for Geisinger Health System
State College, PA
This is part of our series, Flattened By the Curve, which features the voices of doctors, nurses, healthcare workers, and others on the front lines against COVID-19. For information on how to submit, click here.
Signs dangle from light posts outside my clinic office building. #longliveheroes. These posters are not for me. I am an imposter, never less a doctor than now, in the time of Covid-19.
In late March, our clinic breaks into a sick team and a well team to minimize exposure for our vulnerable partners and avoid cross-contamination to our well patients. I am assigned to the sick team. I decorate my office with print-outs of protocols, which I tape to the cabinets above my computer and to the walls. I gather my PPE from the head nurse: a surgical face mask, a reusable face shield that can be wiped clean in between patients, a disposable gown with a hole for my thumb to ensure it doesn’t ride up. The nurse hands these items over cautiously, afraid our allotment will not sustain us throughout the ordeal. Only for the most likely patients, we agree. My parents offer to house my children for the next few months so that I won’t bring this virus home to them (or my parents). We have daily clinic-wide meetings to prepare for the surge. I binge on scholarly articles during the day and CNN in the evenings.
My first PUI (patient under investigation): A 21-month-old boy with fevers and diarrhea. His family visited Washington, DC just before it shut down. Multiple family members are febrile, some cough. Tests are pending. I pause outside the exam room door, close my eyes. Without an N95 mask, I have some defense against any SARS-CoV-2 in the room, but no gleaming armor. I think of the picture my mother texted me this morning of my blond-haired children working on Chromebooks at home. Bored eyes. Confident smiles. Healthy cheeks. No sense that I am in danger or, worse, that viral particles may blow through my surgical mask, hide in the ridges around my fingernails, take shelter in my frizzy curls that they love to nuzzle. I think of my parents, in their upper sixties, schooling my children at my home as, the way my Dad puts it, their contribution to the cause.
I examine the boy. He measures me in my PPE, only my eyes visible. As I take my seat, my mask creeps up to cover my bottom lashes and I wiggle my nose to get it back down. It creeps further. Whatever expression my wrinkles convey is invisible and I know I appear alien-like. He screams when I reach my stethoscope toward him. He jerks his whole body in his mom’s arms when I push the swab deep into his nose. I intend to twirl the tip five times but I am lucky to just get it in place before he swats me away. His mother carries him from the room, eyes full of fear. I will call in five days with the results.
My second PUI patient has a bright smile and a fever with no other symptoms, a playful two-year-old with special needs. I am braver this time. I take a deep breath, and I enter the room. Her exam is normal, except for the temp of 30 degrees Celsius. My PPE style is humorous to her, and she laughs every time I speak. I pull out all my tricks to keep her giggling. I sing a song with made-up lyrics (and if the cat falls over, Mama’s gonna buy you a camel…) while I complete the workup. She stops laughing when my nurse holds her still for a bladder catheterization. Even in the time of COVID, the common ailments are common, and I fear missing a UTI in a girl who can’t tell me it hurts to pee. I twirl a swab inside her nose and pirouette myself but the laughter is gone, my PPE no longer a costume. I have hurt her feelings. She sees it as a betrayal, as taking advantage of her favorable humor. Her mom and I exchange a glance. Try not to worry, we tell each other. I’ll call in five days.
Next, a teenage boy after a spring break trip to Florida. Fever. Cough. Shortness of breath. Wheezing although he has never wheezed before. He sits on the table, tired but not struggling. His father looks at me with eyes that ask, “Could it be?” A chest x-ray shows pneumonia. It could be. “My mother is 75,” says Dad. “I take her groceries every week. If we quarantine, who will care for her?” I shrug with as much empathy as shoulders can muster. I know my eyes are already wrinkled with worry. Five days, I say.
I, too, watch the news stories with open mouth: a day in the life of an ER doctor in NYC, an interview with a new mom who lost her otherwise healthy love, the doctor so overcome with grief at the staggering loss of life that she takes her own. I am outraged at the deniers and at the lack of PPE and ventilators. Then, I hit the power button, and coronavirus disappears.
The tests on my patients come back. All are negative. Over the days, the weeks, I order more tests. All negative. On the other side of the screen, the world is changed. I rush in, stethoscope and protocols in hand, and bounce off the glass.
Most days, my pediatric clinic is nearly empty, all non-urgent appointments postponed. Office paper printed with large black arrows directs parents to one checkout or another, depending if they are sick or well. I consider that, maybe, I should stand there instead of the signs and point with my idle finger.
Most days, the clinic is devoid of me as well. Two days per week I spend on mandatory paid time off. Pediatric clinic volumes across the country remain so low that many private offices face bankruptcy, and the American Academy of Pediatrics warns of a crisis of vaccine-preventable illness looming.
As our nation slowly reopens, I remain prepared. My face shield is freshly sterilized, my mask, molded across my nasal bridge. Updated protocols hang in my office. I stand behind all the healthcare heroes in this country, nodding to the posters from my place far below, hopeful, yet ready for my first positive. I fear it is coming.
Kati Eisenhuth is a general pediatrician in State College, PA. When she isn’t butchering lyrics with her patients or stumbling on solar-powered Lego creations at home, Kati runs and writes in whatever quiet corner she can find.
The thoughts and opinions expressed are Kati Eisenhuth’s and not necessarily representative of Geisinger Health System.