Back at Work as a Doctor with CF During COVID-19
Today was my first day back at work after 75 days in self-isolation. That’s 51 work days, or 10 work weeks, that I missed. I haven’t been absent from work for more than a couple of weeks since my twins were born in 2002, when I took three months off for paternity leave. Over the past 2.5 months, I worked remotely almost every single day of that time, save some weekends. Conference calls for the hospital and my practice, telemedicine with my outpatients, and phone-triage night-call for the answering service made up most of it, plus some consulting work and chart review on the side.
I'm a doctor who has CF
See, I’m a doctor – an internist and a gastroenterologist – but I also have cystic fibrosis, a pre-existing chronic respiratory disease that has caused permanent damage to my lungs. Because of this comorbidity, I had to put my own health and my family’s long-term needs ahead of my patients during this time.
It killed me to not be at work and to have my colleagues cover for me. I had a lot of anxiety and consternation about the situation, and I was worried that one of them would get sick working in my stead. I also am fiercely independent to a fault and pride myself on the excellent care I give my patients. I found the entire quarantine paralyzing, and wound up feeling helpless--or even useless--at times.
Confronting COVID-19 with CF
Despite being physically absent from work, I thought I understood COVID-19. The epidemiology, the virology, the statistics. I thought that by watching the news, reading the paper, talking to my colleagues, and staying abreast of all of the recommendations, I could stay in the know. I wasn’t on the front lines, didn’t get or deserve any accolades like standing ovations or anonymous gifts to my door--but that was fine. I was on Twitter and Facebook, LinkedIn and Bloomberg, reading every article, absorbing and analyzing the data. I thought that was enough.
Then this morning came around, and it literally was the dawning of a new day. I actually found myself delaying leaving this house this morning because I was nervous about going into a hospital--into the belly of the beast, if you will--that has 20 known COVID+ patients as well as 20 additional “PUIs” (Persons-Under-Investigation: patients with flu-like symptoms whose test is pending) plus several additional “presumed positive” patients (patients with flu-like symptoms but a negative COVID test). Would I get exposed today? Would I be able to breathe wearing the N95 mask? Do I still remember how to do a colonoscopy? Those questions legitimately frightened me – and as anyone who knows me can tell you, I don’t scare easily.
My first day back
The day started off fine. I rounded “virtually” (via phone or video) on half of my patients who are admitted to the hospital, but for those who didn’t pick up the phone, I went in their rooms. Donning a surgical hat, an N95 mask, glasses, a surgical mask with a face shield, scrubs, a gown, two pairs of gloves, and shoe covers to protect myself from an invisible micron-sized virus as I walked into a patient’s room in the ICU made me feel like I was using a bazooka to kill a fly while simultaneously exposing myself and risking my life more than any other time in my medical career.
I took my time, didn’t rush, spoke to the patients calmly and matter-of-factly, briefly performed a limited physical exam, and then answered their questions as we reviewed their plan of care together. It felt totally normal, like the thousands and thousands of other patient interactions I’ve had over the past 25 years, and yet, also completely and totally different because of the 800-pound gorilla in the room that frightened both the patient and me, the pandemic that is now affecting each and every one of us. I should also mention that in between washing my hands a ton today, using hand sanitizer every five seconds, and wiping down my phone, I felt like my baseline “germophobia” had been magnified a thousand times today. Maybe it will get easier as the week progresses.
My fears about my procedural skills were allayed as I completed my fifth and final endoscopy of the day. It turns out performing endoscopic procedures is a lot like riding a bike – you just pick right back up where you left off. The patients and I got through it OK (there were some AT&T commercial “Guess who just got re-instated!” and “Are you nervous? … Yeah, me too.” jokes that eased the tension), and I’m looking forward to rounding tomorrow to find out how everyone did overnight.
My thoughts on COVID-19
One important takeaway that I want to impress on people is this: I thought I understood the pandemic over the past 11 weeks. I didn’t really, not until today. Until you are on the front lines, seeing the fear, exhaustion, and uncertainty in the faces of your colleagues, who are normally cordial and kind to patients and physicians, and are now are just running on fumes and can barely function, you can’t really understand it. Videos from the ERs of New York or Italy last for a minute or so, and then you can change the channel. This stuff is real. It is intense. It is wearing people down. And it’s not going away anytime soon.
We need to protect each other
I was in the elevator today wearing all my aforementioned personal protective equipment. There was a middle-aged gentleman in the elevator who wasn’t even wearing a mask, even though that is hospital policy in all areas of the building. In a friendly manner, I said to him, “Sir, we need you to wear a mask at all times in the building.” He said he would. I may never know.
To those of you who are considering not wearing a mask in public, who are not socially distancing, who aren’t using hand sanitizer and Clorox wipes when appropriate, please think of this blog the next time you are making this decision. Do the right thing so we can continue to flatten the curve, make sure we have plenty of PPE and ICU beds and ventilators, and don’t burn out (or worse, infect) our healthcare providers.
CF, COVID-19, and bravery
Today I texted one of my best friends and colleagues, my med school roommate and current Chief of Staff at my hospital, that I was back at work. He wrote me back right away, stating that he thought I was brave. His text read “and not like reckless and stupid brave, but real bravery.” I think he meant that I was brave by being willing to go back to work and risk injuring my sub-par lungs on the front lines.
I felt proud to read his words, but I couldn’t help but think that my actions today did not amount to bravery. Instead, it was just another day in the life of having a chronic illness. Those of you reading this blog who have CF (or another long-term malady) know that, when you wake up every morning, you’re just really hoping that you can get through the day, live your life, not develop an exacerbation, and make it until tomorrow. For me personally, that’s not about courage, that’s about trying to not be defined by my illness.
Going to work today was about being time for me to finally step back into the battleground. I felt the need to start back taking care of patients one at a time like was my dream and my calling when I was a kid, my drive and passion in young adulthood, and my profession and my job as a middle-aged family man with a family depending on me. I couldn’t sit on the sidelines anymore. I weighed the risks and waited until we reached a steady state at which I felt it was safe to come back with the right precautions.
At the end of this day, having worked harder and longer than I have in 75 days, I have mixed feelings – I feel nervous and energized, scared and motivated, but most of all, optimistic. I am confident that with all of us doing our part, we will get through this together and come out on the other side better for it.
Have you (or a loved one) been experiencing any negative side effects from Trikafta?