COVID-19: The Health Care System will only work if we all think of ourselves as ESSENTIAL
March 10, 2020
Dr. Plastic Picker is a little bit worried about COVID-19. Like everyone else I was touting hand-washing,which is the best way to contain the spread, and social distancing, which means stay home if you don’t absolutely need to go somewhere. I am worried not because I am worried about getting Coronavirus, which is a cold virus and given my age and no underlying comorbidities, I will likely have a mild illness. I am worried because I know human nature, and the health care system will only continue to run if health care workers think of ourselves as ESSENTIAL and quarantine ourselves if we need to and to show up to work when we are healthy.
When I was a research fellow at the National Institutes of Health, I worked in a small corner of a nondescript buildings that was essentially a hallway. All I had was a desk and a computer. A Nurse Practitioner who worked on a completely different project was at a nearby desk. She was a really nice woman and we were fun officemates. My Principal Investigator was a few stories above me in a big corner office because he was MD PhD and had many many papers. I was working on an adult dataset on sleep and adiponectin/hormone levels in depressed woman. The actual data gathering and experimentation had been done a few years before, and I was mostly just looking at spreadsheets and databases and trying to piece together a few extra papers to squeeze out of the project. One day, there was an email announcement through the intramural campus at NIH that there had been a plumbing leak in the building, and all water was shut off. Only the backup water supply that was for the lab animals was available. All non-essential staff were approved to leave if they were “non-essential” as there would be no running water. The folks that took care of the poor animals that were being experimented on were required to stay.
I kid you not, that entire building cleared out in five minutes flat. The intramural campus of NIH is part of the government with a government mentality. This is the year I finally understood the phrase, “It’s good enough for government work.” The email was not directing people to go home, just that if you were “non-essential” you could go home. So thousands of NIH workers who were getting paid hundreds of thousands of dollars and generous government benefits package, left for the day. Suddenly all those research projects that had received tax payer dollars were not that important. It was also a beautiful spring day.
I was a research fellow being paid a stipend that hardly paid my son’s preschool fees without benefits or retirement. We were stretching to cover our apartment which was behind NIH and kind of cruddy. Mr. Plastic Picker was up in Boston still finishing his fellowship and working extra overtime shifts to cover our apartment and the mortgage on the condo we overbought. The Research Fellowship year was a vital year for me for various reasons, and I was grateful to have my position. So I stayed. I was just working on spreadsheets and all I needed was electricity and I had a single-use plastic waterbottle (that was before we knew how deadly they were). I thought my work at that point was essential to me, because the only way this paper was going to get published if I kept on plugging away. Plus I really didn’t need water otherwise and could do my business later when I got home. So just I and the Nures Practitioner stayed to work. Her husband was an Army Officer in Afghanistan, and I think she felt her work was essential as well. The rest of the building was a ghost town.
So Dr. Plastic Picker is now a middle-manager and a cog in a large health care system. But I am a person who understands human nature. What has always saved me was that I am the daughter of an accountant and small business owner, and if you have your own business and was confronted with a situation like the water situation at NIH – you would never have left.
COVID-19 will be challenging for us because of some of the quarantine restrictions and I have already heard half-joking comments from all corners of work. “I want my COVID-19 quarantine. My 14-days paid off.” I smile and nod, but I stay silent. What folks don’t realize is that the same people who will show up to work even when they are told they could stay home if they think they are “non-essential” are the same people who pick up litter. We believe we are essential. We don’t call in sick unless we are sick and it’s true. Other folks will fudge the truth, and that makes it worse for the people who actually use sick days appropriately because now no one believes anyone. If one is truly sick, you should stay home and not spread that disease to others. We certainly don’t want anyone coming into work when they are sick, and stopping the spread of COVID-19 is the most important thing.
I present myself as a happy-go-lucky pediatrician who skips to the beach finding nirvana on the beach by picking up all your cr@p, but I am an astute student of human nature. Quarantine after quarantine multiplied by hundreds of workers if going to grind our healthcare system to a stop, just when we need folks the most. This is just me the hypothetical middle-manager in an essential industry in our society just typing random thoughts during a pandemic. But just like I go to the ocean and pick up plastic because there is an ocean plastic pollution crisis because I want to be an example. I want to set an example to my colleagues who are ESSENTIAL physicians, nurses and service staff who help made our entire system function.
