I'm Angry and You Should Be Too

I'm angry. It takes a lot to make me truly angry, but us reaching a similar number of cases as in April in the span of a few weeks enrages me. I'm angry at this virus, I'm angry at those who didn't take it seriously, and I'm angry on behalf of those who are going to lose loved ones because others didn't take it seriously. 

I want to be altruistic and be there to support patients during this difficult time, but I've found myself having altruism fatigue. All the "self-care things" I do for myself  like seeing my partner, going to an outdoor fitness class, being able to sit outdoors and have dinner with a friend are slowly being ripped away from me. What will I have left to keep me going? I'll have to figure out something else to cope. My entire residency is now laden with uncertainty. Will I finish this rotation or will I be redeployed to a covid ward? Do I still have immunity or am I just as much at risk as anybody else? Will I be able to write my exams or will they be cancelled over and over again? When will I get to see anyone that I love again?

Everyday for months I have watched people flagrantly violate the rules and regulations. To the woman in the Dollarama whose older child was not wearing a mask and actively coughing, how dare you. To the patient I saw who came in with COVID after having multiple "small gatherings" of over 20 people, how could you. To the healthcare workers I've seen in a variety of settings with their noses out of their masks for prolonged periods of time, what's wrong with you. To the family members of loved ones I have transferred to the ICU, I'm angry that you have to go through this. 

We are all collectively struggling to varying degrees with the same uncertainty, anger, exasperation, and fear of the unknown. As I've come to learn, anger isn't always a bad thing. Instead of letting it consume you, channel it. Let it fuel a fiery passion that drives you to take action and make change. Let your anger about this situation be a catalyst to speak your mind, educate those around you, and stand up for injustice. We owe it to each other. 

Blurred Lines: From Doctor to Patient in the Blink of an Eye

"Oh no, this can't be happening" was my first thought when I awoke Friday morning of Easter weekend. My muscles ached and felt heavy, my throat burned, and I was covered in a gentle sweat—the morning dew of illness. I took my temperature—37.8. I need to get tested. I had worked on a floor with many COVID-19 patients and I knew my risk of having COVID was high.

I heaved myself out of bed and got dressed. I forced down a few bites of oatmeal but I had no appetite. I lay for another hour or two hoping it would pass but it didn't, and I knew I would need to walk over to the hospital having no access to my car and not being allowed to use public transit. It's only 20 minutes, I can do it. Before leaving the house I paused—should I bring anything with me? Nah, this is a simple in/out scenario. Balaclava and winter coat on, I slowly made the walk with only my wallet, keys, phone, and hospital ID. I'm definitely sick, I thought to myself, as I felt more out of breath and dizzy than usual walking up a steep hill. I thought about taking breaks a few times in my walk but instead just slowed down.

In the holding area, I sat with my eyes closed waiting for my turn to be swabbed. All I wanted was to sleep. As they took my vitals, my mind raced with all the things I'd need to take care of—messaging the faculty, finding someone to cover my call, etc. "Woah are you feeling okay?" I snapped back to reality. I could see the fear in my nurse's eyes—it's amazing how much you learn to read people's eyes when you spend so much time working in masks. I looked at the monitor to see I had a fever of 39.5 and my heart rate was running at 140 (normal is 60–100 and my usual normal is about 58). Apart from a bit of dizziness and palpitations I felt alright. They kept me in another holding area where the ER physician peeked in and informed me that they would be doing some blood tests and a chest X-ray. I asked for water and Tylenol which the nurses kindly gave me.

I dozed in my chair waiting for the results. After about an hour, the ER physician returned.

"Are my lymphocytes low?" "Yes"

(Lymphocytes are a type of white blood cell involved in fighting viral infections. Low lymphocyte count seems to be a hallmark finding in COVID-19.)

"Anything on my chest X-ray? I definitely feel a little pain on the left side."

"Yes, we do see a little something. I've seen a lot of patients with COVID-19 lately and I'm a bit worried. I would like to keep you in the ER for some observation, start you on some antibiotics and IV fluids. Please follow me."

It was in that moment I knew in my heart it happened. I had COVID-19. I didn’t care what the swabs said—I had it. No longer able to maintain composure, I broke down crying. My tears pooled inside of my mask. I was brought to a negative pressure room (created with what looked like cellophane and a small generator on the floor). IV fluids were started, and I was hooked up to telemetry (which is like a continuous EKG). In the blink of an eye I went from working in this hospital to being a patient. Various healthcare workers did a double take by my room, recognizing me and sending me good wishes through my plastic wrap window.

To any physician who has been a patient, you know how challenging it is to accept that sick role. The doctor's hat doesn't come off just because the hospital gown comes on. Colleagues had now become my caregivers. The usual mental challenge of diagnosing patients and developing comprehensive management plans was replaced with trying to figure out how to use the commode whilst connected to a spider web of medical tubing. I tried to curb my thoughts but I couldn't help but wonder what if I was one of the young people who would die from this. These fearful thoughts floated in and out of my head, the only sound to drown them out being the gentle hum of the negative pressure generator and the rhythmic dripping of my IV fluids.

