It was a Thursday evening in the fall of 2014, the end of one of those hectic days in the clinic at Bellevue Hospital — hardly a moment between patients and the computer system having epileptic fits. When I finally made my way out of the hospital’s atrium, my head was still swimming in all my patients’ issues. Suddenly I found myself up against a phalanx of news trucks parked in front of the hospital. There was a cackle of urgency in the air, with reporters and camera crews shooting live broadcasts up and down the block.
And then I realized: Ebola had arrived at Bellevue.
At the start of the Ebola outbreak in West Africa, there was chatter among staff — half joking, half serious — that if Ebola was going to come to the U.S., it would surely come to Bellevue. But as the epidemic crescendoed in Africa, the chatter became serious and planning began in earnest. A high-tech isolation ward was created, with its own laboratory and waste-removal system. A specialized medical team underwent exhaustive training.
In the clinic, my office — being closest to the hospital’s entrance — was designated as the Ebola isolation room, should any patient arrive with worrisome symptoms. Respirator masks, gowns, eye shields, gloves, and copies of emergency protocols were piled onto every available surface. Maintenance workers sawed a hole in my door for a glass window to enable communication with potentially infected patients from a distance.
Even with all of that preparation, I can’t deny that a pulse of fear rippled through the hospital when Craig Spencer, a doctor who’d been treating Ebola patients in Guinea, tested positive for the virus and was now one of our patients. It’s one thing to read about Ebola. It’s quite another to have it in your midst.
Fear is a primal emotion, and to pretend that the medical staff are any less susceptible than the general public is folly. Fear is part of what motivates us to learn our craft better —we don’t want to harm our patients, we don’t want to fail our board exams, we don’t want to look stupid on rounds. Fear also instills an appropriate humility about medicine: These are human beings we are taking care of, after all, not credit card charges or airline tickets. We should have a healthy fear before we unleash any medical intervention upon them. The fearless machismo that used to be lauded in hospital corridors is now rightly viewed as a danger to patients.
At times, though, fear can be overwhelming, even paralyzing. Every doctor and nurse can tell you — perhaps more than you’d really care to know — about times when they were incapacitated by fear. This diminishes with training and experience, but fear never goes away, and probably shouldn’t.
I sometimes feel as though we need to negotiate an armistice of sorts with our fears. There is a certain amount of salutary fear we need to accept, the kind that keeps us respectful of the high stakes in caring for patients. But we also have to recognize that there are irrational fears, the kinds that are not necessarily allayed by data.
For nearly three centuries, Bellevue has been on the front lines of public health, treating patients with yellow fever, Spanish flu, polio, cholera, AIDS, and tuberculosis. This is a point of pride among the staff, though it can be tinged with grim resignation. Times were bleak indeed when we were swamped with AIDS patients back in the 1980s and 1990s. It was early in the epidemic, when both treatments and scientific knowledge were in short supply and patients often struggled to obtain medical care.
So it was with awe and pride that I witnessed my colleagues skillfully caring for patients who had been shunned elsewhere. Was there fear when we handled needles with contaminated blood? For sure. But there was also compassion. Our role models were those who removed their gloves to hold their patients’ hands, skin to skin — a triumph of science and humanity over superstition.
Twenty-five years later, health care workers like Spencer assumed that mantle, heading straight for the front lines of the epidemic in West Africa. When Spencer became our patient at Bellevue, there was a sense that we were taking care of one of the family.
Among the Bellevue staff today, there has been a collective deep breath as we face the next emerging pathogen. There are a few nervous jitters, but an overall sense of determination. A public hospital like ours, by definition, has its doors open to all. And if it’s HIV or Ebola or coronavirus crossing the threshold, so be it.
Much of the fears we have to face, in fact, are those expressed by our patients. Misinformation abounds, and a lot of our time these days is spent reassuring our patients. (No, you don’t need to wear a mask on the subway. Yes, you should still get a flu shot.) This coronavirus is new, and the medical community is still figuring out the facts. We have to remember what it felt like when HIV seemed like the Black Plague incarnate.
Luckily, level heads eventually prevailed: clinicians treated their patients, public health officials pounded the pavement, activists kept up the heat, research kicked into high gear, and today HIV sits prosaically alongside cancer, diabetes, and heart disease. It’s just another ordinary illness that we treat. Complex, yes, but treatable.
The same will likely happen with this new coronavirus. We need to acknowledge our fears — the rational and the irrational — and then tuck them away in one of the many pockets of our white coats. There’s work to be done.
Meanwhile, the sawed-in window still graces my office door. Mostly I keep it covered with sheets of copy paper to protect patient privacy (and block out the view of the restroom across the hall). But when the first patient arrives with symptoms that might suggest coronavirus, I’ll be tearing those sheets down.
Danielle Ofri, M.D., is a physician at Bellevue Hospital, clinical professor of medicine at New York University School of Medicine, and editor in chief of the Bellevue Literary Review. Her newest book is “When We Do Harm: A Doctor Confronts Medical Error“ (Beacon Press, April 2020).
Please don’t talk about “epileptic fits”. It is so disparaging and hurtful to those who have epilepsy.
Once again Dr. O your level head prevails. It would be great if this piece could be reproduced on the HHC website for my colleagues.
As one of the readers of the Bellevue literary Review, I wanted to comment on how helpful this article was, and how fortunate we are to have Bellevue! You are so brave, all of you. Also, I’m wondering why no one is mentioning the pneumonia vaccine. Wouldn’t this vaccine help prevent the Corona virus from developing into pneumonia? Thanks!
Thanks Dr Ofri .
Your message in this article is so important to all . You are a global listening legend and this make you more proactive . In ID hospital Kolkata ( formerly Calcutta,India ) already two patients are admitted and there is a panic . I am going to forward this article to all my fellow friends physicians and colleagues .
Beautiful essay. I agree that Bellevue is often on the front lines of care during epidemics. I was a hem/onc fellow at Bellevue from 1983 to 1986 and spent a good part of my fellowship caring for gravely ill young people with AIDS. My colleagues and I did countless bone marrow aspirates and biopsies. Perhaps we were afraid and hid our fears, but as Dr. Ofri describes of the Bellevue staff today, we just took care of the patients and hoped that better treatments would eventually become available, as thankfully they did.
Well written as always. It’s the calming of mass irrational fears that are not responsive to data that is so hard. Primary care and hospital health care workers face people with myriad infections every day and maybe we have an easier time accepting that the risk of contagion is low. The popular image that germ = bad; sick person= contagion; new illness = death, those are hard things to mediate.
What a relief that I don’t need to wear a mask!
As always, the good Dr. Ofri knows how to alleviate our fears.
Fear is a real human emotion, but irrational fear can and often does paralyze nations to the point that nothing gets accomplished other than mass panic and demonization of entire races of people. At the current rate I can envision public murders of Chinese as well as other Asian people out of irrational fear.
Polio was the epidemic I lived through as a child and I had friends in grade school who attended class in wheelchairs.
I was frightened all the time as were my parents and we cheered the vaccines.
As a practicing physician and surgeon-in the 80s and 90s with a family, wife and young children I was very frightened of the lethal Aids epidemic and the patients who came to my office did not have to tell me if they were infected.
And there were the “needle stick” stories about surgeons and anesthesiologists dying after accidents with needles.
I cheered when that epidemic was controlled.
Nice to know that Craig Spencer survived …
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