Medicine and Mothering on the Front Lines of COVID-19

Two weeks ago I picked my kindergartener up from after-school basketball on a routine weekday afternoon. He bounded up to me, backpack in hand and asked, “Mom, do you know about coronavirus?” His teachers had discussed the viral outbreak and the need for good hand-washing skills. My budding epidemiologist went on to explain how the virus spread from bats to another animal to a human to another human to even more humans and so on. I tucked him into bed that night, marveling at his teacher’s skill in stressing hygiene and explaining the novel virus to a group of 6-year-olds.

Of course now coronavirus, or COVID-19, is all anyone is talking about, reading about. Coronavirus has uprooted my personal and professional life. As a family medicine physician working in Seattle, and as a mom to three young children, COVID-19 has consumed my day-to-day activities and workplace. As a primary care clinician and parent at a U.S. epicenter of the outbreak, there is no other word for home or work right now than upheaval.

I am also a writer, a creator of art. But I have struggled to find the time and emotional space to articulate and explore all the layered questions this crisis has presented to me—as a physician, as a mother to young children, as a creative being in this world. Fragments of essays, lines of poems, pour out of me as I wake with anxiety in the middle of the night, as I run around a deserted Seattle park, as my children beg to gather with their friends, as I discharge a clinic patient who pauses as she exits the exam room: “Thank you for being a doctor.”

As a participant of Harvard Medical School’s inaugural Media & Medicine program, I’ve recently been trained in writing Op-Eds for the public, in discerning misinformation and disinformation in the media about healthcare issues, in thinking creatively about how we can use podcasting or plays or poems to tell stories that make a difference to important public health topics. My classmates and I, healthcare professionals from all over the world whose projects focus on varied themes from mental health to vulnerable populations, from physician burnout to cancer awareness, suddenly find ourselves in the middle of a pandemic, sharing stories from our respective locations worldwide.

My work right now, though, is focused here, on my community: the people I hold most dear and the place I grew up in, I trained in, I live. My colleagues and community are at the forefront of this pandemic. I feel the rising sense of fear, the wave of overwhelm, the steady thrum of kindness.

For now, I offer this. Anyone who attended medical school with me knows I like to make lists. I approach a seemingly insurmountable task by compiling, organizing, and splitting it up into manageable components. Over the last two weeks, as local healthcare systems faced rapidly changing recommendations, confusion about suggested protocols, differing messages on testing capability, questions about adequate protection and supplies, as schools closed and family schedules were upended, I gathered information. Here is my contribution, my list of reliable resources and information for the worried, weary, and hopeful among you.

Despite my own swirling anxieties, I’m grateful for the work I’m trained to do, in medicine and in the humanities. I’m thankful for my colleagues—every aspect of the health care team—who are committed to serving our community’s most vulnerable, and each other, through an uncertain time. I’m bolstered by the parents sharing resources and tips about how best to support our children through unprecedented upheaval. This, I know: we are distilled in a crisis to the best, or the worst, that is in us. May we cling to the best, stand firm in sound science, look to compassion and art that sustains our souls, and encourage others to do the same.

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Paris

Bonjour! I’ve been remiss with posting lately due to travels. I went to Paris in early June for both work and pleasure. It had been a decade since I’d visited the City of Lights, and, despite several stressful setbacks (beware that Airbnb, even if reserved months in advance, can cancel within days of your scheduled arrival!), Paris did not disappoint.

I have a special affinity for the city, as it was the first place I traveled internationally. I took French in high school and went there as an exchange student, living with a host family for just a couple of weeks. It was the first time I’d been anywhere predominantly non-English speaking and my host family was attentive, warm and forgiving. My time in Paris was a gentle nudge out of my American suburban bubble. More drastic shifts in my world perspective would come later, but I always think of Paris fondly as my start to a love of travel. And, of course, it’s Paris! The richness of art, architecture, food, parks, history…. I’ve been back to Paris once each decade since and this, by far, was my favorite trip.

