As a doctor, I've seen some unusual things during the coronavirus pandemic

The people who need my help aren't always the ones who already have Covid-19

I've known some of my patients for 30 years. I wasn't about to leave them on their own (AFP)

Detroit was “flyover” country, so we thought the virus would fly over us. We ignored the obvious: Detroit was actually “fly-into” country. Even after China’s self-imposed internal quarantine, a minimum of 17 flights carrying passengers from Wuhan to Detroit arrived on a daily basis.

For me, the first evidence of the pandemic hitting American shores occurred in a grocery store. I saw two tiny women wearing trappers’ hats with butterfly nets covering their faces. They stared out of the netting through amber ski goggles, their noses and mouths covered by surgical masks. They wore long vinyl raincoats: one kelly green, the other fire engine red, and black rubber snow boots buckled up to mid-calf. They talked back and forth with squeaky, muffled voices and filled four carts with essentials which included two cases of cat food and several bottles of white wine.

I steeled myself for the professional challenge as a physician. The 1918 Spanish flu epidemic seemed safely tucked away in history and remote, but it was back to the future. Michigan had been spared — but my friend who owns an ice arena had been asked if his rink could be used for morgue overflows. The sound of skates scraping the ice, the echoes of pucks slapping off hockey sticks and collisions of players against the boards would be replaced by the silent, collated dead. I was horrified.

Michigan would soon rank third in the number of deaths from Covid-19.

Given my age of 68, I was told I did not have to attend — and should not attend — patients infected with the deadly virus. For a brief moment, I was elated.

I have been in the practice of nephrology since 1983. I’ve ushered my patients through dialysis and kidney transplants. Some of them have been with me for almost 30 years. I’ve grown to be very fond of them. After 30 years, it was difficult to keep an emotional distance; if they get the virus, I couldn’t abandon them. Shame on me for even momentarily entertaining cut-and-run thoughts. I continued to make daily rounds.

At the entrance of the hospital, I was screened for infection and passed. The hospital was weird and reminded me of walking through an airport after arriving on a red-eye flight or the airport described in Station Eleven. There were very few people, the shops were closed, the seating had been removed. Footsteps echoed.

The younger doctors formed Covid teams and I asked their advice. They told me they didn’t go into the patient’s room but reviewed their electronic medical records and used telemedicine to observe patients remotely.

I was skeptical. I trained when the time-honored tradition of the laying on of hands was thought to be part of the healing process. Since the AIDS epidemic those hands, though gloved, still touched the patient.

With coronavirus, even gloved hands rarely touched a patient, except by nurses. I made rounds and encountered a man with Covid-19 undergoing kidney dialysis. The operator of the kidney machine sat outside the room; the dialysis tubes and IV lines were extra-long and draped to a vantage point allowing the nurse to monitor at a safe distance behind a closed door. A video monitor was used to observe the patient. I scanned the monitor and saw the patient on a fuzzy screen; it reminded me of watching an astronaut in a space capsule. I talked to the patient over the intercom. Ground control to patient, ground control to patient…

It worked, but it felt like cheating, so I dressed in scrubs, a gown, a surgical mask, gloves and a face shield and physically entered my patient’s room. I had to do it. The family could not visit, so a familiar face — mine — though heavily sealed and concealed should provide comfort to a frightened and possibly dying patient. The patient thanked me.

I left the hospital but the thought of my friend’s ice arena bothered me. I went to a drug store to obtain items thought to protect one from the virus. I purchased a load of vitamins. Would they work? Who knows?

The drug store, too, was weird. I was the only customer in there. A masked woman of around 60 years old rang up my purchase, stopped, and stared at my pager. The skin of her neck flushed red and she started to cry. She left the register. I followed her.

“Can I help you?” I asked.

“You’re a doctor?”

“Yes,” I said. “How did you know?”

“The only people that still carry pagers are old doctors.”

I nodded. I was getting used to being referred to as “old.”

“I work in this store. I just got out of quarantine. I’m okay. But they forced me back to work. I get panic attacks. I can’t do this. I don’t want to catch the virus. I’m a cashier, I have to talk to people, touch money.” The woman’s eyes stared over her mask and were fixed in unblinking horror. Beads of sweat dotted her forehead.

“Did you call employee health, or go to HR?” I asked.

“They told me to call my doctor. I did, and she didn’t call me back.”

“Most offices are closed now, with this coronavirus thing,” I said.

“I have papers to be signed, then I can get approved leave. I have a sick husband at home. I can’t lose my job. If I refuse to work because of the virus, it’s considered a resignation. Will you sign them, please?”

It was obvious the woman was in no shape to work. But I was not allowed to sign papers of this nature in people who were not my patients. Early in my practice years, I would have signed them. But with HIPAA, Medicare fraud concerns, insurance fraud and all the other anti-doctor handcuffs, I couldn’t risk it. Doing the right thing brought trouble; no good deed goes unpunished.

“If you were my patient, I would have signed your papers. Keep calling your doctor — she will respond. She has to,” I said.

The cashier put her face in her hands; her chest and abdomen contracted. She was going to get sick — that much was obvious — and she ran to the restroom. I left the store.

After I returned home from work a few days later, still feeling shaken about that exchange with the cashier, my wife said to me, “A woman met you at the drug store last Monday, and she was having a breakdown and you said you would help her, but didn’t.”

“I couldn’t,” I replied.

“What?”

“I remember the woman, but I’m not her doctor. I can’t sign her papers.”

“Well,” my wife said. “I’ve been on the phone with her for over an hour and she is unable to reach her primary doctor. She needs our help.”

“Our office is closed till this virus thing is over. How did she get our number?”

“One of the pharmacists recognized you and gave her your phone number. He’s afraid she’ll do something drastic to avoid going to work.”

The pharmacist was correct, I thought.

“She’s really in trouble,” my wife continued. “What about telemedicine? Talk to her over the phone. She needs a primary doctor to clear her so she can see a psychiatrist or psychologist. If she doesn’t report to work, she’ll be fired unless you sign her papers.”

I shook my head. “This telemedicine stuff seems like fraud.”

“I have her number — I’ll get her on the phone and you can talk to her, get her history. You already saw her in person and that’s better than most of the telemed docs that see them on TV. We won’t send her a bill.”

“That’s fraud also,” I said. I thought of my dialysis patient on the closed circuit. “And I don’t have her vital signs,” I added.

“Her vital signs are: she’s going off the deep end. Talk to her so the psychologist will see her. Then she can fax us her medical forms.”

My wife dialed the number and handed me the phone. I talked to the woman and obtained a very thorough history. I gave her my complete attention as I didn’t have to turn away from her and check numerous boxes on a computer screen. I jotted relevant notes in longhand, just like the old days.

I called the psychologist and indicated that I would be the woman’s primary care physician. Because of the coronavirus pandemic, the psychologist engaged her using telemedicine.

I signed her papers. She doesn’t have to return to work and her job is no longer at risk. When this is over, I’ll give her an appointment and tie up all the loose ends, check the required boxes. For now, the woman is safe.

This virus made me one with the doctors of 1918. I can appreciate the suffering they witnessed and had very little to offer except comfort.

My thoughts turned to the woman at the register and I felt better. I could use a vinyl raincoat, rubber boots, ski goggles and a trappers’ hat.

Olaf Kroneman, MD, is a physician and writer living in Berkley, Michigan