Covid-19 patients and a cancer diagnosis: the anxiety of an ICU doctor.

About four weeks ago, after already postponing twice, I went for a routine dentist visit. An exam of my tongue revealed a small white spot or “leukoplakia” on the side of my tongue that I had neither seen nor felt. I was told it needed to be biopsied. A few days later, the coronavirus forced my dentist to stop performing such routine exams.

Two weeks ago, an ear, nose and throat colleague performed the biopsy and removed that white spot. The next day, he also stopped seeing outpatients. But my procedure had been done in time. Four days later, I had the results: squamous cell carcinoma in situ.

So, the cancer part was bad. Cancers involving the head and neck do not respond well to radiation and chemotherapy and have a high rate of recurrence. But the in situ part was good. It means the cells are misbehaving, but it looks like they all stayed in place. I scheduled surgery nine days later to remove more tissue from my tongue, making sure there are no cancer cells seen at the margins under a microscope.

Two days later, I went back to work at the intensive care unit. That was a mistake.

Speaking was painful and eating nearly impossible. The fatigue caused by my rapid weight loss was a constant reminder of my diagnosis, making it hard to tamp down my cancer worries. I admitted six patients overnight during my shift, three of whom were potential covid-19 cases. There was no safe haven for my brain. I had to lie down several times to slow my breathing and get my heart rate under control. After only one night shift, I knew I was not ready to go back.

My defeat was actually a blessing in disguise. Because I’d been working in the ICU I could not have the cancer surgery until I was 14 days free of covid-19 exposure, to ensure that I couldn’t infect anyone during my procedure, which would require anesthesia. Some Chicago-area hospitals were beginning to cancel surgeries. I did not want mine to be one of them.

So now I sit at home, worrying about things out of my control. Forced social distancing is simultaneously decreasing the spread of a viral pathogen the world wasn’t prepared for and giving me quiet time to think. I feel a mix of fear, anger and guilt.

Fear of my own cells that betrayed me, that one or two might already have escaped and spread to other parts of my body, which can happen with squamous cell. Fear of my impending surgery and pain. Fear, frankly, of returning to the hospital after I’ve recovered and caring, as I am called to do, for the covid-19 sick. I fear leaving my family without a father or a husband.

Anger about inadequate personal protective equipments and ventilators that should already have been made and ready for everyone who needs them. Anger that people who should have been paying attention and preparing the country for this pandemic let things fall through the cracks, with all of us vulnerable as a result.

Guilt that I needed help covering my ICU shifts. Guilt that I get a pass from dealing with an increasing number of patients and shrinking supply of PPEs and from an ICU where the specter of covid-19 permeates everything. Guilt that I’m not there and at the relief I can feel at not being there.

Like many people at home with time to think, I also feel a profound loss for a life and a community that has so suddenly changed, and I wonder when it — and the overwhelmed health-care system I’ve always assumed would be there — will come back.

I know I am lucky — I will have surgery that will I hope cure me of a threatening disease. Forty-eight hours was the difference between the dentist and ENT being available and being forced to wait until social distancing is relaxed. Waiting months for that to happen could very well be the difference between “in situ” progressing to “invasive” on the biopsy.

Yet, I wrestle with the knowledge that there are so many people having to manage far greater degrees of uncertainty with their own acute and chronic diagnoses during this pandemic.

Too many doctors have closed their offices. Emergency departments are overwhelmed. Surgeries and other important treatments are being delayed. Hospitals have never been scarier for patients who are now alone without family and friends allowed inside. As a physician, I know I have more insight and control over my path than most.

But this surgery will be my first, and it will be a role reversal for me. I’ll go under anesthesia and be on the other end of a breathing tube, ventilator and a fancy laser scalpel to remove part of my tongue. My MD degree will not spare me from being nervous and vulnerable. And hopefully all will go well.

Most important in this time of coronavirus, I will be buoyed by multiple tribes — family, friends, medical colleagues, neighbors, teammates. These ties have never felt more important than right now.

I will wake up from surgery. Eventually, my tongue will heal and my ability to speak and eat will return to normal. I hope my cancer will be gone and not return.

My world will still be filled with uncertainty; adjusting to whatever my results will show with a global pandemic in the background. But I will be ready to leave the sidelines and help be part of finding a way back to the normal we all crave.

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