I had initially planned to attend a writing retreat right before my medical conference, but as the retreat was canceled, I instead had several days completely to myself in Paris before my husband arrived and my conference started. As a working mom with three little ones, solitary time in this magical city was bliss. I strolled the narrow streets, stepped into cafes and hidden parks. I hit my favorite Musée d’Orsay and Rodin and sat in quirky bookshops sipping espresso and writing in my notebook. I even had a chance to read a poem during a multilingual open mic night.

The summer institute I attended was also exceptional, an annual meeting of the minds hosted by the CHCI Health and Medical Humanities Network. This organization is a “hub for health and medical humanities research and collaboration” and this year’s theme, “Health Beyond Borders,” brought together experts in both narrative medicine and global health, each particular interests of mine.

Several talks I particularly enjoyed were:

A keynote by Ghada Hatem-Gantzer about her incredible work with women and girls who have suffered violence.

I connected with Shana Feibel on #somedocs prior to the summer institute when I stumbled across her post about presenting in Paris. Dr. Feibel spoke about a topic that resonates with me: “Bridging the borders between Psychiatry and other Medical Specialities: A Case for the Medical Humanities.” I hope to continue to learn from her work in this area.

Sneha Mantri from Duke is a neurologist with her Master’s in Narrative Medicine and gave a fascinating presentation about border crossing and modern medicine as it relates to Mohsin Hamid’s novel Exit West. I also learned Dr. Mantri was in the same narrative medicine class at Columbia as Stephanie Cooper, who I’ve gotten to know well through the Seattle chapter of the Northwest Narrative Medicine Collaborative. It’s a small, connected world!

Columbia’s Danielle Spencer presented innovative work on the idea of lived retrospective diagnosis, or metagnosis. I’m looking forward to her book on this topic, forthcoming in 2020.

Emergency Medicine physician Craig Spencer gave a moving keynote presentation about his work with Medecins Sans Frontieres and specifically the migrant crisis in the Mediterranean.

I returned from Paris rejuvenated and energized on many fronts. C’est magnifique.

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A Turning

It has been a season for me. I remember when we got married our pastor talked to us about seasons of not just marriage, but also of life. The last two years have been one of these unexpected seasons. Facing the end of this year, I feel a turning, a shift, the wide open expanse of a new season. Struggling through the valley I have during the last two years, gratitude has taken on new meaning.

My youngest is well into toddlerhood, I’ve reached mid-career, mentoring and teaching and taking on new leadership positions at work. Part of it, I’m sure, is turning 40, the new comfort I have in my own skin, my decisions, my priorities. I have friendships that are true, my relationships are richer for the authenticity they now enjoy. I am planning more trips and solidifying dreams, in medicine, in writing, and at home.

Each year for many years, I’ve worked through Tsh Oxenreider’s alternative to resolutions. She has questions to both look back on the previous year and project forward into the next (now called 12 Months From Now, but I’ve used the older version for years.) As I look back this week on everything I wrote down in January 2018, I am aware that the gift at this time, in December, is much more than I dared hope for. May you know that whatever darkness you find yourself in, whatever hope has been lost, whatever stage consumes you, that there always is hope, there always comes a turning. For me, that time is now. Happy New Year.

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Free Write Friday: Santa

All she can think about is David Sedaris’ Santaland Diaries. She heard it on NPR a few years ago and now she wonders if she’s scarring her children by taking them to this place. As a child, though, she longed to see Santa, the fancy department store one: billowing beard, velvet suit, matte boots.

So she takes her children now, clothes them in glittery dresses, in dapper sweaters. The youngest likes fancy “party shoes” so she buys gold flats on clearance at the Nordstrom Rack, presents them to her with a flourish. Unfortunately, the toddler refuses to wear socks, shuns tights. Instead her tiny heels blister, redden with the rubbing of a stiff shoe. By the time she gets to Santa’s lap she has kicked them off, bare feet dangling. Her face clouded by the confusion of curiosity about, and fear of, this large stranger.

The five-year-old has written a letter this year, presents it to the man in the red suit. He wants mom to sidle up, support his entreaty. Head down, he makes his requests in a small voice, so different from his usual chatty nature. He is lately into jewels, into diamonds, into geodes, the shiny treasures of this world. He is lately into big cats, wants to travel to the Serengeti, tells any who will listen his animal factoids. He makes his request, then shuffles away to the safety of mom’s sturdy legs, strong arms and the reward of a sticky candy cane.

