I am a nonbinary physician of color. I actually worked for the state governmental COVID 19 response here in Oregon, as my first job in this state.
I felt tremendous responsibility and pride in doing the work I did when I did it, because there was an acknowledgement of community stake, partnership and investment with the way we did our work. Blue state vs. Red Federal policy clashes somewhat helped with the ability to do the work, above and beyond what the CDC was publishing in those days. We were in a group of about 18 physicians and scientists writing policy and guidance from a variety of lived experiences. I contributed heavily as a physician of color and made some of my first few friends in Oregon working in POC predominant teams as the scientific liaison to state based community engagement work. I was publicly shamed and ridiculed on the internet by trolls and those at odds with the state’s policies that emphasized community action and non- pharmacologic interventions to keep everyone safe from a new, scary and unpredictable threat. Yet through all this, I persisted.
I ended up leaving my position in early 2022 when after more than a year of conflicting policies, shifting narratives, the politicized CDC influence on state-based policy making was too great and overrun by individualistic public health policies to an airborne pathogen. For something as contagious as COVID-19 and with ongoing high mortality and even higher morbidity, an individualistic approach just serves to marginalize the few- the disabled, the elderly, the chronically ill, and really a lot of female bodied people without any of the above conditions with the disproportionate and increasing toll of long Covid in all these populations.
Out of concern for my own safety and to avoid new disability, I have continued to avoid getting infected. These days it has been getting increasingly difficult. I spent the 6+ years of my medical training suppressing and coping with a moderately disabling condition to know how terrible it was to feel even moderately disanled compared to peers. A friend even casually mentioned one day that I was a 27 year old in a 40 year old body. Ableism exists and even worse so for people in the health professions. I also don’t have the luxury to assuming that my family with chronic illness including immunosuppression will survive repeat COVID infections without worsening of their chronic conditions, or loss of their transplant organ.
Since COVID-19 continues to kill 1.5 times as many people as seasonal influenza, and maim even more even in the times of Omicron sublineages, I don’t have the choice to ignore it. Ignoring it could potentially risk my livelihood, my intellectual ability, including the brain that got me through years of medical school, and the physical ability that allows me to enjoy life without pain and restriction.
As an extrovert, my life has changed dramatically. Negatively? Not necessarily. I’m selective with my friendships, I have stopped seeing a lot of my friends who have moved on mostly because of dismissive or slighting comments, and unwillingness to make accommodations to see me. My life is full of outdoor patios, and masked brief indoor outings here in the states. I have traveled and continue to travel with my partner- albeit in lower frequency than pre 2020 – in fit tested n95 respirators. I got to go to Japan to experience life in a collectivist society, even if for a brief while, earlier this year. My respirator kept me safe, as did community masking through all kinds of crowded venues.
The costs of my life are that I know more, and care more about chronic illness and the dangers of reinfection. Much more than my immediate family, my partner and oftentimes some healthcare providers. That’s been a side effect of always staying appraised and up-to-date on this virus and its accompanying set of illnesses. It’s a burdensome role, shared by many other new branded COVID experts, even larger of a burden for those studying long COVID, those studying end organ system and immunologic impacts, who then have to share this data with the public. It’s a tremendous moral injury to be a caregiver of people and of populations in these times.
I returned to clinical practice for a short while between policy changes, for a half day per week from the summer of 2021 to 2022. I had a mostly substance use reduction based practice and felt uncomfortable in increasing workloads of COVID-19 positive patient care that I knew were upcoming especially with increasing community transmission. However, with societal reopening and the end of the mask mandate on transit, my commute on crowded max trains got increasingly uncomfortable, and especially so during times of high community transmission. I left in-person clinical practice, a year after I had re-entered it. I feel increasingly reluctant to return especially with the loss of universal masking in healthcare settings even more recently. Unfortunately, this virus is not at a virulence that I can tolerate workplace exposures without reasonable mitigation. Despite some personal and group based advocacy I engaged along with others, mostly disabled, suffering from long COVID, or other chronic illness that puts them at risk, we failed to achieve a stay on healthcare masking. I have been lucky enough to not require frequent healthcare services for myself during this period of sustained viral infectivity and severity combined with falling mitigations. But these compounded losses as a healthcare provider, I will grieve for longer, and more deeply than some of my other social and community losses where I could rebuild and forge new connections from the small but still strong community of people who care about community caring, love, support and wellness.
The only times I feel concerned for my wellbeing and mental health are in the gaslighting and minimizing comments by healthcare providers, and colleagues both in public health and healthcare who have “moved on” and make comments to indicate disapproval or worse, incredulity.
I knew, years ago, when I entered Healthcare as a profession, that this was a place for healthy people, who “worked out”, who experienced no chronic illness, both physical or behavioral, or none that they could show transparently. This has been highlighted by the Oregon Medical Board’s decision to remove stigmatizing language on the attestation forms for physician licensure around mental health and substance use. But cosmetic fixes like this don’t dismantle the very real systemic ableism in healthcare that continue to persist. Some of the same reasons for physician suicide I see replicated in the gaslighting, marginalization and repeated dismissal of physicians who desire and have very real physical needs to avoid and minimize infections and reinfection with COVID as a reason to avoid or reduce the chance of disability. If our healthcare workforce, agencies and systems can’t even care for our own, who will care for our patients?
