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. 

There is a place for people with disabilities in medicine

Medical Leave - I had a feeling this was where I was going, it was only a question of when not if. After struggling throughout the entirety of my medical degree, I was diagnosed with ADHD and another learning difficulty - both which had been missed my whole life because I was smart and externally appeared to compensate.

But the inside never matched the outside. People saw good grades and conscientiousness on the outside; whilst anxiety and impostor syndrome because of my difficulties lurked on the inside. People used to compliment me on how organized I was with my to do lists and notes; little did they know that I would be completely dysfunctional without them. The streamlined conveyor belt that is medical school allowed no room for learning differences. You were expected to learn in certain ways, meet milestones at certain times, and all the feedback I received was "compared to others at your level".  While I understand the challenges faced when trying to train hundreds of doctors in a timely fashion, this system did more harm than good for me. It made me feel like I didn't deserve to be there and I gradually developed anxiety about trying to "be like everyone else". 

Being diagnosed in my final year of medical school did not afford me much time to deal with these challenges before starting residency. The bar was raised, responsibility increased, hours increased, yet I had few more insights on how to work around my limitations.With each passing month, I felt myself falling ever more behind. The same criticisms day in and day out. "Your performance is not where we would expect it for someone at your level". The anxiety continued to grow as I became more and more fearful about not meeting others' expectations. After months of crippling anxiety, the negative feedback slowly started to infiltrate deeper and deeper. The sun shone a little less brighter, exercise gave a little less high, each day I had a little less energy. But it all seemed to so justified, I mean who wouldn't feel that way working 80h work weeks? When you are working crazy hours, anything you are feeling seems justifiable. Too tired to cook, too tired to go to the gym, too tired to eat, too tired shower. But it wasn't until I got physically sick that I realized how unwell I'd actually become.

I took a few weeks off to recover physically, emotionally, and spiritually. I decided behavioural intervention was no longer sufficient and made the difficult choice to start medication to treat my ADHD and the associated comorbidities. I saw a quote somewhere that really stuck with me "If you can't make your own neurotransmitters, storebought is fine". Like anything else it was trial and error until I found something that worked for me. I'm not out of the woods yet and I still don't have all the answers but if my time off has taught me anything it is that there is a place for people with disabilities in medicine. We add a whole new layer of insight, wisdom, and diversity to the field. These differences should be embraced instead of being seen as a hindrance or inconvenience.

Not everyone will experience their disabilities the same way, but for many of us it may take longer to get where we need to go. You have to throw away your timelines, disregard comparisons to others because it is like comparing apples and oranges. You will meet those milestones but in your time and in your own way. Don't be afraid to ask for help, try medication, and take time off if you need it. It's no longer about making the outside match the inside; it's wearing the inside on the outside with pride.   

Losing your "favourite" patient

*All descriptors of this patient interaction have been changed to protect their identity*

When I met Mrs. J we instantly bonded over our sarcastic sense of humor and common heritage. Knowing a few words in her mother-tongue language solidified that doctor-patient relationship almost instantly. Having had a healthcare background herself, she knew all too well what was happening with her breast cancer. She tread that fine line between staying optimistic in the face of dying vs denial. And it didn't help that her husband believed she could still be cured despite CT scan after CT scan showing tumors spreading throughout her body, like lights on a macabre Christmas tree.

Mrs. J had a lot of pain from her metastases that made it hard for her to sit, eat, and drink. Having previously worked as a head nurse, this immense loss of independence troubled her greatly. She had gone from being in charge to needing a two person assist to use the washroom. After several days of following her on another floor I felt it was time for her to be transferred under palliative care.


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When I went to see her in her room, there were yellow flowers at the bedside. The half eaten remains of her pureed food sat on the tray table to the left of her hospital bed. She sat up and smiled at me. She always found a way of smiling. I asked how she was feeling, how her pain was, and if there was anything she needed that day. With heartbroken acceptance, she opened up woefully about her pain and everything she had lost. She told me everything. Everything but the elephant in the room, the question that has been plaguing her since she was diagnosed. "What will happen next? How will I die?". No words were needed to express what was on her mind, I just knew. I sat with her and we held that fear together.

