Rockville, Maryland, United States
From the safety of my home, I watch the unfolding of the slow-motion car wreck that is the COVID-19 pandemic. Retired from the practice of neonatal medicine for over eight years, my medical license has been inactive for half that time. In my state of Maryland, the web page for the state licensing board indicates that I could volunteer as a physician even with an inactive license, but—what use would I actually be? Hospitalized COVID-19 patients are nearly always adults. Sure, I could probably still intubate a newborn or a few-months-old infant; but anyone with teeth? No, thank you.
How about telemedicine? This seems to be a promising way to deploy retired doctors, and it makes a lot of sense: at-risk senior physicians can free up their younger, healthier, and more up-to-speed colleagues to confront the virus. But—adult telemedicine? This wouldn’t be teleconferencing with residents or fellows in a NICU, or the familiar experience of fielding phone calls from the anxious parents of preemies. No. For me, it would require a crash course in internal medicine. A lot has changed in the forty-three years since my last fourth-year rotation on an internal medicine service!
Would I really want to be on the front lines with the younger doctors—suiting up to care for COVID-19 patients, worrying about the supply of ventilators and wondering if my battered N-95 mask will hold out for one more shift? This is a daunting prospect, to say the least, especially when I recall how I struggled with the stress of the deaths and disasters that came with working in a NICU—the bad nights, the losses, and the heart-wrenching decisions that will stay with me for the rest of my life.
But even as I fear for my contemporaries who are still in practice and thus closer to the danger than I am, there is a part of me that longs to be in on the action. I feel like I have been sidelined, like I am missing the big game. Some of this is probably a reactivation of the adrenaline addiction to which any physician in an intensive-care field is susceptible. As a neonatologist in the delivery room, I checked my own pulse at many a STAT C-section for cord prolapse, abruptio placentae, or loss of fetal heart tones, while frantically setting up with a nurse or two for intubation, ventilation, and umbilical catheterization for volume replacement. I felt my own blood pulsating in my ears while trying desperately, sometimes unsuccessfully, to restore a newborn’s heartbeat. In the NICU, there was the terror of a “crashing” apneic preemie, and the giddy relief after the airway was established, the blood pressure restored, and the first dose of antibiotics administered.
What my younger colleagues face with COVID-19 is not the saltatory series of sprints I experienced in the delivery room or the NICU, but a long, grueling marathon whose finish line is uncertain, only known to be a long way off. The experience I can best relate it to would be working in a NICU whose census is twice what it is supposed to be for months on end, which is still an inadequate comparison. My nostalgia for intensive care medicine pales next to the specter of what they will endure and are enduring. I certainly do not envy these front-line warriors the awful waiting for the wave to hit, the unspeakable chaos when it does, or—especially—the devastating choices some of them will be forced to make, decisions that will scar them for life. I don’t begrudge them their abrupt confrontation with their own mortality: writing wills, appointing guardians for their children, sequestering themselves from their families for weeks at a time to avoid bringing the virus home. Then there is the constant worry and frustration about the lack of PPE and ventilators and the deplorable absence of the widespread testing that would reduce everyone’s anxiety and make their own job so much easier; the callousness of the higher echelons of the mega-healthcare systems that value their own bottom line more than their employees’ and contractors’ safety and even their lives; the lack of leadership at the highest levels of government which puts our front-line healthcare workers at the mercy of their state governments and governors—some of whom are excellent but others, not so much.
For all its horror, though, practicing medicine on the front lines of a pandemic is a quintessential experience of service to others. This is at the very heart of medicine. This is what the Hippocratic Oath is all about. That is what I really miss.
When the governor of our state issued his official stay-at-home order in March, he said, “Every single Marylander can be a hero just by staying home and by practicing social distancing.” And John Milton once said, “They also serve who only stand and wait”—which sounds to me in 2020 a lot like staying home, practicing social distancing, wearing a mask, and rigorous, frequent handwashing. Maybe for me as an older physician there is an element of service in the act of staying home after all, even as I wistfully sit in the bleachers, rooting—and praying—with all my heart for the players on the court, our brave pandemic warriors.
KATHERINE C. WHITE, MD, is a 1977 graduate of the University of Maryland School of Medicine. Dr. White completed pediatric residency training at the University of Maryland Medical System in 1980 and neonatology fellowship training at Georgetown University Hospital in 1982. Board-certified in Pediatrics and Neonatal-Perinatal Medicine, she has worked at hospitals affiliated with Georgetown University Medical School, Children’s Hospital National Medical Center, and Johns Hopkins Hospital. Publications include “Baptism by Fire” in Grace in Darkness, Melissa Scholes Young, ed., American University Press, 2018; “The Last Picture Show” in Hektoen International; and “Into the Mystic” in Maryland Literary Review. Her memoir about medical school, Stress Test: One Woman’s Story of Becoming a Doctor in the 1970s, is being submitted for publication.