By Dr. Mary Poston, PA-C for Firm Foundations Healthcare Clinic in Liberty
I can think of many firsts in my life, some that brought great joy and others that brought great pain. The first time I held my husband Matthew’s hand, two teenagers completely unaware of what the future held, but only of this growing fire in our hearts. The first time I saw my daughter, Vivian – the growing, moving body all tiny and vulnerable outside my womb. The first time I practiced medicine and wondered in terror if I was really qualified. The first time I practiced medicine outside of the country on missions, with very little access to higher care or diagnostics. And I remember the first time I heard about the coronavirus, almost a full year ago now. I remember reassuring Vivian we would be just fine – it was far across the ocean on another continent. Gulp.
But this month brought a brand new first my way. A couple of weeks ago, I heard from my brother who practices medicine in Anahuac – the larger hospitals were full and he was having trouble transferring critically sick patients out who needed higher care. Little did I know the growing COVID-19 crisis would bring the same problem right to my doorstep.
It was a busy clinic day, as they have all grown to be in this crazy COVID-time. I rushed from room to room, feeling like a spinning top at times, ordering tests, fielding results, and giving advice and treatment as able. I found myself grateful for the random foot pain or simple UTI that interspersed the COVID swabs. Most of the COVID patients felt rotten, but were certainly stable. I have grown strangely accustomed to the knowledge that we have little to offer outpatient – the words of encouragement flow more easily now that they will most likely be just fine. Go home. Get some rest. Hydrate.
I took a look at the X-ray before I went in with my second-to-last patient for the day. I had preordered it based upon his symptoms and his oxygen level before I went in to see him. My heart dropped a little as the white infiltrates lit up the lung fields that should be dark on the film. Not that long ago, we were googling what COVID looked like on chest X-ray. Though I haven’t seen many COVID pneumonias in clinic since the pandemic began, it’s something you don’t forget. The last one that looked this bad was on an elderly gentlemen who miraculously made it home after weeks inpatient and then in rehab. He had been so very alone. His precious wife of more than 50 years prayed her heart out at home, unable to even provide him with a change of clothes.
I looked up from the X-ray viewing box to meet the eyes of our X-ray technician. My father, mentor in life and in medicine, had taught me: we treat the patient, not the film. I held out hope that maybe the patient didn’t look as bad as this film and low oxygen level predicted. One glance at her gave my answer before I even got the words out, “How does he look?”
“He doesn’t look good.”
I gathered my strength and headed into the room. An otherwise strong, vibrant 49-year-old male raised his head from the bed he had been resting his head on. His words were brief, spoken between quick breaths of great effort. The X-ray had not lied. My mind started racing with what our options were. By this time, it’s 5:30 p.m.
Science has been racing with nearly the same speed as the virus itself. Nearly. But not quite. One by one, our most hopeful outpatient treatments have failed to pan out beyond the lab, leaving us with very few options. I went to discuss the patient with Brandon Smith, my boss and colleague – honestly, I had planned to throw the proverbial “kitchen sink” at him, in every effort to keep him out of the hospital. It was quickly evident and obvious to my boss based on the patient presentation: he had to go into the hospital. I stared at him grimly as he repeated, “Right? He has to.”
Up to this point in my practice, as a family practice PA in this great nation we are privileged to call home, I have had a secure and solid safety net – I am never the last stop, there is always more and greater help available at the ER. There are many fears in medicine, but losing that safety net was never one of them before this pandemic. Brandon had greeted me that morning with the news: the day before, he had contemplated admitting a patient only to find one hospital had 15 patients in the ER waiting for a bed, the other three. There was no room at the inn.
So, this became my new first. It is one I never dreamed of facing. Was the little and unlikely-to-help treatment I had to offer as an outpatient better than the risk of sending this patient to the ER? What. On. Earth. Seeing those words in black and white right now still takes my breath away. My mind races for a way to make sense of it – we are still in America, right? Not on the mission field?
Ultimately, I decided to send him, as my training has taught me. I tossed and turned all night, catching snippets of rest between prayers for this man struggling to breathe. And, in the end, it would be God who carried him through this one – as my fear became reality. Both ERs he tried were at full capacity. After hours of waiting to be seen, he gave up and went home. He ended up with no care. And I am so thankful the Great Physician took this round; while still struggling to heal, he is slowly improving. But what if the next one does not? As of this writing, we have surpassed 2 million deaths worldwide, 400,000 nationally, and 30,000 in Texas. It seems just a blink ago that number hovered in the 5,000s for weeks. This virus is racing at the speed of light.
