Yale vs Covid

Richard Borge

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Family

By Anna Reisman ’86

When a close relative who lives a couple of towns away called me in mid-March to ask about a sniffle, I said, it’s just a cold.

She and her husband and their daughter (abruptly back home from grad school) had been puttering around their house in those early unsettled weeks, quarantining, studying, writing, Zooming, cooking, binge-watching BBC miniseries.

She hadn’t been going out much, just to CVS or the supermarket.

It seemed like a straightforward cold at first, some fatigue, with a hint of unrelated back pain. Her doctor prescribed antibiotics over the phone just in case it was bacterial pneumonia, which she’d had once or twice before.

Wishful thinking, in retrospect, but back then, it was hard to believe that COVID would hit the New Haven area so soon—and almost unthinkable that COVID would hit someone close to me.  

As the doctor in the family, I checked in multiple times a day by phone. I gave her advice on how to manage symptoms. I provided instructions to all of them about wiping down groceries, of being keenly aware of what their hands had most recently touched. I kept my phone’s ringer on at night, just in case. 

Her cold symptoms were replaced by a severe headache and diarrhea, and now the fatigue was overwhelming, and she was coughing a lot, and it was no longer possible to deny what we were all denying—that this actually might be COVID-19.
Somehow, she drove herself to New Haven for testing, and while we waited a few days for the results I suggested ways to minimize the risk of transmission within their home. I was most worried about her husband, who was older.

I knew their house, and so I closed my eyes and imagined myself at the round table in their kitchen, on the white couch in the living room. I conjured up the location of each bedroom and bathroom. I pictured her relocated to the guest room, which is downstairs, with its own bathroom across the hall. I pictured the other two moving around the spaces upstairs, occasionally descending to the sick room with chicken soup or scrambled eggs, a fresh glass of ice water. I visualized daughter and father wearing masks, sliding their gloved hands along the banister, and I advised them to wash their hands before retrieving the dirty dishes and again after, then to wipe down every high-touch surface—the banister, doorknobs, tabletops, backs of chairs, bathroom faucets.

Like every other person in the health professions, my clinical work has changed drastically in the last few months. I’m an academic general internist—I run a program and teach at the Yale School of Medicine—and I’ve also been a primary care doctor for more than 20 years. I don’t have my own panel of patients right now, so every Monday in recent years, I’ve seen patients in clinic for urgent visits.

Since mid-March, these visits have been via telephone, and almost every person I speak with is concerned about whether their symptoms could be COVID-19. People describe fevers, cough, muscle aches; some feel tired; some are short of breath. Some have conditions that put them at higher risk, like diabetes and obesity. Some work in nursing homes or supermarkets, some are retired, some have lost their jobs. Everyone is scared.

There’s a lot I can do: I can send people for testing; I can suggest what to do for particular symptoms. I can explain the difference between quarantine and self-isolation and when it’s safe to go back to work. I can urge them to buy a thermometer (not so easy these days) or a pulse oximeter (also not so easy these days).

I can ask about the spaces they inhabit, how many rooms there are, and who spends time where, and what parts of the space are shared, and whether there are doors that can be closed between rooms.

I can do almost all of the things that I did for my relative, when she was sick.
But what I cannot do—no matter how much information I get, no matter my training, my experience, the knowledge I’ve been amassing piecemeal about this virus—is to prevent people from getting sick. 

I was lucky that I knew my relatives’ house and their habits, that I was able to give detailed instructions on how to minimize breathing the same air or touching the same objects. I felt pretty good about my thoroughness.

Until the day that I realized none of that mattered, that I’d missed something big. Her husband was still using his home office—a space immediately adjacent to the sick room, right across the hall from the contaminated bathroom. He’d kept working there even after his wife had moved to the guest room. He thought it was safe if the door was closed.

Then their daughter developed a runny nose, then that same terrible fatigue. 
A few days after that, my relative’s husband started feeling wiped out, too, and soon enough there was the call late one night to ask about calling 911 and whether I could stay on the line, and then the controlled chaos of the emergency medical technicians asking questions and giving instructions and the strained voices of my family saying goodbye, trying to sound reassuring.

During those tense weeks when all three were sick, I couldn’t help but wonder whether, if my spatial reasoning had been a little sharper, or if I had just asked the right questions sooner, two-thirds of this could have been prevented.

Then again, all three recovered.

I was fortunate, far more fortunate than too many of the nurses and doctors and other health-care workers fielding similar calls from family members, offering advice, trying to prevent the virus from digging in.

You wipe surfaces, wash your hands, wear a mask, keep a distance.

And then you cross your fingers. 

Primary care doctor Anna Reisman ’86 directs Yale’s Program for Humanities in Medicine.