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Month: March 2020

Happy Doctor’s Day

“The best way to find yourself is to lose yourself in the service of others.”



Happy Doctor’s Day to my fellow physicians. We don’t typically celebrate this day with any fanfare, but it often is a time where we feel as though our work matters, because someone thought at some point there needed to be a day to celebrate us.

Today, I would like all of us to remember how we got here.

I was eight years old when I decided to be a doctor. Actually, I initially said I would like to be a nurse, I come from a family of nurses, my great grandmother and my grandmother were both nurses. My mother offered me the option of being a doctor, it was casual, like—you should do this instead. From that moment on, I continued to consider other professions, engineer, mathematician, but I always came back to medicine.

I was destined to become a doctor. I think all of us were destined to be doctors.

I spent my twenties studying. I was the student that needed to study a lot, and for me to make it in medical school that meant creating class notes and study guides, and having a favorite spot in the library to do so. I learned discipline, I also learned that I hated long hours of studying, but I rationalized—it isn’t ‘actually’ physically painful, it is just hard to decide to review notes when friends are partying, or all you want to do is watch television. To survive, one must be laser-focused on an intangible future, one that also is filled with hard work and sacrifice. Before residency, medical school was the hardest thing I ever did.

Residency and fellowship followed. Six years of 80 hour work weeks, 2 weeks vacation a year and one weekend off a month. Our lives become consumed with our profession, whether we go into surgery or pediatrics, emergency medicine or orthopedics.  For me, it was really hard to have relationships—both in and out of the hospital. The job becomes center-stage, it is demanding and unforgiving and leaves little room for anyone else. I used to joke that I couldn’t keep a plant alive, and could barely cook enough to keep myself fed. I would not have been a good partner and I was definitely not a good friend.

Because of these struggles and challenges, it is like we enter a club when we become physicians. It is a ’brotherhood’ and a lot of us feel most comfortable around each other. No one else fully understands the sacrifices we make to become physicians. One might try as they witness things from the outside, see us do our work, lend an ear as we cry, nod knowingly as we describe our exhaustion. But no one knows what it is like unless they have to do it. I see so much dedication and resilience in all of the physicians I know. I look at my colleagues with admiration, awe and deference because I know each have had a path, an arduous journey to get where they are today.

Today, for International Doctor’s Day 2020, we have COVID-19, and with it brings all kinds of feelings, but the one I am feeling most readily is grief.

Never in my life have I felt as much grief on a daily basis as I feel right now. We are in the middle of the worst disaster of my lifetime, patients are dying, and people are getting sicker than I or my colleagues have ever seen. We don’t know entirely how some people get infected and others don’t, and for the first time for most of us, we are worried about our own health. We are understanding that our profession now means possibly getting sick. This time, that illness is also deadly.

In a time when physicians should be lauded and listened to, for the mere fact that we are the only ones who can help some of these patients to live, we are faced with our own crises, which is an inability to protect ourselves. The country is facing a massive shortage of masks, gowns, and sanitizer. For those at home, this may not affect you, or it is a mild annoyance to hear it referenced or discussed on social media. For the healthcare providers on the front lines, it is devastating.

If you would have told me, years ago when I was a naive medical student, that the US would be facing the greatest pandemic in a century and the doctors and nurses working on the front lines didn’t have access to basic personal protective equipment like masks and gowns, I would have laughed at you. I would have told you that our country wouldn’t let that happen, that we would have a nationwide effort to protect the very people that are preventing even more death. But that is not true. There is no ‘nationwide’ effort. Our doctors and nurses continue to go to work everyday, some telling their families goodbye in order to care for the sick.

I am scared. I am scared for my own health, but more than anything I am scared for the health of my brothers and sisters in New York, in Louisiana, Florida and all over the world. People are dying, doctors are dying from being too exposed. We should be protecting the last line of defense (our healthcare field). It is unconscionable that we are not. We should be outraged and rioting in the streets. But we can’t, we are seeing patients, the sick and dying. We accept ‘makeshift’ masks from sympathetic strangers, we fashion gowns out of trash bags. And we hear of colleagues that die. And we go back to work. While the rest of the country mourns the loss of their freedom, we worry about our families, we worry about our friends, and we grieve.

We grieve as the patients get sicker, as the death toll rises and we ask ourselves, ‘what else can we do?’

We grieve as make sure our advance directives are signed and our wills are completed. We plead with family and friends to stay inside and die a little when we see pictures of the beaches in Florida. We don’t understand the lack of urgency from every government official and person in this country, and we feel like we are watching a train barreling toward a wall that no one fully sees. And we are so angry because some of our friends will die on that train. Some of us will die taking care of patients.

It is Doctor’s Day. To all of the doctors out there—I see you. I know what you have been through. I understand your anger and your grief. I cry with you every day. Be well, you are amazing.