Anyone who knows me well knows I am one who avoids conflict. Sometimes at all cost. This pandemic has led to quick and loud opinions at every turn, thus far keeping my mouth sealed as I weighed the medical findings being published against the weight of public opinion. I have heard the harrowing stories of ICU and ER providers in one ear and the cries for the freedom to breathe and expel COVID-carrying air in the other. And I finally reached a breaking point. Along with our medical resources.
I acknowledge that it may be your right to become contaminated and spread the virus. However, who is speaking up for your right to emergency medical care when you need it? When the beds are full, they are simply full! So when your grandmother has a heart attack, or your child is in a wreck and needs emergency surgery – resources will be thinly stretched. I can no longer be quiet about the disconnect, as one side of our community fights day and night for their patients to make it another day, only to lose one after another: the ER nurse whose shoulder is strained due to performing chest compression after chest compression. Her coworkers are pouring vodka into their sprite just to make the drive home after another endless shift ends. We have to WAKE UP. These are our neighbors. Our loved ones. We cannot simply charge along as if we are not affected. At the current rates of infection, you and a loved one will soon be affected, if not already.
What can we do to make a difference? While public responses may have felt confusing or contradictory at the national level, I am here to say what I have found and know to be true. Things we can do as a community to help improve our chances of making it through this together.
- Wear a mask! My staff and I have faced this virus for over nine months. We mask faithfully. Not one of us have caught it from a patient. (Those of us who got it know it came from someone else exposed in our households.). The link below enumerates how even cloth masks are working! What is not working, and maybe even hurting, are the cloth gators. In order to work, masks must cover your nose and your mouth – especially while speaking! https://health.clevelandclinic.org/new-study-highlights-new-evidence-that-masks-prevent-coronavirus-spread/
- Please avoid gathering with people outside of your home! Yes, we spent Thanksgiving and Christmas alone. Yes, it was different and a little sad. However, the most succinct way I’ve heard it said sums it up: we gather alone this year so that next year no one is missing. Most of my patients are contracting it from a family member outside of their homes. While most of us are getting it and recovering, the cost of those who perish is too great. I know the numbers are growing too large to even grasp, but each number represents someone’s loved one. If you do gather for worship or other reasons, please try to maintain social distancing and wear a mask. I do not feel faith and wisdom regarding this are mutually exclusive! And I do not believe wearing a mask is a sign of fear, but wisdom. And love for one another.
- Do not eat inside a restaurant! Not while the case numbers are so high. I have decided this is the one piece of advice I’m trying to give as many patients as I can (in addition to the above!). El Burrito’s patio has become my friend, as well as Red Top Wagon! Take-out is fine – I am not worried about the food itself. It is the shared, enclosed airspace!
Other tips I find myself giving often have to do with how to retain our sanity as we buckle in for this continued ride.
- Get outside! Thank heavens at least the outside is safe. The UV light kills the virus, and exercise improves our immunity, as well as maintaining a healthy weight.
- Eat plenty of fruits and veggies! We “kinda sorta” really are what we eat, cell by cell over a lifetime. Let’s put in good things, that protect and heal us rather than break us.
- Pick up the phone! Stay connected to those who help ground you. Or go for a walk with them! (Outside, of course.)
- Seek mental support if needed. Many counselors are available virtually, and there are medications that can help improve serotonin levels during this time. (Check out https://www.betterhelp.com/online-therapy/ and Talkspace – #1 Rated Online Therapy, 1 Million+ Users)
- Don’t lose hope.
We will find our way to the other side of this. Vaccines are rolling out, and science continues to race toward new and better treatment options. But while longing for that day, we must work together to bring as many friends and family members to that day as possible. And that can only happen when we choose to have each other’s back.
I will leave you with a quote that recently nailed how I have been feeling lately, as a provider in these crazy times. It is known as the Stockdale Paradox. Admiral Stockdale was a prisoner of war during the Vietnam War at the infamous Hanoi Hotel. He was there eight years, and used his time there to make life as bearable as humanly possible for himself and his fellow prisoners. When asked who did not make it out alive, this was his answer:
“The optimists. Oh, they were the ones who said, ‘We’re going to be out by Christmas.’ And Christmas would come, and Christmas would go. Then they’d say, ‘We’re going to be out by Easter.’ And Easter would come, and Easter would go. And then Thanksgiving, and then it would be Christmas again. And they died of a broken heart. This is a very important lesson. You must never confuse faith that you will prevail in the end–-which you can never afford to lose–-with the discipline to confront the most brutal facts of your current reality, whatever they might be.”
Mary I am so proud to know you and your family. I love your heart.