COVID reminded me of why I became a doctor. Below is an unpublished account (in short story form) of my most memorable day during the height of COVID. It is a reminder that we can remain true to our intrinsic motivators rather than victims of extrinsic factors. And most of us still have the opportunity to choose every day which forces rule our day: intrinsic or extrinsic.
On a Tuesday morning in the middle of August 2021, during our surge of the Delta variant of SARS-CoV-2, we received an email request into our incident command center inbox, asking to include the daily number of COVID deaths in our daily report, broken down by those vaccinated and those unvaccinated.
Our information officer handed a paper copy of the letter to the incident commander (IC), who read the email out loud. Our IC tended to process information aloud, so it wasn’t unusual for us. After he finished reading the note, he began processing the reporting request out loud. He was standing by the command center door, which was wide open for any passerby to catch a glimpse of the room or overhear a phrase.
In a noisy and exasperated way, the IC said, “What does it matter? People die. It’s a pandemic. People die!”
I shot up from my chair at my computer desktop station, farthest from the open hallway door, and nearly ran over the IC as I reached to shut the door, shouting the whole way, “Shut the door! Shut the front door! Shut the mother trucking door! There are people out there who can hear you!” I didn’t use those exact words. I unloaded the proverbial f-bombs from high altitude.
A couple of days later, around 0900, my CEO came into the command center and leaned over to me, saying, “I need some alone time with you. Now.” Of note, the IC who stated noisily that people die in a pandemic is the very same person who is my CEO. Further, the CEO’s “need for some alone time” was code language for the demand to have a crucial conversation with me. He walked out of the room as sharply as he had entered just a moment before.
I painfully followed the boss to his office (a long walk down the hall from the command center), and he politely and professionally shut the door behind me as I entered the room. It seemed very clear to me what was about to happen. He instructed me to sit down at his conference table, and he sat across from me, arms folded. He said, head shaking, “What you did the other day? Not OK. Not OK. Not (pause for effect) OK. You cannot do that. Disrespectful to me and to everyone in that room.”
Silence erupted between us. I nodded ever so slightly, acknowledging his status, wise counsel, and admonishment all at once. But then, I very carefully and with as much restraint as I could muster, replied, “But talking about death in a pandemic like that without regard, factual as it may be, was equally disrespectful and potentially triggering to everyone in that room as well as everyone in that hallway.”
Volcanic silence erupted at this point. And, for added measure, we were now in a kindergarten staring contest. Neither of us blinked or said a word for what felt like an hour (probably about 7 or 8 seconds in reality). I broke the silence and stated that I agreed to never, ever do anything like that to him, to an incident commander, to the team, or to the hallway staff ever again. I got up from my chair without waiting for any acknowledgment, either verbal or nonverbal, and I walked out of the room not knowing if that would be the last day of my employment.
The rest of the week was unremarkably remarkable in every sense of the words. We were still in a COVID surge unlike any other to date. We trashed the whiteboards with census numbers, staffing needs, critical care bed availability. We worked the phones, prepared our daily reports, held calls with county officials and area hospitals. It was our daily grind, and it was wash, rinse, repeat, for days on end. No one mentioned the Day of the DoorDash.
On Tuesday the following week, I was back at my workstation. I had been working all weekend as IC, and now I was back at my medical/technical specialist workstation inside the CC, unshaven, in scrubs. It was approaching lunchtime, and I was starving, down a few pounds from my fighting weight. We had just hit our all-time high of COVID inpatients, 338 to be exact, slightly more than half of our entire inpatient census. Not any different from any other hospital system going through the same ordeal, but unheard of in the modern era, where one-half of your inpatients should all share the same diagnosis.
I was sitting there, staring at my monitor, starving, and a carryout Styrofoam box was placed in front of me. Between me and the keyboard. Between me and the monitor showing all sorts of data, unopened emails, news headlines, pharmacy information, and countless other windows of digital detritus.
I opened the lid to the polymer box and saw inside a soggy, greasy, musty po-boy sandwich with a side of cold french fries and NO ketchup to be found within reach. Yet another essential supply item presently unavailable.
I put my face down over that box, careful to lift up the fulminating mess of bread and filling, and took a huge bite of what would suddenly become the best worst sandwich of my entire life. I was having a moment. I had f-bombed my boss (and somehow remained gainfully employed), I no longer cared about my appearance, I wasn’t taking care of myself properly, and I was taking no pleasure from that sandwich.
By most accounts, that’s classic burnout. Exhaustion. Depersonalization. Compassion fatigue. But if you had interviewed me right then and there to ask if I was suffering, I would have told you that I felt great. Absolutely great. And I began to love that horrible sandwich.
And later that day, I asked myself; why did I feel that way in that moment?
I had zigzagged my entire life to that moment. I left everyone and everything in my northern home state to move to the deep south for my training after medical school graduation. I left fellowship one year early to get started in practice. I left two decades of clinical practice and broke the hearts of all of my patients (and my nurse and my partners) to go into administration full time. I became a physician executive; neither physician nor executive, but both simultaneously. Yet always physician first. To do no harm.
To have a chance to advocate for staff who were getting triggered and collectively traumatized day in and day out, to manage a cohesive medical response for fifty percent of an entire hospital census with a singular illness none of us had ever seen, much less trained for, and to teach the CEO a lesson about humility, compassion, and empathy (and, yes, maybe a little righteous indignation).
If I was miserable at all on the day of the email or the day of the stare-down or the day of the sandwich, I could have self-rationalized my choices to make myself feel better. This was the opposite. I was in a state of flow and had lost all sense of time and space. A state of being that does not require rational explanations. I remained true to my oath and to my calling. Nothing has ever tasted so good.
Lee Scheinbart is a medical oncologist.