Merry Christmas, Rogue Readers!

This is my first true blog post since July 2019 — I have only posted on the blog four times in 2020. Once was to link to my one and only self-produced podcast, one was an anonymous guest post, and the other two were links to my YouTube channel with two fantastic videos that are sure to leave you wanting more.

Several notable things that have happened in 2020:

• Harry and Meghan quit the royal family
• Kobe Bryant died
• Parasite won Best Film
• I got divorced
• Australia was devastated by bush fires
• Quibi
• Elon Musk had a baby named “X Æ A-12”
• Mr. Peanut died

I know many of you are still shaken by the death of Mr. Peanut, a tragedy to be sure.

Also, 9 months ago I got COVID. Yep, I decided to beat the rush and get it early.

Between Quibi, divorce, Mr. Peanut, COVID, and Kobe Bryant, I haven’t had the bandwidth for blogging. So I decided to give my dear reader(s?) a retrospective of my COVID experiences. Forgive any typos, the lengthy thoughts, and some of the lack of smoothness in my writing, for it has been awhile. Some thoughts/questions that may be prompted for those of you that read below may not be fully explored, as there is just too much to cover.

Remembering the ‘Rona

A COVID vaccine is not only imminent, at the time I am publishing this, over 1 million people in this country have received their first vaccine dose. So why write now about my COVID experiences now?

Well, according to GoDaddy, this website is worth $591; I need to keep producing content so I can sell this site and quit medicine.

Also, I value sharing my experiences, No one else may learn anything from me, but I learn by writing. Also, if I don’t write now I may never write again.

So let’s travel back to the heady days of March, 2020. COVID had escaped the fish markets of China, torn through Italy, and was hitting New York City hard.

My university was ramping up preparations for COVID, worried a surge of patients would overwhelm our system the way it was happening in NYC (btw, remember in March when people thought we could identify people exposed to COVID by asking if they had recently come from Wuhan? I miss those days).

A Visit to Sin City for Second Victims

As COVID was racing around the globe, I went to Las Vegas.

Yes, Vegas. Before you throw a shoe at me, hear me out. Only then may you throw your shoe.

I was an invited speaker conference on the subject of Second Victim Syndrome. This is its own topic, a full recounting of which is beyond the scope of this writing and well worth its own deep dive.

In short, I went through a period of significant personal distress related to a young child I took care of in my ER who died. The impact on me was deep and long-lasting — the reasons and the experiences are too much to tell in this blog post.

However, as part of my journey to recovering, I wanted to speak publicly about my experiences. It was both a way to help others, but also to help myself. I submitted the concept of this talk in early 2019, and was accepted in summer 2019 to present at the conference in Las Vegas, scheduled for March, 2020.

Once accepted, it is difficult to overstate the importance I placed on this talk. This case had an enormous negative impact on me both personally and professionally — I had realized that if I did not open up publicly about it, I would not be able to truly move past it (to the extent one does). So I started preparing for this talk months in advance.

The days leading up to the conference, COVID was on everyone’s minds. A debate arose about whether the conference would be held, whether people should attend, etc. Ultimately, the conference organizer went ahead with it. Most cities, states, and organizations had not yet implemented significant travel restrictions. Some individuals opted out, but most still attended. Many people were in limbo, trying to decide what to do.

The Debate

Both then and now it’s clear my personal dilemma echoed much of the public health decisions that have led us to where we are now. Many of our political leaders abdicated their responsibility and left it up to individuals and groups to make decisions that were informed and motivated by an infinite number of factors. This has led to a fragmented and confusing approach both at the outset of the pandemic as well as now.

I was torn — I partly wished the conference had been cancelled so I did not have to decide whether to attend/present. While my employer had restricted some work-sponsored travel, my trip did not fall under their travel restrictions (trust me, I verified this multiple times).

After much deliberation, I decided to attend the conference. I asked friends the safest spot to sit on the plane. I wore an N95 mask on my flight — one of only two people on the plane wearing a mask. It was clear that most travelers were not worried about COVID.

By the time I landed in Vegas, a shockwave had occurred.