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Free Write Friday: Carving

She likes pulling the top off at the stem, the way it can be placed right back like a corresponding puzzle piece. She’ll use a scoop but finds more satisfaction in her bare hands, stringy innards gripped with tenacity, pulled at until they give way. She’s the one to sort through the gourd’s flesh, retrieve each slimy seed, spread them on a baking sheet to roast to nutty perfection. The five-year-old shouts a reminder to save a few seeds for his garden; he’s studying plants, learning about spiders at school.

Then, the design. A template or a copy, stolen from a previous October or a Pinterest post. She never was good at coming up with artistic inspiration on her own. A traditional cat, an astonished ghost, a toothy grin with triangular eyes. The children need help with the markings on the convex surface, the wielding of sharp tools.

They place a tealight in the bottom of the hollowed out orb, set the creations on the front porch steps. Barely evening, it’s dark already, light from the jack-o-lanterns wink at those passing by. Children satisfied with the bright orange set against Benjamin Moore’s Newburg Green, they retreat to the warmth of the indoors to sip hot cider. Cinnamon and cloves suffuse the air as they gather roasted seeds to snack.

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Free Write Friday: Tractor

We arrive late afternoon, after the youngest wakes from her nap. Pumpkins first, the field is littered with families arranging their littles on orange gourds, with teens snapping selfies before disappearing into the corn maze. It’s the weekend, late in October so the pickings are slim. My five-year-old rushes to a perfectly rounded pumpkin, the appropriate size, just to be shattered when he realizes the rotty blemish on the bottom precludes this particular selection. My eldest squints from the harsh sunlight, peels off her fleece jacket as she rushes across the field in search of less picked over options. When sufficiently satisfied with our selections, we wheelbarrow them back to the entrance, pumpkins flanking the littlest for the ride.

Kettle corn is next, oblong bags hung on an apple cart, ready for sticky consumption. I like the crunch, the mingling of the salty with the sweet as remnants of kernels wedge between my teeth. Little fingers joust for a handful of the popular snack.

We meander to the petting zoo, a miniature horse and stench of pig slop greet us near the barn. My son clambers onto the old tractor, rusty and stationary. He turns the wheel this way and that, bares his teeth in glee. He hops down eagerly when I mention the slide.

They climb the hay bales to the top and glide down, side-by-side, each on a burlap sack. Parents wait at the bottom of the slides,cameras at the ready, crane their necks in anticipation of their child’s turn. A few revolutions and mine are ready to move on to the bouncing blog, an inflated rubber pillow of sorts, embedded in the ground. Children hop and skip across, as if weightless on the moon, as if soaring off a trampoline.

The toddler pleads for the tractor ride, a lumbering pull past the corn maze and the play area. The rest of us acquiesce her request, tiny squeals still ringing in our ears. We sit shoulder-to-shoulder, hip-to-hip with other families as they snap pictures, wave to those we pass. My youngest rests her arm on a stranger’s leg to steady herself as the tractor lurches forward. The woman smiles down at her as we make our way back along the dusty lane.

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Free Write Friday: Low Tide

We wait until morning, sip percolated coffee, nibble day-old donuts bought at the new gourmet shop adjacent to the ferry terminal. A friend saunters up from an adjacent campsite to let us know they’re heading down to the beach. “It’s low tide, right now!” Kids circle their way back to the campsite, wheels turning. They discard their helmets as we stroll to the rocky cliff.

A woman stands by a sign outlining the local sea life, pulls up her scuba gear, ready to search for urchins, float among the kelp.

We clamber down a few concrete steps, then cling to the rock face littered with barnacles, making our way to a sandy cove. A parent points out footprints: a second grader’s sneakers, a crab’s pointed tracks, the imprints of a dog’s paws padding across the compact sand.

A rock island is exposed, tide pools revealed. Green anemones open with neon fronds, swaying gently until startled into retreat. Bouquets of mussels jut out in clusters among mossy kelp. Limpets cling to the black rock, suction secured. We stop, we bend down to observe.

