Upside Down and Backwards

By Annie Brewster, MD

Suddenly everything is different. The quiet is a mix of unsettling and lovely. The chaos and constant motion I have grown used to are gone. No more frenzied efforts to get kids up and out of the house for school in the mornings. No more packing the dreaded school lunches. No more feeling like a taxi driver as I shuttle my kids from sporting event to sporting event, shivering in hockey rinks and on lacrosse sidelines, the sports mom I swore I would never become. And yet I miss all of this. The structure was comforting, or at least predictable. We are all working to create new structure. I hate board games, but we are playing them at night, because my thirteen-year-old forces us to. This is what her friend’s families are doing, apparently. Move it along, please. It was Mrs. Peacock in the Ballroom with the wrench, I guess prematurely. We are striving for normalcy.

Thank god for online school, and for the fact that my kids are old enough to manage their own learning. It helps my anxiety, and theirs, to have “classes” scheduled. There is so much that is unknown. Anything predictable is helpful. I feel grateful that I can put on my scrubs and go to the hospital for my scheduled shifts. It gives me purpose. It makes me feel useful. I am grateful for this. I hear my son telling his ninth-grade classmates during a zoom class that his mom is working in the hospital, seeing patients with COVID. His voice is strong and confident when he says this. He feels proud, and it gives him purpose, too. Yes, I am grateful.

I have never been a germaphobe and I’ll admit, I sort of poo-pooed this whole COVID thing at the beginning. During flu season each year, while many of my colleagues wipe down their entire exam room with Clorax after each visit and wear masks while they see flu + patients, I do not. The mask makes me feel too separate. We will be fine, I kept telling people as COVID started to creep into our realities. Relax. Eat a little dirt once in a while and you will be better for it. My invincibility complex rearing its head. I was so wrong.

Now, I read an “in memoriam” list of healthcare providers who have died from COVID that pops up on my news feed. I am overwhelmed, fixated on their names and ages. Okay, I’m scared. I am a patient and a doctor. I have MS and am on a medication that is messing with my immune system. Does this put me at increased risk? My neurologist says no, as long as my white blood cell count remains normal. Does he really know? I’m not sure. When I stop to reflect, I realize that my long-held shield of invincibility is ridiculous, a defense to protect me from the fact that I am actually already broken, as I guess we all are. How is it that I think I am unstoppable even though I already have a degenerative neurologic condition with no cure? It is almost humorous. Today, my shield has a crack in it. I worry about leaving my children without a mother, fleetingly. Regardless, I want to go to work. I am staffing one of the new RICs, or Respiratory Illness Clinics, at my hospital. We are seeing some very sick patients, because you can’t even get in the door unless you have symptoms suggestive of COVID and are somehow high risk—old, frail, otherwise sick. But weirdly I feel safe. I have on my mask and my goggles, my gown and my gloves. We have protocols. We have awareness and fear, and this fear is helping to keep us safe. But it feels weird to be afraid of my patients. I internally cringe when one of them takes off his mask to blow his nose. Don’t look in their throats, I am told! If you think they might have strep throat, give them an antibiotic. Everything is upside down and backwards.

But I still feel somehow sheltered from the truth of this pandemic. Boston has not yet been hit by the surge. I am not seeing the patients who are intubated in the ED. I am not seeing patients extubated in the ICU, often alone, when continued treatment becomes futile. I am not seeing the bodies. I have not yet been personally touched. No one I love has died. Yet. I am still standing on the sidelines to some extent, even though I am not. This makes me feel a little guilty, like I should be feeling the piercing pain.

I can no longer say I am not a germaphobe. I came as close as I ever have to a panic attack the other day in the supermarket. I was in New. Hampshire, which is behind Boston in terms of COVID awareness. I walk in unprepared. No one seems aware of the rules. No hand sanitizer anywhere. No crowd control or distancing. No wipes to clean the handles of the carts. Even the bathroom is out of order so I can’t wash my hands. I have to touch the food, the credit card reader, my credit card, the cart, the bags, the steering wheel of my car. My hands are contaminated, the enemy, and I wonder if I can trust them. I want to get away from myself, but I can’t.

Annie Brewster, MD is an internal medicine physician in Boston. She is the founder and executive director of Health Story Collaborative.