
Only a few chaotic months ago, as a family physician in my own general practice, I thought I had a grasp on how I could contribute to the ever evolving health crisis of coronavirus disease 2019 (COVID-19). I have to be honest and say that today I no longer have a handle on much. As the pandemic evolved, I was immediately reliving the many difficult emotions I experienced 2 years ago, before I started treatment for leukemia.
Disruption and compromise
Early in the pandemic, I envisioned myself playing an active role alongside my colleagues in our health care team, managing frantic telephone calls, triaging patients for swabbing, and providing continuity of care for those patients requiring ongoing chronic disease management. Those enthusiastic ideas abruptly changed when the potential severity and virulence of COVID-19 became apparent. I have a compromised immune system as a result of undergoing chemotherapy in late 2018 when I was 36 years old. Because of my cancer, I was sternly advised to stay home, without any sense of when I could (and would) safely return to my workplace. The uncertainty and unpredictability I have found in living with cancer carries on in more ways than I have imagined.
My history of cancer puts me at high risk of infection. If I were to get COVID-19, the complications could be severe or even life-threatening. I returned to work as a family physician 3 months into remission last year, with hypogammaglobulinemia, fluctuating neutropenia, and ongoing lymphopenia. Every day, like you, I am exposed to viruses and potential infections, putting myself at risk to do the work I love. Owing to the recurrent infections (viral and bacterial) and hospitalizations I’ve endured, largely a result of workplace exposure, I’ve been advised many times to consider a career change within medicine so that I would have less patient contact and, therefore, a reduced risk of acquiring work-related illnesses.
Call me stubborn or even reckless, but I love what I do and the patients I care for. Yet the fear I feel right now owing to the threat of COVID-19 is far greater than I could have foreseen. After all I have experienced in the 3 years since my diagnosis, one thing is for sure: I do not want to mess around with my pre-risk probability.
As COVID-19 asserted its presence around the world, I immediately realized that I was a person first, a doctor second. I did not need to be a hero and risk my life by exposing myself to this virus. I have had to create my own contingency plan during this pandemic, as a vulnerable, essential health care worker. Throughout my journey with cancer I’ve struggled with the need to stay away from work and take the time to heal and rehabilitate. I don’t think I am alone in my thinking. As physicians, we often struggle with balancing life and work; never before has this been so literal.
Overload and rebalance
Maybe, like me, you’re finding the sheer volume of information available in relation to COVID-19 overwhelming, even a bit anxiety provoking. You could spend entire days reading guidelines for care and personal protective equipment use (which seem to change daily), watching news briefs to catch developing updates, and reviewing literature to gain clarity or a wider evidence-based understanding of this pandemic. You might feel simultaneously cloudier than when you began and fueled by an urgent sense of personal responsibility during this public health crisis.
Since early 2020, we have witnessed the broadening states of emergency and the upheaval of life as we knew it. Every day, thousands of people around the world are being diagnosed with COVID-19 and many are dying of it. The scale of the crisis is difficult to comprehend, let alone acknowledge, while we do our own part to flatten the curve and preserve lives, working in our respective health care professions. We circulate in our physical-distancing worlds, avoiding human touch and contact, hoping to evade and reduce the transmission of this virus. Myriad emotions roll around with us in our bubbles of quarantine, as we wonder when our lives will return to “normal.” By now most of us are recognizing the unparalleled shift taking place in the universe, and the approach to moving forward from here has never been more critically scrutinized. For good reason.
When I pause and reflect, I can identify many similarities between my personal experience with illness and this pandemic. For example, I’ve had to self-isolate, on a smaller scale, during the past 3 years since my leukemia diagnosis. Before this outbreak, I knew I was responsible for micromanaging my own risks. I also knew how to mitigate external factors that could pose a threat to my health. With a weakened immune system, I am conscious of the risks that I take, leading to added caution and awareness. There are also variables that are simply out of my control. Many individuals practise self-isolation for extended periods while receiving or recovering from immunosuppressive treatments. This is not a new way of life for us.
Just as there was a “before” COVID-19, I believe there will be an “after” to this pandemic—an “after” that will be filled with hope and promise from all corners of the world, as well as a realization of just how fragile we are on this earth. Getting there will take a marathon effort rather than a sprint to the finish, and will rely on our training—both at work and at home, as humans first and professionals second—to save lives. The approach I have been taking throughout the course of my illness is much the same, with small victories along the way and a great appreciation for the village around me. We cannot achieve success on our own; we need teamwork and a collective, collaborative mindset. Eliminating COVID-19 demands a group effort.
New perspectives
Like many of you, I’ve made adjustments so as to safely practise medicine in the future and to have longevity in my career. As COVID-19 emerged, I found, too, a maturity in myself that has opened my eyes in an extraordinary way. I am more aware than ever of my own safety and how to effectively prioritize it. It is important to acknowledge this milestone and the introspective work it has taken to get here.
I am vulnerable and afraid but also filled with common sense and optimism. Despite feeling like a high-risk bystander as I rely on my dedicated colleagues to directly care for my patients, I am acutely aware that doing so is necessary. Developing the wider perspective that allows me to recognize when a situation is potentially too risky or one I should avoid has been a golden lesson, one that benefits not only my work but also my wellness. And my survival.
We have learned how it feels to have the treadmill abruptly switched off and to face instead a steep climb with few handholds. We continue to believe in the positive building blocks of humanity, relying on our neighbours and colleagues to look out for one another by displaying safety and compassion. Above all, we have witnessed many extended hands from all corners of civilization, uniting as one collaborative effort. As professionals, we have had to stay both flexible and discerning in a constantly evolving environment. My greatest source of comfort is acknowledging that we truly are all in this together, with our feelings and challenges and solutions being shared worldwide. I have never witnessed such a universal, collective display of cohesiveness and community.
May you take a minute of self-care and thank yourself for whatever small victory you have achieved in these moments as you navigate your own path in these unsettling times.
Footnotes
Competing interests
None declared
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