As the fever came down over the course of the next 6–7 hours, my appetite came back. My faster heart rate, however, persisted. Even simply sitting up would send my heart rate skyrocketing and my machines beeping. I called the nurses stating that I was ravenously hungry despite the small cheese sandwiches I was given earlier. Much to my surprise they came back with several slices of pizza. "We've seen you work here. This could have been any one of us. We need to take care of each other." They also lent me a phone charger so I could continue to give my family updates.

Later that evening I was transferred to a COVID floor for continued monitoring. It was so surreal being wheeled down the very hallway I had walked hundreds of times before. At around 1 am, a code white (aggressive patient) erupted next door. I heard yelling and objects being thrown. Unwilling to accept the patient role in that moment, I peeked my head out the door asking the nursing staff if they needed help—they told me they had everything under control.

As the days passed my heart rate slowly came down. I spent most of my time lost in thought and chatting with friends/family. My best friend dropped off some much-needed supplies, which helped make my time in hospital more bearable. I never realized the degree to which patients are stripped of their control while in hospital. Being woken up every few hours to have your vitals checked, receiving meals whenever they come, etc. You could sometimes wait two hours to be seen after calling the nurse for something non-urgent because they are dealing with more urgent situations with other patients. Despite receiving stellar care, there were still moments I felt dehumanized.

Three days later I was finally stable enough to go home. I was brought home via a special taxi. The first night back in my bed was glorious. The next seven days were spent mostly asleep, fuelled by Gatorade and Kinder Surprise chocolate. Every morning this virus felt like a new illness: some days the predominant symptom would be joint pain, other days it would mainly be coughing. Around days 6–7 of illness I completely lost my sense of smell—quickly realized when I felt the need to add salt to my Campbell's soup. By day ten, I started to feel like me again. My sense of humour, my appetite, and my drive to get back on the front lines to practise medicine all flooded back in. After two repeat negative tests, I was allowed to go back to work. I did it. I survived COVID-19.

Pandemics can bring out two kinds of people: the person who hoards or the person who helps. I have to say after the initial frenzy of toilet paper buying, I'm seeing more and more of the latter. Neighbours and friends dropping off food in my mailbox to make sure I had something to eat while sick. Donations from various companies to healthcare workers and those in need. Patients more than ever asking me if I'm doing okay during their phone consultations. Although our experience of the pandemic is vastly affected by our level of privilege, we are going through a collective trauma. And even though many of our rights are taken away, we still have tremendous power to help others.

So please, I implore you—reach out to those who are vulnerable and see if they need help. Groceries, a phone conversation to combat the isolation, you name it. I can tell you firsthand that these gestures go a long way in making these difficult times more manageable. Social distancing will keep us safe, but kindness will keep us human.

Going to War

"Dear resident, you are being contacted for redeployment..." I had to do a double take reading this email. Redeployment? I may not be a soldier in the conventional sense, but as I stared at my screen in awe, it became painfully clear that this is war. Our freedom is restricted to ensure our collective safety. Our food is rationed as demonstrated by the stream of signs in the grocery store stating: "please no more than two articles of each item per household.” Around the globe we face a similar unsettling climate, fearful of what's to come and unsure of how long it will last. The clicks of the hand sanitizers are our drums of war. The masks, face shields, gloves, and gowns are our armour. Yet our enemy is invisible to the naked eye. As far as I know, this is the first time in human history that we are fighting a war for each other and not against each other.

As the days turned into weeks, the "rule out COVID" on my consult sheets slowly turned to " COVID positive.” One by one services shut down and wards were repurposed in preparation for the influx of patients requiring more care.

"Mrs. G spiked a fever last night. We've swabbed her for COVID and rearranged the rooms to put her in isolation," said the head nurse. I could see the worry in her eyes. The scraggly blond hairs jutted out between the taught elastics of her surgical mask, almost as though they too wanted to flee the situation. I frantically flipped through the chart, praying to find a possible history of exposure—perhaps a family member who came for dinner? Recent travel? Anything to reassure us that it wasn't acquired in hospital. Yet I found nothing. At 4:55 pm, nearing the end of my shift, I refresh one last time to see if the result is in: SARS-CoV-2 virus detected. I break the news to everyone, and our hearts all break at the same time. Contact tracing is initiated and everyone who interacted with the patient without wearing protective equipment is sent home on mandatory quarantine. Our nursing staff halves within a week.

