When you come out of the storm, you won’t be the same person who walked in. That’s what this storm’s all about. ― Haruki Murakami
My patient needs to be admitted to the hospital now. He had been recovering steadily from the throat cancer surgery I performed a month ago until he started intermittently bleeding last week. The bleeding has continued – and worsened – since then. He drives in from out-of-town and shows me photos of what he has coughed up. It’s bright red. Arterial blood, I think.
“There is the real possibility that this might suddenly become dangerous,” I tell him. “We need to admit you to the hospital today. Now. We have to stop the bleeding before it gets worse. I don’t want you to drive home.”
“But, Doc,” he replies, “what about the virus? I don’t want to be in a place where there might be coronavirus! I had cancer and I’m sure my immune system is weak. Isn’t there another option?”
He and I have both been watching the news. Only a few cases of coronavirus have been reported in Wisconsin so far, but pandemics can overwhelm entire countries in a matter of days. Experts warn that we may be on the front end of a massive crisis.
I had been reviewing my upcoming schedules with the office staff just before my bleeding patient arrived. We had cancelled all of my elective surgery to preserve gowns, masks, and gloves and had moved routine clinic visits into the summer to prevent unnecessary viral exposure to patients and staff. All of us are preparing for the worst. He is right to be anxious.
“I hear your concern about the virus,” I say to him, “but we’ll do everything possible to protect you while you’re here. I’ll get you home as soon as possible.”
I know he needs the bleeding controlled but cannot know with absolute certainty if the benefits of admission outweigh the risks of a possible infection while he is in the hospital. After more conversation, he relents and is soon on the way to a room. I type up my note and head back to my office.
As I walk down the quiet, deserted hallway, I shudder, recognizing the same, unsettled churning in my gut I had during the early days of the HIV/AIDS epidemic decades ago. Back then, there was no reliable HIV testing, only a rudimentary understanding of disease transmission, and no effective treatment. AIDS cases were increasing rapidly, people were dying, and there was no end in sight. As a young trainee, I wore a protective gown and a mask whenever I evaluated or tended to one of the shivering, emaciated AIDS victims. We read reports of health care workers at other hospitals contracting and dying of AIDS after puncture wounds.
One day in 1986, I plunged a needle deep into my thumb while operating on an HIV-positive patient. As the blood collected under my glove, I was terrified that I would be dead in a few months. I had a blood test to check my T-cell ratio. “It was a suture needle and not a hollow needle, so your risk isn’t as high,” the doctor told me. “Come back in a month and we’ll see if your counts drop.” For four weeks, I feared I would leave behind my young family just as my career was supposed to be getting started. I was fortunate. The memory that sticks with me from those dark days is the dread uncertainty. It is indelible.
My patient undergoes successful treatment of the blood vessel that had broken open into the surgical tissue. He does very well, has no more bleeding, and is soon ready for discharge. No fever, no complications, nothing bad. “Thanks, Doc,” he says. “Really glad to be going home.”
We bump elbows and he laughs. It’s the new normal.
“Keep me posted,” I say. I assume he will be fine now. But, of course, I realize I don't know that with absolute certainty.
Scientists much smarter than I will eventually understand the COVID-19 coronavirus, just as smart people eventually discerned the properties and treatments for the plague, cholera, influenza, polio, HIV, SARS, and Ebola after they first appeared. Each pandemic left its mark. I am certain that the caregivers who stood near each victim experienced gnawing uncertainty wondering, at some point, what was going to happen to their patient and, maybe, to themselves.
Here we go again. All we can do is be present, follow the guidelines, and hope that we do the right thing for this patient in this place at this moment. Because the storm is coming. And it might change everything once again.