I’m an ICU doctor in the middle of a global pandemic. I am trained to manage ventilators and care for the critically ill. My city, along with others, is preparing for a surge of patients requiring hospitalization and intensive care. 

And I’m nowhere near a hospital.

Haven’t been for a week. I am home, with my family, living a different life than my physician partners and colleagues of fifteen years. I am on the sidelines, forced to watch from afar, by a set of circumstances I would have thought impossible. But then again, in a world now ravaged by the novel coronavirus, many things once thought unimaginable are now our reality.

For a week I’ve been at home. A TV on in the background with a constant flow of repeated information. New COVID-19 Cases displayed via logarithmic graphs shooting towards the sky, while the Dow and S&P careen into the earth. Twitter is constantly refreshed on my iPad, while my laptop displays the Johns Hopkins COVID Dashboard. All are unhealthy distractions from my new medical issues.

Facing one’s own mortality, whether from an invisible viral pathogen or a cluster of hidden cancerous cells lurking on the side of my tongue, can activate a few coping strategies. My brain has rapidly cycled through both emotional and intellectual responses. In the time BC (Before Corona) I was doing a mediocre job of adjusting to my middle age. Now, I am forced to sit with the reality that my health is far more tenuous, and less under my control, than previously thought.

Eleven days have passed since I heard the pathologist say the words “squamous cell carcinoma in-situ” over the phone. Forced social distancing has both the benefit of decreasing viral spread and giving me plenty of quiet time to think. Now I am finally ready to stop cycling between either my emotional or thinking brain and maybe hold space for both. There are so many thoughts going on inside my head. Like painting when I was a kid, mixing all those water colors together. The colors would start out vibrant and bright, but when brushed altogether, I was left with just a dull watery black. It has been easier to let these emotions blend together into a kind of white noise, muting their individual impact. But it’s time to identify and make room for how I feel. Fear, Anger, Guilt.

FEAR. I have felt fear a few times before. A nightmare. An irrational thought gone rogue about something bad happening to my children. But now that my own cells have betrayed me, there is this fear of my own body. Fear that maybe a cell or two might have escaped. Fear of surgery and pain. I fear the hospital, my home away from home. The surfaces, counter tops, door handles and keyboards. I fear the harm I might suffer by doing my job, taking care of the sick.  

ANGER. Anger at ratings and politics are driving communication and decisions, instead of science. Anger that my colleagues have inadequate PPE’s. Anger about ventilators that should already have been made. Anger that empathy and compassion are so foreign, so unknown to our president, that he is incapable of even faking them.

GUILT. I sit here at home. Waiting for a surgery on my tongue that prevents me from working. I’m not allowed in the operating room until I am 14 days free of COVID patient exposure. So, I get a pass. From an increasing hospital census and shrinking supplies of PPE’s. From an ICU with the specter of COVID-19 permeating everything. And guilt, maybe, for feeling a little bit of relief, not to be there.

Fear. Anger. Guilt. They are uncomfortable. But I try and stay with these emotions. Not push them away. And by doing so, these isolated notes combine to form the more complex chords of loss and gain.

LOSS. Some quick thoughts jump out first. A sense of loss for my kids, home from college, their newfound independence abruptly taken away. Waving goodbye to my yearly goals or New Year’s resolution,  which seems now quite superficial and vain, in light of the global medical and economic havoc. But the majority of changes in my family’s life are more disruption than devastation. I am acutely aware of the privileged and lucky life my family and I lead.

But this feels bigger. Bigger then the quiet roads, empty parking lots and barren shelves. There is something more profound that has shifted internally.

I no longer feel free and safe to move and travel within my community and the broader world.

For the first time I am concerned for access to food and medication.

I no longer am secure that there will be a health care system available and capable around the clock for my family’s medical needs.

I know that for many in America, and around the world, these have never been given.  That my life and experiences being a doctor in this country is not universally shared. But I do believe we are all reconciling the loss of an illusion about our safety and security. We, as individuals, a community, a country, now know we have always been more vulnerable than we presumed just a few short weeks ago.

GAIN. Loss leaves a vacuum. Physics demands that void be filled and I can feel, more than see, what the shape and contours of what that will be.

The comfort of friends and family, reaching out with love and concern. Because I’m a physician facing unprecedented times. Because of a cluster of shitty dysplastic cells in my tongue. Friendships new and old recharged via Zoom conferences and Face-Time phone calls.

The power of a community. A neighborhood that sends me N95’s. The fraternity of health care workers at the different hospitals where I work, that show up and do their jobs, despite the increasing challenges to their own safety. To draw blood, take x-rays, set up vents, administer meds, diagnose and treat, and clean and sterilize the rooms. Every day. Every shift. Every patient! I hope to live up to the high bar they have set when I recover and am back out there.

The frailty of our health security has always been there even if not recognized by the majority of us.  The same is true for the powerful impact our varied communities can have. It is unfortunate that it took an invisible virus and in my case tongue cancer to bring these truths to light and inject them into the fabric of our everyday life.

I have surgery scheduled next week. It will be my first. A complete role-reversal for me. I’ll be on the other end of a breathing tube and ventilator. There will be some sort of laser scalpel to remove part of my tongue. My MD degree will not spare me from being a nervous pre and vulnerable post-operative patient. 

But I will go under anesthesia, in this time of coronavirus, buoyed by the multiple tribes I belong too. Family, high school and college friends, co-workers, neighbors, teammates. The ties that bind me to them have never been stronger or felt more important than right now. 

I will wake up from surgery. My tongue will heal. My voice will reappear. And I will be ready to leave the sidelines and start doing my part to fill the vacuum of loss with what I have gained.

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