I have seen coronavirus from behind the scenes — as a patient and as a provider. And there is a lot we are doing right.
And a lot more we can do to help.
The ambulance found me lying on the concrete sidewalk outside 7-Eleven. I was flat on the pavement in a winter coat and jeans, across the street from the Copley route bus stop and the bush where my dog had lifted his leg and chased a rat the week before.
Bystanders stayed six feet away, following recommendations we were all starting to absorb as commonplace in the COVID world. They raised their voices to tell me I would be okay, that they wouldn’t leave until the ambulance arrived. No one dared come near me.
“Do you have a cough, fever, runny nose? Any known exposures to a patient with coronavirus?”
I whispered, ‘No,’ to the EMS team, but added that I worked at a hospital. I had been short-of-breath for five days at that point, unable to walk or stand without holding a wall for support, so tachycardic for so long that all I could do to keep breathing was lie perfectly still and instruct my body to take another breath. The vomiting, diarrhea and fevers didn’t bother me — those are just standard flu experiences — but the feeling that my body didn’t know to keep breathing frightened me. I had gone to bed for two nights straight with the conscious decision to tell the people I cared about I loved them because I didn’t know if I would wake up after another night. Luckily, I often felt too ill to fall asleep anyways.
When I next opened my eyes after collapsing on the concrete sidewalk, I was in the COVID unit at Beth Israel Deaconness, seeing the COVID world now as both a health care provider and as a patient.
Pro-Tip: It’s time to call 911 when the sidewalk outside 7-Eleven looks like a good place to just stay lying down.
On March 24, 2020, I had an inside view on healthcare during the COVID pandemic that I never imagined nor wished to see.
To answer the big question…
No, I did not have coronavirus. The nasal swab came back negative, which was consistent with my symptoms, and how they just didn’t match what we would expect of a COVID infection. As a care provider in a Harvard Hospital, I was grateful to have not been a source of COVID exposure for any of my patients or colleagues; keeping the people around me safe is always one of my top priorities, especially in today’s culture.
And, no, the nasal swab really isn’t that bad when you are that sick.
I did, however, have the flu. And despite being young and strong and well-prepared with fluids, saltines, and soup, last week, I almost died from the flu.
Last week, I almost died.
I can’t even believe those words as I write them, despite feeling in my body that truth.
According to the CDC, the 2019–2020 flu season has had upwards of 55 million illnesses. This accounts for up to 26 million flu-related medical visits, 730,000 flu-related hospitalizations, and up to 63,000 flu related deaths. Had I not been one of those 730,000 hospitalizations in time, I would have been the 63,001 flu-related death.
I am grateful for everyone who helped me avoid that statistic, from the friends who cared for my dog and kept me telephone company, to my family who checked in on me every hour by phone, to my doctors, coworkers, and neighbors. Gosh, I am even grateful for my local gym (Barry’s Bootcamp and 305 Fitness) for helping me build enough muscle that my body had something to burn through to survive that infection. (There’s nothing left, so I’m bound to be back when I physically can return.) I was lucky to have started that illness in shape, to have started that illness with a heart rate that could withstand some added speed.
And, I am grateful for the opportunity to see the strengths of our medical system in this COVID world from both the perspective of a patient and a doctor.
What we are doing right. Because there is a lot that we are doing right.
1. Joining as a team.
As a hospital dentist, I know the stress we all face walking into a hospital each day. It is scary to go to work and not know if we are about to contract a virus that could kill us, our loved ones or our patients.
And I know the compassion we all have in healthcare, seeing the stress and the risk and still, very passionately, wanting to serve more. I see the gratitude and humility in our hospital staff and the dedication everyone has to put patient health and safety as our top priorities.
And I see that this passion is carrying us in a direction of unity.
When it feels like walking into a hospital is walking into a battle, out of instinct, the doctors and nurses and maintenance staff and cafeteria workers become a unified army. COVID has broken department walls and merged resources and expertise in a way that is unprecedented in healthcare.
When it feels like walking into a hospital is walking into a battle, out of instinct, the doctors and nurses and maintenance staff and cafeteria workers become a unified army.
