When Dr. Anna Tran comes home from her shift as an internal medicine doctor at Medical City Dallas, she doesn’t hug her three children or her husband. For the last month, she has been caring for COVID-19 patients in the hospital, and because she doesn’t know if she is carrying the virus, she is playing it safe.
Her children are 16, 17, and 20, but the distance is still taking its toll. One of her sons is on the autism spectrum and usually isn’t as interested in human contact as others. But when Tran celebrated her birthday a few weeks ago, he told her he wished he could give her a hug. “When you can’t have that human connection is when it becomes more important,” she says, seeing the silver lining in all this for her son. “The experience has helped him understand that a little bit more.”
Tran works seven days on and seven days off right now, and about 30 percent of her patients are being treated for COVID-19. The hospital is far from overwhelmed; she has less than a full patient load and says they have the protocols and equipment to treat the patients and keep the staff safe.
“I feel as safe as I could be,” she says. But that doesn’t mean there aren’t serious challenges.
Bringing COVID-19 home
The bigger challenge is the stress of dealing with such an infectious disease that can be so deadly. Decisions about how much to isolate from family, how to decontaminate, and how to process the experience can’t be made with good data. There isn’t any. “Every single day it changes,” she says. “You have to be adaptable and learn as you go. At the end of the day you have to do what you think is right based on the evidence in front of you and be comfortable with that.”
Tran has colleagues who have moved their families away or stay completely isolated. Others do an intense decontamination when they get home. Every caregiver is different. Because her kids are older, Tran feels like her plan to decontaminate and keep her distance without completely isolating is what works best.
“I change everything out, go to the bedroom, take a shower, wipe everything down, and walk around the house,” she says. “But I am very scared. I haven’t touched my kids in a month because I don’t know if I am a vector.”
She says other physicians she talks to online and in person are living in fear, though they don’t show it to patients. They are experiencing guilt about not wanting to come in to work. They are asking about how to write their wills. She says she knows some physicians who are teaching school to their kids after shifts treating coronavirus at the hospital. “I don’t know how those doctors do it, but they do,” she says. “You have to just step up.”
The emotional toll at home is matched at the hospital. With patients alone and without visitors, they don’t have the advocates that usually help physicians diagnose and treat patients, much less provide emotional support. Doctors depend on family and friends to know patients’ baseline behavior and symptoms and notice physical and mental changes. When the patient loses that support, the physician loses an important helper.
Sadly, patients dying from COVID-19 and other illnesses are doing so alone. “They don’t have anyone on their side,” Tran says. “The family isn’t able to hold their hands.”
She says most new admissions are either COVID-19 patients or those with similar symptoms, where they rule out coronavirus as a cause. But the patients who are diagnosed with COVID-19 are much more complicated medically and logistically. In addition to the personal protective equipment, or PPE, requirements, the disease itself impacts much more than the respiratory system. She has seen severe impact on the kidney in patients in their 20s, as well as blood clotting.
Tran says the COVID-19 patient totals have gone down for the first time this week, but that doesn’t mean the anxiety has subsided. Tran is no stranger to treating infectious diseases, and has spent time in India and Haiti on mission trips in areas with tuberculosis. But nothing prepared her for this. “In those situations, you are dealing with something you know about,” she says. “You have time to prepare so that you don’t feel at risk.”
Much less is known about coronavirus.
“This is a completely different thing. No one feels prepared,” she says. “There is a lot more anxiety than there usually is.”
The trouble with being called a hero
Another challenge is dealing with the anxiety loved ones have about her, Tran says. Through exercise and debriefing with colleagues, she has been able to control her own emotions, but the feelings of those she loves is another issue.
“It is not just my fears, it is their feelings, which is something I can’t control. And that is the hardest part,” she says. “It is a burden they didn’t ask for.”
Tran doesn’t like using the word “hero” to describe her doing the job she has chosen to do. In addition, words like “frontlines” and “redeployment” are too militaristic, and not something she ever imagined she would be a part of. As has been mentioned elsewhere, calling someone a hero who is just doing their job can hold them to an unrealistic standard and downplay the role everyone has in containing the virus.
“I don’t like to be called a hero,” Tran says. “It puts so much of a burden on us and takes emphasis off of everyone else in society.”
Whether it is supporting essential workers, following public health orders, or giving to those in need, Tran says everyone has a responsibility to do their part. “We all have a role to play. We need a holistic approach to battle this.”
Despite the hardships, Tran has been impressed with the way her colleagues and society have handled themselves.
“Human beings are amazing,” Tran says. “You throw them into a new life threatening and risky situation, and we rise to the occasion.”
