Everything has changed. Every encounter is now eyed with skepticism as we mask and gown to enter a room. Patients look to me, terrified about why the infectious disease doctor is wearing full PPE. After all, they just came for a pneumonia, right?
It is hard for me to understand the full extent my life has changed. As an infectious disease fellow I am an essential employee - which means my work has not changed. I go and see patients and do the best I can for them. However, I now do this without vacations, with less oversight and with less support. Many of the attendings have been pulled to help on a system wide, and sometimes global, scale. What remains is the core of our clinical staff - fellow run teams and rotating faculty. Since all “unessential care” has been postponed we have overall fewer consults. But we also have fewer teams and the consults we are seeing on balance are sicker.
I have certainly seen my share of COVID patients. Unfortunately those are the easy consults - continue supportive care. Nothing more to do. I try to reassure them. To hold their hand when I can. But most interactions are happening through phones, windows, and, when in person, behind a thick veil of PPE. It is hard to be reassuring in those situations. I have exercised my skills in goals of care - helping families understand the quagmire that awaits intubating their 83 year old grandpa. We quickly sign off, knowing their patients will languish for 2-3 weeks before ultimately succumbing to their disease.
The rest of my patients are just as unfortunate. Young 20 somethings with surgical disasters. IV drug users with Staph bacteremias. Homeless HIV patients who can’t afford their meds. I worry even more about those who aren’t coming in. Who have mild symptoms but think they will tough it out until the stay at home order is over. The elderly who have no one checking in anymore. There will be a reckoning down the road - not just of those lost to COVID but of those lost to diseases that did not get care during the time of COVID.
This was already the hardest year of my life. No one anticipated we might add in a pandemic. But at the end of the day I don’t complain out loud. I am healthy. I am employed. And I have something to offer in a time where many feel helpless. Everything has changed. At the end of all this, that’s all I can wrap my head around.