Pandemic apathy or…I think I’m getting too used to being by myself

Cancer plus pandemic has forcibly reduced my level of human contact over the last year. Whether it was due to government regulations or physical restraints from my illness, the effects were the same: less people were physically in my life at any one time. At first I fought it. I felt angry and restricted, especially when I was still healthy. Then when I got sick, I still felt resentful every time I had to be left behind when my family went somewhere or left out of a favorite activity. After awhile though, it started to feel easier to bow out of things, easier to just stay home and sit with my dogs, watch TV, and have no expectations. It started to become too comfortable. It is still too comfortable. Traditionally I am a social person who needs people, who savors life and interaction. Now, it seems like I have to force myself to leave the house and carry out any kind of responsibility. Now granted, I have the plethora of chemotherapy side effects like pain, neuropathy, and intense gastrointestinal distress that legitimately get in the way sometimes. That is true. However, I find myself wondering if I will still have reluctance to gather even after those excuses are out of the way. This is concerning. The words lazy, lackadaisical, and apathetic have never before graced my daily life vocabulary. I don’t really like them setting up residence now, but I am not sure what to do about it. I don’t really think that it is fear anymore that is keeping me inside. I think it’s something worse: apathy. I am just over it. I am just over all the panic and the restrictions, but at the same time I am out of the energy to discuss them, fight them, or act against them. What I need is a strategy for emergence that makes sense for me, my sanity, and my particular set of circumstances and limitations, not anyone else’s. Here’s hoping that I develop a good one and I hope you do too.

Dr. Katz

Is it ever going to be over?

Right now, I feel like we all have divided up our lives into two categories: pre-pandemic and during pandemic. I find myself using and thinking the phrase “before the pandemic” all the time. Before the pandemic I used to go to concerts and go on trips. Before the pandemic I had regular outings with friends. Before the pandemic, I didn’t think twice about going out. Before the pandemic, I had freedom. Before the pandemic, I didn’t weigh out every single social decision against the possible consequences. Now that has all changed. It’s not all bad. There is nothing wrong with actually weighing your decisions a little more carefully rather than flinging yourself into everything. On top of that, I have to admit that I have gained from the extra caution in the world now that I have cancer. I was already getting used to social distancing before my diagnosis. Now the reality of my vulnerable and immunosuppressed state is not such a shock. I have already been practicing the precautions. It is pretty much life as usual.

Still, I wish it were over. I understand all the precautions and the waiting to lift restrictions until more vaccine is distributed. I am just inpatient, even though the increased freedoms won’t really apply to me. I just want to see my friends and family live a little more. I just want to see them happier again. I feel like everyone is in the same boat. It’s ok to be frustrated. It is human nature.

Here is what I don’t understand. We have more than one vaccine now. Despite the perception that these vaccines are somehow new or rushed, the technology being used has been around for the last ten years or so. Yes, we are having issues with the order of availability. That is true. But, we are attempting distribution the best that we can. I say this even though my own hospital ran out of vaccine for me and I had to travel to get mine because other vaccine groups opened up before all of us physicians were vaccinated. Nonetheless, I was grateful to get it when I was able to, even though there was a significant wait. So, we have these vaccines, which are what people have been clamoring for all these months, and yet, many people are still declining them? The scare techniques against the vaccine are particularly insidious and unfortunately, effective. What is the point? The vaccine is our best option to get us closer to this all being over. Why holler and demand for answers and solutions and just shut them out once we get them? I get that there may be risks with the vaccine. There are risks with anything. But, I am here to tell ya, the risks of Covid are much greater than any risks the vaccine could impose. I guess it all boils down to one big question. If what we really want is for this to be over, why aren’t we more willing to do what it takes to make that happen?

Dr. Katz

Man! It’s lonely being a patient right now!

Yet another reason to hate what changes Covid has brought to the world. It seems like no aspect of our lives has gone unchanged or untouched. A lot of it has been inconvenience like not being able to go to concerts and having to wear masks everywhere, which a lot of us complain about, but yet our lives have still gone on. Other restrictions have been down right tragic like not being able to see loved ones for gatherings, accompany them to the doctor or even visit them in the hospital when they are sick. Even with some of the restrictions lifted or modified, it is a lonely lonely time to be a patient right now.

