A COVID State of Mind

I’m a fourth-year psychiatry resident in the final months of training, and I have signed on to continue as an attending physician at my hospital.

In mid-March, my team was consulted on a patient in the ICU. She was one of the first identified COVID-19 cases in Michigan, and our hospital’s first such patient.

The patient was being treated with psychotropic medications, and one of them was decreasing the effectiveness of an antiviral drug she’d been prescribed for COVID-19. Her caregivers asked us to suggest a different psychiatric drug that wouldn’t have this effect.

Over the next hour, my colleagues and I arrived at a recommendation. But by that time, both the patient’s primary team and the hospital’s infectious-disease department had called to say that there was no need: The patient was improving. Her prognosis was good, and they expected a full recovery. She was to be discharged to stay at home, in self-isolation.
It was a tremendous relief. I was so thrilled that I called to tell my parents, an older couple who live close by my home in the Detroit area. Given the COVID-19 pandemic exploding across the US and in our area, I’d been worried about them. I knew that they would feel as comforted as I did by the woman’s recovery: Nothing makes them happier than hearing of someone who’s beaten the odds and overcome adversity.
But our relief was premature. Within forty-eight hours, the woman suffered a rapid deterioration, then passed away in the hospital ICU. She was one of Michigan’s first fatalities.
Throughout the month of March, as COVID-19 cases mounted, the daily routines at the hospital changed. Entrances to the emergency department and parking buildings were locked and monitored. Employees stationed at the hospital entrance screened arriving caregivers and staff for fever and other symptoms. Certain areas were off-limits to all but the primary teams. An atmosphere of fear took root and spread among patients and employees alike.
Now it’s early April, and Detroit is among the US cities hit hardest by the virus. Up to this point, I’ve felt privileged to work in one of the city’s hospitals. But working here–walking the hallways, breathing the air, seeing the patients–feels different now.
Everyone who’s employed here has family members. We have relationships. We fill many roles outside of work. And each and every one of us worries about bringing this scourge back to the people we love.
A week before the woman with COVID-19 came into our hospital, my mother finished having radiation therapy for breast cancer. Diagnosed in December of last year, she had surgery in January. If our prayers are answered, she will join my father in being a cancer survivor. But if, God forbid, she were to contract the virus, her recent cancer treatment would increase her risk of complications. This, along with my parents’ advanced age, makes me feel even more fearful for them.
So I’m not visiting my parents. That’s a big change: I used to see them a few times a week and take care of things around the house. Now, I’m too frightened.
Is it paranoia? I ask myself. I know paranoia; I’m a shrink. In the past, I’ve called other people paranoid for behavior like this.
Yes, for behavior like this, I tell myself. But not under circumstances like these.
I’ve heard many stories of physicians and employees getting sick and being hospitalized or put in isolation. I know two of these people personally: Neither had any clue as to when or how they might have contracted the virus.
This is all happening in real life.
Knowing that I could harbor the virus without having any symptoms? That’s real. Not knowing how long I’d be infectious for? That’s real, too. So is the nightmarish thought that I could walk around feeling fine and meanwhile be leaving contagion and death in my wake.
The possibility that I might unwittingly be a human petri dish makes me want to avoid all human contact: no drive-through fast food, no shopping trips, no idle conversation with neighbors. At home, I watch from behind the blinds as the postal carrier and delivery men come and go, leaving my mail and my produce. If I go on a walk, I literally take the path less traveled.
I try not to interact with anyone at all. And when I do? A surge of guilt. A sense of worry.
Not that I’m sick….at least, I don’t think so.
I find myself browsing online websites for absurd medical supplies: gas masks with industrial filters, hospital-grade disinfectant, astronomically priced gloves and surgical masks. Except that I don’t know if they’re absurdities anymore.
When I speak to friends and colleagues, they seem to see things the same way I do. I’ve gotten panicked phone calls from friends. And I’ve made them.
Me: “Hey…I’m worried about my parents.”
Friend: “Stay away from them. I’m staying away from mine…It’s worrisome, but I think we’re fine. After all, COVID just got here; and we’re being extra careful on service.”
Me: “It can take two weeks to show–how the hell do you know it just got here? You and I both might have it.”
Friend: “Just don’t see them again.”
Me: “If one gets sick, the other does, too. And that’s it.”
Friend: “Don’t think that way.”
Me: “I’m not thinking any way; I’m telling you how it is.”
When you work at a hospital–any hospital, at a time like this–can you truly be paranoid? A cataclysmic event is taking place in our country and around the world. Thousands are dead, and with each passing day, the deaths increase.
I’ve never been much of a worrier. But now, how can I not be?
About the author:
Ibrahim Sablaban is a fourth-year psychiatry resident at Henry Ford Hospital/Wayne State University, in Detroit. His interests include politics and medicine, addiction and the phenomenology of psychosis, and he is a member of the Michigan Psychiatric Society’s legislative and policy committee. “I write for catharsis. Most of what I write, I chuck out. I’ll write on a whim or an impulse, and it’s a very introverted, intimate process. In these times, I felt this piece might resonate with people in healthcare more than some might like to admit.”