While I was in the air, the NBA cancelled their basketball season. Soon, multiple sports league followed, and suddenly a lot more people were taking COVID seriously.

Or so I thought — in Vegas everything looked the same. The Strip was busy, the casino I walked through to get to my hotel lobby was full, and there was plenty of activity.

Conference Time

The conference proceeded with some COVID adjustments. A live stream was provided, social distancing was encouraged, attendees did elbow bumps instead of handshakes. While lax by December 2020 standards, it was far more than most people in Vegas were doing back then.

I spent most of my time in my hotel room. I watched some sessions on the live stream and some sitting by myself in the back of the ballrooms.

I thought I was being appropriately cautious. I was not.

While I took many precautions, I still had a few group meals with a few other attendees from the conference. Some outdoors, some indoors. I did not wear a mask other than when I was on the plane.

Had I skipped those meals, would things have turned out differently? Who knows.

The Talk and the Return

This post is not about my talk on Second Victim, so I won’t delve into it.

I will say this: it was the most difficult, and most impactful talk I have ever prepared and delivered.

It was both cathartic and empowering, and the feedback I received was overwhelmingly positive. It’s led to continued work at my own institution to support other clinicians.

Does that change the calculus on whether or not I should have attended the conference? We’ll revisit that at the end of this writing.

After the talk I was drained, and I essentially hid in my hotel room the rest of the trip. I flew back and had dinner with my family, tucked in my kids, and went to bed.

The next morning, I woke up feeling… off.

I was immediately paranoid. Despite the positive feelings from the talk and my “precautions”, COVID had never been far from my mind. I quickly checked my temperature.

“101. Shit.”

My Corona

There are many advantages to working for a world-class research university/healthcare organization. In addition to being surrounded by numerous people smarter than me, the institution has resources most others do not have. I am grateful for these people and those resources every time I work a shift in our emergency department.

In this case, the resource was our researchers, infectious disease physicians, and occupational health group. I called occupational health when I discovered my fever — they had already been working closely with infectious disease specialists to make preparations for employees who may have COVID. Given the short duration of symptoms and lack of travel to a “high risk” area, they instructed me to isolate and wait.

The next day, still with fever, they brought me in for COVID testing. I had the good fortune (!) to become symptomatic the same week they rolled out in-house COVID testing. The test was so new that it wasn’t available for widespread clinical use. While many around the country were waiting days for a test result (and in many places still are), I was seen in the morning and had a COVID test result that evening.

The occ health employee called to deliver the news in the evening with with a sense of excitement in their voice.

I was positive for the novel coronavirus, and I was one of the first (known) cases in our area.

A deep, nauseous feeling immediately overwhelmed me, as did a sense of regret over my trip.

I had not had an ED shift for several days prior to travel, and was on vacation coming back from the trip, so it was unlikely (though not impossible) the infection was patient care related, one small blessing. Because I was diagnosed so quickly, I also had no opportunity to expose patients. Unfortunately, I was around people other than patients.

Public Health Fail

My local health department, despite having access to the world class infectious disease physicians in-town at my own institution, seemingly had no idea what to do.

They declined to do any contact tracing. They collected no information about my flight, and told me that only people who were around me after I developed symptoms needed to be notified and quarantined. They explicitly declined to collect information about who I was around prior to developing symptoms.

It was already known by then that an infected person could spread COVID before showing symptoms, so contact tracing was important to limit spread.

So a shout out to the occupational health group and infectious diseases physicians at my employer: they were up to date on the latest guidelines (which have evolved continuously), and gave me accurate information on isolation and quarantine.

It was on their recommendation, and not that of the health department, that my parents quarantined, as I had dinner with them the night before my symptoms started. My father, at the time a practicing physician with a busy clinic, cancelled his appointments and closed up for quarantine. My mother, who ran his practice, did the same.

Additionally, I ended up doing my own contact tracing as the health department did not want to do so. This despite having very few known local cases (they were not yet overwhelmed by the volume of cases most health departments were later in the spring or summer).

