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My Oath and patients who don't believe in COVID-19

He was one of my favorite patients. He was surprisingly cheerful and grappled with his new impairments from his brain injury with grace and a strong sense that he would get better. He worked hard every day in therapy, wanting to know what else he could do to improve his recovery. I found myself making extra time to sit down with him and listen to stories about his life. He had many friends, the gift of gab only a salesman could have who had started many businesses. He was, in short, a delight to take care of, the highlight of those several weeks while he was my patient at the rehabilitation hospital where I work.

He was getting closer to discharge, and I was just about to have several days off. He asked if I were going to do anything fun, and I responded that, due to COVID, I didn’t go anywhere other than work, the grocery store, and gas station. I stood there in my mask, he also wearing his, and he commented, “Yeah, I don’t think this whole virus thing is real, it’s made up by the liberal politicians.”

I was astonished and taken aback. I hesitated for a second, then told him it was real because I knew of patients who had died, I knew of patients and colleagues who had a mild form of the disease, and I knew patients who had survived after weeks of being intubated in the ICU. In fact, I told him, a few were currently at the rehabilitation hospital, going to therapy with devastating holes in their lungs, making it difficult to walk more than ten feet without experiencing shortness of breath and a racing heart. Some were going to dialysis after their therapies because their kidneys had failed. Many had nerve damage in their feet, causing pain and weakness which required braces so that they could pick up their feet to walk. I even had a patient who survived after clots in the arteries of his intestine caused it to rupture, requiring a colostomy bag. And, yes, I even had a patient who survived a massive stroke from clots in the blood vessels of her brain, ones so large she beat all odds of survival.

All from COVID-19.

This was early on in the pandemic, spring of 2020, when I was taking care of COVID-19 survivors. Now I am taking care not only of the survivors, but also patients with active SARS-CoV2 infections as well all the other rehabilitation patients who are fearful of getting the disease.

When I left work on Friday, I had an ill patient who needed to be tested for the virus. I was standing next to her bed, double masked, with double eye protection, gown, and gloves, watching the nurse get ready to swab her nose. She was going to allow the swabbing but told me that even if it came back as positive, she wouldn’t believe that she really had COVID-19. I was surprised, but also really wanted to know what she was thinking, how she came to the conclusion that COVID-19 wasn’t real. She told me that she knew of people who had died of something else, like a bad heart, and the doctors just said it was COVID-19. I responded that it was true that those with underlying health issues are more likely to die from the disease, but even healthy people could get the virus and die. She then told me COVID-19 wasn’t real because people were making money off of it. I didn’t even know how to respond to this comment. I told her, sincerely, that it wasn’t my job to convince her that COVID-19 was real; she could believe whatever she wanted. As I got ready to leave the room, I said, “But if your test comes back positive, we have to move you to the COVID-19 respiratory wing, which means you’ll have to do therapy in your room and won’t be able to come out for ten to twenty days.”

It is true that this is the most challenging time I have had thus far in my career as a physician. And it’s not just the long hours. It’s the environment of fear and anxiety that surrounds me at work. It’s the extra workload when co-workers, nurses, and nursing aides are out sick with the virus. It’s the layers of protective gowns, gloves, and masks that put a barrier between me and my patients. It’s the discomfort of the tight masks that makes it hard to breathe and talk to patients. It’s not being able to send a sick patient to the main hospital because there are no open beds. It’s the daily unpredictability of what new protocol has been put in place since yesterday. But it’s also the stress of taking care of patients who don’t believe in COVID-19, of which there are more than I’d like to admit.

I remember the words I solemnly pledged so many years ago when I entered medical school: The Oath of Geneva, known as the Hippocratic Oath. Here it is in part:

Oath of Geneva

I solemnly pledge myself to consecrate my life to the service of humanity…

The health of my patients will by my first consideration…

I will not permit considerations of religion, nationality, race, party politics, or social standing to intervene between my duty and my patient.

The challenge for me in upholding my oath is in learning how to extend compassionate care to those who are refusing the science. It’s well known in psychology that denial is a coping mechanism; by refusing to accept a threatening reality, one’s fear and anxiety can be decreased. But when taken to extreme, and for too long, denial can become a barrier to healing. How do you get patients to accept treatment for a disease they do not believe exists?

This is a question I ask myself every day, and I still do not have the answer.

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