Coronavirus heroes: the doctors carrying an immense burden to care for us

https://www.theguardian.com/world/2020/mar/25/doctors-coronavirus-pandemic-stories

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Doctors across North America are worried about bringing coronavirus into their homes, separation from loved ones and the basics of running a home

Doctors across North America are bracing for a surge of critically ill patients, knowing that the more patients they see, the greater their risk of becoming infected with Covid-19.

Their commitment to work comes with a heavy psychological burden that their many hours in hospitals could harm their families.

They worry about carrying the virus into their homes where their children, partners and parents could be exposed. They worry about long hours separated from their loved ones during a time of unprecedented generational stress. They worry about the basics of running a home: childcare and lesson planning, food and, yes, even toilet paper.

Dr Michael Szava-Kovats, emergency medicine physician

Calgary, Canada

Five weeks ago, Dr Erin Bruce, an anesthesiologist, and her husband, Dr Michael Szava-Kovats, had their first child, a daughter. He agonizes over the thought of exposing his young daughter and wife to infection. He accepts that he may get coronavirus. The risks to his family are outside his comfort zone, he says.

Last weekend, he moved into an empty condo owned by friends.

“The biggest justification of it is because we’re in uncertain times and whatever is going to declare itself is going way too rapidly for us to be able to be reactive to it,” he says.

He worked five days in a row after his move. On his first day off, the sadness of their separation hit him. He feels a combination of guilt that he’s not there to help with a newborn and heartache that he missing out on the first months of his daughter’s life. He longs to be with his wife during an event that’s changing their lives and history.

“It’s hard because I want to be with my family. I am not doing this because I want to.”

The couple is considering meeting for walks but they aren’t comfortable with it yet.

Szava-Kovats has set out strict rituals to stay focused and calm over the next weeks. He calls Bruce at the same time every day and meditates before each shift at the hospital. He goes through a painstaking hygiene protocol at every stage of a workday: getting dressed, leaving the apartment, entering the ER and then decontaminating himself when he leaves.

He described morale as high among his colleagues, and they have united together for the good of their community. But there will be long-term psychological consequences for everyone, he said.

“I think the prescription that we have for the community of staying home is the medicine that’s going to make us as safe as possible, but it has side-effects that we have to be aware of and take care of those.”

Dr Bonnie Larson, family medicine physician, and Dr Alan Chu, anesthesiologist

Calgary, Canada

Drs Bonnie Larson and Alan Chu met at medical school and bonded over their shared interest in global health. They’re married with two children.

Larson is a frontline physician working with the city’s homeless. She’s working to keep Covid-19 out of local shelters. Chu is leading online training for residents about coronavirus and airway management, but is readying for a crush of sick patients to arrive in the ICU.

They wonder what it will be like for their kids, ages eight and 10, to go through the pandemic without at least one parent home all the time.

“It’s anxiety-provoking, for sure, for us,” said Chu. “The [kids] would rather have their parents around them but they also know this is what we do.”

The pair is relying on neighbours, other physicians and medical students to help with childcare. Their regular nanny, who has worked with them since their second child was born, also cares for elderly members of her family, and they are uncomfortable with having her at their home for long hours during a pandemic.

Larson cried as she described hearing other parents talk about homeschooling schedules and meal plans for their kids. She wishes she could make a lesson plan for her kids and be with them over the next few months, “but that’s not happening. Our kids are going to have a bit of a different experience.”

Over the last week, Larson and Chu were busier than usual, readying their departments for the unthinkable. Friends gifted them rolls of toilet paper because they knew the couple didn’t have time to stock up.

Larson and Chu plan to continue to be there for patients and colleagues as long as they are needed.

“In medicine, at this point in our careers, what we can potentially offer, it doesn’t make any sense not to show up just because it’s scary or hard,” says Larson.

Dr Zara Mathews, emergency room physician

San Mateo, California

Dr Zara Mathews is 34 weeks pregnant and mother of a toddler. She plans to work for another week and half, keeping to the schedule that she set out months ago.

Her home and work lives have never felt so intertwined, she says.

“Normally, when I’m at work, my patients are my priority and when I’m at home, my family is my priority,” she says. “But now there’s this question of whether doing what I need to at work is potentially going to put my family at risk.”

She takes extra precautions at work, wearing gloves and a mask all the time. After each shift, she changes out of her clothes at the hospital, showers at home and puts on clean clothes before interacting with anyone in her family.

She feels like she can’t isolate from her family in this adrenalin-soaked environment with a baby on the way.

“I’m still interacting with them but I’m trying to be extra-vigilant. I’ve washed my hands more times in the last couple of weeks than I ever have.”

Dr Mathews says her parents and husband worry about her, but she is more concerned for her kids and her patients. Most physicians feel the same, she said. Everyone has concerns about risks that they bring to our family but the primary focus is doing everything they can for our patients.

“I’m pregnant. My colleagues are balancing risks in their own lives. Everyone has, very briefly, been able to put those aside when they’re at work and done everything they’ve had to do for very sick patients. And that makes me really proud of my profession.”

Dr Christine Carter Toevs, trauma surgeon, intensivist, ICU co-director

Terre Haute, Indiana

Dr Christine Carter Toevs, who has worked in medicine for more than 30 years, says she always worries about bringing home illnesses that could affect her husband. He has respiratory issues and diabetes. When he gets a cold, it lasts for ages.

“I wonder if he’s more susceptible and maybe I wouldn’t have any symptoms,” says Toevs, also has a master’s in bioethics.

“Do I run the risk of bringing it home? Sure. But I also believe God is sovereign in the universe. There is a plan, he is in complete control.”

As a trauma surgeon and ICU director at a hospital for city with a metropolitan population of 170,000, Toevs’s priority is on looking after patients and keeping the hospital going, she says.

She is concerned about what will happen if high numbers of staff get sick, or she gets sick. Even if one trauma surgeon becomes unable to work in a community of this size, it affects the hospital’s ability to provide care.

“When you’re in a limited resource environment and some of your people get sick, it makes a difference.”

There is not yet a single known case of Covid-19 in Terre Haute. The hospital has restricted its entrances and exits, and patients are verbally screened before they come in. The first person could be anyone, so everyone is a risk.

Everybody has a responsibility in this pandemic, she says. Non-essential workers have a social obligation to stay home to minimize the risk for everyone. Her responsibility is to care for patients. “I get up every day and make a commitment to take care of people. To sit at home and live in fear is a terrible way to live life.”