Issue link: https://viewer.e-digitaledition.com/i/1240593
One of the hardest things about what we are facing in this pandemic is how much of it is u n k now n . We have no playbook for any of this, nor do we know how long this will last. Many clinicians will be dea ling with death on a sca le that, even as seasoned professiona ls, we have never previously faced. This may be directly in the ca re of ill a nd dying patients. We will also be needed to provide support to many of our long-term patients as their families undoubtedly are impacted by the loss of family mem- bers. It stands to reason that many of us will be shouldering the weight of this responsibility while a lso dea ling with the loss of our own family members and loved ones. An unprecedented number of physicians have been updating their wills and advanced directives in the face of this pandemic. We are very aware of our own risk and vulnerability. We are struggling ourselves to know how much social distancing is needed to protect our families. The norma l stresses of sleep deprivation, interruption of norma l lei- sure activities and social supports, and a lack of exercise are an added cha llenge. My personal road map is to attempt to maintain as much normalcy as possible. I have been a lifelong rower/athlete, and this is an essentia l for me. I wa lk the dogs (more than they want, maybe). I am trying to protect my sleep schedule (not always possible) and maintain a healthy diet. I have received great moral support from the outreach of family, friends and many patients from far and wide. I am blessed with a large family, both locally and around the world (Canada, Spain, Ireland and Australia), and we have been video chatting and connecting often. All across the world, we really are living the same experience right now. I have, like everyone else, found myself connecting in video chats with family members and dear friends and asking ourselves, "Why were we not doing this before?" DIFFICULTIES FOR PATIENTS Many of our patients are dealing with the challenge of preexisting mental health issues. This is compounded by job loss, added financial stress, increased social isolation, and fears about their health and physical safety. Other patients face the added stresses of working from home, trying to balance child care and home- schooling and, often, without the support of grandparents, who are themselves in isolation. Our elderly patients face the added stress of adapting to telemedicine and isolation, something that may be very foreign to them. Getting the elderly patient on a telemedicine platform can be daunt- ing and stressful for all involved. Ma ny of our patients have been in isolation for weeks now. They are fearful and often without their normal family interactions and supports. The elderly realize they are at very high risk in the event they become infected by the novel coronavirus. They of ten do not fully understand the mode of transmission or the best practices for social isolation. They fear being without care for other medical problems if those should arise and of being without needed medications or health care as the systems become overloaded with the care of COVID-19 patients. Patients are terrified of needing to show up in an ER or the need to be hospitalized for any reason. Part of our outreach primary care role is to attempt to help triage, support and maintain patients in their homes in order to lessen the risk of disease transmission. My advice for people who need medical care is: + Use virtual triage with telemedicine when possible. + Avoid hospitals and in-person doctor's offices as they are becoming petri dishes for infection. + Know that much more can be accom- plished with telemedicine than doctors may have thought possible prior to the pandemic. In my experience, patients are enjoying telemedicine, and I do too, surprisingly. I think it is one element of healthcare delivery that will endure in some form after this is all over. My advice to people who are NOT in need of medical care is: + Do everything you can to keep it that way. Reasonably avoid high-risk activi- ties — don't put yourself in a situation where you could fall off a horse, break a leg, etc. Stay healthy. + If you have the good fortune of excel- lent health and perhaps extra time on your hands, give thought to reach out to more vulnerable friends, neighbors and family members who may be in need and isolated at this time. I encourage all of us to consciously think of those who fit this description, and to reach out, even if virtually. FINAL THOUGHTS This will be the most challenging thing most Americans, and the entire human race for that matter, will ever face in our lifetime. We are in this together and must do this together. We are, as a society, only as weak as our weakest link, and in this, I speak to the moral imperative for proper social distancing. None of us is without risk, but the v ulnerable among us, in particular, rely on us doing this together and following medical guidance. I implore our government leaders to listen to scientific and medical experts and clearly communicate and mandate what is needed from all of us. I implore them to find a way to provide adequate protection and support to the frontline soldiers — our clinicians — in this war (and it is a war). I honestly believe that on the other side of this horrible ordeal, the world in some ways will be a better, gentler place. We have been forced to stop and reevaluate everything. Our common humanity is on full display as every nation on earth is living this pandemic together — black white, yellow, Christian, Muslim, Jew. We are being given a chance to reconsider our priorities, the meaning and purpose for our lives, the value of relationships, even our very relationship with our planet. The best of humanity is already on clear display in the generosity, compassion and bravery seen on the front lines and in our communities. My plea is for all of us to do all we can to beat this together. Hope to see you on the other side. n M D N E W S . C O M /// M D N E W S C E N T R A l N E W Y O R K ■ 2 0 2 0 1 3