A COVID-19 Test Journey
On Saturday afternoon after a long morning run, a fever came on me with a vengeance, and I had a somewhat sleepless night. Sunday morning a few other symptoms appeared, and I began to wonder if I had become infected with the COVID-19 virus. By mid-day, I used the MGH patient message portal just to let my PCP know my status when she would arrive at work after the weekend.
She has always taken excellent and supportive care of me, most notably when I had a fever of unknown origin (FUO) four years ago that resulted in a long MGH hospital admission with no ultimate diagnosis other than FUO. Fever always brings on a bit of flashbacks to that event. As I lay asleep in bed with my fever growing, my wife, Ariane, made the decision to call the MGH on call doc who informed my PCP.
My PCP called by mid-day, a call I had not anticipated, and she reviewed my symptoms before saying, “I recommend an assessment for COVID-19. You have symptoms and you’re in the older high-risk cohort. I can get it done for you Monday morning at our Respiratory Clinic which has been set up specifically for assessing patients at high risk. You won’t have to go the ER.” So today, Monday, Ariane drove me to the MGH Respiratory Clinic set up off site of the main campus. Even though I have worked as a clinician and administrator in healthcare for over 50 years, it truly felt as if I was walking into a war zone. I had images from the ET movie of ET and Elliot in the isolation unit. It was completely choreographed for viral safety. MGH had commandeered a section of a parking garage set up only for patients being tested just below the Respiratory Clinic.
In advance, an individual from MGH “Capacity Management” had emailed instructions and documents that were coded and needed to be shown in order to be allowed into the garage and to be seen and escorted through the maze up to the Clinic. Masks were given immediately upon exiting the car. Everyone in the garage wore masks, they directed me to an elevator run by a masked staff member, up to the Clinic, greeters behind plastic, name given, told to follow not the yellow but the blue tape on the floor, blue for higher risk patients (my age and symptoms qualifying me).
They had created new walls with very narrow corridors that kept people away from each other by the narrowness of the space. At the end of the corridor was a large room full of healthcare providers in masks and gowns and folding card table chairs spaced 10 feet apart with numbers on them. A gowned and masked individual was moving through the area cleaning the chairs. I was number 14, but there was only one other person in the room at that time, an older man seemingly in his 80’s in chair number 6. Vital signs were taken by a male nurse who, no lie, said to me ‘rock star’ when he finished seemingly indicating that the vitals were pretty OK and making an effort to pick up my mood perhaps. This surprised me as I thought my BP might be through the roof. Deep breathing and meditation can work.
Quickly, I was escorted into a room with a young male physician who took me through the protocol questions for COVID-19. Fever, yes, fatigue, yes, muscle ache, yes, runny nose, yes, sore throat, no, cough, no, tightness in your chest, no, trouble breathing, no, poor sleep, yes, sweating with fever, yes. He said, “It’s not clear to me if you have COVID-19, you might have the flu, you might have a virus of another sort, but I think I should start you on Tamiflu and then we can see what the COVID test shows in three days. Any other questions?” “No,” I said. “Hmmm,” he said, “You’re like a lot of men of your era, you minimize talking about symptoms.”
As I started to leave, he said, “Your PCP tells me that you’ve been a hospital CEO and that you teach healthcare professionals how to be leaders. Can you give me some quick advice? I’ve just been asked to take on leadership of a team of physicians. I have only a very little idea of how to do that effectively.” No kidding, this happened. What could I possibly say in a few seconds that might be helpful, I thought? I said:
“Just remember leadership is about knowing that teams go through stages where they form, storm, norm and perform. They form when they are given a mission and purpose; then in an atmosphere hopefully of safety they storm by debating tactics and strategies; then they norm by agreeing on the team rules and protocols for success and then they perform by getting down to doing the real work on hand. But don't worry, in a crisis teams in healthcare come together quickly...it's leading with empathy through the trauma where you become a better leader.”
He nodded, “Perfect, yes, that feels right.” The knock on the door announced that the next patient was ready. We each thanked each other, wished each other safe journeys and parted.
I was then immediately escorted into a room with a female nurse who said “I’m here to take care of you, this is only a bit unpleasant but it’s quick,” and it was; in went the nasal swab, didn't even have time to imagine I was at the beach. I thanked her for taking care of me, and she said, “You can’t see, but I’m smiling underneath this mask.” As I left, she said, “You’ll be hearing the results from us in three days.”
And then we drove home. My fever sent me back to bed. Near dinner my phone alerted me that I had a message in the MGH portal. Surprised that it was not the three days I had been told, I read the test results: “Negative.” Moments later, my PCP called me. She discussed the results and underscored that I rest, knowing me well that I would need that reinforced.
Relief. Sasha, my stepdaughter, and Ariane gave me a virtual high five, and we texted the rest of our adult children.
Back to social isolation, rest and Zoom meetings I thought to myself. But there is more to this story. I began to feel that I should write up this experience, as it is one that is now happening to so many people in the world, in different ways but perhaps with some similar truths...the test is out of one's hands, the threat of the virus is potentially controllable but also potentially deadly, it can't be seen and the experience of the process of discovering whether you have it or not is full of existential threat, worry and more. Living though the virus’s reach is also revealing of the process of discovering the connections we have, create, need and acquire even in brief human interactions. I know that as I went through each stage of the process of testing I was aware that each person was doing this at risk to their personal safety, had loved ones at home worrying about them and was committed to the patients who were arriving. I was certain that on some level they were each in their own way experiencing some fear and anxiety about their own health and that of their loved ones, perhaps worrying if they might bring it home to them.
I also experienced the individual humanity of each provider who took care of me starting with my PCP and their brief interactions with me buoyed my morale and made me smile and feel cared for and about. It was a brief but profound experience, but I believe one that is happening every day in healthcare. Because I continue to work in hospitals as a consultant, it underscored what I knew to be so true about healthcare professionals; that they are practiced and trained through rigorous protocols to care for their patients and that they work as a team to accomplish small and large miracles in the face of both known and unknown risks to themselves. It also reminded me of what I have learned from my best teachers, that noticing how people connect is the best pathway to relationships that sustain in times of crisis and in everyday living.
As I fell asleep that night, I thought that clearly the country has been experiencing the stages of crisis leadership with many variations and versions on the themes of denial with much storming and late norming increasing the potential of the virus’s danger. I smiled thinking of my young physician moving forward into his new leadership position knowing that just his proactive search for knowledge already predicted his potential and emerging success.
Robert E. Simpson, Jr., DSW, MPH
Robert Simpson is an esteemed TLD Group coach and consultant. As the former CEO of an historic psychiatric hospital, the Brattleboro Retreat, Dr. Simpson knows well the challenges of guiding employees, state legislatures, business, political, regional and national leaders through critical strategic decisions in a time of acute crisis. He has a leadership and coaching reputation as an outcome focused, pragmatic and supportive transformational leader who can quickly assess and develop a focused plan for leadership success. As a doctoral level clinician with an additional public health degree from Harvard University, he has worked extensively with physician leaders enhancing strategies to create clinician and leader resilience.
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