It is study proven that family support increases the likelihood of successful treatment and recovery, whether that be from surgery, addiction, or cancer. So, what have we done? We have completely eliminated that extra advantage with the Covid restrictions. I feel like we have failed patients because we didn’t even consider other options. Patients have had to go alone to complicated doctor appointments. We all know that it is always better to have more than one set of ears to listen, especially when it comes to complicated diagnoses and instructions. Patients have had to go through chemo treatments alone with no one to pass the time with. Sometimes those sessions last for 8 hours. For a while, patients were languishing in the hospital with no visitors, unless their case became terminal, at which point all communication opportunities and precious time were already gone and families experienced twice the loss: the loss of the loved one and the loss of the time they could have shared. When I was in the hospital in January, there were patients that had been on the oncology floor for almost a month with no visitors, fighting for their lives with no family support.

Back to reality. Of course, I understand the concern for spread of the virus and the potential consequences. But now we have rapid tests for covid. We could test visitors and assess for positivity in a potentially expedient manner. I know what you are going to say. The tests could be false negative. Yes that is true. Nothing is 100% fool proof and there could be risks. I understand how serious it is. However, my educated crystal ball says that we are going to look back on this time period and notice that recovery rates for all hospital-based illness went down by at least 25%. At this point, I am just not sure that the tradeoff has been worth it. None of those lonely patients will ever get that time back.

Dr. Katz

Takin it easy is not the same thing as being a prisoner.

Oh man am I having trouble with that distinction lately! First of all, limitations have never really been my jam to say the least. I have been a patient more than I care to admit in my lifetime. You know, multiple surgeries, medical emergencies, accidents, time off work, the whole nine yards. I am usually the one who is walking the halls just hours after emergency surgery. I am not a stay tied down kind of person. Now that the universe decided that cancer with chemo plus a pandemic was a good idea, I am looking at a whole lot more than just some temporary limitations. There is no way around it. I feel like I am looking at house arrest for months. Let’s face it, I will be immunosuppressed, on top of having cancer, in the midst of an ongoing pandemic. I can’t afford to take chances so I need to suck it up.

Yes, I exaggerated. I won’t exactly be on house arrest. I am going to work when I can. I will need to leave the house for doctor appointments. I just won’t be going out of my way to go out to dinner or take unnecessary risks. I probably won’t be doing any hospital procedures either. It’s just being smart. To be honest, it won’t be that different from what is going on now, except for the fact that the chemo I will be on shoves me from the mild risk category to the top of the highest risk category when it comes to death from infection and Covid. Yippee! This is not the kind of line that I wanted to cut to the front of.

In my rational moments, it all makes sense. There is no point in fighting hard to dodge the cancer bullet if I am just going to open myself up to the Covid one. That would be ridiculous. The restrictions are in place to help keep me safe and see this thing through to the end. I choose to follow them. I know that. And, it’s not as if there isn’t enough Netflix to go around to entertain me.

There are other things that I worry about though. Yes, believe it or not I worry about being bored, even though I am working on a book, a podcast, a blog and I try to post daily updates. I worry about having too much time to think which runs the risk of being counterproductive and focused on worrying with nothing to distract me. I worry about resenting my family and friends as the pandemic restrictions lift and life resumes again while I watch vicariously through a proverbial window. I worry about being consumed with guilt from letting people down. I realize that everyone is being tremendously understanding now, but everybody has their limits. See! I wouldn’t have so much time to overthink all of this unless I was on restrictions!…lol

Oh who am I kidding? No one really has to enforce my restrictions. My body takes care of that nicely. I never know which version of me is going to lift her head off the pillow in the morning: the one that is raring to go for several hours or the one that gets short of breath after about three steps and has to sit back down. It is a real Wheel of Fortune going on around here and I am definitely not the big winner the majority of the time. I am kidding myself to think that I could really change that even if I wanted to right now. It is what it is. The only real choice that I get to have control over is my attitude and my willingness to accept the advice of my doctors. I have to realize that this is not their first rodeo and that they do actually know what’s best based on experience, knowledge, and training. Like I am always saying, I need to be a team player in my healthcare. If coach says I need to sit on the bench for a bit, well then I better just sit.

