We all are essential

Hugh Silk

Not sure how many have seen the movie Contagion – the 2011 Steven Soderbergh film about a pandemic that spreads from bats to pigs to humans in Asia and spreads around the world. It certainly was a little ahead of its time and quite accurate.

There is a scene mid-movie where the character played by Kate Winslet, a public health specialist gets sick and she wishes she could do more. Here watch it for yourself:

I too have had that feeling that Kate Winslet had during COVID – wanting to do just a little more. The images of ICU docs in NYC, of our own nurses and fam med docs in the tent at UMass, the hospitalists and their busy work of COVID and non-COVID patients. I look at the teens bagging groceries at Market Basket and home care aides going in day after day despite the risk. Where was my moment during the pandemic to be?

I signed up to help out at the medical shelter for the homeless at the Worc Tech highschool and later the DCU center (which Adam and Erik have spoken about at Med Moth as well). This taught me the skills to open another medical shelter in Fitchburg for the homeless. But it was in the DCU center that I had a powerful experience where I watched a man one night go from talking and laughing with me, to not feeling quite right, to collapsing as I walked him to an ambulance. Right there, his pulse ox was 80%, he had a seizure. He was revived and he made it to the hospital but recently I found out he died. That was the most impactful moment for me during this crisis. I cried for him. He seemed like he was a kind man, a good man. It all happened so fast. The virus is so ruthless.

But that is not what I will remember years from now. That is not the lesson that has been ingrained in my soul. The role of the front line workers is very very important. It is crucial and it is impressive. And yet there is so much more going on behind the scenes as well. More mundane work but also essential.

As I mentioned – think about the folks going about their jobs – taking the bus, showing up, and doing it without mention. Often without the protection needed.

And so I turn to my own work and the work of my primary care colleagues. It is not as thrilling to be protected on the other end of a telemedicine screen or phone. And yet that is what I will remember years from now. The patients I call each day – scared, lonely, looking for a familiar voice to answer their questions, to offer comfort and offer a friendly smile or chat. Today I spoke to a woman that could not stop crying. Her mom had died in a nursing home. She had cared for her so carefully for so many years, and then to not be at her side to hold her hand as the virus robbed her spirit, was just too much. I couldn’t hold her hand either or offer her a tissue. As my mentees need advice and support – that too is through zoom, and reaching out to new medical students as a transitional mentee, and my research, and my caring for those with opioid overuse who need their suboxone – all through the airwaves, no PPE, and yet so essential. And I am just one PCP of many.

It is in these moments that I think we as primary care have done our best work.

I think of the quote in Abraham Verghese’s book Cutting for Stone – What is the only treatment in an emergency situation that can be offered by ear? Words of Comfort.

I have been focusing on the mantra: It’s ok to stay in our lane. It’s ok to do what we can do. We need to care for others with the skills we have AND take care of ourselves; all while recognizing our limits.

In the movie Contagion, there is also a scene later in the movie when the scientist character has to draw a line for herself. (View the first 45 seconds).

We can only do, what we can do.

Let me switch gears with an observation I have made recently that I think might act as a metaphor for what’s next.

I have been missing the din of the city – the sound that the city makes where I work.

Long before the pandemic, I learned some techniques in meditation. Each morning when I arrive at work I sit in my car for a short while and do a meditation. The person who taught me meditation skills said you should have a focus that you go to. For most people that is the breath. From me overtime it has become the sounds around me.

So often those sounds involve the twinkling of my engine as it cools down, the gurgling of my own abdomen, the sound of a car rushing past, or this time of year – birds chirping. But in between those sounds is a constant din, the din of Leominster and Fitchburg. It turns out every city has one. I remember listening to an NPR show where a musician went around to each city and checked what note it was in. One city was B flat and another was C sharp.

I don’t know what the note of Leominster and Fitchburg’s sound is, but it is an important sound in my life. And now it is missing. I lament this like so many things we are grieving during this pandemic. No need to even try and start a list.

This has me wondering – what will the sound be like when things open up again. How will the sound of the city differ? Which has me contemplating – how will all of our lives be different? The sound will evolve, and so too will our work, our social interactions, travel, etc

But here is one thing that I don’t think will change – the essence of who we are as medical providers.

Which brings me to a piece I read recently in the NEJM. The person talked about a poem by William Carlos Williams – Williams was an old-fashioned General Practitioner in NJ who practiced in the 30s and did home visits and home births. I was moved by the poem, called “Complaint;” it goes like this:

They call me and I go.

It is a frozen road

past midnight, a dust

of snow caught

in the rigid wheeltracks.

The door opens.

I smile, enter and

shake off the cold.

Here is a great woman

on her side in the bed.

She is sick,

perhaps vomiting,

perhaps laboring

to give birth to

a tenth child. Joy! Joy!

Night is a room

darkened for lovers,

through the jalousies the sun

has sent one golden needle!

I pick the hair from her eyes

and watch her misery

with compassion.

We may not get to pick if it is wintery night, or a pandemic; a baby to be delivered or a person needing to be intubated, or simply a person who needs to talk about their diabetes and hypertension. But all situations will require comfort, and sincerity, and love. They will call us, and we will go.

To watch the above reflection in its entirety, as shared in MedMoth in May 2020, please view the video below:

Hugh Silk, MD, MPH is a professor in the UMMS Department of Family Medicine and Community Health and is working with two other faculty to create a UMMS Medical Humanities Lab.