This is the story of how I ended up in self isolation. On the 19th of March it was my birthday. The coronavirus pandemic had already restricted most of my plans. But I am a lover of birthdays (most likely caused by a childhood of themed cakes and birthday party treasure hunts) and I was determined to squeeze as much joy out of the day as possible.
That morning I went to work as a General Practice registrar and saw a full case load of patients. Brayden had his four-year-old health check and vaccinations, Janine was referred to the Emergency Department with chest pain, and Mildred and I discussed how we could best protect her from coronavirus as a seventy-nine-old woman with hypertension and COPD.
After work I got on the train to Circular Quay to meet my family. The lockdown was not yet in place and restaurants were still open. By the end of the day I had noticed that I had a slight tickle in the back of my throat, but I otherwise felt completely well. I said to myself “I am a doctor, I see people every day with mild viral symptoms and I have never cancelled an activity because of a sore throat, let alone my birthday!” Was my throat really even sore?
The slight dry scratching feeling would come and go. I told my family and we all agreed it would be okay to stay for a light meal, sitting well apart with no contact. My mother, a loving and committed worst-case-scenario planner, gave me these N95 masks as a gift. We all laughed.
Two days later I woke up coughing with fevers to 39ºC. In that disquieting state of being both a doctor and a patient, I picked up the phone and called my medical friends for advice. Yes, of course I had to be tested for SARS-CoV-2 today and go into isolation. I walked to the hospital testing centre and in the fog of fever my head spun:
How long was I in the clinic room with Mildred?
Did I touch any of my colleagues as I handed out birthday cake?
My father is almost 70 and suffered from childhood asthma. What if my father dies of COVID-19 and it is my fault because I was too selfish to cancel my birthday dinner?
While nervously awaiting my results in isolation I began the deep dive into the coronavirus media. I apprehensively reviewed the death toll first thing each morning, I was glued to Twitter, with TV news always on in the background. There was no lack of supply, every COVID-19 podcast and news story fed my insatiable hunger for information. Are we too late to flatten the curve? What is the true mortality rate? Will this plunge the economy into a Great Depression? Are we all going to lose a loved one?
Wrapped in a blanket on my couch I could see people gathering on the main street, laughing, hugging, having coffee together in cafes. The social distancing restrictions were slowly being tightened, and perhaps not quickly enough. I felt resentment, jealousy, and guilt. I had been just like those people, thinking that because it was my birthday, that I was special and somehow exempt.
After 48 hours my physical symptoms had mostly plateaued, but I was emotionally exhausted. My hunger for answers was driven by fear and a desire for security. But in these unprecedented times, there can be no certainty. We are all going to have to go through this for the first time together.
In situations of panic and uncertainty we are all susceptible to fear. Fear short circuits our ability to think clearly and calmly. The frontal lobe of our brain, the areas of responsible for reasoning, decision making and planning, steps back from running the show. The amygdala, an almond shaped cluster of nuclei in the temporal lobe, takes control and starts to sound the alarm that we need to act. We go into fight or flight.
In her book Burn Out, Emily Nagoski (1) explains how we can separate a stressor from the physiological stress response it creates. We cannot eradicate the stressor of coronavirus. We can reduce our risks of transmitting it by practising physical distancing, washing our hands, and using Personal Protective Equipment (PPE). And we can manage the stress response evoked in our body.
My first step was to limit my media consumption to one hour a day, staying informed through a sensible amount of public health information and high-quality news media. Next I began to tend to my anxious thoughts through mindfulness and meditation. I started with the Coronavirus Responders meditation on the 10% Happier App (2). This could not take away my difficult feelings completely, but it reminded me that it is okay to feel anxious. For a few minutes at a time, I found I could take short breaks from my worries.
Next I lay down on my yoga mat. Even while coughing and feeling tight in the chest, I moved my body while breathing slowly and as deeply as felt comfortable. I was too unwell to exercise, but mindfully moving helped me to slow down and to feel a little less tense.
Most importantly, I reached out for connection. I Facetimed close friends. I called my family to check that they were well, and we all made space to talk about life outside of coronavirus. I texted my colleagues to ask how they were doing. I joined a webinar with other General Practitioners. I kept my physical distance from others, but through technology, I stayed socially connected.
After four days my phone rang. It was Jarrad from the Public Health unit. He was happy to report I tested negative for SARS-CoV-2. I could return to work after my symptoms had resolved for more than 24 hours.
I know that as a General Practitioner it is very likely I will be exposed to COVID-19. If I am honest with you, I feel afraid. I am scared I will get sick. I am scared my loved ones will get sick. I am scared about the suffering and loss that COVID-19 is going to bring to our communities, locally and across the world.
But there are bigger things than fear. We can rise above the fear if we stay connected with our values and with one another. Victor Frankle, Austrian psychologist and Holocaust survivor wrote in his book Man’s Search for Meaning that:
“Those who have a ‘why’ to live, can bear almost any ‘how’”
The ‘Why’ is our commitment to medicine. It is our sense of duty as doctors and our sense of belonging within our community. While we need to stay at a physical distance to stop the spread of coronavirus, as a community we need more than ever to stay connected with one another and remind ourselves why we are here.
To all of my fellow doctors, nurses, researchers, allied health practitioners, practice managers, receptionists, cleaners, and support staff out there:
Thank you for turning up to work. Thank you for being courageous and reminding me why we are all here. I wish for you to stay safe, stay well, and stay connected.
Simonette VajaApril 6, 2020 at 7:32 am
Brilliant article – so proud of you Isabel and all that you are contributing…great practical advice for all of us. I am looking forward to reading more…