Day 7: psychosomatic coronavirus

The writers of ICD-10 diagnostic codes, whose praises we have had good reason to sing in previous blog entries, have, bless their cotton socks, once again risen magnificently to the occasion, this time providing a off-season urgent addition to the codebook, so that doctors can officially diagnose COVID19. The variations include 'confirmed COVID19,' 'suspected COVID19,' 'contact of person known to have COVID19' etc. They have yet to create the ICD10 code, however, for 'psychosomatic delusions of COVID19 in healthcare provider,' which I think is an oversight, as both trophy BF and I have come down with this, and more data need to be collected with regards to prognosis and morbidity of this. For the last few days I have been increasingly convinced that every time I swallow or take a deep breath, it's _going_ to hurt; meanwhile the only symptom of actual COVID19 that I have currently is fatigue, and that might have more to do with the fact that I'm up at 3:30 in the morning writing a blog and trying not to scratch my poison oak than any phantom viral infection.
The very beloved clinic where I worked for years burned down four and a half years ago, and I cannot help but feel that there is a parallel between what happened then and what is going to happen on a much, much, much larger scale now. I found out about the arson in the middle of the night, when one of my colleagues rang me, and over the two and a half years between the fire and eventually leaving the job, the emotional landscape unfolded as follows;
- initial surprise - whoa that's crazy, but why did I need to be woken up to get told about it?
- over the next few days - things got easier and more fun: we didn't have to do any actual work, because there was nowhere to do it, and when we did have to do something, it was mostly sitting around in meetings getting told about what the plan was going to be, which (again), way easier than actual work, plus people were really nice to us and we got a lot of cake and sympathy.
- over the next few weeks - an enjoyable sense of solidarity and Rosie-the-Riveter-iness as we mucked in and started seeing patients again in a tiny trailer parked next to the smoldering ruin of our clinic. The Germans probably have a better word for it, but until then, I'll bookmark it with auto-preschadenfreude: the pleasure in the drama of one's own's misfortunes before the full impact of those misfortunes has really hit you.
- over the next few months - deep, deep tedium, as the computers in the trailer continually crashed due to dodgy internet, and patients were bad-tempered with us because trailer, and the summer was really hot, and the trailer smelt like a sewer because something was up with the plumbing in the microscopic loo, the nurses and front desk staff were in different buildings so we never got to see each other anymore, plans to put together a new building were stalled out, and the administration moved into spiffy new digs in Sebastopol and yet somehow we were still in the shitty trailer.
- over the next 1-2 years - a profound drop in morale despite having moved into a fairly reasonable prefab building as a temporary space; meetings in which everyone was pissed off, and bitter, and tired, in which we were asked to do more and more with less and less, and the administration gave peptalks about preventing provider burnout without actually doing anything of the things that have been shown to decrease it, etc. etc until
- 2.5 years later I quit and started doing all locums.

I think a lot of health care providers are going to leave medicine over this, and a lot of young people who might have gone into medicine will not, and telehealth will become the new normal in primary care, which in some ways is great (no infection risk sitting in waiting room, more convenient for patients, doctors get to work from home, etc) and in some ways is terrible (it's harder to love a patient that you are looking at on a screen than one you are sitting with in real life, and harder to really understand what's going on with them). We'll see. But right now, at least at several of my jobs, we're in the everything-is-ironically-easier phase: with everything on lockdown, most nonessential visits have been cancelled; those that remain are happening by phone, and we're just waiting for the other, much heavier, shoe to drop.