch tv made him search out these conflicts to spice up his life.
“So…? Are you going to get the vaccine?”
“Yes, Papa. And it’s not going to make me sterile. My ovaries turning 35 this month will, so you can put Mama’s fears to rest.”
It was his turn to sigh. I kept finding new and interesting ways to keep squashing dreams of pinching chubby cheeks.
“Well, what should I say to Paul?”
“It doesn’t matter.”
“Doesn’t matter? Why do you say that?’
“Because he’s going to do what he’s going to do. He’s going to believe what he’s going to believe. He’s going to say I’ve been brainwashed by big pharma and I’m not to be trusted.
… Whatever. Let him do what he wants.”
“Aren’t you supposed to be out there convincing people to take the vaccine?”
“Probably. But people like Paul aren’t high yield. We can vaccinate the ones who want it, nudge those who are on the fence, and those who refuse will just suffer.”
“You’re a doctor! You’re just going to let people suffer?”
The flash of fury I suppressed earlier that morning unexpectedly came back in a blaze. I heard the volume of my voice rise alongside the heat flooding my cheeks.
“Who’s letting who suffer, Papa? Is it me? Is it doctors and healthcare workers who’ve been trying to stem the tide of this pandemic? Or is it the people who refuse to believe in science and have been spreading the plague because of their right to personal freedom?
Who carries that responsibility? WHO CARRIES THE BLAME?
I am DONE with that ‘moral’ argument. I’m done with people shifting responsibility because they don’t have the capacity to understand that they’re the ones creating this very shit they’re rolling around in yet complaining about.
So at this point, let him do what he wants. The people in his life know where he stands, so they’ll decide how they want to deal with him. Let him be pushed out of his grandchildren’s lives because his kids won’t want his unvaccinated self around. Let him experience the emotional burden of knowing he’s the reason why the fragile people around him got COVID. Let him watch them suffer and die via iPad.
Choices have consequences. I can’t make anyone’s choices for them – I’ll try to steer them to better choices if I have the chance and they’re open to it, but I’m not spending any more energy on spilled milk.”
“Spilled milk… what happened to the M who ran back into the hospital in March?”
I waited for the pang of guilt to hit. Regret at uttering these words.
Nothing.
“She grew up.”
And with that, the foreign burn of welling tears caught me by surprise.
I had tried. SO HARD.
For the longest time, I clung onto this vision of a world in which if I was just educated enough, passionate enough, caring enough – I could convince people to make changes to help them live healthier lives. If I could just find the right words, mirror people in a way they felt seen and heard, validated their concerns, people would listen to reason.
But this year, with every donning and doffing of my aqua blue gown and n95, with every frustration absorbed from entitled people unable to carry their responsibility, I’ve come to accept the world for what it is.
I’ve come to understand we are sold this beautiful lie in order to trap us into forever playing this role of rescuer.
There has always been this orchestrated dance between the helpless-helper, feckless-responsible, victim-savior. I am but a pawn in this infinite game – as long as there are dreamers, there will be people lining up to take my place.
Let them deal with the weight of things I’m no longer willing to carry. Let them try to move the immovable. Let them break themselves over and over following the game’s grand design, calling it “burnout” until they realize the only way to break a pattern is to respond differently.
As for me, I’m no longer interested in being told what I must or must not do in order to uphold this farce we keep spinning in. If me holding the line of my boundaries is enough to bring this all crashing down, then perhaps we should contemplate building a different game.
Settling back into my safe state of detachment, I wondered how to fill the awkward silence.
“Look, Papa. I’ll focus on those who want the vaccine or are on the fence – the others will either be peer pressured by their families or society, protected by herd immunity, get COVID or… eventually die out.”
Unable to resist the dark humor I used to hide away, I allowed myself a smirk.
“If you want, you could tell Paul he’s one step closer to God by refusing the vaccine. He can interpret that in whatever way he wants.”
Despite himself, my dad let out a chortle. In a half hearted admonishment, he finally responded.
“He would not find that funny.”
“Mmm.. that joke wasn’t for him.”
Who am I to infringe on people’s personal freedom to believe what they want?
And who am I to rob people of the opportunity to take responsibility for their own actions based on those beliefs?
Is it not fair to place the consequences squarely back at their feet when they’ve rallied so hard for the right to choose to not wear a mask or not get a vaccine?
Yes, I’ll still take care of that person in front of me if the opportunity presents itself.
But let’s be crystal clear on who owns their mess.
Hate to break it to ya… choices have consequences.
