|World map of covid-19 cases. |
Source: wikipedia, licensed for reuse.
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.
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.
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%.)
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.|
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.|
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.|
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.