Yesterday there were a few broadcasts on health care workers coping with COVID-19-infected patients on the radio. I’ve been home, mostly, like all of us, but I had a few errands and I heard some of these on my car radio.
On an afternoon run to the dump there were some interviews with nurses and doctors, about isolation from their families, about the neglect from and distrust of their hospitals, about their fears and their own illnesses, and I found myself weeping. All day I cried and I tried to figure it out. I assumed it was something akin to “survivor’s guilt.”
I am 66 years old and was told gently that I should not be in our health center and could work from home. Taken off the front lines. That caused me a bit of distress, but it couldn’t account for the deep grief I was feeling.
Much later in the day, I had a vision: Brandi Alexander, a – what was then called “Transvestite” – patient of mine in the very early 1980s at Memorial Sloan Kettering Cancer Center where I was a nurse, a sweet man who had what we know now is AIDS and who died a rapid and difficult death.
I had my “aha” moment. The hospital staff who are in the very thick of this pandemic and fighting with their lives for their patients remind me of the early days of the AIDS epidemic in New York.
Sloan Kettering was the center for the care of these patients because we were competent at caring for those who were immune deficient, those who had pneumocystis carinii pneumonia (a nasty lung infection in some chemotherapy patients) and patients with Kaposi’s sarcoma.
In the very first years of HIV infections, we were working truly in the dark. We didn’t know what the infecting agent was, we weren’t even sure if it was infectious. We had scads of very ill young men and no tools or skills to divert the inevitable downward slide to their deaths.
The public sentiment was very difficult to contend with. They were gay, God was punishing them, we needed to shun them. When it became known that it was a viral infection – thanks to the work of Dr. Anthony Fauci’s team – a new condition emerged that we, in the medical community, cynically called “AfrAids,” and no one wanted to be near any gay man. But for us, the nurses and doctors caring for these men, all dead now, it was a fight. They were so sick, required so much care, so much support and so much love when everyone else was turning away from them.
So why did this harken to those days? Well, we put ourselves as health care providers right in the middle of a complex medical situation no one else wanted to deal with. We cared and showed up when everyone kept a distance. We took their grief home, we wept with them, we heard the wonderful stories of their lives, we talked to their families, even when many had rejected them.
My desire to go back there, to be in the midst of the fight for people’s lives needs a reality check. I am a 66-year-old family physician, former nurse, who hasn’t worked in hospital medicine, aside from pregnancy care, in about 10 years. I would not be very useful, not familiar with equipment, bumbling with hospital protocols and generally in the way. Now I do telemedicine, which is incredibly busy and valuable. I am doing homecare with daily check-ins for our patients who are infected with COVID-19. I have daily conversations with the understandably worried well, and I perform my family medicine visits in telemedicine formats.
So what is different? Then we didn’t know who our enemy was, now we do. We didn’t even practice universal precautions in those days and it’s a miracle we didn’t get infected. But AIDS did not and doesn’t infect the general population, but this virus does. We know how to retard and prevent its transmission, a luxury we didn’t have 40 years ago with HIV.
All of my first AIDS patients died, but this is, mercifully, not the case now. We know that the medical community and those they care for need and will use all the support we can offer them, in the smallest to the most magnanimous ways.
This knowledge that we have now ought to move us forward and motivate us. We know what we have to do, and these next weeks are crucial. Just stay home, or walk in the woods and mountains with your dog (my daily task) seeing as few people as possible. Reach out in every safe way you can to those whose lives are currently the most difficult. Old folks truly isolated would love letters. Send flowers. Make meals to leave on porches.
But the best that you can do is to stay away. Please. And weep, if you can, with me for those victims of past epidemics, those who are currently suffering, and the people who deeply cared then and now.
(Dr. Laura Fry lives in Bow. She is the associate medical director for Amoskeag Health in Manchester.)