This was a low week. Delta is ripping through our community, one which was relatively spared in all of 2020 from COVID due to our remote area and (mostly) responsible behavior. I have the "please get vaccinated so we can end this pandemic " discussion at least 8-10 times per day with patients (many of them pregnant and hesitant and after talking about what they're actually there for, because I feel it's that important), even at the cost of running behind in clinic. It's so disheartening and exhausting-- I am having a really hard time understanding how patients come to doctors and trust them for diagnosis, advice, and treatment, and reject this component of preventive health (This Atlantic article said it well). Unfortunately, I take it rather personally, especially when it's from patients and people with whom I've built a decade-long relationship and really like and (used to) respect. Some local physicians (Kelvin and I included) signed a letter to the community penned by our local Medical Society, which captures what so many of us feel. In a few years, I wonder if there will be doctors and other health-care workers not traumatized by being dismissed with respect to COVID-19 that are still in medicine and willing to care for patients who defied all logic and medical advice, and who made our jobs (and lives) incredibly harder and more stressful while straining hospital and clinic resources.
A couple of (unvaccinated by choice, shockingly) staff members recently tested positive for COVID (one is moderately ill or so I hear), leading to call coverage scrambling, clinic staffing issues, and rounds of preventable employee testing and stress. Thankfully, herd immunity within an almost exclusively vaccinated staff pool (and masks, which we've continued to wear) work-- an outbreak was spared (even though a at-home quarantine and "break" from work sounds pretty good about now). Now, we have an employee vaccine mandate, although it arrived just about six weeks too late.
I had one of the hardest weeks I can remember with respect to OB call. We found out that the provider who was supposed to fill in on a weekday call day for another doctor going on her maternity leave in September decided to bail because of the Delta surge (she is vaccinated but older and nervous). There's no way to easily fill that hole due to our already shallow pool of stretched-thin people and after much agonizing, crying, and trying to figure out how I (quite depleted already) could give even one ounce or minute more, I agreed to step up and temporarily (at least for September) take an additional weekday call day (doubling it, going from one to two), already dreading the strain this will have on my family practice patients' needs (not being met unless outside of visits, as I opted to decrease my clinic time to adjust for the extra hours I'll be working), my own family and quality time with my kids (who, still unvaccinated, face the threat of disruptive quarantines), any chance of consistent sleep, and my emotional well-being.
During my recent long call weekend, I was up the entire first night with four vaginal births in ten hours, which is a LOT for our small hospital. One was unvaccinated and COVID-positive (as was her husband, and so per new CDPH guidelines he was not allowed to be a health care facility "visitor" and attend the birth of his child due to the extremely vulnerable population on the unit). I know doctors and midwives have been attending births like this for months since 2020, but this was just the second "COVID-y" birth for me. The mom was very mature about it and had a smooth birth and healthy baby, but the mom birthing alone (except for me and the nurse in full PPE) struck me hard. When she FaceTimed her husband to show him the baby's first cries and moments, I teared up behind my N95 and face shield. Due to a now-largely preventable illness due to widely available vaccines, this man missed the birth of his child, which is not a moment this family can ever get back. This felt so devastating to me not only as a doctor trying to prevent situations like these by vaccine counseling, but also as a parent and a human.
The weekend ended with three more urgent/emergent cesareans, two of which required extensive neonatal resuscitations and one in which the baby is not likely to make it, despite my arriving promptly after being called by the primary provider and surgery happening very quickly for a small rural hospital (the mother is thankfully okay, despite experiencing an exceedingly rare but catastrophic obstetric event, which happens in somewhere like 1/5000- 1/20,000 births). I have never lost a baby, and I am extremely traumatized and devastated. The very next day, one when my hospital lacked pediatric coverage for births due to a short-notice absence of the main pediatrician, I had to do an urgent cesarean on a very preterm mom who just exited her COVID isolation window for absent fetal movement and a non-reassuring heart tracing (I am almost 100% certain that, the way the placenta looked, this was COVID-related. She, too, was unvaccinated). A pediatric colleague who was not on call graciously came in to take the lead on the baby, who also need CPR, respiratory support, and a NICU transfer, but I couldn't shop shaking at the position we were in. Short staffing, busy (and overtired) providers, and hospitals too full or unable to take moms in transport cost lives and are some of the indirect but serious costs of this pandemic.
I could really use some pick-me-ups and prayer. It's hard to see how this "ends" when you're in the thick of it and when you feel like humanity is letting you down. I have started not sleeping well when on (or the night before) OB call because of the anticipatory dread about the stress that might accompany the day (and long, dark, often lonely night that follows). It's going to be a long fall and winter in these parts as I think we're really only starting to see the rise in COVID badness now. I've even considered a future career change/ walking away from medicine (I took Simone Biles' "prioritizing mental health" actions to heart, and God also winked at me by throwing Glennon Doyle's "Quitting" episode in my podcast feed which is a really wonderful listen). I'm entirely human, and not a superhero, but could use some "superhero" vibes for the short term. Here are photos of one I love and am trying to keep safe (who can't wait to get his shot) for attention. I sure have been hugging my kids a bit tighter these nights.
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