Physicians are on the front line of this pandemic crisis.  I am in a unique role as an orthopaedic surgeon. One of my friends said last week, “if anyone thinks that orthopaedic surgeons are going to be caring for patients with Corona virus, they are sadly mistaken.”  As correct as he is, our duty to lead from where we stand is immense.  

The CDC and the Surgeon General have recommended that we postpone elective surgery.  We do not want to expose our patients to Covid 19.  We do not want to use materials that are in short supply, like masks and protective gowns.  We must understand that the children of doctors and nurses and physician assistants and medical assistants and x-ray technicians and orthopaedic technicians are home and in need of care.  Our resources are short.  We must be ready to use these resources for the waves of sick patients who are likely to come.  Our elective surgeries are cancelled for now. Like joint replacements, and ACL reconstructions, and shoulder arthroscopy and carpel tunnel releases.

What about elective care?  Last week we made the decision to review all charts of patients waiting to see us in my orthopaedic clinic to convert to virtual visits whenever safe and possible.  Social distancing is meant to flatten the curve of spread.  We must avoid patients and healthcare professionals coming into mass contact to address issues that are neither urgent or emergent.  Most patients have received this information with grace and gratitude.  People want to stay safe and to keep those on the front lines safe.  

Some true colors are shining through in the past days.  Support.  Working after hours and on the weekend to do the right thing.  Keeping public health and the greater good in mind, many are rising up, leaning in, and supporting one another.  

And some are not.  This has not landed for some of us.  I had a patient’s mother yell at me last week for the 2 day wait to see her child with a non emergent problem.  I received this without the compassion and empathy that I usually conjure.  I am sure this woman was scared and frustrated, perhaps short on toilet paper, and daunted by the lines around the block at the grocery stores.  She was likely overwhelmed with the mixed messaging coming from the press and our government.  She was absolutely trying to advocate for her child.  And she was certainly not able to see that we are far from business as usual in the orthopaedic clinic.  I cannot blame her.  But I did not have the ability to offer her what she needed, patience and understanding.  

Last night my 13 year old had a sleepover planned with a new friend.  I do not know the friend’s parents.  I should have cancelled.  But I felt bad for the girls, and wanted to let them have one last hurrah before lockdown.  In the middle of the night my 10 year old daughter woke up with a fever.  I did not call the friend’s mother.  I made the call to keep my sick daughter in our room away from the friend.  This was not the right call.  The friend’s family was correctly upset.  All I could do was apologize, and this was received with much appreciated forgiveness.  

Today I went to my favorite Sunday yoga class, usually filled to the brim.  There were 5 students.  And a teacher dealing out everything I needed.  Hard work, deep breath, sweat, and focus.  I am sure even this outlet will shut down within the week.  

We are all so raw.  As parents.  As doctors.  As people.  Our leaders cannot get it right when there is no precedent in contemporary times.  A partner texted me, “our leaders are waiting for word from other leaders, and it all feels like trying to do a U turn in a big rig on a cul-de-sac.”  I have shifted to asking for forgiveness instead of permission.  I must do what seems right.  This is not the time for rule following, as there are no rules.  I am going back to my Hippocratic Oath.  Just trying to do no harm.  

To all of my tribe in medicine, let’s be patient with ourselves.  Let’s support one another.  And let’s remember that we have exited a world of patient led care and “customer” service in medicine.  As we do what we believe is right, we may not have consensus.  The moral and ethical barometer that comes with the art and practice of medicine cannot be dictated or scripted in these times.  Let it be said that we tried to do what was right with courage and even ferocity.  

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