I open the box of masks one morning to find only one left. We look around, with furrowed brows and palpitations. None left on the ward. Is this it? Is this the day we've finally run out of masks? But somehow, we always find more. Sometimes we must wait a few hours but eventually they come. I've stopped seeing most patients altogether—sending one person in to do my physical exam and report back with the findings in an effort to save equipment. As I write my discharge summaries, I'm seeing less patients going home and more patients being transferred to the COVID wards, many of whom will take their last breaths there.

Day in, day out, after watching these scenarios play out, I retreat home to my empty apartment, left only with my thoughts and last week's leftovers. I think one of the hardest things about being isolated is that you realize how vulnerable you truly are. You are now stripped of the many outings and work meetings you hid behind to avoid those deep dark truths within yourself. Slowly, I've started dealing with these truths. Love from my partner, family, and friends has helped to catapult a flurry of personal growth.

These are dark, scary times. Thankfully, darkness makes the light that much easier to find. Like the sunshine peeking under your bedroom door in the early hours of the morning, we must cling to those tiny rays of happiness when they strike. That warm fuzzy feeling when you catch up with a close friend that you haven't seen in years because your workloads have kept you apart. The smiles after achieving the perfect April fool's prank. The stopping mid-meeting to sing a colleague happy birthday as loud as you can until they blush uncontrollably with embarrassment. Yes, we are at war, but we can also find peace within that. There's still beauty in this time of tragedy and I encourage you to use your newfound time to find it. You'd be surprised to see how it has been there all along.

Week 1 - Working During the Pandemic

The perspective  of a 1st year family medicine resident:

"Do you have a cough, fever, sore throat, or have you traveled outside of Canada in the last 14 days?" has become the new greeting that replaces "hello" when I first get to the hospital. We silently queue one by one as the masked security guards ask the same questions to everyone and enforce mandatory hand sanitization. All visitors, non-healthcare workers, and anyone with symptoms are turned away immediately. With a flash of my badge and a dollop of hand sanitizer in hand, I'm allowed to begin my workday.

The hospital is alive, almost like normal, but so far from it. The entire atmosphere feels like the holding room before the start of a big exam, except the exam never comes and we hide our unabated anxiety with nervous laughter. I see the worried looks on people's faces, the noticeably empty hallways, shortened cafeteria hours. All food and drink is now prepared behind the counter as an infection control measure. Chairs in waiting rooms and eating areas are taped off or removed to enforce social distancing. These tiny differences make a place that once felt like home feel almost unrecognizable. Colleagues pass each other in the corridors, coffee in hand. They smile and chat but don't shake hands or hug like they used to. Meetings and case reviews happen from across the table and you don't dare touch your supervisor's mouse to show them a lab result. Not anymore. It's hard to keep up with the never-ending string of emails about covid this, covid that, at all hours of the day. We are constantly receiving new guidelines on how to go about our practice. Family medicine consultations are mostly done by phone now. I mail my patients their lab reqs and try to avoid sending them for any non-urgent testing for the foreseeable future. All gonorrhea/chlamydia testing must be done by urine now so the swabs can be reserved for covid testing.

On the wards for now we are in the calm before the storm. The rest of medicine however continues to surge on. There are still people coming in with heart attacks, strokes, kidney infections, and everything else. But now every fever, every cough, every sneeze ignites collective anxiety. Treat everyone as possibly infected until proven otherwise. On the way down the hall I pass several rooms with patients on precautions (meaning healthcare workers must wear gloves, gowns, face shields, etc to enter). Sign-in sheets are taped to the doors to keep track of who goes in and out. These measures are in place until testing comes back. I feel occasional guilt for using gloves to examine patients not on precaution because I do not know if we will run out of them in the future. In hushed tones behind closed doors we discuss, we plan, and prepare. Seminars on how to swab people are given. Power points and other learning resources are shared. I'm still learning how to manage patients in critical condition and I'm privy to discussions of the next steps in care as the disease unfolds. I've even heard theoretical discussions on how we can hook up two people to a ventilator at once - just in case.

I struggle daily with the balance of social distancing and maintaining sanity. Do I see my partner or am I putting him at risk? Do I go to the dollar store to get a few creature comforts to help me cope at home although they are non-essential items or am I being selfish? I am graced with the support of family and friends who call and check in regularly.  Yet when you spend your whole day seeing everything first hand and you don't get a break, you just want someone physically there with you. That human presence that everyone craves when receiving comfort. But you can't. In times of sleep deprivation the anxiety takes over and worst case scenarios trickle in.You flush them out with Netflix and other distractions until sleep finally comes.

In times of trouble I've always turned to nature and thankfully that's one thing I don't have to give up during these surreal times. As spring approaches, the sun shines a little bit brighter, the birds erupt into spontaneous song, and the air is fresher than I've ever known living close to the highway. This is a challenging time for everyone but humans are resilient and it's going to be rough. Despite all the uncertainty, I have no choice but to believe we will get through this together. Socially distanced, but standing as one. Just take things one day at a time, one moment at a time, one cough at a time.