Dr. Dorothy R. Novick is a Pediatrician in Philadelphia. Her areas of expertise include trauma-informed care and social determinants of health.
Submitted May 8, 2020
Realizing the Magnitude
Seeing a graph of New York City’s available beds versus their predicted needs, and realizing that what happened in Italy was about to happen in my hometown. I had read all the stories about what it was like to be a health care provider in the hardest hit areas — how patients were dying just while waiting in line for the ER and how physicians were having to ration care. All of my friends and relatives, some of them elderly, are in New York. I called them right away to implore them to leave. Some did and some stayed. Thank goodness they are all safe and healthy, but that was a moment of real awakening.
Anxiety provoking. The greatest source of angst, early on, was being two steps behind. We could feel this thing coming. We knew it was all around us. We assumed that a number of patients we were seeing with respiratory symptoms in the office might well have COVID-19, but we had no tests. We couldn’t practice universal precautions, which would have meant wearing protective gear with every patient just in case, because we would’ve run out in a matter of days. We were worried not only for ourselves and our patients, but also felt responsible to protect our nurses, front desk staff, and cleaning people. We had to overhaul every aspect of our practice, from our schedules to the layout of the waiting room to where we keep supplies. This took almost a month, and meanwhile, sick patients were coming in all through each day. Everyone was scared, tensions were high, and rumors in the media weren’t helping. I have never experienced physical symptoms of anxiety like I did in those first few weeks.
A Lasting Memory
I was asking a COVID-positive mother, who was visibly breathless and coughing frequently, how she was doing and whether she had help caring for the baby. She said no one could help, and that if she had to call 911 she would need to bring the baby with her. I started to ask about relatives and friends, but gradually her reality sank in – the baby was contagious. No one could watch her should mom have to go the hospital. The thing is, I’m a problem solver. All day long people bring me their problems and I set out to find solutions. Even when I don’t have the answer myself, I know who to ask, how to advocate, how to insist on some kind of resolution, and get the job done. But I was at a complete loss. There actually was no answer to this question. Not even foster care, always our last resort, would be an option for a child contagious with COVID-19. There still is no answer today.
Trying to do the vital signs myself, instead of having a nurse put on PPE, as a way to conserve. I’ve been a pediatrician for 25 years, but for the life of me, I could not manage to work the nuances of the pulse oximeter and digital thermometer. Simple things, like if you take the thermometer out but don’t use it right away it goes into standby mode. Here I am wrestling with how to get it back on while mom and baby are both coughing, and I’m trying to hold my breath, knowing full well that prolonged face time increases the risk of spread. Ever since then, we have the nursing staff wear PPE and enter the room with us, but there was a lot of trial and error as we experimented with new systems early on.
I’ve heard stories of medical staff refusing to come to work, but in our office it’s the opposite. From the cleaning staff to the nurses and registrars, every single person is motivated and mission-driven to provide the best possible care to our patients. One of our medical assistants, who had been crying early on from the stress of single parenting while schools were closed — and the worry of bringing the virus home to her daughter — was the first to volunteer when an extra hand was needed caring for a developmentally delayed child with COVID-19. Watching her gown up and enter that room despite everything she was going through helps inspire me through each day.