Wellness Duality, COVID-19, and 2022: Being a Caregiver and a Patient

Duality, COVID-19, and 2022: Being a Caregiver and a Patient

By Al’ai Alvarez, MD, on behalf of the SAEM Wellness Committee

A year into the pandemic we saw a glimmer of hope thanks to unprecedented scientific breakthroughs in vaccine development. Concurrently, vaccine misinformation spread like wildfire, adding to the increasing death toll from COVID-19. Within a short year, the virus mutated several times, and what was deadly at the start of 2020 evolved into something milder but more highly contagious. We saw recordbreaking numbers of new cases, and many of us saw our roles, our own lived experiences, and perspectives change. 2022 has been a year of duality.

While so many of us have been vigilant about this virus (we washed our hands, masked up, socially distanced ourselves) transmission rates are nevertheless significantly higher with Omicron. Consequently, we have found ourselves in roles we have tried to avoid: • as caregivers receiving care • mourning during times of celebrations • angry at someone we love and care for deeply because of misinformation and decisions about how to handle this pandemic • hopeful and scared for the future On December 19, 2021, a few days before a much-anticipated vacation with my family, I started feeling myalgia after a day of hiking with colleagues to celebrate the closing of 2021. I did not think much of it. I thought maybe I was no longer fit to do that much hiking — another consequence of the sedentary virtual meetings the pandemic brought. By nightfall, I was shivering, my head was pounding, and I felt congested. I’d heard about Omicron, but as an emergency physician, I looked back and convinced myself that I could not possibly have become infected. After all, I did everything right, including getting triple vaccinated. Maybe it was rhabdomyolysis, I told myself. But why the chills?

I isolated myself starting on day one of the symptoms. By day two, I still could not compel myself to be tested. I felt partly ashamed, as if getting a positive test would mean I, too, am now like “them.” But wait! How could that be? After all, I had been “good” (as if “being good” had any bearing on contracting COVID-19). I set my sights on a shortterm goal: vacation in three days.

The relief that thought brought was fleeting. My mind started racing. I could get my family sick! And what about everyone on the plane? I woke up early on day three to drop off my PCR test. I’d taken two tests to be sure: one by mail and another dropped off at the

hospital. Taking the tests offered me a sense of relief. At least, I would know. I texted my family about my symptoms and spent the rest of the day at home, isolated, and waiting. I received no news that day, nor did I hear back on day four. Testing sites were overwhelmed too, and the turnaround time increased.

That same afternoon, a dear friend and fellow emergency physician whom I’d had dinner with five nights prior texted that she had a sore throat. She told me the rapid test she took was positive. I became even more certain of my own test results.

I could have asked my friends sooner if they had any symptoms. I could have asked my colleagues, with whom I went hiking, if they had any symptoms. But I didn’t. I could not. I was ashamed that I may have exposed them and would cause them to miss their family reunions during the holidays. My isolation offered me time to reflect, ponder, and rationalize the “what-ifs” and “shoulda-couldawouldas.”

But maybe I was negative! It was as if the possibility of contracting the virus would suddenly become my identity.

At 12:30 a.m. on day five of symptoms, the first of two tests came back positive. I woke up later that day to a few missed calls from the hospital confirming the other test I took was also positive. The thought that I may have exposed others weighed heavily on me. Unequivocally, I had contracted the COVID-19 virus that had killed so many and upended how we lived.

Armed with confirmed tests, I overcame the guilt and shame and started texting colleagues with whom I’d been in contact to alert them of my positive results. For every ounce of trepidation, there was significant relief whenever I heard back: “no symptoms.”

The hospital offered me hotel accommodation if I needed to isolate myself from family members. They also offered a gift box and support. But I felt so guilty! I initially thought about not calling back. I was then reminded of the practice of self-compassion and allowed myself to receive the care. The kindness and generosity I experienced reminded me of how good it felt to be cared for when sick.

Omicron allowed me to slow down. The key, I am learning, is to embrace the dualities. We do not have to be one or the other all the time; we can be both. This experience forced me to understand that we can coexist with the virus, even while in pursuit of work-life balance, because the virus is everywhere, and it is here to stay.

My experience was also a reminder that doctors are humans, too and we must allow ourselves to get help. And while we have been vigilant about keeping ourselves safe, perhaps boundary-setting means more than just being on one side versus the other; perhaps it also means accepting what we cannot change, embracing the emotions that come with this realization, and holding space within us to still hope and see the goodness around us.

The recent COVID surge has affected our emergency departments, with hundreds of physicians becoming sick and their clinical shifts needing coverage. Guilt, shame, and disappointment are some of the many emotions surfacing as a result. But we can learn to embrace the dualities. For instance, we can embrace the duality of acknowledging disagreements about this virus and showing compassion for ourselves and others. We can hear our colleagues’ frustrations about work, exacerbated by COVID, and continue to find things about our profession that give us meaning.

Every day, as we make our choices, we must remember to hope. What gives me hope are colleagues who step up and cover empty shifts and colleagues who check in with each other. What gives me hope are the creative solutions we make as emergency physicians. While we may not always have the answers, we can use the lessons we’ve learned from this experience to educate our patients. We can use turn this experience into an opportunity to prepare our colleagues for the inescapable. I wish it had not taken me catching COVID-19 to understand this.

“This experience forced me to understand that we can coexist with the virus, even while in pursuit of work-life balance, because the virus is everywhere, and it is here to stay.”

ABOUT THE AUTHOR

Dr. Alvarez, is the director of well-being at Stanford Emergency Medicine and chair of the SAEM Wellness Committee. @alvarezzzy