Some Tough Love In The Time Of Coronavirus

It has taken me a long time to sit down and write this. My mental state has oscillated between panic, optimism, grief, and disappointment. For now, it’s settled somewhere between fury and acceptance. I am uncomfortable, but I can sit still long enough to type.

I do not intend to speak for anyone but myself.

I intend to be candid.

Our current healthcare system is built on the backs of the American people’s suffering. This I have known to be a fact. For the past four years, as a medical student in New Jersey, I have been privy to patients who were denied healing, at times curative, treatments on the basis of unemployment, lack of insurance, being underinsured, being undocumented. I have seen a 27-year-old woman with end-stage kidney disease worry about losing her job and therefore her health insurance if she becomes too sick to work. She had two options. Option one: stop working, lose insurance, get sicker – but now she’s sick and she has no insurance. Option two: keep working to keep her job, get sicker, apply for Medicaid due to disability, wait for Medicaid to kick in so she can get her medications, keep working to keep her current insurance in the meantime, but now over a month (…she’s lucky) has gone by, and she’s been working full time when she should have been resting, so her health has gone from shit to complete shit. So she can get on the list for a kidney transplant. She can wait. Maybe she can pray. Thoughts and prayers. Guess which option she picked.

It’s a Catch 22 at its absolute sickest… Literally.

In medical school, we don’t get formally taught about the intricacies and downright injustices of the system in which we will ultimately care for our patients. Rather, we get glimpses of it on the wards in the hospital, in the Emergency Department, and in physician’s clinics. All I really know from what I have seen is that when I take care of my future patients, I will answer to a system that essentially gives me my bottom line. This system tells me the boundaries of what I can and cannot do for my patients. Invariably, for at least some of my future patients, better treatments will be inaccessible and lesser alternatives will by default become their treatments. It will be on me, the doctor, to guide my patients through this labyrinth we call our healthcare system. I am smart, and I will do my absolute best to do right by my patients, but I can’t help but feel like it will be the blind leading the blind.

I thought the system had already revealed itself to me.

But nations, individuals, leaders – and systems – only truly reveal themselves in times of crisis.

Over the past several weeks, doctors, residents, nurses, many of whom I know personally, have tested positive for COVID-19. They have been on the front lines of this crisis. They have been in direct contact with multiple suspected and confirmed cases of COVID-19, over and over again, for days on end. I have heard of reusing of personal protective equipment (PPE) such as masks and face shields, for entire days if not weeks. I have heard of nurses using trash bags over their gowns to help extend how long they can use them. I have heard of hospitals requiring possibly infected employees to return to work after just 48 hours with no fever. I have heard of hospitals not testing employees because, we do not have enough tests – if you have heard otherwise, you are incorrect. I have heard of doctors and nurses being intubated as their lungs fail. I have heard of a disproportionate amount of death in all healthcare workers, who “by nature of their jobs,” have high levels of exposure to the virus.

Let’s be clear here. Doing no harm, taking care of the ill, curing sometimes, healing often, and comforting always are “part of the job”. Running towards the pandemic, not away from it, is “part of the job.” We have a moral duty to take care of our patients, and that IS the job.

But working without proper equipment (N95 masks, gowns that fully cover the body and neck, face/head shields, gloves), is NOT “part of the job.” However, most people I know in healthcare would “do this job” regardless of protective measures for themselves. And they have been. That is why they are sick. That is why they are dying.

I’m paying attention to their stories.

In 3 months (or less, depending on which way this goes), I will be on the front lines with these brave people in a hospital in a major city, working as a first year resident. If things remain the way they are currently, I will be reusing as much equipment as I can. I will carefully wrap my precious N95 mask (if I even get one) in paper to reuse shift after shift after shift. I will be exposed to high amounts of viral load as I see patient after patient after patient during my 80 hour work week. Through my reused mask, I will breathe in contaminated air and breathe it out to my other patients – and to my own family. I will always treat myself as if I have been exposed. I will try to physically distance myself from everyone I know – and everyone I don’t. I won’t sleep in the same bed or use the same bathroom as my soon-to-be husband. I’ll section myself off in our guest room and maintain six feet from him at all times, excessively disinfecting everything I touch. I will hold myself accountable if he becomes ill, feeling the guilt misplaced from a system that set me up to fail in the first place. If I get sick, my symptoms will hopefully be mild. Hopefully, my lungs will not fail. Hopefully, I will not have to be intubated. Hopefully, I will live. I do not want to die. I have a lot I want to live for.

I try to not think about the grief and anger I feel for the healthcare workers who have been personally devastated by this crisis because it would consume me. And right now and in the coming future, there is too much work to do to be paralyzed by emotion.

For the past four years, I have seen my mentors, the doctors and surgeons who have been my teachers, follow their sense of “good will,” sometimes even over protocol. I have seen many of them perform surgeries for free for their patients who needed them. I have seen them find creative ways to get patients access to drugs they would have otherwise never been able to afford. In no way am I trying to mint every doctor I’ve ever met to sainthood. There are all kinds of people in every field. Rather I mean to say that overwhelmingly, I have seen that most people in medicine practice medicine first and foremost for the good of their patients.

However, to my disappointment, over the past couple weeks I have learned that not only is our healthcare system built on the backs of the American people’s suffering, but also it is built on the backs of ALL healthcare workers sense of ‘good will’ – nurses, doctors, janitorial staff, physician assistants, therapists, technicians, clinical and non-clinical pharmacists, food services staff, and the list goes on. If you’re considered an “essential” healthcare worker, you have been exploited by the current healthcare system.

There is no metaphorical fire under the behinds of our political and economic leaders to stop everything and first and foremost work to bridge the personal protective equipment gap that unnecessarily overexposes healthcare workers. And why should there be? They know that we will show up to work regardless, ready to save lives, ready to help, no matter the personal cost to ourselves. Because we have a moral obligation to our patients.

They are right.