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  • Rosalind Kaplan, M.D.

Dream a Little Dream


Things I Miss:

Live Concerts

Wearing real clothes, especially my green cowboy boots

Dining out with friends

Dining in with friends

Traveling to other cities

Traveling to other countries

Seeing my students in person

Hugging people

Going to the gym

Going to parties (sort of)

I had a dream that I was at a large party. Everyone was milling around, drinking champagne, talking in tight little groups. The friend who was hosting a party is a fellow Internist, and I watched her float through the kitchen with trays of hors d'oeuvres. I suddenly felt that something was amiss, but couldn't identify the problem. Then it dawned on me: there is a pandemic. We shouldn't be at a a party. What was my physician friend thinking? What was I thinking? Also it is late at night, and I don't even like being out late! I don't particularly like drinking. And I don't even like parties that much! In the dream, I am alarmed. I need to leave the party immediately. Then I wake up.

It's funny how dreams in the pandemic seem to be literal rather than symbolic. I don't need to mine my subconscious or conjure a Jungian concept to make meaning. The anxiety of this dream, the anxiety of relaxing social distancing for fear of spreading or acquiring disease, is right on the surface.

In fact, this dream happened right after I got the results of my Covid antibody test. As part of a study on healthcare workers, my husband and I drove to a tent in a parking lot and had our fingers pierced for a drop of blood, which was then analyzed for antibodies. Neither of us has had any suspicious symptoms. But given the fact that many infections seem to be asymptomatic, and that I'd been repeatedly exposed to others with mild or minimal symptoms for short periods of time during my work in Urgent Care (sometimes in PPE, and sometimes, when the patient arrived in our clinic for other reasons and symptoms were only uncovered with intensive questioning, not), I was not all that surprised when my antibodies for both IgM and IgG were positive, indicating that I'd been recently infected, and had mounted an antibody response, with both early and late antibodies still present. What surprised us both was that, despite that, and the fact that we have continued to have close contact with each other, my husband had no antibodies.

We don't know yet what 'having antibodies' even means. In the very best of worlds, it might mean that I am immune for some period of time. Or not. Perhaps, as an asymptomatic person, I have not mounted enough antibodies to actually protect me. Or perhaps, the antibodies created by Covid patients in any circumstances do not provide immunity. My antibody test will likely be useful to the study, looking at the rate of asymptomatic infection in healthcare workers, but it is not particularly useful to me currently. I must still consider myself susceptible to both getting and spreading the

virus.

I think the fact that I had IgM, the early antibody, was what triggered my dream. It's likely gone now, but it means I have had a recent infection. And I didn't know it. I worked and went to the grocery store during that time. I always wore a mask, and was incredibly careful about handwashing, but could I

have inadvertently infected someone? I'll never know, but the idea that I could have given the virus to someone who was vulnerable and who ended up seriously ill is daunting. It points to the tremendous responsibility every one of us has to control the spread of virus. Any one of us could be infected, and could spread infection, without a clue on any given day. It also gives me a look into the horror that healthcare workers on the immediate front lines may feel when they haven't had proper PPE and realized they could easily transmit illness to family or to other, uninfected patients.

The other problem with the fact that I have antibodies and my husband doesn't is that it makes us doubt the accuracy of the tests. The particular test we got is FDA approved and supposedly has a very high sensitivity and specificity. But the results seem not to make sense. Except if some people are very resistant to infection or perhaps some asymptomatic patients shed very little virus. All stuff we need to find out- and hopefully we will know pretty soon.

Taking care of ourselves and others in light of 'reopening' of businesses in the face of the pandemic is not going to be simple. We each are going to have to make risk determinations about a variety of different activities. The risks will be in flux for a long time to come, so our personal strategies will need to be flexible. Right now, I'm doing necessary errands with precautions. I only see friends with strict social distancing outside. I'm not sure when that will change. I can't imagine enjoying a restaurant with social distancing and the servers in masks and gloves, so I don't think I'll go when restaurants open up. I might go to the park but with a mask and only if it isn't too crowded to stay far away from others. I don't like any of this. It feels all wrong to someone like me- I'm social. I'm a hugger naturally, in fact. I will be much happier, I think, when 'social distancing' becomes a thing of the past, but I'm still doing it!

Yes, I dream of going to parties, even though I don't even like parties that much. I just miss the possibility. All the possibilities- of going out and going away and hugging my friends, and not wearing a mask. For now, the only parties I'll be going to for a while will be the ones that happen in my sleep. I'm hoping to dine out in my sleep in the near future, or maybe to go to a concert wearing my favorite green cowboy boots.

#covid #selfcare #isolation #coronavirus #compassion #physiciansatisfaction #doctor #physicianwellness #narrativemedicine

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© 2017 Rosalind Kaplan