Rural physician takes a measure of himself in the shoals of the pandemic

April – May, 2020

Rising to the call
May 21, 2020

Doctors and nurses begin their health care careers knowing that at times the work will be physically and mentally grueling. But few U.S. clinicians would have expected to have to put their lives on the line to care for others. The risks of contracting COVID-19 from patients and possibly infecting loved ones has given pause to many clinicians, throwing into question what the next days, weeks or months will bring.

At age 59, Dr. Dan Florey, a primary care clinician, had settled into a comfortable career and work/life balance. He is on the staff at Avera Tyler Healthcare Center, an Avera Health critical access hospital in Tyler, a small town in southwestern Minnesota. But the spread of COVID-19 across the U.S. forced everyone off autopilot, causing countless people to take stock of their lives and livelihoods. In early May, a colleague speaking on a group call asked primary care providers to share their emotions related to the pandemic. Dr. Florey said he had too much to say about his powerful and conflicting feelings to speak up. Instead, he put his accounting down in a letter to that colleague dated May 9. A lightly edited copy of his missive is reprinted here with its author's permission. As of May 18, Lincoln County, where Tyler is located, had four diagnosed cases of COVID-19 and no deaths.

w200521_Dr Daniel Florey_a

In Tyler, I feel like I am standing on a beach. I have heard the tsunami warning and I know that a disaster is approaching. I am trying to prepare for the wave that most certainly is coming. But, right now, the beach is quiet and peaceful. There is nothing to fear here. I have heard and read stories of people in my position who have seen and fought the wave that is to come. I have seen the pictures of the bruised faces surrounding the profoundly sad eyes of distant colleagues who have worked tirelessly in intensive care units fighting off death. But I am here standing on the beach watching the water recede from me.

So, there is a sense of guilt. People thank me for working on the front lines. They describe my efforts as putting my life and health at risk to care for my patients. But I know that is not the reality. Is it right for me to sit safely in Tyler while my colleagues truly are risking their lives and health to take care of people suffering from this disease? Intellectually, I know that my role here on the beach is important, but it hardly feels heroic.

Dr. Dan Florey in the personal protective equipment he wears to treat patients who do not have symptoms of COVID-19.

So, there is also a sense of shame. I don't want to risk my life and my health to fight this disease. I'm 59 years old and I know that health care workers have tended to get more severe cases of COVID-19 when they get it. The thinking is that it is because we are exposed to a higher viral load and our immune systems may be compromised because we are tired and stressed. I want to stay safe although my calling in my profession is to care for the sick and to be a channel for God's healing grace.

I don't want to die of this disease. It isn't that I fear death; I know that what awaits me when I leave this life is better than what I can imagine. But there are so many things that I want to see and to do. I want to grow old with my wife. I want to see my daughter's career flourish. I want to meet the grandchildren that I know I will eventually have.

There is sacrifice. I had gotten to a point in my career where I was told that overnight call, weekend call, and holiday call were a thing of the past. But here I sit in the hospital call room in Tyler in the middle of day six of a seven day stretch of call. Because I live an hour away from Tyler, seven days of call means 170 hours away from home. It's what I have to do now, and my wife knows that as well, but it feels like a sacrifice. But, then again, what is it compared to what the doctors in New York, Detroit, New Orleans, and other hot spots have had to sacrifice? What is it compared to distant colleagues that have given their lives?

There is anger. I hear people say that the pandemic isn't real. It makes me angry to make my little sacrifices and to see and hear about the apocalyptic conditions in the hotspots while they engage in their denial.

There is sadness. I miss normal and I mourn its passing. I am sad thinking about the very real possibility that I may attend the death of a nursing home resident for whom I have cared for years. I am sad thinking that they may die not having felt the touch of a loved one for weeks because of lockdowns and quarantines. I am sad that the last face they may see will be that of a nurse or provider wearing goggles and an N95 mask. I am sad that the last touch they may feel will be through gloved hands.

There is pride. I am proud of the steps that we have taken to prepare to help our community in a time of crisis. I am proud that I can help find ways to bring healing to my patients without necessarily putting them at risk of having them come into the office. I am proud to be part of a team that can creatively imagine and implement plans to more than double the number of people that we can care for in our little hospital on the prairie. I am proud that I made a choice to go into a profession where I am able to make this kind of difference for my patients. I am proud that my choice rubbed off on my daughter and that she is successfully training to make her own path in a career in medicine.

So, there you go. My guess is that I haven't even really connected with half of what I am feeling.

Copyright © 2020 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.