FRANCIS V. ADAMS, MD
Covid-19 has affected every aspect of life on this planet – how we live, and in many cases, how we die. No field or profession has been impacted more than health and medicine, especially for those who practice at the bedside. According to the CDC (April 17th report) nine thousand health care professionals in the United States have been sickened by SARS-CoV-2 and to date, nineteen physicians have died. Of the nineteen, only one was under the age of 65. In a short time, I will be 74 and celebrate 50 years from graduation from medical school. In less than three years I will have been a pulmonologist for half of a century. Covid-19 has made me face what I have preferred to ignore – my aging image in the mirror and the risk to my own wellbeing.
My practice is primarily ambulatory medicine in an academic specialty group with infrequent weekend rounds. On my last weekend before the coronavirus outbreak, an elderly patient I was seeing with the assigned pulmonary fellow commented that I looked like someone who “should not be working weekends”. I was taken aback by this but attributed it to looking my age, something that also prompts longstanding patients to inquire if I am planning to retire. My answer has always been truthful – I still enjoy what I do and plan to continue as long as I am able. I am aware, however, that many of my generation of attending physicians, some younger than myself, have chosen retirement.
Covid-19 has made me confront aging and my ability to continue to practice medicine. I am not alone as thousands of retired physicians have answered the call to bolster and often enrich the medical community’s response to this pathogen. As a young pulmonologist who relished performing bronchoscopies and pleural procedures, I found that I was welcomed into my academic community. One senior physician, however, would often say to me that although he respected my abilities he wanted “some grey hair” – a more experienced physician to verify my opinion. I confess that I was irritated, even a bit insulted by this request, but as time has passed, I have come to understand its meaning.
The learning process in medicine is never ending and is fueled by the interaction between teachers and students. This process is heightened by the urgency of a healthcare crisis. Certainly, the knowledge gained from years of diagnosing and treating multiple infectious diseases such as influenza, tuberculosis, and HIV is invaluable. Yet physicians of my age must struggle with weighing the benefits of our experience at the bedside against our vulnerability.
It is also clear that PPE has failed to protect many in our profession as the number of sickened healthcare workers grows. The AMA has labelled whether senior physicians should be on the front line of patient care at this time a “complex issue” and the CDC has been silent on this matter. At the very least, physicians sixty-five and older, should be given the option to avoid exposure.
I must be truthful. If I had been asked twenty years ago if I would accept an accommodation allowing me to avoid bedside exposure, my answer would have been a firm “NO”. Now that Covid-19 has made me confront my life and whatever time remains, I answer, “YES”. The face in the mirror tells me so.
Francis V. Adams is a pulmonologist at NYU Langone Health and an Associate Professor of Clinical Medicine at NYU Grossman School of Medicine. He is also a Police Surgeon with the NYPD and hosts the pulmonology show on Doctor Radio on SiriusXM weekly.