So I contacted the conference organizer and everyone I had seemingly prolonged close contact with (i.e. a meal) to let them know. Everyone took appropriate precautions and self-isolated, not necessarily an easy thing to do as everyone from the conference was a healthcare worker. I was told later at least one person developed COVID, though I have no idea if they were my exposure or vice versa, or if we contracted it completely separately. The incubation periods and exposure timing makes it impossible to tell.

Quarantine

Having COVID at any time is a scary experience. Having it in March, when there were no real treatments available, very little idea of how likely one was to become seriously ill, and lots and lots of scary stories of healthy young people dying, was downright frightening.

It was also isolating and stigmatizing.

I felt (and still feel to a degree now) that I was wearing a scarlet letter C. The local police (!) drove by a couple times to make sure I was in quarantine. Others in my neighborhood found out about my illness, likely because of the police and gossip. While my occupational health group did a great job helping me, I had the strong impression from others that I should keep the news of my infection quiet.

The isolation, even in my oversized bedroom, was scary. Hearing all the stories of a mysterious heart ailment and/or rapid decompensation, I spent the first couple nights wondering if I would die in my sleep. That, clearly, did not happen.

I had fever almost continuously for five straight days. I never developed any respiratory symptoms, just vague achiness.

The fatigue and exhaustion were the most profound symptom of those first several days. As an adult I’ve had mono and pneumonia. Both made me feel more physically ill more than COVID, but neither one exhausted me the same way.

I slept twenty hours a day for much of my quarantine. I would wake up, feel really tired, and just go back to ned. I had three separate days where I walked under 1000 steps. Some days I tried just to pace back and forth in my room, but I mostly just slept. My Apple Watch captured how little I was doing.

The Smell of COVID

The loss of smell associated with COVID was in the news in March, but mostly buried under the avalanche of concerns about respiratory problems. It’s now been clearly recognized as a relatively (though not unheard of) marker of infection.

What had not been described at all in March, and still only occasionally described now, is not just a loss of smell or altered smell, but presence of a new smell.

The day my fever broke, I woke up more energetic than I had been in days. I took a deep breath in through my nose, and that’s when it hit me: an overwhelming, pungent odor, disgusting beyond description, and unlike anything I had ever smelled before.

Alarmed and confused (at first I thought something was burning), I went to my bathroom and started smelling things. Cologne, rubbing alcohol, toothpaste, etc.

Nothing.

Every time I took a breath through my nose all I could smelled was this nauseating odor, as if something awful was dying in my nose.

I could find no mention of this as a symptom anywhere online. I decided that maybe that is what I was smelling — my olfactory nerves dying. Nothing else seemed to make sense.

This smell was pervasive with every nasal breath for a couple weeks, then it slowly fade, though for weeks I would intermittently notice a whiff.

The fatigue took at least 4-5 weeks to recover from. I was fortunate never to have any respiratory symptoms or need medical care.

The COVID Fallout

The worst part of having COVID was not having COVID. It was realizing I had exposed my parents. Before I exited quarantine, my mother fell ill from COVID, a good 10 days after our dinner.

Whatever fear I had my first couple days of being ill on my own, it paled in comparison to the stress of my mother becoming ill. I had on repeat in my my mind the thought, “what if COVID kills my mom, and what if she only got it because I exposed her?, and what if that only happened because I decided to go on this trip?”

For the few people who’ve made it this far I’ll fast-forward — she was more ill than me, but thankfully never needed hospitalization. Moreso than my own illness, her illness brought a great deal of clarity.

Tangentially — had we followed our local health department guidance, my parents would not have self-isolated. Because we followed the advice of my university occupational health group, my parents quarantined and did not expose anyone else.

Separating during COVID

The rest of this post is really just a mish-mash, catching up on the last several months.

My ex-wife and I started the divorce process in 2019, and filed the papers right before my trip to Vegsas. We finished the process while the pandemic was in full swing and the world was off-kilter. Similar to second-victim, divorce is not the focus of this blog post, and I will not be delving into it.

Sufficed to say, divorce is difficult during the “best” of times, but doing it during a pandemic added interesting levels of difficulty to the process.

