|World map of covid-19 cases. |
Source: wikipedia, licensed for reuse.
A friend of mine has been keeping a "plague journal" during this time in which our lives have been heavily impacted from the coronavirus pandemic. She then emailed a bunch of her friends to ask for guest entries, and this post is mine. It's going to be a bit messy because I've never allotted a lot of time to editing this post, but enjoy!
I became aware of a novel coronavirus in China at a medical conference in the first week of February. There were murmurings of it, like there were murmurings about H1N1 in its early days. But it wasn't yet dominating small talk like Ebola was when I was a fourth-year medical student. We were focused on our conference. I was learning Twitter, which I had gotten a few years ago but never used. As February ended, a moratorium on travel to and from China began. This impacted me because coworkers had recently gone to China and were planning to go to China to learn CVS and amniocentesis at high volumes. Those trips stopped completely and those who had just come back had to call our employer for 14 days and check in as afebrile.
|Healthcare worker donning PPE. Src: DOD.|
Licensed for reuse.
Then, in early March, a small natural disaster happened in my city, prompting most locals to go into mini-crisis mode and stocked up, got gas, boiled water, etc. In my hospital system, flow was diverted and shifts were changed at the last minute, which increased the feeling of "Something is different and we're adapting and life is thrown to the winds to take care of patients." By this time in March, I had enough insight about covid-19 coming to the U.S. as a pandemic to remark to friends that this small natural disaster was preparation for covid-19. March 13 (a Friday the 13th to beat all Friday the 13ths forever) was my last Mass and last hug for some time. The very next weekend our obligation to attend Mass was lifted, and I did not go because I had just spent a week huddled over a manuscript with someone who was now febrile and super sick at home (turned out not to be covid-19 but still). I felt quite conflicted about it then, but now would feel extremely good about that. Interesting how my sensibilities have changed!
I was on a month of outpatient clinic in March, and starting from the beginning of March we were making drastic changes to the way outpatient obstetric and gynecologic care worked. We were postponing all postponable visits (e.g. well woman exams) and we were spacing out obstetric visits whenever possible ("I see you're 13 weeks. See you at 20 weeks!"). Even for women with pregestational diabetes who had very complex insulin regimens with weekly changes, we converted all insulin management to outpatient visits (telephone calls and virtual visits with diabetic educators). People senior to me did most of the design of how visit scheduling would change, but I was the one to comb through clinic schedules and say when people could be put off to. Clinic work began to leak outside of the (admittedly light) schedule and I did work from home a little.
|Person in PPE. Src: Google images.|
Licensed for reuse.
I signed up for the emergency physician pool in our hospital system, which could call upon physicians to work in various needed disciplines if our medicine and ICU volume began to peak due to covid-19. I volunteered to work the ED and wound care clinics as well as OB and GYN shifts if they arose. In the mean time, I began to prepare for the next month, during which I was scheduled to work an average of six 12-hour shifts per week on our inpatient antepartum service. That schedule had been made long before the pandemic, but now it turned out that I would be working inpatient during my city's predicted peak of cases. I was nervous, but not anxious. I was not preparing for the right catastrophe.
The peak in March never came, and the peak in April never came. We successfully flattened the curve in my state and city, and we were working at about 50% capacity the entire month in terms of ICU beds. In fact, there were relatively few pregnant covid patients during my month. (50% may sound disappointing, but please remember that with exponential functions like x^2, each step is doubled and perhaps the step after 50% would be 100%. So I was very happy with 50%.)
|N95s. Front left and front right are the types I've used the most. |
Back row is actually worse for because it has a valve that allows
unfiltered breath back out. I donated some of those to our system
because paint guys still gotta paint and I don't want t
hem using our healthcare-grade ones. We resterilize 10 times.
Src: pxhere, licensed for reuse.
Many of my friends who are conservative and drink a little more of the red koolaid than I do were very dissatisfied with the lockdowns, etc. I listened (I even listened while eating on patios and in people's homes for a little while), but I couldn't empathize. Perhaps this was because I got onto Twitter in February at that conference, and #MedTwitter is usually drowning in blue koolaid if anything. I felt very, very uncomfortable with the tension between my couple of right-reactionary-conspiracy-theory family members, my Trump-loving-friends, my extremely-progressive coworkers (I'm in OB, what can I say?), my rad-trad pastor (who nonetheless has been a staunch advocate of masking and social distancing), and the schizophrenic news cycle. All this plus the strain of April's average of six 12-hour shifts per week and I was spent. There was plently of workplace strife surrounding all this (safety and tradition driven, compromise averse), and that made it stressful, too.
