I had a normal electrocardiogram, a normal troponin and a CT chest showing only the well-described groundglass changes and no pulmonary embolus. No one knew whether I had ongoing viral replication, reactive airways or my own mini-cytokine storm (which I decided to call a cytokine drizzle, because it wasn’t quite as bad as a storm). I wasn’t sick enough to be admitted and was sent home with albuterol.
After three days of staying in bed to avoid recurrent symptoms, I decided I needed an actual doctor instead of texting friends and colleagues. I set up a telemedicine appointment with a trusted pulmonology colleague. Just seeing his face over the computer brought me comfort. His humanity extended through the screen, as he listened to my story thoughtfully. He took me through his thinking, and he started me on prednisone. Another of my patients’ drugs, but to be fair, also his.
My husband and I marveled at his bedside manner, more impressive when transmitted through a tiny screen. It was a lesson from a master clinician.
With the prednisone, my chest cleared over 48 hours, and I started to drink in full breaths and accept residual pain and tachycardia as deconditioning. What helped most with the uncertainty was good medical care.
Over the past two weeks, I have continued to wait to see what happens next. It is all I can do.
A New Normal
I have started to conduct telemedicine visits. The familiarity of seeing my patients, despite this new method, is reassuring—although exhausting. The usual algorithmic decisions are completely disrupted. What should we do with your biologic when your autistic son works at a supermarket? Why did you stop your biologic just when we finally got your disease under control after a year of trying? No, it’s not okay to wait to check labs if we just adjusted your methotrexate and you simultaneously started on metformin. Do we give you your rituximab for granulomatosis with polyangiitis to keep your lung disease from flaring or hold it to avoid suppressing your immune system? I dread the conversation I’ll have the next time I need to start someone on hydroxychloroquine.
I am plagued by decision fatigue and uncertainty.
So I try to channel my pulmonologist.
I try to reach through the screen and bring comfort and good decisions to my patients. We end each visit with a plan for another one, and we will see at that time what a visit looks like.