Apart from adjusting her pain medication, she asked if I could do something for the diarrhea she had been having. When I examined her abdomen, I could feel the rock hard tumor that lay beneath, notably bigger than two weeks ago. I told her I would do what I can and that we might run a few tests. With the guidance of my staff, we adjusted her medication, ordered basic blood work and a CT scan. "To follow up tomorrow" I jotted down on my to do list.

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"How are you feeling today Mrs. J?"
"Oh I feel good, so much better. Whatever you did with my medication has really helped. This is the first day that I am pain free and my appetite is good too!"

She went to hold my hand and I hesitated, blushing with embarrassment. Breakfast was a long way away and my hands were ice cold. Exactly the kind of hands you don't want your doctor to have. She took them none the less and exclaimed:
"My goodness are you alright?!?! Why are your hands so cold??"
I reassured her that I was fine but she insisted that I sit down so she could warm them up. I sat at the edge of her bed and she slowly eased herself towards me. Her grip was firm but gentle. She warmed my hands between hers, her hospital bracelet every so often tickling my wrists. When she was satisfied, she let my hands go and went on to talk about how she used to do the same for her kids. We exchanged a few laughs and I let her know that I would be back later to check on her. As she waved goodbye, she gave me the brightest smile I had seen in nearly two weeks.

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As I sat at the computer going through my to-do list, I noticed that the results for Mrs. J's CT scan were back. I opened the labs first and they were abysmal. I was surprised she was even conscious with lab results like that. Next I opened the CT results - and just as we had suspected - a bowel obstruction. The tumor had now invaded her bowels. The obstruction was only partial for now which explained why she was having diarrhea. This is something known as overflow incontinence - where not yet fully formed stool passes around the obstruction. But eventually this obstruction would be complete, resulting in intractable vomiting and ultimately palliative sedation during her final days. It broke my heart to know what this sweet, courageous woman might have this in her future. She had survived war, raised a family against all odds, and started her own business. How could I possibly maintain this person's dignity with what lay ahead. In that moment I decided that for as long as I could, I would always make her smile.

My staff and I discussed our approach to management and he got up to go explain to the patient the next steps in her care. I stopped him: "Please, let's not give the results today. She finally feels good. Let her have today". When I went back to check on her she was in her chair enjoying her evening soup. She asked about the test results and I lied, saying that they weren't in yet. She didn't care, she felt good and hummed to herself gleefully between spoonfuls.

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She had grown substantially weaker and now spent most of the day lying in bed sleeping. She sipped some juice from time to time, but no longer had the energy to sit in her chair and eat meals.
"Mrs J? Good morning, sorry to wake you. I just wanted to see how you were doing."

She gently opened her eyes and looked at me. She shrugged her shoulders.
"Any pain? " She shook her head no.
"Any appetite?" She shook her head no.
"Anything else bothering you?" She shook her head no.
"Ok well I'll let you get back to sleep" I took her hand. She held mine gently, nodded, smiled at me and said "Thank you"
She was already asleep again before I left the room.

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"Mrs J? Hi, how are you?"

She weakly opened her eyes and held my hand. From her chart I read that she has not eaten in several days, only a few sips of juice here and there. I sat at the edge of the bed and asked the same questions I did each day.

"Mrs.J remember yesterday I told you that today would be my last day?"
She let out a deep sigh and squeezed my hand tightly. I squeezed her hand back and said:
"You are such a strong, wonderful woman. You have done so many great things in your life and you should be proud of that.  It was a pleasure to meet you, and I wish you all the peace and comfort you deserve."

She gazed up at me, her eyes filled with tears and she softly whispered "Thank you, thank you for everything".  I sat in silence smiling at her, holding her hand for several minutes until I had to leave to go check on another patient. Neither of us wanted to let go but we both sorrowfully accepted that this would be the last time we would see each other. I walked slowly out of the room, her hand lay at the edge of the bed exactly where I left it.