Waiting For the Tsunami

“Being brave isn’t the absence of fear. Being brave is having that fear but finding your way through it.”
-Bear Gryllis


Winter in the Emergency Department is chaos normally. Viral illnesses permeate our population, and the season is usually from November to March or later.  Young moms get nervous, fevers get really high, and our volumes skyrocket. We typically see relief in late April or June when the sun comes out and everyone can be outside a bit more.

Now that Coronavirus is on the horizon, things are different. We are in limbo, not really knowing what to expect.

I have fortunately been able to test the patients that come to the ER that are suspected COVID infections, and I have done so with a handful of kids. None of the tests I ordered became positive. It’s so hard, no one really knows what the mild COVID illness looks like. The flu? Sort of, I hear. According to reports, I know most cases are usually accompanied by a fever, but what if you only have a cough? Also, the reports say that most children are spared from the worst effects of the virus, but we don’t know how much they are responsible for spreading it.

I got sick on a Friday before I was supposed to work the weekend. Our hospital had just opened a drive-by testing for healthcare providers. I wasn’t sure if I should get tested. I felt really fatigued and only minimal cough. I normally would go to work under these circumstances. But these are not normal times. We have an ill-defined, but seemingly inevitable wave of tragedy that is about to hit our medical community. The old rules don’t apply anymore.

I decided that the best course of action was to assume I had it, stay home from work and get tested. It was more scary to potentially expose an entire ER of healthcare providers than to admit I was sick and stay home.  Fortunately my test was negative. I was sort of hoping it would be positive, just so I could say I had it, it was mild, and I recovered fully. I went back to work on Sunday. By now, things really felt different. The hospital is eerily quiet. It feels like  summer, from the number of patients, but very different in other aspects.

We are all holding our breaths. Waiting for the storm, bracing for impact.

I heard yesterday that an ER doctor from our community is ‘critically ill.’ He is reportedly only 40 years old. I am feeling with increasing dread that my job is dangerous. Honestly, I am not concerned too much about the health and safety of my children, as I commented earlier, the reports out of China have very few children getting seriously or critically ill.

But I am not immune, and I am in the eye of the storm.

I am becoming increasingly aware of how hard it is to practice ‘social distancing’ in the ER. We talk to our trainees, our nurses, our patients and our patient’s parents.  Our protective gear is there to protect us, but it is had to wear all the time.

By distancing ourselves with our protective equipment, we are also distancing ourselves from our patients, which is not traditionally what we try to do as doctors. You can’t express as much when your face is covered with a mask. Connection becomes that much harder, as my compassion and sincerity aren’t able to be communicated as easily. It is also really hard to hear with the noise of the fan on in our ‘respirators.’

I start to feel crazy, wiping everything down all the time. I start to get paranoid. Did I clean my workstation enough? Do I need to clean it again, every time I return? I now am spending more time cleaning than working, it seems. My hands are dry and cracked due to the amount of hand washing and antibacterial gel.

Then there is a kid who is unexpectedly ill with a respiratory illness. Maybe they have COVID, maybe not. Maybe you put all of the protective elements in place, only to find out that a colleague that you worked with a week ago is feeling sick, and the child is negative. Or a family member you recently had dinner with was around a person that tested positive. Am I now infected? Am I spreading this illness?

This whole event is becoming very real for me. I am starting to think about my own mortality and what would happen if I got sick. In China 4% of their confirmed cases were healthcare workers. Healthcare workers had a 15% chance of their illness being severe or critical. What are my risks? I have also heard that a recovery rate is only 5% if one is sick enough to need intubation, but I haven’t seen the data speaking to this specifically.

I feel deeply attached to my role in this pandemic, to be on the front lines, doing my best to stay strong, positive and tend to the patients that need it the most. What happens when we start to question this role? Is it better for me to triage and care for my patients, or my family? Can I do both effectively? What happens if I get sick? Will I be ok? What happens if we all get sick and can’t come to work?

I hear that the pediatric doctors will be pulled to care for more adults, there will be a sense of ‘all hands on deck’ if it gets to epic proportions. What about our mental health? What about our ability to stay resilient in times of crises? I understand that I and my colleagues are in the field we are because we like this atmosphere. But I also would like it to end quickly. The idea of weeks of this, massive amounts of patients, uncertainty, possibly working more than ever to tend to the ill is daunting.

I can imagine that too much stress and work could lead to the healthcare providers being prone to illness. A few companies, Headspace and Ten Percent Happier are providing free services for healthcare workers during this time. Many facebook groups are popping up, one for support of colleagues, the other to share clinical data and treatment modalities.

Life in medicine, as in other areas as well, will be remembered as ‘before the pandemic’ and ‘after the pandemic.’ We will never be as ill-prepared from a testing, staffing, availability of personal protective equipment, as we are in this moment.

I am taking it day by day, watching the trackers closely, anticipating that things are going to get a lot worse in the next few days to weeks. I hope all of you can stay safe, stay home, and get support or help if you need it. Don’t be afraid to stay home from work to get tested either, we are all in this together.

How are you coping? Please leave a comment about what the impact has been on you or your job, family, etc