I wrote recently of intubating my first suspected COVID patient.
It made me feel like a huge liability to my family.
We know that persons infected with COVID can remain asymptomatic for days after exposure, and that they can transmit disease during this period.
One of the few characteristics I am grateful for is that so far children do not appear to become critically ill from the disease. I'll accept comfort however it arrives.
I could still pass it onto my wife, on the other hand. I don't know how I would forgive myself if I got her sick, even though she is also a doc and understands the occupational hazard completely.
There is the as yet unexplored medical malpractice liability. I was speaking to a colleague about the possibility of informing patients that there are no remaining ventilators available for their use, or more difficult still, that they do not meet criteria to receive those few ventilators that remain based on a rationally created institutional policy.
Imagine for a moment that you are the patient, or their family member. Imagine that you come to the hospital and get this information. It will be a time of crisis. There will be no quiet, comfortable room upstairs for you to be whisked away into.
More likely, it will be pandemonium, and the floor upstairs will insist that they cannot accept the patient because they have their own fires to stamp out. The staff in the ED will be overwhelmed. No one will bring the blanket you asked for or the food tray that was requested because people are busy dying. It will be a horrible experience for the patient and the family.
As for the doc, nurse and tech - we will all go home and fall apart having been unable to deliver on what we entered our respective fields to do.
We will risk our health and the health of our families, and then we will get sued, because that is how human beings express displeasure and vent righteous indignation in America.
We will understand and share their indignation. I work at an incredible facility with top notch colleagues who make me better at what I do. How could this happen? How did we fall asleep at the guard tower?
Those who eliminated the offices tasked with pandemic surveillance will not be held liable in the way the front-line medical personnel will be held liable.
In addition to risking our physical and emotional well-being, we will perceive risk to our financial security.
It doesn't much matter that the perceived risk is overblown, and that we will likely prevail in the lawsuit. The process of being sued is inherently destructive to your ability to continue practicing medicine.
I'm feeling pretty disheartened about the practice of medicine these days, even as I know I'm most needed to be present for it.
I'm far from alone.
Chin up, get through the next shift, help my friends come together so we can do the impossible for one more day.
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You are spot on with your assessment with this.
It is sad that people risking their own lives and the lives of their family will also be under the gun with potential malpractice cases.
I am curious what this will do to people with future interest in medicine. Will they go into front line specialties or medicine at all after seeing this play out?
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I’m always curious how this plays out with the incoming generation of docs, Xray. On the one hand, most of us in the pit have cynicism to spare. On the other, I was 90% idealist (I’d wager you were, too) when I decided on my path to medicine, so I imagine there will be more students wanting to pursue altruistic careers that elicit an appreciative 7PM clapfest than seeking MBAs. Only time will tell…
Hey CD,
Our family did talk about the risk if me bringing home Covid inadvertently. I have had several resp failure patients at this point, but it has all been in a pretty controlled environment. My family is low risk of getting really sick even if we get it. As you allude to, there could also be significant psychological burden if things were to get really bad. Colleagues have talked about staying in hotels, but there is no way that my family would condone me facing that type of situation and then forgoing their support to sit alone elsewhere. It made for some lively debate in our house – I would be devastated if I made one of us critically ill and they wouldn’t be able to stomach the thought of me going it alone. We compromised and I simply get hosed down in the garage upon return from work.
-LD
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LD,
I’ve heard the full spectrum of distancing and disinfection practices – one colleague parked an RV out front and stayed there, until it became too heartbreaking to remain apart from her family. Now it’s a stage in her decontamination process.
Another will kids in diapers was staying in a motel, and got so down being away from the kids she decided to give away all her shifts for a month so she could reunite without feeling like she was risking their health.
A nurse I work with who has joint custody is foregoing seeing her daughter, but I don’t know how that will work if this is the years-long process it is likely to be.
I shower at work, change into clean scrubs, lysol my shoes, get home, strip off scrubs and shoes before entering the house (I like to act as if I’m dancing around a pole when I do it just to elicit grimaces of embarrassment and desperate pleadings of, “This is so wrong, Dad!” from the kids before showering a second time. It makes my wife more comfortable that the miasma of disease are being left outside the house, so I do it.
We similarly decided as a family that we are staying together, because the emotional toll would be too great to remain separate during this time.
Good write up…of subjects many physicians are talking about now. Did you see the anonymous post Rogue MD Dad put up? If not, worth a read.
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Enjoyed the Rogue Dad MD post, thanks for the recommendation and for stopping by.