May saw me transition to a lighter outpatient rotation. Where March and April we had spaced out ultrasound visits, in May we started to go back to normal because covid-19 cases were declining. This was just in time for my ultrasound rotation that had been scheduled in May, and I was very excited about that. This rotation was known to be the most formative in terms of ultrasound skills for the first year fellows. It didn't disappoint, it was a great rotation. I'd been universally masking since mid-March, but it was still somehow odd to wear a mask in an ouptatient setting. It had been drilled into me as a student and then as a gynecologist that wearing a mask outside the OR was rude for me. Occasionally anesthesiologists, CRNAs, or ICU personnel would have one around their neck or on. I guess I'd seen them on healthcare workers during flue season who weren't able to get the flu. And all those years, it had seemed a silly look. Sort of out of place, unnecessary, dorky.
|Source: pxfuel.com. Licensed for reuse.|
Now I shudder when I see a photo without masks. (Sometimes to absurd levels. I saw a photo of St. Theresa of Calcutta and Pope St. JPII without masks and thirty-some years ago, and I still had a visceral reaction before reminding myself "They're not giving scandal, they're just in the 1980s.") The debates between Republicans and Democrats on social media blew up. I saw liberal friends who wholeheartedly trusted bodies like WHO and CDC quietly retract their early support. I made futile attempts to convince alt-right loved ones about virology. And I watched Trump go from strong-economy-unimpeachable odds at re-election to I-and-those-I-chose-botched-two-major-events-in-history odds at losing to Joe Biden.
I watched Catholic and pro-life figures choose the wrong side of biology and the wrong side of the racism debates...so disappointing. (It strips any of us of our credibility, it urges people away from the truth! My whole work/prayer/life is about urging people toward the truth about hot-button topics, and boy do I feel undermined.)
In June I took two weeks of vacation, because I had to "use" them because "they won't roll over." Interestingly, for separate reasons many of the faculty were burning vacation days at home because the department (like most hospital departments that rely on elective cases) was issuing physician pay cuts and requesting the voluntary use of vacation time in large blocks to spend down excess. The first week of "vacation" I spent basically doing a normal week, half-heartedly trying to take it easy. The second week I just hauled out to visit friends in another state (plane trip very not socially distanced, but with reduced seating and universal masking). We didn't do anything too scandalous, although I did break down social distancing barriers between two households.
|Src: navy.mil, licensed for reuse.|
Now we're in July. I've been stressed because 50% of my job is technically research, and not a lot of that got done in three months of clinical work and one month of nervous vacation and housework catching up from said three months of clinical work. So now I'm trying to start over, giving my day structure with exercise and work from home and occasionally from clinic. Cases in my city and state are rising again because of reopenings. I'm on genetics (a lighter clinical rotation that should let me catch up on research), and all genetic counseling had been made remote during March and April. Just in May it had returned to in-person, but now in July it's being made semi-remote again, especially after there was a small cluster of covid-19 positive workers in one of our clinical sites.
I haven't gotten off the rollercoaster, but I've found a new normal. Strange to say that the new normal is putting on N95s with tally marks to show how many times they've been reused by different people. Strange that the new normal is texting with one neighbor about the positive cases at her job and offering to collect her nasal swab, and meeting another for the first time because of an Amazon mix-up (I rarely if every got stuff from Amazon before this). I've weathered it overall well--economically I was unscathed, and work basically flowed through my normal rotations. But psychologically it's been a strain, more because of the political battle and the drama these stakes can create in a medical workplace, rather than any physical strain or apocalyptic hospital scene.
|Src: whs.mil, licensed for reuse.|
I have come to expect and accept that I may get covid-19. I was ready for it in April, now I'm expecting it in August. But I'm living with structure. My prayer life has been steady through this, with times of consolation and times to desolation. Some of the sweetest experiences come when one thinks about one's own death, and finally shaking off this life and going to be united with one's Spouse! Other times the exhaustion and failure to prepare for mental prayer made meditation more like a duty. I went without Mass for 7 weeks. I watched overly scandal-given Catholics make this into another bishop scandal, rolling my eyes as I did. (Parenthetic rant: The Church suspending the obligation for weekly Mass is not impossible or unprecedented, and it is not for the laity to complain about it! The trads who were having tantrums "on the timeline" about it are making the same mistake some followers of Vatican II did when they overpriestified the laity. The clergy have legitimate authority, be obedient to it! "One communion lasts until the next," as St. Faustina wrote. Many Catholics went years and generations without the Mass, let alone without the Eucharist. Chill out!!)
This July fourth, I will not be going to Mass or going grocery shopping (even though I need both) because cases are surging. Our ICUs are full at my hospital, although the community hospitals are not full yet. A prominent children's hospital has begun to admit adults. In a way, perhaps it's a particularly bad time to write a covid journal, because covid is very much not over. But it's a start. I pray that the future brings economic stabilization for the less fortunate, lower death rates for the sick, listening and neutrality back to public discourse, unity back to Christians, and adulthood back to politics.