Photo taken at dusk in Mount Hood National Forest on my 35th birthday after a wonderful afternoon of snowshoeing with my husband.
If you’ve enjoyed these photos and have ever thought to yourself, “I’d love to hang that on my wall!”, you’re in luck!
After I realized 17 of you donated to Paltown after reading my ode to N, The House You Built, I realized there was so much more I could do to rally support for worthy causes PLUS give you something in return as a token of my gratitude.
Allow me to introduce Reflections of a Millennial Doctor’s Spring 2021 Gallery!
Every quarter, 10 new photos will be made available for purchase to beautify your walls and warm your hearts, knowing 90% of the proceeds will go to charity (10% will be held in reserve to cover the costs of the blog).
This quarter’s proceeds will go toward Hollaback!, an organization that hosts free online bystander intervention and de-escalation training, giving people tools to use when they encounter xenophobia and harassment in action. Even if you don’t purchase anything from me, please definitely check out their webinars! It’s time to move beyond safe declarations online and start taking action against racism.
If you prefer to donate directly to the organization for tax purposes, let me know so I can thank you!
Click HERE to check out the Spring 2021 Gallery!
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Finally, I know I’ve been remarkably absent from the blog for the last 2 years, but for the remainder of 2021, I’m aiming to write 2 posts a month! I’ll be switching to an every other Sunday schedule from here on out, but if you’d like to keep the Wednesday tradition alive, feel free to continue checking in on Wednesdays too!
Sign up below for email updates when new posts go out OR follow me on Instagram where I post the latest updates as well as receipts to see where your purchases went!
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Footnotes:
*As of 12/16/20, the CDC opened up rapid antigen testing for both asymptomatic and symptomatic patients. You can see the most recent update to antigen testing guidelines HERE.
**Historically, I’ve never used real names. But you better believe Paul is this individual’s actual name ¯\_(ツ)_/¯
People meditate for years and years and still never reach the point you’re at, where you can sit with that anger for a few seconds until it passes, and respond to the patient in a way that steers him toward what is best. That part is amazing.
It’s the detachment and depersonalization part that needs work.
The first part allows you to get through to people who are very difficult to reach. Figuring out how to do that while not detaching and depersonalizing would make you the ultimate superhero, who could not only do her job, but find deep fulfillment in it.
I would totally tell you my secret, but then I’d have to kill you (for all you sensitive folks out there, M and I are buddies – she knows I’m joking).
Haha… when I’m ready to take on your pathologic tendencies, I’ll let you know.
In the meantime, I have zero interest in becoming a superhero, nor am I interested in defining myself by what other people “need” me to do for them when they are fully capable of doing these things themselves.
I think you presume if I could master the stoic’s indifference (which I assume is where you’re pulling your philosophy from), only good things would happen. But trust me… you don’t want to see me indifferent.
If you’ll forgive me for pushing back a bit, M, I think you’re mischaracterizing my point. I don’t think you need to reach a state of indifference, nor would the Stoics counsel that. In fact, you necessarily cannot be simultaneously indifferent and personally fulfilled. I believe those two states of existence to be mutually exclusive.
The point is, I would think, to find some kernel of fulfillment in this work that could level up your happiness – at least a little. Let me put it another way: if you actually had the choice between having a healthy amount of satisfaction with your practice vs continuing to find so much of it onerous and unpleasant, wouldn’t you choose the former?
Of course, you know I’m no pollyanna who thinks one can simply self-talk oneself into happiness – that’s rubbish. But what if you could build on your already impressive ability to sit with anger and frustration, examining it and then letting it go, thereby achieving a successful outcome like the one with your patient in the post? And when I say “building on your already impressive ability,” I’m referring to honing a different skill that has the potential to achieve the same outcome for the patient, while also increasing your personal satisfaction.
Whether you know it or not, you’re already incredible at practicing mindfulness during tough interactions. But you may not have tried also practicing “loving kindness,” another form of meditation that – after you puke from my nausea-inducing woo – you may want to try. If you were able to recognize your common humanity with your dips**t patient and still wish him happiness and inner peace, it is possible that you might leave that type of visit slightly less drained and empty – “I tried to relish this victory. Nothing. No relief. No adrenaline rush. No joy.”
I realize this is incredibly difficult, especially in the moment. If you decide to try it, you’ll probably have to “fake it ’til you make it” for quite awhile. But eventually, you might turn a 95% painful experience into a 50% painful experience, allowing you to claim a small win, which might level up your happiness.