Five Things You Should Do If You Work In Healthcare Right Now
- Don’t Put Yourself At Unncessary Risk of Exposure: You are likely young and healthy and not going to get that sick from COVID-19. It’s more likely you are going to get exposed early and have to quarantine. This is why Dr. Plastic Picker and Mr. Plastic Picker cancelled our vacations and stayed in town this week. We know how disruptive it will be to our departments if either or us are out. It is the ultimate in selfishness to put yourself at risk of not work when our country is facing a pandemic. Society paid millions to train us, much more than our loans covered, and we are responsible for the health care of our specific patients but for the country. Medicine is not a job, it is a calling.
- Have Back-Up Childcare Ready: This is the reality of life. Schools may be cancelled, and children might be at home. Physicians are not normal people. Despite Dr. Plastic Picker always having secret envy of my friends who are stay-at-home moms, I realize that I am not a stay-at-home mother. I am a pediatrician that sees sometimes up to 30 families a day that need me. Have back up child-care ready in case daycare and schools close. I have little sympathy for physicians who have not built up a back-up system in their lives. We are paid a lot of money and you could have built that in your budget. I love my mother-in-law dearly but I am one of the few people who has successfully lived with my mother-in-law for over 15 years. I live with her and we deal harmoniously together because I need her to take care of my children, and I treat her well so that she will treat my children well. My own mother lives nearby and I have a sister-in-law as well. This was important when my children were younger, but they are teenagers now.
- If your child is 12-years-of-age, train them to be able to stay home by themselves: The American Academy of Pediatrics recommends children under 11 years of age be supervised. But that means that if your child is 12 years of age or older, they can stay home by themselves. I know your children are precious, and my two children are precious as well. But they can take care of themselves and likely babysit other people’s children when they are over 12 years of age. Start training them to make a simple sandwhich for lunch, flush their own toilet, and how to dial the phone if they need you.
- Have Essential Items Ready: Dr. Plastic Picker does not recommend a general panic. For healthcare workers, we are going to be very busy the nex few months. I think it’s reasonable for us to have stuff ready so that we can go to work. Just extra pet food and maybe a bidet, so we are not panicked regarding toilet paper. The great thing is personally, I have a hybrid plug in electric so I will need very little gas so will always be able to go to work. Mr. Plastic Picker and I will fill our gas tanks today though.
- Settle-In and Get Ready To Work: We have all been through much worse. Flu pandemics. Measles scares,. Armed assailants that ran into our clinics from the nearby Walmart shopping center and a Code Silver was called. Opiod epidemic which is still ongoing and does not get half the press that COVID-19 has received. Healthcare workers, we are a tough bunch. This is one of those times where we have to own our special role in society, and settle in to work. We will need all hands on deck.
This is what I recommend and I wish that everyone will do. But given that Dr. Plastic Picker is a student of human nature, I know that some of those I manage won’t listen. They will think of themselves are non-essential. If lives were not at sake, I would not care. But I know that access to care equals lives, and that all parts of our system need to keep on churning. It is all connected to be able to open up bedspace for that critical ICU patient that will come. The outpatient MD that does not come to work, will domino to more people drive to the ED/urgent care, driven to longer wait times, which will drive to more sick people getting care later, which will drive up ICU need. We are are related.
Five Ways Dr. Plastic Picker the Middle Manager Will Check-Mate You to Help the HealthCare System and the Country
- Sent an Email to My Co-Leaders About My Concerns
- Develop an Alternate Virtual Work Responsibilities if MDs are Quarantined: Virtual appointments and Assisting with Nurse Triage Calls
- Proposed Mobilizing Roving Computers to Be Deployed to Other Staff that May be Quarantined, so they can work virtually from home. Not sure this will work but it is an intriguing idea.
- Set a Good Example
- Mobilize Part-Time Workers if Needed: I will canvas my pool of part-time MDs and see when they can work and have them ready to deploy if needed.
I forgot! There is also a robot in our building that I’ve always wanted to try out. I’m going to see how it would work for a doctor who is quarantined to virtually see patients with the robot! Yeah!!! Looking on the bright side of things. What is the idiom? Necessity is the mother of invetion. Dr. Plasitc Picker planning away in our small corner of the health industrial complex in-line! We got lives to save!!!