This past week as I called my patients to do office visits either by telephone or video, I was so struck by the gratitude they express. One patient thanked me for being concerned about him and calling. They think these visits are special especial in this trying time. I want to say, “I am just doing my job, no need to thank me,” but I don’t. I am frustrated about the technical difficulties that occur when they can’t download the program for a video visit. They apologize, but I want to say, it is not your fault, it is ours. We’ve allowed this technology divide to prevent many from being able to benefit from this technology. We should have moved ahead with these platforms, and when people came to the office, we should make sure they all have smartphones and have our Apps downloaded. We needed the Tech team to meet each patient at the door, but we didn’t, and we failed our seniors. They are the ones we could have helped more. Why do they always have to come to our office? They would benefit from these video visits. Imagine a virtual picture of their home and to make sure they are safe.

I really don’t need a pat on the back for just doing my job. Doing it well was what my grandmother always instilled in us. You must be “ten times better to get 1/10 of the recognition”. We failed our patients when we didn’t help them embrace technology and health. We failed when we didn’t ensure that being healthy meant having a smartphone or a way to connect to their doctors. Also, we allowed many of their grandchildren to be in schools that now can’t provide them with Ipads or laptops at home to do their homework. These wired kids could have passed on their knowledge to their grandparents.

I completed the phone visit with one of my seniors, and she said, “I will be so glad when this is over so I can see you. Please take care of yourself.” I wished I was there to set up her phone so I could see her face.

America should not be lulled into patting someone on the back when all they are doing is the job they are supposed to do. Unfortunately, it was delayed because of politics, failure to listen to experts, and arrogance. Now, hold us responsible for making sure going forward; we are forward-thinking, innovative, and compassionate. We need to make sure that insurance companies do their job and help their patients. We need to make sure all Americans have health insurance, and they have access to health care that is responsive to their needs.

The truth is that our finest moments are most likely to occur when we are feeling deeply uncomfortable, unhappy, or unfulfilled. For it is only in such moments, propelled by our discomfort, that we are likely to step out of our ruts and start searching for different ways or truer answers.  Scott Peck

Patience was never one of my virtues, as I have stated so many times in past posts. I think I am even more impatient now. Each day feels like it is 100 hours. By the time you finish notes, answer phone calls, and deal with all the emails; you are exhausted. Truthfully, we have just begun this battle with COVID-19. It is touching every person I know. Patients are talking about friends and family members who have lost someone from the complications of this virus. They are young and old. Many of my patients are African American. It is affecting our staff and family members of our colleagues.

I am not sure what the toll of this virus will be on our community, but if you read the experts, it will be extensive. We were dealing with health care disparities and lack of primary care to meet the medical needs of African Americans, Latinx, and Native Americans before COVID-19. Now, it will become more apparent about the lack of primary care for these vulnerable populations. The Emergency Rooms are not the place to go currently. People need to be able to reach out to their primary care doctors to get guidance and help them navigate how to care for themselves at home. That is all I did this morning. I arranged for a patient who is a high risk to get tested. She should not be in an ER but only need to do the drive-in testing. For the drive-in testing, you need an appointment, which would mean having a primary care doctor to get a referral. Some sites do not require a doctor but do require you to schedule an appointment.

My highpoint came during dinner because my husband made my favorite fried oysters. I ate my oysters during a 7 pm Zoom meeting with URM Scholars. We had a very productive meeting. I marvel at their resolve to complete this manuscript for submission while dealing with the reality of being primary care providers during this challenging time. Well, I will rest and get ready for tomorrow.

I find hope in the darkest of days and focus in the brightest. I do not judge the universe.

Dalai Lama

Physicians learn that community is essential. I had my first community with a very close-knit group of cousins. We played together and managed some mischief that was quickly squelched by our grandmother, who was our babysitter. When I entered grade school, I got into trouble because I love to talk. I was a true Scorpio. An introvert who could function as an extrovert. In college, I joined a sorority. In medical school, they assign in you to a team that starts day one in gross anatomy and continues through the clinical years. You must function as a team and study group to be successful. You become a community. You even end up partying together. One classmate gave me rides home to Birmingham from Nashville. He lived in Montgomery. He also picked me up on his way back to Nashville.

I have maintained some of these close friendships over the years. The first was with my best friend from Medical School. We call each other and try to meet up when we can. The second is with my best friend from residency. It started with Sunday night phone calls after graduation in 1990. It included meeting up for major conferences at least once a year.

When I moved back to NJ, my life was a bit more flexible so that I could meet up with friends on a more regular basis. My residency friend and I went to our meetings and met up for lunch dates. My friend from Med school, and I continue to meet up at least once a year.