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Comments

10 thoughts on “A COVID State of Mind”

  1. Leo Elizondo M.D.

    lIbrahim, the comment of it takes courage to do the work we do I learned and herd it at Rachael Remen M.D. workshop on physician burnout.

  2. Leo Elizondo M.D.

    Ibrahim, your narrative essay is heartfelt. It takes courage to do the work we do and now more than ever, I think it is normal to feel anxious and paranoid. Sharing amongst friends and colleagues helps. It touches me that you are so honest and sincere with your feelings. Take care of yourself, your parents and your patients.

  3. Judith Kunisch

    I am former director of Yale School of Nursing Doctor of Nursing Practice leadership program. I no longer care for patients however as an adviser to several full time nurse leaders enrolled in our program, I am talking with them about the overwhelming work at their hospitals. One of my advisees is nurse manager at a NYC acute care hospital. She texted me saying “I am drowning.” I keep encouraging her but I cry after our “talks.” No one can truly know how hard the nurses and physicians are working! God speed to them all.

  4. Vinia Dakari, PhD

    Being open about your own vulnerability is the essence of empathetic care. You are practicing the art of medicine the right way. You are a true healer because you first and foremost acknowledge that you are human and in need of healing. Our parents ground us in the nexus of things. Losing them we lose our roots to the world. I wish there were more individuals like you out there. Thank you for this intimate sharing.

  5. Susan McAnanama

    “In times like these”
    We will come out the other side different and moved.
    I’m in awe of medical professionals’ sacrifices for the common good.

  6. You are on the frontlines of a war and are doing your best to help your patients and protect people in your life. I salute you.

  7. Marc D Wager, MD

    you nailed it! this is so well-written and accurately describes the crazy thinking and behavior that all health care professionals are going through nowadays, all of which used to be thought of as paranoia in the past but is so necessary right now to stay safe and protect our loved ones. thank you for writing this and sharing your experience. i hope you stay safe and continue to protect your parents.

  8. Ibrahim, I am so appreciative of your experience, wisdom, and challenges. I was born in Detroit, went to WSU (Music) and then Stanford and Fielding Graduate University. My family, 4 generations…lived in Detroit coming from Eastern Europe. I am only sharing this with you because all of my relatives in Detroit have passed. My Mom was the Chairman of Blue Cross Blue Shield and HAP…the first Board of Directors. I am pained by so much. She Died at Henry Ford Hospital. I am giving you a gift to help…
    https://www.healinghealth.com/covid-resources/

    Please take care of yourself. You are just what this world needs, skill, heart, knowledge, and compassion.

  9. Laurice Gilbert

    I’m so sorry this is a burden you have to bear in the USA (and the UK and so many other places). I wish you all the best of luck, and I hope your parents get through this safely.

    With much love and virtual hugs from New Zealand.

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