Dr. Katz

Has everyone lost their minds?

I just want to start off by saying WHOAH people! What is happening to everybody? Where did logic go? Where did common sense and understanding go? In just the past 24 hours I have seen people finger pointing, yelling at each other, shouting about conspiracy theories, threatening others, protesting, and panicking. That is a ton of unfriendly verbs right there. There is nothing good that is going to come from any of it. What’s simmering underneath all of it? : the pandemic and the politics swirling swirling around it. Let me take a minute and give you my honest perspective on it. Let me also be clear that what I am going to say is based on facts and personal observations. I am not here to sway you, convince you or otherwise change your direction. I just want to give you something to consider. If it happens to help you press pause on panic and anger, fantastic! If it doesn’t, it needs to be said anyway.

Ok here goes. I am here to tell you that Covid 19 is a real virus in the Corona virus family, which is the same family of viruses that cause the common cold. As you know, there is an infinite variety of viral mutations that can cause a cold and thus, we will probably never have a vaccine for it. Some of us will go down like a wildabeast for weeks with congestion, trouble breathing, coughing and even fevers. Some of us will get a little runny nose for a few days to a week and that’s the end of it. A small group of high risk people may even die from it. Now here comes Covid 19, a corona virus. It can mutate like other Corona viruses. It is ridiculously contagious like a cold. The vast majority of people that get it will have bad cold symptoms. Some people will be completely symptom free. A small subset will get seriously ill and may even die. This is crazy scary right? Of course it is. That’s a natural response. But, let’s put it in perspective. There is a certain subset of unfortunate people that are more at risk for everything due to comorbid conditions. These are the folks that need to always be careful, whether there is a pandemic going on or not. When you do the actual math on the covid thing, with verifiable numbers, the death rate is extremely small. I get it, even one death is too many. Of course it is. I am just saying that it is my opinion that our reaction and response to Covid perhaps should be in better proportion to the actual statistical risk it poses. We deal with many infectious and terrible things that can kill people every single year and they have not instigated a world mess of this proportion. I seem to recall complaining about the “latest shitty upper respiratory illness” as it blows through the world every year. In my lifetime alone we have had AIDS, H1N1, SARS, ebola, and the year round outbreaks of flu. I have news for you. AIDS and the flu have not miraculously disappeared, just because we are not talking about them. They are not the cool kids anymore, but I can remember being inundated with all kinds of bits of information each time one of these outbreaks started and feeling momentarily overwhelmed, but then we all went on. We didn’t shut down the economy and add financial despair to the shoulder weight of an already distressed country. We didn’t wipe out all other news and saturate all of our overwhelmed receptors relentlessly for months.

Let me be clear. I know this virus is real. I work in three different hospital systems. I have seen everything from the icu patients to the asymptomatic patients and everyone in between. Half of my family has had it….all have survived thank goodness but other people I know haven’t. One of my favorite people in the world died of Covid. But guess what, every time I have found myself scratching my head on why someone died, I realized after investigation that they actually had a comorbid condition that adversely affected their Covid path. It just makes sense. These cases we hear about in which someone died unexpectedly, I am willing to bet that the vast majority of the time there was an underlying condition as well. Just because we don’t hear about it or the person didn’t know, doesn’t make it not true. I think in the case of Covid, it’s all the things we don’t know or feel sure of that get to us the most. We hope a vaccine is coming, but it won’t be universally available for awhile yet. When it is, I am sure that some people will refuse it like they refuse everything else, even though we have all been clamoring for one for months. How does that make sense? It’s like we want to be able to control a decision about something, anything, just to say that we did whether it is good for us or not since we all feel so out of control.

