“There comes a time when one must take a position that is neither safe nor politic nor popular, but he must take it because his conscience tells him it is right.“
Dr. Martin Luther King
I woke up this morning and found while doing my morning mindfulness training that my left eye was twitching. I had not experienced this in a long time. The last time was when I was studying for my Family Medicine Recertification. I was studying and looking at my computer and phone to answer practice test questions. Since the COVID-19 Pandemic, I have been working from home doing virtual visits and participating in Zoom, Skype, and Facetime meetings. I think I just have brain fatigue. I have had too much screen time. I have also been participating in web-based conferences and discussions dealing with the Pandemic. I feel I am an expert in COVID and especially racial and ethical issues surrounding this disease.
Now comes the murder of George Floyd. The painful reminder of all the other killings in the past (lynching and police violence). The image of Mr. Floyd has shaken my mind. I witnessed the moment of death now etched into my mind. As a physician during the week that I was treating patients on the COVID floor, I had to suppress the urge to rush in and treat my patients before donning my Personal Protective Equipment (PPE). As I watched him die, I wanted to jump through the screen and save him. I know what those bystanders were feeling. In the hospital, if a patient is a Do-Not-Resuscitate, then we just must stand-by and allow them to die with dignity. During this Pandemic, it was often without their family present or by using an iPad. Mr. Floyd had people (4 police officers) who ignored his cry for help and those too afraid to rush in for fear of they would be shot by one of those police officers. That is too tragic to fathom. My heart was broken. I went to work, and I just lost it in a meeting. I have not had that happen in years. The next day I apologized. I realized that I had seen a man die, and the conversation we were having was too trivial, but it was not their fault. My nurse, who has known me for 18 years, just said, “I knew there was something wrong because I have never known you to behave that way.”
So, I am reacting to what I have always known and have worked to overcome. The structural and institutional racism in our society kills people. In Medicine, it is making our patients sicker because we do not have the diversity in our workforce to address the social and structural determinants of health. The Centers of Disease Control and Prevention (CDC) defines these as: “The complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities. These social structures and economic systems include the social environment, physical environment, health services, and structural and societal factors. Social determinants of health are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world.”.
We need to address these issues by dismantling the racist systems that prevent underrepresented in medicine students (African American, Latinx, Native Americans) from ever entering or completing their medical training. It is not hard for those of us who work in this area to know the next steps, but it will take the willingness of those in power to force a change. The steps are the same and must happen with policing in America. How is it that a White male who guns down innocent people in a church gets treated to lunch when finally captured and a Black male killed over a $20 bill? There is no acceptable justification, and the video evidence is there for us to watch repeatedly. The tragedy now unfolds as we learn that Mr. Floyd, victimized by a tainted officer, who, unfortunately, derailed his career opportunities when he was so young. This injustice has happened to too many, and we must review all these incidents and make amends. Too many locked out of career opportunities, especially in Medicine.
As one of my colleagues put it, you must watch that video and see the horror that we see as we watch our husband, partner, brother, uncle, friend, and fellow human murdered. As another colleague texted just before she lost it in a meeting, “This is not watercooler talk. A man was killed.”
Mr. Floyd’s death happened to all of us. Institutional and structural racism harms all of us, but it kills African-Americans and Native Americans, and we must dismantle it in every corner of our society.
“It is from numberless diverse acts of courage and belief that human history is shaped. Each time a man stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, he sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current that can sweep down the mightiest walls of oppression and resistance.”
Robert F. Kennedy
“[If] a man does not have a job or an income, he has neither life nor liberty nor the possibility for the pursuit of happiness. He merely exists.” Martin Luther King Jr., A Knock at Midnight
I have been angry for several weeks; I cannot bear to hear stupid comments anymore. The news media asking someone to predict what the fall may look like is one of these questions and the comments that follow. I had a beautiful day. I finished all my patient visits and completed my notes and then had dinner. I went to bed early for a change, but I had the most vivid dream. I dreamt I was screaming. My husband, my son, and the world all trying to calm me down, but I kept screaming. I finally stopped, rolled over, and said, “I am sorry.” My husband moved over and went to sleep. I realized that this was a dream. The difference between sanity and insanity is not to scream out loud, but if you do, you make sure no one hears you. I woke up and felt a weight was lifted. I am not sure why I was screaming. Maybe it has to do with all we have lost, the lives lost, loss of insurance due to job loss, and all those people not wearing masks. It may be because of the white men carrying guns on the steps of statehouses or the vicious killing of another black woman’s son.
Perhaps I have watched too many White House Coronavirus Task Force Briefings or listened to too many people complaining about having to teach their children or being bored. My sister and her husband, with a joint effort, helped my 11-year-old nephew complete all his assignments for the school year. She was immensely proud of their work. Maybe I am anxious about him returning to school in the fall. Perhaps I am anxious about the fall and the prediction of a “second wave.” As we reopen our offices, I am concerned about not having enough PPE.