As a patient, I never expected a maintenance man to deliver an air purifier — to clear the room of viral particles — in a hazmat suit. Yet, he has a key role on our COVID-fighting team, and less choice than our doctors who come to work each day about whether or not he wants to accept this dangerous role; and so, he was handed more protection than the doctors and nurses I saw as a patient in the Emergency Department.
The compassion in that choice is inspiring. The teamwork is essential to our success in this COVID fight.
2. Creating protocol to minimize contamination.
Best we know how, we are creating barriers to COVID. And as a patient in a COVID ward, I felt safe.
- I had a mask the minute I entered the hospital.
- My doctors and nurses were fully gowned; as a doctor, I know the masks are reused and eyewear wiped down, but as a patient, I, too, know particles had no way to transfer from my cough or speech to a doctor’s eyes or mouth.
- I never saw another patient until leaving the hospital, and I never experienced the hospital team’s anxiety in their delivery of care to me as a patient.
What I saw in this Harvard hospital is that a lot of the systems we have in place are working. Physically, they are blocking the spread of COVID. Emotionally, they are giving patients hope, which is vital in recovery.
While not every hospital is the same, some more burdened right now than others, what I saw in this Harvard hospital is that a lot of the systems we have in place are working. Physically, they are blocking the spread of COVID. Emotionally, they are giving patients hope, which is vital in recovery.
3. Accepting reality.
When I was discharged from the hospital, my doctor said in no short words, “You need to be here longer. Ideally, you would be inpatient longer. But, speaking to you as a colleague in health care, you understand when I tell you, you are better off at home.”
I knew he was right. From the minute I called 911 for help, I knew. The hospital is not a safe place to be if you are in any way sick or immunocompromised right now. Our bodies don’t stop having strokes and heart attacks and cancers because of coronavirus, and so, sometimes, we do end up collapsed outside 7-Eleven needing 911 emergently. But, ideally, those who can, should stay home. Ideally, any non-COVID sickness would kindly wait for the coronavirus burden to die down so that resources could be replenished and risk of infection upon hospitalization could be reduced.
Ideally, COVID wouldn’t be burdening our society.
But in the face of a pandemic, it is ideal that our doctors are caring for their patients with the respect of honesty, making risk-benefit analyses and decisions as transparent and collaborative as possible with the patient so that everyone understands that we are not making ideal choices, but we ARE making best possible choices.
Still, there is a lot that I saw as a patient and provider that scared me.
1. Supply shortage.
It’s no secret that our supply of personal protective equipment (PPE) is running low. Doctors and nurses are reusing eyewear until they start to disintegrate. Friends in healthcare across the world are begging for neighbors and extended family to dig through their attics for that leftover paint mask from the remodel a decade back. Schools are 3D Printing what supplies they can, but there’s just not enough supply to keep up and our standard of what is acceptable with regard to PPE use has changed drastically over the past weeks and months.
Our doctors and nurses are working harder than ever, which leads to exhaustion, burnout, and increased risk of illness amongst medical professionals.
And our hospital space will run out.
As both a doctor and a patient, I was acutely attuned to that last point in my own illness. I am not one to complain with illness, so I don’t take going to a hospital lightly. But I never imagined pre-COVID that I would be in a position of wondering if, despite needing a hospital bed, I should dare to take that space.
I called my father at one point and told him, “Dad, can you call me every hour? I need someone to know where I am if I stop answering.” My words were distanced with attempts to catch my breath, even though I was lying flat in bed as I spoke, the only exertion being that of my chest trying to rise.
“Dad, I need someone to know where I am if I stop answering the phone.”
When I decided to try to make it to the doctor’s office, I held my Dad on the phone line again, saying, “Dad, I need you here in case something happens on my way downstairs.”
Being this ill, I immediately began to question my judgment in signing the lease on a four-story walk-up.
But the truth is, knowing I needed to be in a hospital wasn’t enough to convince me that I should add to the problem of overburdening our health care systems. Despite how sick I was, I feared our healthcare system was that much more ill.
Note to self: add social responsibility to our 2020 list of barriers patients face when accessing care.
