On my first day in the hospital after quarantine began, the chaplain ended a team huddle with a solemn reminder that we were ordinary people doing extraordinary work. It was a sentiment he frequently shared, but in recent days it had taken on new meaning.
The first patient I visited during rounds was an elderly man, frail, his eyes searching mine for answers. The language barrier, masks, and loud humming of the negative pressure ventilation system made communication challenging. "Do I have that virus?" I did not know. "Is it going to get harder to breathe?" I was not sure. "I need my daughter. Can you ask her to come?" I could not; visitors were no longer allowed.
This was clearly not going well so I pivoted, focusing on what we did know, what we were doing, and how we were prepared to support him. But I was yelling comforting words at a video interpreter. None of this working.
My words offered neither the answers nor the support he needed. So I stopped, squatted down next to his bed, and placed a gloved hand on top of his own. We sat there in silence and I hoped empathetic eyes were worth something.
Practicing medicine has always been personal. In the first year of my training, I delivered babies, pressed on chests of dying patients, and witnessed colleagues, caregivers, and patients at their most vulnerable moments.
At night, I was kept awake reliving the joys and sorrows of the day. With time I learned what any seasoned physician will tell you; surviving in the medical field requires a degree of social distancing. One must learn to establish boundaries and recognize and respect limits, in order to keep the work from overwhelming private life.
And so I drew (and redrew) lines that helped me to leave more of my work at work and protect personal space.
Three months into my first job as an internal medicine doctor in New York City, my mother was diagnosed with stage four cancer and things got messy. Arriving home from each chemotherapy session, I would immediately grab a pair of scissors and ceremoniously cut off the medical ID band from her wrist, declaring, "There are NO patients in this house." It was a feeble attempt to draw a line and protect some part of our lives from the illness consuming us.
At night, once my mom was asleep, I responded to messages of support and planned special moments with my newborn daughter, attempting to consolidate years of family activities into a few months. Exhausted but unable to rest, I would flip open my laptop and spend hours checking my mother's labs, reviewing her images, and researching experimental treatments. Daughter. Doctor. Mother. Patient. The lines were blurred.
Six months after she died, I started specialty training in pulmonary and critical care. The once familiar beep of continuous monitors, and rhythm of rounding medical teams consulting, conferring, consoling, were now resonating on a deeply personal level. I scrambled to find new ways to disentangle professional from personal.
Overwhelmed by the reality of being a caregiver in need of caregiving, an abandoned phone booth became my lifeline. Located down the hallway from the ICU, the payphone and phone book had long ago been removed. Left behind were a small bench and an empty shelf. Several times a week I would slide the folding door closed, press my hands into the walls, my feet into the floor, and breathe deeply, sorting my emotions and roles, trying to define a line.
Of all the patients I met that first year, there is one I still carry with me daily. She was a middle-aged woman with two concerned daughters and a husband who did not leave her side. It was a family dynamic I knew all too well. Admitted with progressive respiratory failure, she was afraid yet calm, struggling to breathe yet using her words to comfort others -- mothering to the end.
During her 12 days in the hospital, I spent a lot of time in that phone booth sorting and processing, often uncertain who the tears were for. In the end, I gave up on the lines and boundaries and brought my grief into her room. Sitting with her daughters as she passed was a moment for which I am forever grateful. That is the thing about practicing medicine -- sometimes you are at your best when you let it get personal.
Now weeks into the coronavirus epidemic I am exhausted, anxious, and feeling quite ordinary. The work is evolving, uncertain, overwhelming, extraordinary. Coronavirus has turned the practice of medicine upside down, leaving a nation of health care workers struggling to reorient.
Each day we invite patients into our homes, conducting telemedicine visits from our private spaces. We care for hospitalized patients, acting as poor substitutes for the loved ones ordinarily at their bedsides. We advocate for PPE, consume public health updates, and mourn the mounting losses.
At night, weighed down by the emotional, physical, and cognitive load of this new reality, we carry our belongings home in bags, wash away the day, and hesitate before kissing our children goodnight. We check in on friends, families, neighbors, and colleagues -- a nation of patients and caregivers in need of caregiving. And then we open our laptops and spend hours checking labs, reviewing images, and researching experimental treatments.
Doctor. Friend. Patient. Colleague. The lines are blurred. This is personal.
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April 17, 2020 at 09:34PM
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Doctor. Friend. Patient. Colleague. - CNN
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