Shaken, but not deterred

Especially during a pandemic, internists are front-line health care physicians.

The new decade and my ACP Presidential year began in January with a big shakeup, literally. My husband and I went to Puerto Rico three days early for an ACP leadership meeting combined with a Puerto Rico ACP Chapter event, to celebrate my birthday, the big 6-0. Little did I know how earthshaking it would be as we were awakened in the predawn hours the next day by a 6.4-magnitude earthquake. The violent shaking of our bed and the swaying of the 11th floor of our high-rise hotel is another story for another day. This meeting would become the first of many ACP meetings this year to be canceled. As I write this column now in late March, the president has declared a national emergency and the COVID-19 pandemic has arrived at our shores. Earthquake, pandemic—what next, locusts? Forget I asked.

The old adage “may you live in interesting times” takes on new meaning as we search for stability and order in our new directives of social distancing and doing our part to “flatten the curve.” We not only live in interesting times, but it seems so much of what we know and how we have done things is being disrupted. Earthshaking, indeed. The pandemic is now transforming how we live day to day. Everything is affected, our work, our leisure, our travel, our worship, our shopping, our bank accounts, and our families.

So how do we live as physicians, many as frontline health care workers, in these times of national emergency? Do we live in fear? Fear for ourselves, our families, our patients, our community, our economy, our personal finances? Or do we live in faith? Faith in our calling as physicians, in our colleagues, in our public health departments, in our government, in our professional organizations? I have always believed becoming a physician is a calling to something greater than ourselves. Caring for the sick and working to prevent illness and disease are not 9-to-5, Monday-through-Friday jobs or occupations where we punch the time clock. No, now more than ever, we are called to serve our patients, our families, and our colleagues.

We internists are truly on the front lines of providing health care to our country, transcending all our differences and diversities. Illness, disease, and the daily provision of health care are oblivious to political parties, ideology, socioeconomic status, gender, race, culture, and ethnicity. This pandemic starkly reminds us that contagion and suffering do not respect state or country borders. I'm reminded of the photograph of our earth from space—one small blue-and-white planet that is a unique marble in a vast universe. So beautiful, so delicate … so finite? We are all in this together. This image devoid of boundaries serves as a stark reminder: We must all work together, care for one another, and care for our sometimes fragile existence.

Through illness or tragedy or even those “big birthdays,” we are reminded again how sweet life is and how much we want to live it fully every day. As physicians, we see both how fragile our human condition is and how remarkably resilient the human body and mind can be. We see how much it can take and still recover, while at times just a simple infection, a small clot, an irregular electrical impulse can be fatal.

I am prompted again to value each day, to have an attitude of gratitude for every blessing under heaven: life, family, food, daily work, and my body that is “fearfully and wonderfully made,” as the Psalms tell me. I am blessed as a physician to bring the hand of medicine and hand of prayer together to bring health, comfort, and healing to my patients and families.

I am so grateful for ACP, which has truly been my professional home as an internist. Through this storm, ACP is providing critical resources of information, advice, and best practices for our health care system. It is what we do; it is what we have always done. As we approach our “new normal,” it will be together and with the highest ethical principles and with the highest regard for the health and health care of every single person living in our country.

In a pandemic, access to health care is important to everyone for the greatest protection for all. When I say everyone, I mean not only you, me, and our families but include those without any health insurance, those underinsured with high deductibles, those undocumented immigrants, the homeless, “those people,” whoever they are. A pandemic does not distinguish “us” from “them.” Any human body will do. We cannot isolate our health care recommendations to just some of our people in this country and ignore those who live in the shadows. If we truly value all life from birth to death, then every person's life truly matters. We are all God's children.

If our country ever needed universal access and health coverage, the time is now. This pandemic makes this need acutely and abundantly clear. Indeed, the government has a crucial role to play to provide an inclusive system, but it will take more than just the government. The new system will take business, large and small, industry and agriculture, private and public partnerships, hospitals and physicians, nurses and all other allied health care workers, to all come together and decide we, the American people and all who live here, are worth it.

The earthquake and my 60th birthday this past January shook me up, making me reflect on the previous decade and ponder the new decade of the 2020s personally and professionally. At the same time, ACP made tectonic moves with the publication of our Vision for the U.S. Health Care System in Annals of Internal Medicine. ACP reiterated our call for universal health care coverage through either a public option that builds upon the current Affordable Care Act, or a single-payer option that more drastically changes our current system.

More important, the three key policy papers give the details of how health care delivery and payment could change, how to decrease administrative burdens on physicians and our clinician team members, and how to champion the investment in primary care that will be necessary for a system that is balanced, with primary care physicians, hospitalists, and medical and surgical specialists. Our health care system is clearly not balanced now, nor will it be if the payment system does not dramatically change and administrative burdens are not drastically reduced. If you haven't already, I encourage you to examine these articles yourself and come up with your recommendations for how we can best get to universal health care access and coverage for our country. I look forward to hearing from you.

During this time of social distancing, meeting restrictions, and travel bans, I struggle with feeling isolated from my ACP friends and colleagues around the country and from around the world. I missed getting to be with so many of you at Internal Medicine Meeting 2020. Our separation just makes me cherish all of you even more. I know how much your presence and my interaction with you every year at the annual meeting, Chapter meetings, and other committee meetings buoys and sustains me throughout the year in my professional life and career.

I am missing how much your encouragement, wisdom, and knowledge help me to be the very best internal medicine physician I can be. I am missing how each of you inspire me as you share your experiences, your different perspectives on life, practice, and policy. I am missing how so much of our in-person banter and collective input creates the most important policies and recommendations for the practice of medicine in our world, and how we deliver and pay for health care in our own country.

I truly look forward to seeing you next year at Internal Medicine Meeting 2021 in Orlando. I hope to see many of you at your Chapter meetings in person or virtually later this year. As we get through these next weeks and months, know that your ACP staff and leadership have your back and are constantly at work, even from home, on your behalf to improve your capabilities to provide health care to your patients.

Yes, this crisis may have shaken us up, but as internal medicine physicians and ACP, we are not deterred from our calling and our daily work. May the challenge of this 2020 pandemic crisis give us 20/20 vision for the decade ahead as we work together to care for our patients and all the people on this little blue marble.