Thankfully the most important people in the process, our three fantastic boys, are doing great. While the three of them have taken advantage of extra time together to discover new ways to injure each other and themselves, they are all overall quite healthy.

Virtual learning sucks, and while they’ve returned to partial in-person school, it’s still far from perfect. My children compared to many others, however, are fortunate, as they still have many resources and individuals to support them. Many other families and children do not have these resources, and our society is doing a shitty job helping them. Just one of the many reasons I’m happy to see a new administration entering the White House.

Antibody Check and Vaccines

I enrolled in a study through my university to track my quantitative COVID antibody titers. In June, September, and December of this year I’ve had blood draws and found out I had antibody titers of 1:810 at each check.

What does this mean? I have no idea. The people running the study can’t tell me (though maybe when the study ends they can give more insight). Given the virus has only been around for ~12 months, there is not enough knowledge to tell me what type of immunity it may offer or if/when it would be expected to wane.

I do know that it’s lowered my internal dread of quickly becoming infected again, thus lowering my stress level at work.

That did not cause me to slip in my PPE usage — while I’ve made plenty of jokes about not needing PPE anymore, I’ve been quite vigilant for myself and co-workers. I do not want to go through COVID again, nor do I want my co-workers to have to go through it.

I’ve taken care of many, many children with COVID the last 9 months — the youngest was not even one month of age. It. Is. Everywhere. It does appear true that most children are not becoming as seriously ill as adults, though I have seen some very sick patients. Hopefully this stays that way, as many other viruses have a disproportionately worse impact on children.

Speaking of…, over the past two weeks my workplace gained access to the Pfizer COVID vaccine and I became eligible to obtain it.

I again faced a quandary. Knowing that I have some antibodies, I debated whether or not to get the vaccine right away. Our employer said we have enough supply now/over the next few weeks for everyone here to be vaccinated that wants to receive it. They intentionally chose not to differentiate based on recent infections (many others in our organization have contracted COVID in the past nine months) given the lack of data (not that many people know their antibody levels, and no one knows how to use that information).

I’ve also engaged in plenty of discussions about whether the vaccine was “rushed.” I certainly had concerns over the summer that Trump would try to push out the vaccine before data were available just to help his re-election campaign.

I decided to go ahead. It came down to trust in the scientific process and knowledge that I am not really “taking away” a dose from someone else in my organization.

There are many reasons for others not to trust. It’s easy from a physician scientist viewpoint to criticize those who do not want the vaccine (and many are doing so), but COVID has been politicized beyond a degree even a skeptic like me thought possible,

Add that to the historical distrust earned by the scientific/medical community by systematic mistreatment of minorities, and there are at least some groups that rightfully need to be convinced.

I hope for those from marginalized backgrounds with a stronger reason to distrust that trust can quickly be earned and people become more accepting of the vaccine. For those NOT from those backgrounds, who instead do not want the vaccine because their leadership and role models continue to downplay COVID, I don’t know what to say. I believe those leaders and role models leaders failed them, and they may have missed the window to make amends.

The Next Chapter

So was it a mistake for me to go on the trip to Vegas to deliver my talk? I made the best decision I could at the time, but yes, I do think it was a mistake.

I’m relieved the extended harm from my contracting COVID was minimized. I know my talk benefited people other than myself (and will in the future). Yet I would skip the trip if I had a chance to do it again.

I can’t do it again though, I can only learn, look forward, and share my experiences.

As I look around, I know for many, the vaccine feels like the first glimmer that life may go back to “normal.”.

However that “normal” is the past. Life was never on hold. We didn’t hit a pause button on the world when COVID hit, and we can’t hit “play” now that a vaccine is here and pick up where we left off. Everyone has to find their new “normal.”

My kids did not stop growing or needing my support. My divorce did not stop.

My parents have kept growing older and over the summer my father became seriously ill (from something other than COVID). My need to help my parents did not stop.

We have to give ourselves grace for letting some things go and changing priorities, but we also have to establish our new normal, and write a new story.

Between divorce, COVID, and Mr. Peanut, I think I have plenty more stories to tell. Even if no one is around to read them.