Anyway, that’s one of my secrets, so now I guess I have to kill you. Sorry.
Just linked to you from Physician on FIRE and wanted to compliment you on your excellent writing. I can’t imagine how frustrating it is for health care professionals to watch all the nonsense. Thank you for taking care of us all and for all your sacrifices! Even though it has been such a difficult year, I am proud to have followed public health advice, stayed healthy and done my part to keep others safe too. And, when it is my turn, I can’t wait to get vaccinated!! Keep up the great work!
Marla,
Thank you for your kind comment and for doing your part! It’s much appreciated and quite honestly the only thing I keep grasping onto when I full the urge to rage quit. I know there are so many people out there trying to be safe and healthy during the pandemic, and that knowledge keeps me going.
Take care and I wish you a speedy vaccination!
M
M-well written, as always. Still waiting for you to write a book 😉 (speaking of books, have you read “Burnout” by the sisters Nagoski? I am reading it right now and wish I had read it years ago!)
Haha.. I actually penned an outline for a book (or really, a series of essays for each month of 2020), and then I realized I don’t really want to relive 2020 any time soon, nor do I think anyone is ready to read it yet! But, the outline is there nevertheless… maybe when there’s more healing from this wound. I loved reading your most recent post about your personal COVID/FIRE journey, so maybe that day is closer than I realized.
I have heard of the Nagoski sisters’ book! I listened to their podcast episode with Brene Brown, and if you haven’t listen to that yet I highly recommend it. It’s on my to read list… but I realized today that list is 91 books deep, so I’ll have to put it closer to the top.
Thanks for stopping by, as always!
M
I was disheartened to hear my step mom, nay my dad’s second wife, say she is skeptical and doesn’t want the vaccine. She eschewed ‘cell & Gene Therapy’. It’s in the title of the company subdivision I work for. My dad had a heart attack a few years ago, and we’ve collectively done so much to keep him healthy and safe, and she’s refusing! After the phone call, I texted my friend ‘I’m going to go cry now’ and sat in my hallway sobbing ‘I don’t want my daddy to die ‘.
I am going to get vaccinated. But we (drs etc) aren’t sure I won’t be able to carry it to him. I will have a huge decision to make soon. I haven’t hugged him since Feb of 2020.
The Monday after the phone call there was both a work & other ( w/ Dr. Fauci!) town hall. My question of what to do about reticent parents made it into both. The work one said, use science. The other sort of the same. She already dismissed my experience.
Thank you for not making me feel so alone in this. Thank you for all you do as a physician. Thank you for sharing your amazing skill as a writer.
I am working on finding joy in the spring air, birds, flowers, sunsets, my adorable cats. So that the numb for the not great stuff doesn’t dull the joys.
P.s. My mom is fully vaccinated! (Happy). My friends are getting their shots as they become eligible. (Relief!)
Jacq,
I am so, so sorry. That is devastating to not be able to hug your dad for that long, and to not see an end in sight for this separation when you know it’s possible.
One of the major shortcomings the scientific community has had during the pandemic is believing that people make decisions purely based on data and facts. We are so entrenched in the science we don’t know how to bridge the gap to people who don’t see facts like we do. I often have to remind myself – I’ve been studying this stuff for 15+ years! How can I expect people to just “know” facts when they see it? It doesn’t translate and it leaves people feeling lost, like when you tried to ask for tips on how to approach your reticent parents.
You’re not going to convince someone to change their mind until you’ve met them on some emotional common ground. Only when you’ve found this footing will you be able to show them information that conflicts with their world view. If that’s not established, people tend to just dig their heels in and actually become harder to win over the next time you try to have the same conversation in the future. An obvious common ground in your case would be your love for your father – this must be the starting point with all these conversations, re-directing the focus whenever the conversation seems to be overtaken by his wife’s beliefs.
I’m not sure what misinformation she believes in, but if you were looking for language to address some of her concerns, Univ of MI has a really good article for some common anti-COVID vaccination arguments including micro-chips:
https://healthblog.uofmhealth.org/wellness-prevention/not-sure-about-covid-19-vaccine-get-facts-then-decide
For all of the vaccine hesitant patients I’ve taken care of, I’ve found it’s not the big blow out confrontation that changes their minds. It’s the building of trust, the knowledge that I would never knowingly put them in harms way, the little sound bites that wear their arguments down over time. It’s tedious, maddening and sometimes it feels like an utter waste of time for no gain. But it can work.
Best of luck with everything, and hang on to those happy moments when you can!
M