I suffer from periodic insomnia. I chalk it up to years of a nonroutine work schedule as an emergency physician — days and nights, weekdays and weekends are largely the same. My current sleeplessness, however, is driven by something different. I can’t turn off my thoughts and am wracked with questioning: Should I separate from my family and physically isolate from them, too?
I am an essential health-care provider. This has been my and my colleagues’ role well before COVID-19 precautions, though it’s more readily recognized these days. The emergency departments (EDs) where we work are on the frontline of every public health crisis our communities face. The attitude of gearing up, showing up, stepping up is an inextricable part of how all of us — clerks, environmental services, techs, nurses, and doctors — approach our work. We act as a unified team, extending outwardly to include emergency medical services and inwardly to other critical-care providers, to help anyone who comes to us in need.
Yet, the frontlines right now are defined by contradictions. While it brings unrelenting responsibility, it also gives me merciful permission to leave social isolation. I escape my house to work side by side with people of unparalleled skill and work ethic. I can take a break from my apparent incompetence in homeschooling my children, to stretch out in the realm of my expertise. We break the six-foot distance; we know we can rely on each other to take the strongest precautions possible. I get human contact with other people, whether it’s my gloved hand on a shoulder while I listen to someone’s lungs or the in-person discussion of concerns and fears.
At the same time, I selfishly enjoy that my family is homebound. We have never had this many meals or movie nights together. Beyond vacations, we have not all been in the same place for hours on end. I can see and feel their restlessness, but I know they are safe. I have, at times, felt almost guilty at being able to go to work, to feel like I still have something constant, and maintain the sense of connection that has always motivated me in my work.
I remember a patient I once cared for in the ED who was in severe respiratory distress. When treatment started, I stood at the foot of his bed, trying to talk him through the panic of not being able to breathe. A year later, when I walked into another treatment room, the same patient looked up, smiled, and said: “You’re the doctor that squeezed my toes.” I hadn’t realized that while I stood, unmoving from the foot of his bed, I had a hand on his blanket-covered foot. I have no doubt my squeezing as much reflected my own tension in the moment as it aimed to reassure him.
Now, I have to decide where in my life I can hold onto physical closeness: home or the ED. Do I need to self-quarantine within my house to protect my family from unintentional exposure to particles, microscopic risks I might carry with me, despite all conscious efforts to wash them off?
I’ve never really worried about going to work before. As the number of COVID-19 cases mount and the availability of protective gear diminishes, I’ve experienced unfamiliar anxiety. It’s a shift to think about putting my family’s and my immediate safety at the near top of the list. In my career, I’ve never had to reuse materials, worrying they could be contaminated. I’ve never questioned whether the supplies I need to protect patients would be in their usual spots in the ED. Now, we’re receiving nearly weekly emails with updates on evermore stringent guidelines for using personal protective equipment, like masks, due to resource shortages.
Staring down this reality, here I sit, in the dead of night, slowly realizing it’s time to make a sacrifice for the good of those I love the most. The only way I can keep them safe and well is to isolate from my children and husband. I must put a hold on the meals and movies together, lazy lounging on the sofa together, hugs and kisses good night, until we reach the other side of the curve. There are no specific guidelines to reference, just the knots in my stomach and a need to regain some control.
Each of us in hospitals has a lot on our shoulders. Every facet of our work revolves around trying to keep people alive, well, or safe. Our families do the same. They pick us up and heal us.
But the time has come for me to stand on my own, dig even deeper, and take another serious step to shorten this COVID-19 period. I must withdraw my touch from those I love in order to keep reaching my hand out to those in need.
We all need a reassuring touch to get us through a scary situation. For now, I look forward to the best group hug of my life — when we get to the other side.