I loved meeting colleagues at lunch and medical staff meetings. I always take time to talk to staff and find out how they and their families are doing. Now with the COVID pandemic, none of that can happen. The hallway chats and curbside consultations are on hold. All in-person meetings are canceled. The skype calls are rushed. I just want to say, “Let’s Breathe for just one minute together,” We are working from home and doing virtual visits with our patients.

I talked with my best friend from residency over the weekend, and we agreed to return to the Sunday night phone calls to catch up. Like the ’90s, she will call around 9 pm, and we will run down our week.

“Alone, we can do so little; together, we can do so much” – Helen Keller.

Amid the flurry of emails, meetings, checking residents’ notes, calling patients, and refilling prescriptions, I received a cryptic message in my Epic in-basket “Patient status change.” I clicked on it, and my heart sank. “patient status change: deceased.” I looked twice and then called in our RN. She had not received any notification. I chart checked realized there were no new notes. I finally decided to dial her cellphone, and then that status was confirmed. Her family confirmed she had indeed died at another hospital.

I cried. We violated “social distancing” because it hit us all. My patient was gone. In the past, I would have received a call from the emergency room, but now, they can see my notes because of the electronic health record. They did not have to notify me because they can do it in their chart, and I get the notice.

This process does assume I don’t have a close relationship and would not have an emotional response by the sudden death of a young African American woman who was a beautiful wife, daughter, and especially a mother. I enjoyed seeing her in the office. We had some open discussions about her health and the tragedy that occurred in her life. I loved her relationship with her daughter and enjoyed having them come in together. I will miss those visits.

I have lost many patients over the years. There are so many that have etched their names in my heart. Amid this pandemic, I just realized that I do have to deal with the day-to-day patient care and the unexpected tragedies that will happen. I have been training to perform telehealth visits, and now, I must fast track. We are shifting gears and speeding ahead. As we switch to these virtual visits and limited in-person contact, I realize my status has changed.

“Remember that people are only guests in your story – the same way you are only a guest in theirs – so make the chapters worth reading.” ― Lauren Klarfeld

I had been so busy; I never made it to the local YMCA to work out. Several years ago, I designed my home Yoga practice because I had received my 200-hour certification. I had planned to go for the 500-hour, but my work schedule exploded. I then had to design a home meditation practice, so I used several apps- InsightTimer and Deepak and Oprah’s meditation series.  I also went to a HEAL1 series.

For my workouts, I started walking 3-4 miles and then added a workout App called Seven. It helped. It was so important after I had surgery. I used all of this to get back into shape.

Now with the social distancing required to prevent the spread of COVID-19, I am so happy that I designed this program. As a physician, I find that this home gym has helped decrease my stress level and keep me grounded. I need to stay healthy, so I can work and teach my residents. My patients said as they left the office” Stay safe.” This our new reality.

It has been a hectic two weeks for me as a physician. I have been staying updated on COVID-19 and trying to see my patients. I had two patients come in for post-hospital visits, and I told them to call and stay out of the office until everything slows down.

I am a constant hand-washer in the office. I have a slight sensitivity to all hand sanitizers, especially our hospital-grade one, so I use soap and water. I use the hand sanitizer on rounds and then race to the sink when it is available. I always wear makeup to prevent myself from touching my face. I have used this precaution as long as I can remember.

We had a virtual meeting yesterday to kick-off our mentoring program and practiced social distancing. I could not talk with my mother for long yesterday, so I called her today.

Me: Hi, mom. How are you?

Mom: Oh, Judy, I am fine. I am not letting this upset me.

Me: Do you have enough groceries?

Mom: Oh, yes, I just have what I need and not the whole shelf.

Me: What?

Mom: Well, I was watching the news, and they interviewed this man outside of the Publix in Hoover. He said people needed to calm down. “Just buy what you need, not the whole shelf. We all need to calm down.”

Me: Are you going to church?

Mom: No, Reverend C closed our church. Your sister sent us the information so we can stream the service from her church. I am not going out. Of course, everyone is thumping on the bible right now. If they just did what it says, we wouldn’t be in this mess. We have had influenza, AIDS, and other plagues, and we didn’t all die. So we all just need to calm down.

Me: Yes, we were talking about the lack of ICU beds and ventilators for those that may need it. I told my friends that you have told me not to put you on a ventilator.

Mom: I never want that. You are right. That is not the way to go.

COVID-19 is a reality, and we have to have real conversations about what is essential in our lives. Buying what we need and thinking of others. Following the rules on handwashing, social distancing, and self-quarantine to keep our family and colleagues healthy. Then, there are crucial questions about end-of-life care we must have with our loved ones. I feel better now. For useful, accurate information:

https://coronavirus.jhu.edu/