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  • Rosalind Kaplan, MD

Random Thoughts in the Age of Social Distancing


I'm listening to Rita Wilson's Quarantunes playlist, a list of songs she compile to listen to while in quarantine with the coronavirus. It's a catchy, smart list of mostly upbeat songs like Bobby McFerrin's 'Don't Worry, Be Happy' and Billy Idol's 'Dancing With Myself.' Also included is 'Don't Stand So Close To Me' by the Police. That's okay; She didn't leave much for me to include it in the 'Social Distancing' playlist I keep thinking I'll make someday.

In fact, I almost said "Don't stand so close to me" to a guy in the pharmacy a couple days ago. I was waiting in line to pick up a prescription when he joined the line right behind me, standing just a couple feet away. I moved a few feet forward, and he didn't get it. He also moved up. So I moved a yard to the side. Then he realized I was trying to distance myself from him. He looked a little miffed. Maybe he doesn't know he's supposed to stay six feet away from other people? More likely, he doesn't believe it's necessary.

It's hard for me to distance. I am ordinarily the most social of creatures. Before Coronavirus, I regularly struck up conversations with strangers. I touched people's arms while talking with them, hugged my friends, and often sat in cafe's to write, as I find the silence in my home deafening. Just a few days into the more stringent measures to keep COVID-19 at bay, I already miss these interactions. Like many of you, I find myself wandering around feeling lost and lonely and a little confused, a little sad, more frequently now. Already. I'm sometimes scared, thinking of the unraveling of the daily routines, the economic stability, and, more importantly the health of our country, which was already so imperiled by the lack of collective infrastructure (our failure to institute universal health coverage, the epidemic of physician burnout, etc).

I only experience those emotions on my days off. Not because work gives me so much structure or comfort, but because when I'm at work, I'm too busy trying to take care of patients, and to protect both patients and staff from COVID to feel much of anything. At the beginning of this crisis, I felt like I had no control at all over the flow of potentially infectious patients in and out of our Urgent Care site. I was appalled at our inability to keep people safe because of our own lack of planning and preparation as well as the lack of awareness in the general population. People walked in with fevers and all manner of respiratory symptoms, and often didn't answer our screening questions thoughtfully or even honestly. They'd deny fever and cough at the front desk but by the time I saw them, they would state that they had a cough, or the nurse would take the temperature and find a fever that the patient was unaware of. By the time it came to my attention that we had a patient who might have Coronavirus, multiple people had already been exposed.

That's improved, now, but not enough. Our ability to test patients at risk has increased, but nowhere near enough. Our ability to protect ourselves has improved, but is far from ideal. Our system leadership has finally posted signs on the outside of the door, asking that patients with suspicious symptoms not walk in, but call from their cars, so that we can don protective equipment, keep them out of the waiting room, and get them into isolation. We're all wearing masks all the time, but we don't want to run out of the special N-95 masks and the protective gowns we use, so I am the only one who puts on full personal protective gear and sees the patient unless I can determine that they are not, in fact, at risk for COVID. I spent most of my day yesterday sweltering in a blue plastic gown, gloves, a respirator mask and a face shield. After each high-risk visit, I doffed my gown and gloves and put on new ones for the next patient. I reused my mask until it got damp or soiled, as recommended. I performed nasopharyngeal swabs, feeling like Nurse Ratchet doing brain biopsies as I stuck the swab sticks high enough into the nasal cavity to get an adequate specimen.

Encouragingly, health systems in the Philly area are finally setting up drive-through testing sites. The whole testing process has been a moving target for the last week. First we had to call the State Department of Health (DOH) for every COVID test we wanted to send, and we were discouraged from sending many as only one state lab was performing the tests, and both materials and test performance were scarce. By the end of the week, there were multiple state labs and even more commercial labs doing the tests, but commercial labs take 4-5 days compared to the state lab's 1-day turnaround. But we can send to the commercial labs without approval from the DOH. Which is a good thing, because when I called the DOH yesterday to try to get an expedited test for a healthcare professional who may have exposed others, I was number 143 in the phone queue. When I finally got someone on the phone, there was still no promise of expedition, as the labs are overwhelmed.

Lots of my friends have asked if I am worried for my own health or for my family's health. The answer is very complicated. Both my husband, who is also a physician, and I are at increased risk because of our potential exposures and our age. But we are both in very good health and our exposures are not the highest risk exposures, as we do not treat sick hospitalized patients who are more likely to be high infectious and to need high-risk procedures, such as intubation, which spread viral droplets (THANK YOU to our colleagues who do that work). so far we've had enough protective equipment (many healthcare workers don't) and we are taking precautions as much as possible. So I guess I'm not so worried about me, and only a little more about my husband. Of course, as a mother, it's my job to worry about my kids, but they are young and healthy, and I think they'll be okay. They are following the social distancing precautions, and in fact my son and his wife, who live in the SF Bay area, are on 'shelter in place' orders, so they have no choice.

I am more worried about how my young adult children will wade through the craziness and this new threat in our already terrifying world. I worry for their sanity and resilience with each added blow. They lived through the trauma of 9/11 and its fallout. They deal with gun violence and racism and antisemitism and general incivility. They live with the tremendously divisive politics of our country and the world. They struggle with the very real threats and effects of climate change. As employed people with benefits, they are better off than many young people, but they also have to be concerned with economic instability. I am truly afraid for the collective future of all of our young people.

Rather than dwell on all this worry, I am trying hard to create good in the world, as I know my kids are also doing. I'm trying to maintain a high standard of medical care for my patients. I'm trying to stay close-by phone, email, text- to my family, friends and neighbors, and to reach out to those who need help with everyday needs- grocery shopping, errands, just hearing a friendly voice...I'm looking into how to support local economy by ordering takeout from local restaurants, tipping couriers, ordering books from small booksellers, etc. When I feel helpless or panicked, I let myself wallow for 60 seconds and then get back to whatever work I am at.

I thank the universe for the company of my husband, and the support, even if at a distance, of my kids, other family, friends, and community. I am grateful for the outdoors and the coming of spring. Walking the dog, hiking, biking and just being outside are all good for both physical and mental health. And I'm not forgetting the benefits of creativity and the arts. Reading and writing are saving graces for me, as I know creating art and music are for others. There are great books to read, great movies to watch, and great music to listen to. I still have Quarantunes on- Leonard Cohen's 'Come Healing' is playing right now- and it's made my day better. Thanks, Rita Wilson, for sharing your playlist! I'll get to work on mine soon.

#physiciansatisfaction #urgentcare #selfcare #compassion #narrativemedicine #patientcare #physicianwellness #physicianburnout #doctor #writing #creativenonfiction #medicine #trauma #patientsafety

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© 2017 Rosalind Kaplan