Donning and Doffing: A Piece of My Mind

In this JAMA Piece of My Mind article, Physician and patient Michelle S. Mourad, MD relates her experience of being diagnosed with cancer and managing her serious illness during a pandemic.  

If you are going to get diagnosed with cancer, better to do it during a pandemic. When your imaging-guided biopsy runs longer than expected, the nurses will show you the small windowless room down the hall from radiology where you can join your 11 AM scheduled Zoom committee meeting, presenting slides from the neck up, with an ice pack and an ace bandage wrapped around your bruised chest. When they give you the call later that week, there’s no one around to see your expression change, to watch you numbly searching for answers on UpToDate while virtual meetings continue in the background. 

Through the months of chemotherapy, as food starts to taste like sawdust, and you prefer smoothies to solid food, no matter. There aren’t real lunch meetings anymore. During the first month people won’t really notice as your face thins and turns pale. Zoom has that “touch up my appearance” filter; you are pleased that it hides how fragile your skin has become, the little telangiectasias that sprout up over your cheeks fade away on the 2-dimensional screen, painted on eyebrows look real. And as weeks pass and the hair shedding becomes too much to bear, don’t worry, you are in good company. Everyone is sprouting new hairdos brought on by the pandemic. Colleagues who you swore had straight hair, suddenly wear it with their natural curl. Your new style may be a bald spot on the back of your head—a secret between you and the mirror only. 

When the oncologist calls during a meeting, don’t forget to mute your Zoom and hide your video, easily done with practice. You’ll get used to the hundreds of messages coming through your patient portal, it’s just another overflowing in-box to manage. Health system coronavirus disease 2019 (COVID-19) updates will mix with your patient advisories, but you’ll quickly learn the pattern of which part of you they are meant for. Employee daily symptom screens and patient symptom screens will become ridiculous as they ask you about all the symptoms that you are expected to have during chemotherapy: fatigue, nausea, vomiting, diarrhea, muscle aches—yes, yes, yes, and yes. Does neutropenic fever count? You may need a COVID-19 test until the granulocyte colony-stimulating factor kicks in. The distance will be a blessing, you’ll see. No undue scrutiny by well-meaning family and friends. No exposure to coughs or colds. Your sinuses have never been so clear. 

You’ll have some weird times. While being seen in the oncology clinic, you may run into a trainee, a former intern of yours, now a fellow who brightly says, “Hi,” before her face falls with the realization that you are out of place. The interventional radiology attending placing your port might recognize you from the COVID-19 town halls. While in the infusion clinic and also in a Zoom meeting, your IV machine may start beeping while you are speaking, an instantly recognizable sound. You are hiding in plain sight. 

The numbers of physicians who simultaneously manage a serious illness during their career is unknown, like many of them, you may not want to share your story. It is no wonder. Physicians are bred to be superhuman. Eight-hour certification examinations, 36-hour call, and poor backup coverage prime you to function even in the most suboptimal circumstances. While you may be privileged with the knowledge of how to navigate the world of urgent care, clinic visits, and emergency departments, you will probably want to ask friends and peers for advice, so as not reveal yourself to a broader group of colleagues. We don't want their sympathy or the inevitable preconceptions about our professional abilities that comes with it. 

But maybe, as the COVID-19 case numbers start to fall in your state, and you are feeling like the months of shelter-in-place and diligent masking have paid off, you’ll realize that there’s a place in all the grief of the pandemic for your personal grief. Hiding an illness from a profession supposed to take care of illness is exhausting, even at such a distance. You’ll tell one colleague and then another. You will share with your patients, who are struggling through chemotherapy, that you know what it is like to no longer feel invincible. During your days, now spent donning and doffing, you’ll realize you can be both a physician and a patient with cancer. You’ll let those close to you in on your private struggles; they mix and mingle with the heartache of all those around you: protests in the streets, homeschooling, lost jobs, and lost relationships. And with each telling, if we are lucky, our personal protective equipment is no longer something we are hiding behind but something worn in solidarity with all those around us fighting for better times ahead. 

Read the article here. 

Full link: https://jamanetwork.com/journals/jama/fullarticle/2776204