Covid Journal 6: Lung Cancer in the Time of Coronavirus.

My office practice has been slow here in North Carolina. I have been doing all of my patient visits via telephone, but even those are becoming rare. So I was glad when I got a call to see a patient with respiratory problems up on the wards. The patient herself was an elderly woman with an abnormal CT scan who had also undergone a test for Covid-19. Those tests are taking 8 days or more to come back unfortunately. Like many patients we test, it’s like that she would be discharged home before getting the results. Her doctor asked me to see her to see if the pneumonia they thought she had could be Covid-19. Looking at her CT scan I knew coronavirus was not the main problem, she had a lung mass which was probably lung cancer. 

In order to minimize our exposure time to infected patients many docs have been in the habit of calling in to the patient’s room to speak with the patient before entering the room for an exam. Impersonal yes, but probably safer. So picked up the phone and dialed into the room. As I pressed the phone against my ear I immediately regretted the decision. Thinking through the countless e-mails and meetings about Covid-19 preparation, I couldn’t think of one that mentioned anything about a phone sanitizer guy. Luckily I was bailed out by a busy signal. 

So I got up and walked over to the PPE station. This would be my first experience with PPE. Unlike NYC, New Orleans, and Detroit, Covid-19 is still new at relatively new at hospitals in North Carolina.

I had sat through a PPE demonstrations a few weeks  ago, there weren’t enough PPE for each of us to try it ourselves but I was pretty sure I got the jist of it. The process started with choosing a face shield or goggles. Apparently I’m a goggle guy. The patient was under droplet precautions, not airborne, which meant that the infamous N95 was not required, so I donned a surgical mask. Then it was the blue plastic barrier, finally gloves, and into the room I went. 

I’m always amazed at the resilience and courage of so many people when they hear that they have cancer. I do the best I can to be in the moment with them, there’s tears, touching, hugging, prolonged silence, questions, and more tears. It must be especially hard being told of this in such an impersonal matter. Our words competed with the loud device that recycled the air. As I hugged her I was somewhat self conscious about how it must feel through the cold shiny plastic that I wore. There was no way for her to see any of my expressions, my smile, my magnificent smile that everyone always compliments me about. I usually offer to call family for patients to help explain the diagnosis to them in the presence of the patient. I offered the same to her, but then I realized that taking out my phone would violate precautions, so the call would have to wait. 

I left the room, and was immediately met by a spotter who guided me through the doffing process. As I went through the steps I started thinking about what had just transpired. Covid-19 has just arrived and will be with us for at least several more months, if not longer. Lung cancer, too, is not going anywhere. I need to get better at this.