In March 2020, medical articles and personal stories were emerging from Wuhan, China. The one that kept me up at night was a story in The New York Times of two physicians, both healthy, both young, both who got COVID-19 at work, both who needed ICU care, and only one of whom lived. The widower husband said, “I can’t bring myself to tell our son yet that she’s not coming home from work.”
After 15 years in the field, this would be like no other year of medicine.
The next weeks were spent in a flurry of meetings (some of which were the first virtual meetings I had ever convened) with my physician partners at Lakewood Family Medicine. We were suddenly pivoting to provide care for our 25,000 patients in a safe, high-quality way that still allowed access for all the “other” medical maladies that happen every day, and in ways that would also protect the 80 members of our staff.
Office could not close
In February 2020, my office had had one box of 10 N95 masks, which we saved for the rare suspected tuberculosis patient. By the time we realized the scope of what we would need to safely see sick patients, the markup from suppliers was astonishing.
We made a list of diagnoses (fever, cough) that prohibited patients from coming into the building; they would have to go to urgent care until we could secure separate space and adequate personal protective equipment (PPE). We decided that we could not completely close the office.
Thinking this disruption would last just a few months, we moved routine adult physicals out to May. We removed chairs from the waiting room.
After discussing potential telehealth video visits for several prior years, in a matter of days we tested, retested, wrote a grant, and purchased software (before we knew if the grant was going to be funded) for video visits.
We quickly realized that with lighter patient schedules — even with staff performing more cleaning (we ran out of sanitizing wipes in short order and actually went to the dollar store for bleach to make our own) — the clinic needed to downshift staff to stay financially solvent. One of the hardest decisions we made was asking our valuable employees to reduce their hours dramatically for a few months and take unemployment for hours lost.
Yet as a physician, the hours I was putting in reminded me of my residency days. I frequently logged into my work computer from home to refill prescriptions for patients who were running low, to answer myriad patient questions, and to continue to communicate to staff the latest guidelines and plans.
PPE plea and evolving research
I contacted every scientist I knew in the community (thankfully, my spouse is a Hope College chemistry professor) and begged for PPE donations from their furloughed labs. I spent nights reading the most recent research, which changed weekly — and sometimes daily — about how COVID-19 was spread, how to protect our staff, and how to spot cases (toes that looked like frostbite, loss of taste and smell, atypical white blood cell counts, distinctive imaging on chest CT) when definitive coronavirus testing was not readily available.
A general lack of information, followed by conflicting information, and lack of supplies brought a low point. What kind of crazy world experiment was this? The N95 mask — which was a one-time, one-patient-use item a month prior — was now being rationed such that personnel at the hospital were given five for the month and asked to rotate them by days.
We desperately needed testing, but hardly any was available. Patients were dying, and there was still little data about what helped and what caused harm.
West Michigan did its thing
But then, West Michigan did its thing. PPE from furloughed workplaces arrived with such frequency that a hospital administrator was reassigned to manage it all. Home-sewn masks, scrub hats, and isolation gowns were donated. Hospitals and independent clinics shared information about infection control, COVID-19 test kit numbers and sites, as well as protocols of who and when to test.
Everyone lobbied for more available, more reliable, faster testing, and more shipments of PPE. Breweries made hand sanitizer. Donations of meals, coffee, oil changes, flowers, and prayers arrived on days when it seemed like we were in a bad dream.
Patient interaction remained the bedrock of why we showed up every day. Whether it was helping a new parent navigate life with a newborn when grandparents couldn’t visit, or ordering a round of physical therapy for an assisted living patient who was forgetting to get off the couch since the group dining room was closed, or having a video visit with the COVID-19-positive family and coaching them through getting their first Shipt order delivered to their porch, patient interactions still felt “normal” in the midst of so many abnormal aspects.
My family also showed resilience I never knew they had. My kids (ages 10, 12, and 14 at the beginning of the pandemic) quickly established that they were capable of doing school from home, meal prep, and home chores if bribed with the right motivators while I worked weird schedules and went straight to the shower upon arriving home.
Gradually, things improved. Testing became widely available. Usual care, like physicals and elective surgeries, resumed. Lakewood Family Medicine leased space and opened a separate “sick” clinic, where full PPE was worn to see ill patients safely and efficiently. Monoclonal antibody infusions for high-risk patients changed the game from “fluids, acetaminophen, and prayer” to “we have an outpatient treatment that works!” Chairs returned to the waiting room, albeit socially distanced. Safe and effective vaccines arrived.
Just as West Michigan rallied in 2020, Michiganders will soon open doors and fill tables and chairs with community conversations and precious human interaction. COVID-19 will not disappear, but we will live safely with the knowledge and resources of how to protect ourselves, our families, and our neighbors.
We will be able to honor the memories of those we have lost, celebrate our resilience, ingenuity, and community commitment, and move forward — stronger — together.
Dr. Beth Peter is a physician at Lakewood Family Medicine in Holland. She is a graduate of the University of Minnesota Medical School and completed her internship and family medicine residency at Poudre Valley Health System in Fort Collins, Colorado. She and her husband have three children. Together they enjoy gardening, winter sports, and music.