So what am I really saying is that I think the whole pandemic has provided us with a view into how quickly everything can go wrong with misleading information. It has showed us how forced panic is not the way to go to convince people to follow guidelines. It has showed us that leaving people to their own devices without clear communication leads to nothing but chaos. It has showed us that when we come at people from all sides with negative and oppressive tactics, we don’t even allow them the opportunity to make good decisions. We have got to get it together and do things and think things based on actual facts and reintroduce common sense into this global scenario. Otherwise, we are just not going to make it through this.

Hang in there.

Dr. Katz

Is It Time To Be Thankful Yet?

So, Thanksgiving just passed. Did we all remember to be thankful, or did we get mired down in complaining about not seeing the usual volume of family members and bemoan the current status of the COVID pandemic? I think that a lot of people fell into the second category, if they are being honest. I admit that, even though I have realized all of my current blessings, I still fall prey to the diffuse and sometimes oppressive fatigue of depression that has followed me around for the last 9 months, despite all my best efforts. This begs the question then, when is it time to be thankful? The answer is: RIGHT NOW! For a lot of us, things aren’t really going our way and haven’t for a long time. The economy is tough. Family relations are strained. Family members have been lost. People are fed up and spend a little too much time like little powder kegs ready to blow at the slightest opportunity for conflict. On top of that, the capacity for empathy is not so great right now. I have to admit that, even my standards for thankfulness have had to be lowered a bit just to keep things in perspective and convince myself that I am not “reaching too high.” …lol. Still, I am above ground, I have a family to miss, I have my health ( most days), and I still get to do what I love and take care of people. Essentially, it is all I really need so you betcha I am thankful. Don’t let me kid you. I have ” days” like everyone else. I am still human. We are all feeling the struggle right now. It’s a normal human response to the sense of loss of control and freedom. But, just when you feel that whine coming on I urge you to think twice before you do it. There is always the possibility that someone is worse off than you.

Dr. Katz

Here We Go Again!

Greetings from Michigan, where the shutdowns are back, viral cases are surging, morale is down and the economy is heaving along, the best that it can. Whew! That is both a mouthful and yet another heavy set of burdens for us to bear. What are we going to do? What can we do?…that we aren’t doing already? How are they deciding what to shut down? which schools to close? In the midst of the new resurgence of information overload, in combination with the overwhelming sense of loss of control, everything starts to merge together and nothing really makes sense anymore. With a sense of frustration and a deep need for answers and assertion of control, we start pointing fingers and making enemies and burning bridges right and left. We forget what’s really important anymore because we are so distracted by our unhappiness, our loss of freedoms, and our fog of depression that never seems to lift anymore. What we don’t realize, is that by launching our own attacks and tossing aside what’s familiar and devaluing those around us, we are just perpetuating our own isolation further. We are actually making things worse! If it is community that we truly crave, why fight amongst ourselves and elevate our level of pettiness to historic levels? What is that really doing? How is that supposed to make us feel any better? I have news for you: it isn’t and it won’t. So….stop already! Please! I get that it completely sucks to not be able to see the people you want to see all the time. I get it that we can’t frolic at concerts right now and family gatherings have become but a blip in the rearview. Businesses are struggling and people are at risk of losing their livelihood. I know. I am one of them. Big stuff is at stake. It all seems out of proportion to the actual death rate of this virus, but you and I both now, that we are not privy to all of the information. Therefore I have to believe that the “experts” aren’t just trying to screw us. I just can’t go on thinking like that. I am not talking about being lemmings or sheep, but, we just can’t afford to give in to hate and despair like we are. Nothing good will come of it. I am still hopeful that it is not forever. One thing IS clear in my mind: I know for sure that any of my own potential methods for self-destruction will not make things get any better any faster. I know how hard it is to be positive right now. I am struggling just like everybody else, but you will not see me giving up just yet and I am hoping against hope that you will join me.

Dr. Katz

Physician Burnout

Being a good doctor has been especially tough lately. It seems like there are so many obstacles to being able to provide quality care without completely sacrificing your own mental and physical health. Fortunately for me, I consider myself to be very strong of mind and body and my love for my patients and my job still far outweighs all the negative impact of the obstacles. I am very grateful for that, but, some are not so lucky.

