COMMENTARY

COVID-19 Diary Day 6: Clinicians' Choices Shouldn't Be Judged

Don S. Dizon, MD

Disclosures

April 10, 2020

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Yesterday we celebrated the 12th birthday of my twins. We had a special dinner before we sang "Happy Birthday," ate cake (which I made myself!), and opened presents.

There were no other family and friends at our house because of COVID-19. The absence of one particular woman was painfully obvious. My mother-in-law, Marilyn, has been an intimate part of our kids' lives since they were born. She has always been there for our kids: celebrating baptisms and First Communions; attending soccer games, baseball games, and cheerleading competitions; being with us for graduations and, of course, birthdays. Whenever I travel, she steps in to help us. Whenever we have to work on weekends, she volunteers to babysit. She is a best friend to my oldest daughter and the reason we live in our town. She has never missed a celebration.

Until now.

I tried to convince myself that she could come over, that we could all wear masks. That even if she didn't come for dinner, she could still sing "Happy Birthday" and take a piece of cake home. But she couldn't hug the kids or give them a kiss. We couldn't hug either—we could not even shake hands.

This might sound overblown. But I'm still working at a cancer center. True, I change into scrubs at work and then back into street clothes when I leave. I shower when I get home and immediately throw everything into the washer.

The author's twin children with their grandmother Marilyn.

But at our institution, we aren't testing for COVID-19 in the absence of symptoms, nor are we screening all healthcare workers for fevers. There is no way for me to be absolutely certain that I am not an asymptomatic carrier. Knowing that this virus tends to be particularly dangerous to older people, I wouldn't be able to look at myself if she got sick. I would feel responsible.

And so we celebrated, privately, physically distanced from her and other family members, resigned to this new and hopefully temporary reality.

We are not alone, particularly considering the Easter holiday this weekend. From fourth-year medical students forced to celebrate their residency Match Day in private to those of Jewish faith not allowed to gather around a communal table for Seder, I have heard from friends, and read online, about the sadness that comes from quarantine.

But at least in the stories I've heard and read, this has not morphed into anger or frustration. No one has screamed about the unfairness of life or proclaimed that COVID-19 was an overblown hoax. Having witnessed this sobering wake-up call—1.6 million confirmed cases and more than 97,000 deaths worldwide—we have been forced to accept this as a global healthcare crisis. All of us, my own family included, have realized that there is no choice.

Never have I felt prouder to be a part of a group.

I've also been forced to think a lot about the notion of choice as a physician. As we developed our contingency plans for oncology at Lifespan Cancer Institute, we had options: We could make sure that everyone attended the inpatient service equally, or some could choose not to.

Guided by our division director, Dr Howard Safran, we decided to take personal circumstances into consideration and crafted exemptions for attendings over 60 years of age, dual-clinician families, and those with ongoing or active medical problems like asthma, cancer, or heart disease. They didn't have to choose one way or the other; we simply wouldn't ask them to make the choice.

At Rhode Island Hospital I took a different approach, one that depended on choice. I created a 12-week plan for inpatient service and asked my colleagues to sign up—no minimum or maximum service times. I just wanted to see what would happen.

Within 48 hours, every slot was filled. Some signed up for 2 weeks, others for 1 week, and some took extra weekends. Never have I felt prouder to be part of a group.

This is the dedication that we see every day in our healthcare workers in New York City, Chicago, New Orleans, and everywhere that COVID-19 has escalated. We are choosing to show up. And we don't point to our colleagues who choose not to, for one reason or another, and ask, "Why didn't you do the same thing?"

I see it in the nursing staff in our infusion units, the advance practice providers staffing acute care visits, and our nurse and lay navigators who continue to show up day in and day out—all out of a sense of duty to our patients. I also see it in the fourth-year medical students who have chosen to graduate early so they can begin their residencies fighting this pandemic.

Yet I also respect those who have chosen not to. At the end of the day, our choices are guided not only by our duty to patients, but by the duty we have to self-preservation and to protecting our families. As the number of those infected grows in our own communities, I desperately hope that the ability to choose remains.

Don S. Dizon, MD, is an oncologist who specializes in women's cancers. He is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital.

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