Reflecting back on the past few months, I wonder at the vague, troubling unsettledness that shrouds my daily life. The COVID-19 pandemic shocked us all by revealing our vulnerabilities. We witnessed thousands falling ill, many becoming hospitalized, and too many dying. As health care providers we often felt helpless, wielding treatments with limited evidence, managing with inadequate supplies of personal protective equipment, struggling to make sense of what was happening while seeing patients and calling families who were not allowed to share in the suffering of their loved ones in order to protect them. It all seemed like some surreal nightmare.
Some of us fell ill with COVID-19 while caring for patients. I felt powerless between the fever and the chills, the aching and spasms of pain, feeling short of breath just trying to climb a flight of stairs. As I lay in my torpor during the worst of my illness, I wondered how to give my life insurance information to my family without scaring them. I couldn’t lie to myself that I was immune to the worst possible scenario. People younger than I had succumbed. I couldn’t think clearly. The virus was too strong and I felt sapped of all energy or wisdom. Only my prayers to God gave me some comfort. Thankfully my immune system prevailed, and I recovered.
Returning to work, I was astounded by the change. The hospital was chaotic and overflowing with sick patients. The administration worked hard to convert units like cardiac rehabilitation and postanesthesia care unit into COVID units. The intensive care units were overwhelmed with patients on ventilators. Inpatient hospice had a waiting list. Covering myself with gown, gloves, N-95 superimposed with a surgical mask to extend the use of my N-95, and face shield, I entered the rooms. Sick patients lay isolated. Only strangers donned in personal protective equipment, faces masked and voices muffled, entered and cared for them. Their families were not allowed to come. Some understood. Some didn’t. Many were too sick to understand. I was grateful for those who recovered. For the ones who were dying, all I could really do was hold their hand, make sure to get an extra blanket and cover them when the overworked nurses were busy, try to say something, anything, to let them know they mattered. I grieved with family members on the phone, struggling through difficult conversations about medical futility and comfort care.
In the office, I had to tell my elderly, chronically ill patients to stay home. We did what we could by phone and tried to figure out the new world of telehealth. Many patients lost their jobs. Those with jobs who couldn’t work from home worried about going to their jobs. The funny thing is so many of them expressed their concern for me. How was I doing? Was I okay? I couldn’t tell them I wasn’t okay. I was struggling to make sense of it all and do my best to provide care in the midst of this crisis. They needed comforting and direction. I was honest about the uncertainty. No one knew how long this would last. No one could know if they went out masked and gloved if they would definitely be safe. No one knew if they got sick if they would need to be hospitalized; we would have to monitor their progress. No one knew if they got sick and recovered when they would absolutely stop shedding the virus or if their antibodies would fully protect them, and for how long.
In family medicine we deal daily with uncertainty. We often encounter the patient with undifferentiated symptoms and need to embark on the process of gathering appropriate history, doing a targeted exam, and possibly ordering tests to help us rule in and out diagnoses on our differential. We try to enlist patients as our allies, sharing our uncertainty, informing them of changes to look out for, and arranging future appointments to follow up on the expected course of illness.1 But COVID-19 overwhelmed us with a tsunami of the unknown, casting doubt on things we once took for granted. We had to keep 6 feet apart and there was a new fear of where the contagion hid—on other people, on grocery cart handles, in the air after someone coughed or breathed.
I swim in the uncertainty with everyone else. And like most people I feel great discomfort with this ever-present entity. I realize I need to accept this uncertainty to move forward. It is okay to grieve the loss of what was normal. I need to let go of it. Only then can I wake up each day and see how much I have to be grateful for. I have a home and a job. I am with my family and can now enjoy their presence. I am alive. Donning my face mask I can step outside, knowing that I am not alone. Uncertainty may never be my friend, but I can learn to deal with its company.