You ask yourself, what kind of obstacles could doctors really have? Don’t they have it made? I mean, don’t they just make a ton of money off of the rest of us and live these amazing extravagant lives? Don’t they just get to direct us like sheep with all of their recommendations, procedures, and prescriptions etc? I hate to burst your bubble, but it is not like that at all, at least not for me.

Did you know that the rate of physician burnout is set to hit and all time high this year? The final numbers are not in yet, but it doesn’t look good. On top of that, Ob Gyn as a specialty has the fourth highest rate of burnout among all the specialties. 46% of Ob Gyn physicians report feeling burnout. So, what is burnout anyway? Physician burnout is classified as a psychological syndrome that is a prolonged response to chronic occupational stressors. Heh? What? It means that the stresses of the job potentially get so overwhelming and so stressful that you kind of break down and just don’t want to do it anymore. Yikes! Sounds awful doesn’t it? I mean anything with the word burn in it can’t be good right?

So, what are the symptoms of burnout? 1) Feeling tired and drained all the time is one of them. 2) Fatigue that does not budge no matter how much sleep you get is another. 3) Feeling sick all the time is yet another. 4) Changes in appetite or sleeping habits 5) Drop in libido or sexual desire 6) frequent back pain, muscle aches, headaches with no other apparent cause.

What do physicians have to be so stressed out about you ask? There are a ton of potential stressors. Let’s start off with the fact that your incredibly high medical school loans offset by the lower average salaries for most physicians means that your debt is not paid off until you are nearing 50. How about the fact that reimbursements for physicians, particularly in my specialty continue to drop, regardless of manhours spent or level of difficulty to the point that I find myself wondering if I am going to be the one paying to do procedures on patients instead of the patients…lol. Let’s think about the hours for a minute. For me, a solo practicing obgyn, I am essentially on call 24 hours a day and 7 days a week. My ability to do anything with my family completely depends on what is happening with patients. I find myself getting coverage if I decide to go to the bathroom in a town that’s greater than 30 miles away, much less if I am going on an actual vacation. I just can’t risk missing a call. For those of you with 9 to 5 jobs, most of you get to be done when you go home. I am never really done. I am always responsible for my patients. I am not complaining. I chose this life and this specialty. I am just clarifying.

Another stressor is the fact that there has been a huge breakdown in the concept of the doctor patient team relationship. Patients are now viewed as consumers rather than patients and as such, this wave of consumer-oriented thinking has brought a wave of bossy, entitled, demanding behavior that is often hard to stomach. I am extremely fortunate that I do not have a lot of these patients, but when I do, it is very exhausting. I have spent too much time invested in my education and have worked too hard and too long to have patients shake their finger at me, dictating their own care without listening as if I am their secretary or sales rep, rather than their doctor. It’s just not right.

One of the biggest stressors is the fact that doctors, even with all of their training and medical knowledge, do not really have the final say in what they can recommend for patients. The insurance companies do. The expenses do. The patient’s ability to pay does. I cannot tell you how many thousands of times in the last 25 years that I have had to change the optimum management, prescription, procedure, etc for a patient because of insurance and cost. Most of the time, my poor patients have to go through multiple treatment failures, medication side effects, extra office visits, etc before I am allowed to finally do the right thing for them because of some insurance criteria. To make it worse, most of them do not understand that I am not the one dictating these delays. They are under the impression that I am just “nickel and diming” them. Nothing could be further from the truth, yet I bear the brunt of their frustration and mine anyway.

