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Wednesday May 27, 2020

COVID-19: Two Sides of the Looking Glass

Three weeks into being a full-time COVID-19 hospitalist, I had reached my stride as a competent, compassionate attending. I had addressed the doctor-mom balance by sending my husband and children to live with my parents in California to reduce their likelihood of exposure to the pandemic -- both physically and emotionally -- and to allow me to work without having to worry about their homeschooling in my off time.

[woman looking at self reflection in mirror]

Then things reached a good emotional plateau and I asked for my husband to come back to support me. That's when we got a surprise. My 72-year-old father-in-law passed out at the wheel of his CR-V in a grocery store parking lot, drove off the lot and hit a wooden fence. He said he'd been dizzy and hot. The police and an ambulance responded, but he refused to go to the hospital. He said he felt better and went home. As a Marine and former mayor of his town, he has a knack for talking his way into, and out of, anything. Initially, my three sisters-in-law, my husband and I blamed his poor sleep hygiene, stubbornness and habit of not always taking care of himself. He likes to stay up too late working, gets up too early and sometimes needs reminding to stay hydrated.

But I paused. He has atrial fibrillation with aortic regurgitation and was due to have a valve replacement this year, and he had never had syncope before. I wanted to rule out a cardiac cause, so I told my husband to make the drive from Boston to Long Island, where his parents live. When he arrived, he cleaned, cooked and organized. That afternoon, his dad had another dizzy episode. My husband took his temperature, which was 102.1. His pulse was in the 130s. It turned out that he also had been having loss of appetite, vomiting, weight loss, myalgias and fatigue for a week. He hadn't even been able to keep down water. My husband split the house into an area for himself, an area for his dad and an area for his mom. He deep cleaned (while masked). I sent a pulse oximeter and a care package with more masks, gloves and supplies. Clearly, my husband would not be coming home any time soon.

My father-in-law continued to be febrile for four days and tachycardic intermittently. He talked to his primary care physician and his cardiologist, who told him to stay home and continue to monitor. I didn't agree. Needing to have someone objective look at his data, I had him (and my husband and mother-in-law) sign up for Duke's national COVID-19 symptom monitoring system.(covidwatch.dukehealth.org) They alerted him immediately via text and email, and a nurse called him within 12 hours to recommend that he go seek in-person care. Yesterday, he spent six hours in the emergency room, where he was found to be weak, dehydrated, tachycardic and febrile. Labs and imaging were done, and he was monitored. They decided he was stable to monitor at home for his COVID-19 infection, knowing he would be checking his vital signs and symptoms twice daily. The symptom monitoring system clinicians will continue to call if he logs any severe symptoms or ongoing vital sign abnormalities.

I had been ignoring my own emotions, focusing on work. My regular schedule: I get home from my night shift and reach out to friends (some of whom are my outpatient patients) who have COVID-19 to see how they are. I reach out to my husband and get his parents' vital signs and symptoms. I go to sleep. I wake up, check in on those same friends/patients. I read any updated algorithms, maybe watch part of a grand rounds, call some family friends to discuss their COVID-19 questions. I come to work. I admit patients, I transfer patients to the ICU, I have discussions with families about their family members if they're getting sicker, and sometimes I have patients who die.

I'm living alone. I don't go shopping. Friends and neighbors generously drop off meals. On my few days off, I exercise early in the morning or somewhere I know no one else will be.

When COVID-19 reached my own family, I was able to continue for about two days. On the third shift, 4 a.m. hit and so did the tears.

How can I call and try to be calm for families that are so scared when I am so scared, too?

Yes, my father-in-law may follow statistics and be fine. But both my in-laws have risk factors, and my mother-in-law has been exposed. My husband also has been exposed. My family members are scared for him. They have reason to be. I track his timeline, just hoping we get through the two-week mark with him still stable at home.

I am not naive to how this virus works. I know there is madness in its method, and we don't understand that method well enough to have effective treatment options yet.

I suddenly felt like I was talking to myself in a mirror. I am on both sides. I am the doctor. I am a family member. I am the one who knows and tries to be compassionate about how alone this feels. And I am the one who sometimes feels so alone.

The teams I work with -- and I mean the floor teams where I am often the only attending with nurses, CNAs, transport and custodial staff -- have been amazing. We share in each other's fears, grief and hope. We are there for each other both in our work lives and in our personal struggles and fears. Many of us have family members who have COVID-19; many of our staff have had it themselves. I came in tonight and they asked about my family and well-being, and I asked about theirs. I brought in cookies a neighbor baked. When this passes, I hope the old silos between nurses, staff and physicians will continue to be pervious. This has been where we have drawn our strength, and for that I am so grateful and hopeful for the future.

MaryAnn Dakkak, M.D., M.S.P.H., practices full-scope family medicine and is an assistant professor in an academic hospital center in Boston. She is also women's health director at Manet Community Health Centers. Her views do not represent those of the organizations with which she is affiliated.

Read other posts by this blogger.

Posted at 12:38PM May 27, 2020 by MaryAnn Dakkak, M.D., M.S.P.H.

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