2. A broken face shield.
No, I did not literally see a provider with a broken face shield. Our health care workers and hospital administrations care too much to let that happen. But, I saw a break in our coronavirus screening methods.
When I called my doctor at the start of my illness with tachycardia and shortness of breath, I was asked a series of screening questions to assess for possible COVID. Shortness of breath is one of the symptoms of COVID but also a symptom of so many other illnesses, and, for a moment, I was afraid: if I answer yes, what happens next? The honest ‘yes’ was standing between me and the doctor I needed. Still, I answered yes, and, as expected, was told to stay home in case I had coronavirus. Our conversation ended there.
And, for a moment, I was afraid: If I answer yes to a COVID screening question, what happens next?
When I called my urgent care that evening with worsening symptoms, they said they were closed because of coronavirus, but that I should go to a self pay urgent care within four hours based on my symptoms. I am fortunate to be in a position where I could do that, and I was told I needed a cardiologist and shouldn’t have come to urgent care because I didn’t seem to have coronavirus. I was also told that, because of coronavirus, a cardiologist wouldn’t be available until May, so “maybe go to a hospital, but we know you don’t want to be there right now with coronavirus going on, so [insert apologetic and helpless shrug from an exhausted healthcare worker]”
I agreed, and went home, more determined than ever to not overburden our health care system, to not seek help.
When I collapsed on my final attempt to get medical care, I finally received the emergency care I needed. However, the barriers to get to that help were profound. We have created so many barriers in an attempt to minimize exposure to coronavirus that we are making access to care almost impossible for those with even urgent medical needs. Our screenings and justified fear are working too well to keep patients away from hospital beds.
We have created so many barriers in an attempt to minimize exposure to coronavirus that we are making access to care almost impossible for those with even urgent medical needs.
When you enter a health care facility, you are asked questions to screen for coronavirus for everyone’s safety. What we forget in our screenings is a statement and demonstration of compassion, a statement that the doctors ten feet down the hall and to the right still want to help. We are forgetting to invite patients into our doors when they are facing an emergent situation in order to seek that help.
So let’s remember to add that to our screening discussions, healthcare friends 😊
3. Social distancing gone wrong.
On a final note, I want to virtually hug every quarantined individual out there right now.
When I was sick, despite the many offers to drop off supplies, I was too ill to walk down the four flights of stairs in my apartment building to even let a friend into my building.
I was physically alone.
When I was in the hospital, visitors weren’t allowed.
When I was discharged without word on whether or not I had coronavirus, I had to get into a cab, already short of breath, and try hard to not breathe into a stranger’s car… alone. I was handed a prescription that I was too ill to take to a pharmacy, and, because of social distancing, didn’t have an opportunity to get help filling the prescription.
I can’t imagine what it would be like to be on a respirator, dying in a hospital right now. But I know how alone our patients today must feel.
Social distancing is working. But when you are sick, social media, electronics, and digital communication are all just too much work. As a patient, you don’t have the strength to reach out, and we don’t have a system in place in our hospitals for others to virtually reach out to you, a system that does away with all that work. I don’t know if there even is a system that could replace the healing power of human touch.
I know how alone our patients today must feel.
But, even if I wasn’t strong enough to see all the messages, I could see the notifications of friends checking in.
And every little check in we do for one another — without expectation of a response — has the power to heal. It has the power to help.
I never entered healthcare expecting to be a soldier in a war. I couldn’t be prouder to join my colleagues in that fight.
I never entered the COVID pandemic expecting to be a patient in a hospital bed. I couldn’t be more grateful for the health care team and family and friends that brought me back to my feet.
We as a society never entered 2020 expecting so much to change, but behind the scenes from every angle, I am seeing selfless individuals rise to save lives.
We will get back to normal — a different normal, and in our health care preparedness, a better normal.
And in the meantime, remember to brush your teeth before getting to your home office. Oh, and if you are sick, don’t keep reusing those infected toothbrush bristles (I am a dentist, so this had to have a dental moral, after all).
Stay well. Stay safe. Thank you to our frontlines across all the industries and to our frontlines in the effort to #stayhome.
This article is written as a personal reflection and does not represent the opinion of any organization or company.