Last but not least, let’s touch on the impact of COVID 19 for a minute. Wow talk about a stressor! Now we have to worry about exposure, like the rest of the world. We can’t hug our patients, hold their hand or comfort them in any way except with words, which is just not enough for some patients. If you thought insurance companies were bad about dictating care, they have nothing on COVID. We are being told when we can do procedures. I didn’t operate for months. We are being told what care is essential and what care isn’t. (Apparently vaginas fell in the isn’t category for awhile, unless a baby was coming out.) Our businesses are shut down and employees are sent home because there weren’t enough patients to keep them. Employees are afraid to come to work even when we have enough patients. We are told to do virtual consults instead of bringing patients to the office. How exactly are you supposed to do that with ObGyn patients? Hold their vaginas up to the screen? Generalization and conformity rules over sense and applicability. Even now when we are allowed to see patients, fear keeps most of them home anyway, crippling my ability to adequately care for them. I can say 100 times that it has never been safer to go to the office with all the precautions and prescreening, but I cannot force them to come in.

Long story short, physician burnout is a real thing. It affects nearly half the physicians in a lot of different specialties, and obgyn is no exception. I just want everyone to keep in mind that we doctors realize that everyone is struggling right now, but we need you to realize that we are right there with you.

Have a thoughtful day.

Dr. Katz

Corona doesn’t just invade bodies. It invades conversations too.

Wow this is so true! I am finding that there is no situation or conversation setting that is risk free of the corona topic. It just creeps in somehow no matter what. I am willing to bet that part of the culprit there is that people realize that I am a physician, but I cannot change that. It’s just that I need a break from talking about it every now and then. It comes up in the most bizarre situations though. It even came up when our farrier was over working on our horses and the llama guys were over shearing the llamas. Heh? Llama corona? Corona and horse feet? Although I also have to admit that I seem to wait with baited breath in every conversation for the corona lead in and on the rare times that it doesn’t present itself, I find myself bringing it up. I seem to have a multitude of strategies pre-prepared just in case. So, I guess I have to embrace a lion’s share of blame in that regard. I am not sure why I do that. I think part of it is that I am determined to share a logical, fact-based viewpoint about the whole situation, as opposed to the barrage of half-truths and conspiracy theories that I hear everyday. I also sense that people just need to hash it over and talk about it still until life resumes some sense of normality so why fight it? I have to admit tho, I do wax poetic, dreaming about the days when I used to talk about something else: books, tv shows, kids, pets, politics( yuck, rarely), and even OTHER world events. Those were the days weren’t they? In the spirit of the return to normal life, let’s make a pact: Have at least one conversation a day without discussing corona virus. Come on! Who’s with me? Cheers to talking about……anything else! Have a fantastic day everybody!

Dr. Katz

Isn’t it strange that it’s ok that I’m human now, but it wasn’t ok before?

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Traditionally, it seems that most patients do not view their physicians as actual, potentially flawed human beings. It’s just too uncomfortable a concept. If patients viewed their doctors as humans, that would mean that they would have to acknowledge the fact that they can make mistakes, have emotions, have physical ailments, and emergencies as well. To most patients, that is an untenable thought. Their doctors need to be superhuman, infallible, and infinitely available at a moment’s notice. This kind of thinking allows patients to engage in demanding, unreasonable, and entitled behavior at times and puts a significant burden on the doctor patient relationship.

Interestingly, this seems to have turned around somewhat now in the time of COVID. Now it seems like patients are attaching themselves more to doctors who are showing their human side. The videos I post of myself at home in regular clothes or talking about how I finally figured out how to do my nails by myself get tons of views. Patients are listening with baited breath to see how I might be struggling with all of these changes. It’s as if listening to me is giving them tacit consent that it’s ok not to be ok right now. I feel like giving them a glimpse into me as a person is actually helpful right now. I can potentially help guide them through the proverbial tunnel to the other side of this thing. I get excited when I post my Facebook live daily video in the morning and all those people tune in. Knowing that I am able to reach all those people in a positive way helps me too. Personally I am loving it. If I can be myself with patients and still help them at the same time, I am all in! I would prefer to be that way all the time, within reason of course. I still stand by what I have said in previous blogs. Patients who are suffering or have just been given a terrible diagnosis do not necessarily care how I am feeling at the moment. Common sense still has to reign supreme here. I guess what I am really saying is that I hope the compassion doesn’t die out when the pandemic does. Have a great day everybody!

Dr. Katz