I have become a fan of the governors of New York and New Jersey. They do not hesitate to express their true feelings. I especially like that they represent what I am feeling. “That is stupid” or “don’t be a knucklehead” and “that is just insensitive and reckless.” I especially like “That shows a total disregard for others.” I am concerned about all those people who may become infected and about the lives that will be lost. I am concerned about those rushing to return to houses of worship.
I am worried about trying to provide an excellent educational experience to my residents. I have scoured the internet to compile resources for them. I realize that the root cause of my anger is my fear. My fear is caused by my concern of not being prepared, not being able to take care of my patients, family, or friends.
“Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity.”
― Martin Luther King, Jr.
I am fearful that there will be a poor turnout for the November elections, and we get a repeat of the last four years. I am scared that ignorance, xenophobia, and racism will win. I am afraid those who proclaim to be religious will continue to spread hatred and evil and promote conspiracy theories over the facts of Science. I have not had that dream again. I hope it is because I have come to terms with this mess, we are in. I can work hard to change the things that are within my power to change but I must accept what is out of my control. Anger has it root in fear. Letting go of the fear frees you from anger.
“Science investigates; religion interprets. Science gives man knowledge, which is power; religion gives man wisdom, which is control. Science deals mainly with facts; religion deals mainly with values. The two are not rivals.”
― Martin Luther King, Jr
Just before the Pandemic hit, I was so busy in the office that I did not get the opportunity to do any shopping for household cleaning products. My husband went out, and none of the products we use were available. So right now, I am living in a house without Lysol or Bleach, and I think we are okay. We went through almost all our Clorox wipes. I have been putting paper towels in the leftover liquid and extending my supply. We do have alcohol, but of course, I never mix products. I could not find cotton swabs for over 3 weeks, so I had to cut them in half to clean my face. We did find Unscented Tide Pods. We do have a good supply of hand wipes. When I do go to my local ShopRite or Target, they are none of these products on the shelf. So, I have just resolved myself to using what I have. I tried one product, but the smell was a bit irritating, so I spray and step out and wipe later.
At work, I wash my hands so much they are shriveled. I use hand lotion after the soap and water. I spend most of So far, we are doing fine. The house is reasonably clean. I have not created any Chlorine gas fumes, and we have not had to go to the ER. The most important part of trying to prevent COVID-19 is handwashing, social distancing, and wearing a mask in public places. We have ordered food but are incredibly careful where we order from. I am a bit about where I eat, and that is a longstanding problem. I think it is from growing up in the south. I do love to eat out and enjoy a great restaurant.
Now, I am concerned. I am running out of my Swiffer Wet and Dry Mops. So, now, I must figure out my next steps. I read one article that said cleaning products may not be available until August. I know we are in the middle of a pandemic, and I hope we speed up access to cleaning products.
I do want to remind people to never mix cleaning products. Bleach and vinegar should never be mixed. Also, never mix alcohol and bleach. The effectiveness of cleaning products is not enhanced by combining them together but can generate dangerous gases and skin irritants. Drinking Bleach or Lysol does not kill COVID-19, so do not buy extra.
You just need to wash your hands, practice social distancing, and wear a mask.
“You have the power to heal your life, and you need to know that. We think so often that we are helpless, but we’re not. We always have the power of our minds…Claim and consciously use your power.” Louise Hay
It took some time before I understood what my grandmother meant by “never let them drive you crazy.” For a long time, I thought she was reminding me of my late father’s mental illness and that I should be vigilant of my own mental health. However, I soon realized what she meant was to stay authentic to your core beliefs. Don’t let them make you lose control and make unwise decisions. That would be giving your power away.
I have always been an active daydreamer. I could get lost in my head or in a good book for hours. One of my heroes was Harriet Tubman. I imagined myself walking through the woods and streams, freeing the slaves, and bringing them to the promised land. I always thought that Harriet had magical powers. I read books about Kings and Queens of Africa and saw myself as the African Queen leading my people to victory against invading forces. I was powerful and in control, and I never lost a battle.
I began to think that as I went through high school and college that there was some magical force helping me navigate the rough waters. Getting through medical school for me was the greatest gift. I never gave up my power.
Right now, COVID-19 is wielding its mighty sword through our community, and I am getting texts from friends of loved ones lost. I feel powerless, so I want to put on my regal garb and fight and get fighting. I want to be Harriet Tubman leading my people to good health and keep them safe. I want to be that African Queen wielding my sword against this invader. If only I could. I know it is not that easy.
