The Covid Balancing Act for Docs

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The Covid Balancing Act for Doctors

My wife's parents have been leading a relatively monastic life since around mid-March.

Both are in their eighties and live independently in rural Pennsylvania. They maintain a three hectare property for themselves. My father-in-law, the elder of the two, bypassed major medical problems despite decades of indiscriminate diet, testament to the triumph of genetics over lifestyle choices. My mother-in-law, on the other hand, had lupus, which flares up regularly and needs medication to suppress her immune system.

When Covid-19 hit, we feared for their health given their age and weakened immunity, and asked that they lock themselves up so we wouldn't lose them to the pandemic.

And they did.

Where they used to shop for groceries at their local Giant Eagle grocery store (which they call "Big Bird"), they instead turned to Instacart for home delivery and shook off the random items that get their buyer wrong with a good mood would.

Where they went to church in person every Sunday, they saw the video highlights online when they became available on Monday morning.

We have arranged weekly Zoom calls with them to replace our frequent visits.

We always said that their social life rivaled ours as they would meet up several times a week with friends they'd known since kindergarten (kindergarten!) To have dinner, drink, or put on shows. Instead, during the pandemic, they replaced those social events with cruises together in their blue '55 Chevy Bel Air, content with the feel of a car they drove for the first time as a teenager, the beautiful scenery, and a wave of their friends who sat at a safe distance on their porches.

Our whole family was so proud of her that she burst. But in September, after six months, my father-in-law got nervous and did the unthinkable: he went to the hardware store, supposedly for a tool, but really to see his friends gather there.

He caught hell for his modest indiscretion, first from his wife and then mine. They explained to him that he could have ordered the piece online. They reminded him that his actions could affect my mother-in-law and her poor health. Finally he had enough.

"I'm 85 years old," he said. "Eighty-five! I'm careful, I was wearing a mask. What do you expect me to do for the rest of my days in prison?"

That gave me a break – my wife too. At 85 he had done math. Despite his fortunate genetics, he probably didn't have many years on earth and he didn't want to spend one or two of them in isolation.

Shouldn't he understand the risks and consequences of his actions and not be able to see his friends at the hardware store and maybe buy a tool while he's there?

Updated

Jan. 7, 2021, 6:03 p.m. ET

I thought about it from the perspective of my patients, many of whom don't have much time on this earth, and the conversations we had in the clinic.

At the beginning of the pandemic, I was “Dr. No, ”which forbids my patients, most of whom are immune system destroyed, from engaging in their usual social activities. Where much of what we had all heard from government agencies about the transmission of Covid-19 was often contradicting, I wanted to offer specific advice.

Attending a family reunion to celebrate a birthday? No.

How about a high school graduation for a granddaughter? No.

Visiting older parents in another state? Not safe for you or her.

A road trip to Montana with a friend (this from a man in his 80s with leukemia): Are you kidding me?

At the risk of sounding paternalistic, I feared for the health of my patients, as well as the health of my in-laws, and wanted to protect them.

But perhaps because our understanding of the Covid-19 epidemiology has improved over time. or with our realization that we may have to live with the pandemic for many months; or given my father-in-law's perspective that people should do their own risk-benefit calculations at the end of their lives, my conversations have now become more nuanced.

I am more open to my patients who do not miss important life events when there may not be much life left for them, provided they take precautions to avoid endangering themselves or those around them, especially given the recent surge in Covid-19 -Cases.

A woman with leukemia received chemotherapy in early 2020 when her daughter miscarried. Can your daughter, who is eight months pregnant again, hold the baby at birth? In any case, let's talk about how to do it safely.

Another patient's mother died. Can she attend the funeral? Yes, with reasonable distance, limited numbers and personal protective equipment. But skip the reception.

The road trip to Montana? I still wasn't comfortable with it, but my patient and his friend left anyway, took their own food, slept in their truck and he came back with no Covid-19.

And my father-in-law? He leaves the house a little more than he used to, but not as much as he would like. On the rare occasions he does these days, he's always masked and left outside, and both he and my mother-in-law remain Covid-19 free.

What I notice about the right balance.

Mikkael Sekeres (@mikkaelsekeres) is the director of the hematology department at the Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami and author of "When Blood Breaks: Lessons from the Life of Leukemia".

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