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It has been several weeks since I last saw her. I haven't found her obituary but I suspect that she must have passed away by now. I don't know when or how it may have happened, but I hope she suffered no pain.  I feel a sense gratitude for having had the privilege to play my part in her dying process. Every so often when a crisp breeze rolls by and my hands grow cold, the thought of her passes briefly through my mind. Her smile and her strong grip still as vivid as the yellow flowers she kept at her bedside.

Declaration of Death: First Day on Call in Palliative Care

*Disclaimer - all identifiable characteristics have been changed*
*Trigger warning - description of examining a dead person and what happens to a body after death*


My first call. Pager? Check. Stethoscope? Check. White coat? Check. Granola bar? Check. Confidence? Well you fake it till you make it so "check"

At a gentle walk, I moved through the corridor of the obstetrical ward. My white coat trailing in the wind like sails of boats venturing through uncharted waters. The distant newborn cries echoed until I crossed into silence. I had made it to the Palliative Care ward. Ironic to have life and death in the same hallway, but in the wake of construction that's how it worked out.

I went to the nursing station, introduced myself and asked if there were any unstable patients requiring my attention. The head nurse replied, " Oh well thank goodness you are here, could you please declare a death? He's been dead for two hours now, the family is waiting for you."

I gingerly stepped into the room with the nurse and introduced myself to the family. I offered my condolences and support, and then explained the necessary steps for the declaration of death. They were offered the opportunity to stay for the exam, but they chose to leave.

There are three criteria used to declare someone dead, you must have at least two of them:
1) Pupils dilated and non reactive to light
2) No palpable central pulse (such as the carotid pulse in the neck)
3) No respiratory effort or breath sounds for 1 minute

Thank goodness I had the teaching on this the day before. We were also taught that despite meeting the criteria for death, the body can remain in many ways "alive" for hours after. From muscle twitches to sounds of digestion, these and many more processes may occur as the various parts of the body break down. Death is not instantaneous despite turning peoples' world upside down in an instant.

Alone in the room, grateful for the nurse at my side, I began to examine a man whom I had cared for for days. Whose labored breathing I helped to calm, whose grimaces of pain I helped to relieve, whose spirit in whatever sense you believe it was no longer there. I approached the patient's face and delicately opened his eyes. Criteria 1 was met. I place my hand gently along his neck, no pulse found. I listened with my stethoscope and watched for one whole minute. Criteria 3 was met.

I went out to inform the family and assist them with funeral arrangements. They expressed their gratitude for everything we had done and left a box of chocolates at the nursing station as a token of their appreciation. I carried on with my day as best as I could but I felt distracted. The events of the morning still lingered like hot coal in a christmas fireplace. I can't help but reflect on the way I see life and death now. It's not static, it's not black and white, it is just grey zones. One can be alive and not living. One can be dying but so full of life. One can be dead to those around them for decades and others can live on through those who loved them.

At the end of my shift, I walked through the same familiar hallway - the gentle wails of new life piercing through sadness of losing my first patient. As I stepped out into the afternoon sun, I sighed deeply. I made it.

A New Beginning

The gentle clamoring  of clammy hands clinging and flinging papers onto the floor next to my filing cabinet. I know it's in here somewhere. Brushing the beads of sweat out of my eyes, I continue my pursuit - the tiny white fan my only solace in the June summer heat. I continue to dig until I grasp the familiar tubular structure, folded upon itself just as I had left it: my stethoscope. Like a long lost friend, holding it felt exactly the same and yet different.

The last few months have been a whirlwind of activity; from the seemingly never-ending travel for residency interviews to the intense studying for the our licensing exams to an equally intense period of rest and untamed hedonism. To go from complete freedom to the impending rigid structure of residency is most certainly a shock to the system. From ID cards being made to sifting through mountains of emails, and meandering through a forest of new colleagues is both exciting and overwhelming. All the while I'm still trying to reconcile that my name appears on a diploma that says M.D.C.M. Doctor of Medicine, Master of Surgery. The title still feels foreign despite four years of work towards it.

As I embark on this new chapter in my medical training, I can't help but reflect on everything and everyone who has led me to where I am today. Growth paving the way for new growth. Here's to a new beginning, a new blossoming from old roots.