Worry

I am not a “worrier”.

But I worry about what has happened to the fabric of who we are as a nation, a profession, and our families during this extraordinary and unprecedented time.

It’s not just one thing.

• It’s the change to daily life as we have known it
• The lack of personal contact with others
• Providers and caregivers are tired.
• The pandemic and surge
• It’s the lack of a uniform approach to the pandemic that normally would be driven by best practices in public health, science, and the common good
• The shutdowns, the economy and the pressure this exerts on families that do not have appropriate living space or the financial resilience to withstand
• The prolonged recoveries from COVID-19 itself, disability, loss of life of families and friends, and other peoples family members we don’t even know that we can only imagine about
• It’s systemic racism and racial inequities in health care
• It’s black lives matter and all that this represents
• It’s division
• And how as a society we’ve changed how we treat each other and what we believe to be important

Frankly, it’s hard to make this stuff up. And at the same time it’s hard to believe this has really happened.

I’m positive and forward looking by nature, but the most accurate thing I can say about how I feel at this moment is that I feel sad about all of this. It’s as simple as that.

Joy

I’m fortunate that I have the opportunity to work clinically as well as serve as the Chief Physician Executive for the Physician Enterprise at CommonSpirit Health. I feel blessed and fortunate to do this work. Clinically I have a small “flock” of patients that put up with my schedule and availability. In return they receive a concierge and comprehensive approach to care that includes availability by text and phone, secure patient portals, virtual and in person visits when appropriate. It works for them and for me; it adds joy, purpose and sustenance to my daily work. In addition to patients, my other practice is the Physician Enterprise itself; it is my job along with our PE Executive Team to take care of “it” and the people who work in “it”. For me as I’m sure for you, this is a calling. I have always said I “get back” far more than I give and that I would pay for the privilege to do this work. I’m thankful, for the social purpose we share, and personally for an enriched family life that includes memories of life growing up, elders, a life partner, children and grandchildren.

I’d like to share a story. A young man goes to college, becomes a mechanical engineer, a pilot, flies medical missions to the Baja Peninsula in northern Mexico and works for a tech startup. After 2 years he realizes he has a different calling. It’s caring for others through the practice of medicine. He continues working but goes back to undergraduate school, completes his pre-med studies, successfully takes the MCAT, and attends medical school with a special interest in international health. As a medical student he works at a clinic in Burundi. During several trips to Burundi he brings to the clinic closer to 20th century technology including a revision of their solar systems, a newly developed electronic health record (they used index cards before), and satellite internet beamed from a fiber-optic backbone that resides on a high voltage tower in the mountains 8 miles from the clinic.

He survives these adventures, completes a combined residency in Internal Medicine and Pediatrics during which he travels to Uganda for a Pediatric oncology and oncology rotation, and then a 2 year Critical Care Fellowship.

As the Chief Critical Care Fellow, he worked on a team to re-vamp their Critical Care Units creating COVID-19 Critical Care, Covid-19 Medical Units and develop a “split ventilator protocol” with the ability to manage 2 patients with 2 separate ventilator circuits and 1 ventilator if the need arose.

He married during residency, and just before completing his training a little boy is born. He is a critical care intensivist, his wife a Nurse Practitioner. Critical Care is not without its risks. Even though critical care units are high risk, they are also more controlled and protocoled for safety. As we know critical care does not always happen “within the bubble of the critical care unit”.

Waiting

Consider this. A “rapid response” is called for a patient on the neurology unit. The team responds, they enter the room, the patient is being “bagged” with an AMBU bag that does not have a HEPA Filter. The patient deteriorates. O2 saturations in the 70’s. The intensivist decides to intubate. He asks for the PAPR (Power Air-Purifying Respirator); sorry, we don’t have one on the floor. The intensivist is given an n-95 mask that doesn’t fit. The patient is intubated and stabilized.

The patient is then tested for COVID-19. It’s positive. In that instance the entire team was exposed.

Waiting. No symptoms at day 4.5.

In an instant from joy to waiting, waiting to worry.

The cycle: Worry → Joy → Waiting.

We share these cycles of emotion. Different events, same emotions. We can’t necessarily change these things. What do these stories say to us? For me it’s that we must be servants to each other and humankind.

• Have and share empathy
• Speak last not first
• Listen to understand, other people opinions matter too
• Practice healing, care for others and ourselves
• Do your best
• Speak from the heart.
• Trust in the healing power of humanity.
• Be kind, serve others; what we give will return to us many times over.

Together we will get to the other side of this. I have faith in all of us that this will be true.