My frontline is the sideline
In this essay, pediatric hematologist Dr. Nicole Kucine gives voice to the feelings of many pediatricians who are waiting to learn whether they will be re-assigned to care for patients on COVID-19 units. Will they be heroes? Imposters? What roles will they play as the COVID-19 story unfolds?
My frontline is the sideline
By Dr. Nicole Kucine, a pediatric hematology-oncologist in NYC
During a recent Zoom call discussing issues of physician wellness, a common theme emerged among some of our pediatric faculty – a form of imposter syndrome. 7 p.m. cheers in New York City ring out for essential workers and medical staff. Calls, texts, and messages come in from friends and family thanking us for working on the frontlines of the COVID-19 crisis. Yet those cheers don’t feel like they are for us. Because we’re not on the frontline of battling the pandemic: We are on the sidelines.
As I’m sure is common at most hospitals, our faculty were told we might be redeployed to other units or facilities in our hospital system to help take care of the countless COVID-positive patients filling New York City hospitals. This, of course, lead to a mix of emotions. On one side, there was the excitement and eagerness of getting to help in one of the biggest public health crises many of us have experienced. The “put me in, Coach” feeling is unavoidable, as all of us in medicine were trained to help, comfort, and heal. On the other side, there was anxiety and a lot of fear. Fear for my own health, fear of bringing COVID home from the hospital and infecting my family or neighbors, and probably the strongest, fear of failing the patients. While as a pediatric hematologist/oncologist I would be happy to discuss anticoagulant use in the COVID ICU, and I would be honored to use my palliative care skills to help a grieving family member make goals of care decisions over Facetime, how could I possibly be of any use when the questions are more likely to be, “Where do you want to set the PEEP?” and “How do we adjust the drip?” (Further solidifying my point, it’s been so long since I worked in an ICU that I’m not even sure those are the right imaginary questions I’d be asked.) Thinking about geriatric patients, with their long lists of medications I don’t know how to prescribe and conditions I no longer know how to treat, gave me palpitations.
While I nervously watch videos of vent management for dummies and see clinic patients largely via telemedicine, I see my pediatric colleagues in the ER and ICU stepping up and absolutely crushing it in their new roles as adult practitioners. I see our pediatric residents traveling to other hospitals to care for both sick children and adults, and I swell with pride like a work mom should. I see old friends who are now ER doctors wisely educating the nation on issues like public health, the need for PPE and testing, and racial and ethnic disparities in our nation and health care system that are being highlighted by this crisis. Watching all this leads to something akin to survivor’s guilt, as one colleague wisely described it. Not because we survived unscathed – no one will be the same when this pandemic is over. We have all been touched by it in some way, and it is clear that things on both a large and small scale need to change to prevent a similar crisis in the future. Yet for those who have had to work days on end while watching patients die without family members at their bedside, for those who have had to care for patients five or ten times older than their chosen profession usually calls for, and for those who have had to move into a hotel room – not seeing their families for days – in order to keep their loved ones safe, the aftermath will be different. I worry about how these real frontline heroes will be when they get to the other side of their service and things are quieter.
Thankfully for all parties involved, I have yet to be asked to help care for adult patients. I still come to clinic once a week and see most patients through video visits. I still try and accomplish some academic work and help with our trainees’ education. I happily answer lay questions for family members or hematology questions for colleagues in need. I bake the occasional batch of brownies or cookies for hospital staff in need of a smile. And I still wait to see if I will get a phone call or email saying I have been assigned somewhere to help take some of the burden off the already over-strained physicians covering the busy COVID units. While I don’t feel like I’ll ever be fully prepared for that, I am ready to step in from the sidelines when and if my team needs me, and I know I’m not the only one.
Published April 29, 2020 at https://www.kevinmd.com/blog/2020/04/my-frontline-is-the-sideline.html