Two moms well versed in marine life point out the chitons, armed with a hardy shell of armor they remind me of turtles, of shields. There are always eight plates, predictable. One child shouts out, “Mom, come over here, it’s the biggest chiton in the world!” We moms give each other a knowing look: could be, but more likely a 7-year-old’s exaggeration. Instead, we find what she describes: a chiton as big as our hand but without a shell. “Maybe someone took its plates.” The thought makes us sad, a thief of the worst kind. We look it up later and, in fact, the creature is just as it was meant to be: the giant pacific gumboot chiton is without a hard exterior. An aberrancy of its kind in size and structure.

A few more from the group straggle, venture out to the ends of the fingery point in search of an elusive seal that pops its head momentarily up above the surf before diving back down again. My son has gathered too many mussel shells, iridescent shimmer calling to him like a siren, the abundance too much to contain his enthusiasm. “Here Mom, I found another one!” I convince him to choose a solitary shell to cherish as we make our way carefully among the slippery rocks back to shore.

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Free Write Friday: Soccer

Her cleats are neon pink, a black swoop to give them credence. She hustles onto the field, tackling her girlfriends in a playful gesture. They run drills, found on the internet by the volunteer coach. Games to teach them teamwork, footwork, skills for basic play.

We bring our camp chairs, a bag of snacks, two water bottles to quench their thirst. The littles run on the perimeter, beeline to the playground where they can swing and slide and dig in the sand for a temporary distraction.

I see the girls from afar, their ponytails wagging as they scrimmage, green jerseys tangled up in the fray. They take turns kicking into the net, ball shanked to the left, to the right. Their legs scissor across the grass, some controlled, some gangly, some running to the goal with intention, comfortable in their bodies, aware of where thye’re going and who they want to be.

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Free Write Friday: Girl Scouts

We met in a Methodist church on a weekday afternoon. Recite the pledge, munch a snack, craft a project. We’d earn badges through field trips, skills, lessons. I was snack helper, clean up helper. We’d rotate through, sit in a circle on the beige carpet. Make new friends, but keep the old; one is silver and the other gold.

We took our sleeping bags to overnight camp, sang songs around the campfire. Kumbaya. I didn’t like the bugs, the forest air was foreign to my sheltered suburban self. I liked the novelty of it though.

I never was good at selling cookies. My dad retired young, couldn’t take them to work like the others. Too many other Girl Scouts in my neighborhood, we had to ration out the doors to knock on. Most people were nice enough to the awkward girl in the green vest but I wasn’t animated enough to make more than a pity sale. My mom, like me, an introvert and not wanting to be too pushy, didn’t help my failing cause. I wanted to be forward, learn the marketing skills, but I never did muster the ability to sell.

I remember traveling with my troop to the Peace Arch on the northern U.S. border, admiring a stylish girl with long braids and a green beret, souvenir pins stuck to her vest. What travels she’s made, what friends she’s met! I started collecting pins that day, not to trade but to keep: document the family road trip to Disneyland, the annual summers in Hawaii, the study abroad in France, the Mekong Delta, the crowded dusty streets of India and beyond.

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Free Write Friday: Pay Phone

We hardly see them anymore, the free standing booth a novelty. A friend’s son once asked, “Mom, why do they say ‘hang up’ the phone?” Well, this is why: the dangling silver cord like a techy serpent, tethered to a bulky handset.

Now we’re all cordless, no need to connect other than with head down, blue screen filtering. Everything is shiny, posed, captured. No hang ups, strings attached, call waiting. All is instant, polished, curated.

I remember anticipating a call at home, phone ringing in the kitchen, my dad answering hello soon after I picked it up in my basement bedroom. “I GOT IT!” reverberating through the house, high pitched preteen voice anxious for privacy.

I remember fumbling with silver coins at the pay phone, flipping through weathered white pages skimming for the right name, pen scratches and coffee stains marking the tissue-like paper.

I remember a friend’s dad’s car phone, brick handset centered between the front seats of their Chevy Suburban. The wonders of a phone call made from a moving vehicle, away from a stationary box without foundation, without directional bounds. It was fancy, magical, very nearly unheard of. I watched in awe as he answered, mid-errand and corresponded, communicated, then moved on about his day.

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