Some real true and hard facts. If you are obese or have hypertension, diabetes, or sleep apnea, you are at risk of dying from this disease. We need to regain control. If your Blood pressure is not controlled, you need to get it under control. No excuses. Most African Americans should be on at least two medicines if not three to four to control high blood pressure. If you are obese, let’s get kicking. No, I mean kicking up your legs by marching in place 10 minutes twice a day. It works and you don’t need to go outside. Exercise can reduce your blood pressure and blood sugar. You can use this time to gain control and get your power back. It won’t be easy but you have to start somewhere. If you need a new doctor, practices are offering virtual visits. Get one now.
We have a democratic government that we elect. We pay taxes and are entitled to be helped by that same government. We should not have to beg our elected officials for the basic needs. So, as I watched my colleagues in tears and asking for the materials they needed to care for sick patients, I realized that we have the power to make changes. It only takes one simple act. We have the power of being a team. That means working together. One way is voting. If our elected senators, representatives, and our president put us in the position of begging for what we have paid taxes to support, then we must regain our power and use the power of our ballot.
Governors who refused to authorize shelter in place orders are not protecting us; they’re protecting their interest. Ministers who entice their members to go to church despite the known fact that this puts them at risk for COVID-19 are not true men of God. My grandmother always pointed to that fact. She was critical of the ministers who she felt were in it for the money.
We have the right to speak up. We need to demand protection, adequately equipped hospitals, and to be respected by those we elect. Remember, we elect them not to serve their interest or that of a party or a president but the people from the states that they represent.
Let’s regain our Power.
Self-reverence, self-knowledge, self-control; these three alone lead life to sovereign power. Alfred Lord Tennyson
If you are a Laurel and Hardy fan, then you totally get the meaning of “another nice mess you’ve gotten us (me) into.” Each movie was a series of antics that started with one innocent act that led to a series of escalating events that culminated in a total collapse of a building, a car crash a train derailment. Each one funnier than the other, but this is no laughing matter. The Oxford English Dictionary shows that back in the fourteenth and fifteenth centuries, as English was coming into its own, nice meant “stupid” or “foolish.” (From the Baltimore Sun)
What a “nice mess” a series of lapses has caused. Once again, innocent people will unfortunately die, and a significant number will be African American. I heard the comment it was because we have so many comorbidities, and that is true. Another real problem is that so many of us do not have the privilege to work from home. We are on the frontlines, even in healthcare. We are the Certified nursing assistants for home care agencies, in nursing homes, in assisted livings and group homes. We are working on the front lines in every area of the hospital, from foodservice to cleaning services, and more. So, when we finally succumb to COVID-19, it will be due to our inability to shelter in place because we are deemed essential personnel. African-Americans comprise a large percent of transit workers, sanitation engineers, new Amazon hires, and working in Supermarkets. Walmart is a significant employer of people of color.
So, let’s not be silent. We must make sure that we are recognized as those unsung heroes that are once again keeping this country running. The blame game will paint us as overweight and sick, but there are many healthy people also dying from this disease. The problem is a lack of access to good primary care and low paying essential jobs that put us in harm’s way. We will see this play out in the rural and urban areas across the country. This disease will spread because of the lack of response by local officials in rural areas in the south and Midwest and by even the ignorance of church officials who are still having church services. We need a two-prong approach from healthcare. To protect ourselves, we need to protect our vulnerable populations that are held hostage to a system that is stacked against them.
Let’s fight to get the statistics out there so that once again, we do not have false information. No, this is not a conspiracy, and the numbers are not being inflated.
“I agree that income disparity is the great issue of our time. It is even broader and more difficult than the civil rights issues of the 1960s. The ’99 percent’ is not just a slogan. The disparity in income has left the middle class with lowered, not rising, income, and the poor unable to reach the middle class.”
When we were kids, my grandmother had a saying for everything. One of the ones that seems apropos for this moment is one of my favorites. “an empty wagon makes a lot of noise”. It was always accompanied by “think before you open your mouth” or “don’t speak out of turn.” It took me a long time to grasp the meaning of these idioms. Empty wagons are “people who know very little to nothing on a subject often talk the most on the said subject,” and it also means that” people tend to talk a lot about nothing pretending all of that nothing is something.”
So, I spent all my life not wanting to be an “empty wagon” or someone who “speaks out of turn.” So, with all that’s happening, there are so many empty wagons. I especially am upset over the late orders to shelter in place by many governors putting many at risk. Who makes statements like “we really don’t know how this disease is spread’.
I spent the past week working in the hospital. It became very apparent how easily COVID-19 can be transmitted. Also, sheltering in place is only valid if people follow the rules. I wear the N-95 mask all day at work, but to protect people when I am outside the hospital, I use a homemade mask to get around town. There are online DIY instructions for making masks, or you could just cover your face with a scarf.
My advice is to shelter in place and wear a mask.
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.
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.