President ’s Page
Hindsight 2020 and Foresight 2021! Ann Goetcheus Gehl, MD
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am a family physician at a Community Health Care (CHC), a federally qualified health center, working with the most vulnerable populations in Pierce County through a pandemic. I have just come off a busy rounding week at St. Joseph Hospital where our group practices true full spectrum family medicine. Here, I pause to reflect on what a year it has been for me, my family, the residents I teach, my colleagues, and the community that we serve. One of my most memorable and heartbreaking patients was an elderly Latina woman who ultimately died of COVID. Although she was comfortable at the end, she was unable to have visitors; her entire family, including her husband of over fifty years, also had COVID and had to stay home. She only had the structured and sterile visits from myself and the nurses as we dressed up like astronauts, ready to venture into a dark and terrible unknown. It pains me that the end of her life lacked the warmth of a doting family member’s hand, that she heard no whispered reassurance from another in her native tongue. The agony that her family endured by not being present with her during her final moments will be forever ingrained in my mind. I attended deliveries in full PPE, with the constant dull roar of negative pressure ventilation in my ears, threatening to drown my words of encouragement as I coached each mother through labor. My congratulations were coupled with counseling about infection precautions as we weighed the risk of keeping newborns at arm’s reach versus opting for the cold comfort of quarantine. Lactation support dwindled, even for first time moms, in order to limit the number of staff entering the rooms of COVID patients. My work welcoming newborns into a pandemic world was bittersweet. Outpatient clinic was mostly telehealth, and exposed glaring health inequities. Many CHC patients do not
have the luxury of internet, so “virtual” appointments were telephone only, frequently complicated by the use of an interpreter. Children struggled with remote classroom instruction, many unable to access coursework or even adequate food. One longtime patient of mine disappeared for months, only to present for a routine visit with tachypnea and hypoxia of 60%. She told me she had been sick for a week but had not sought care out of fear of catching the virus but felt safe in our clinic. She was taken quickly to the hospital, admitted with a positive COVID test and within 24 hours, was intubated and proned. At that time, I was not sure if I would see her again but happily, she recovered and is doing well. More personally, the early days of the pandemic were also difficult. As my husband and I are working parents, we struggled through the challenges of remote learning with our first grader. I performed a decontamination ritual via our basement entrance prior to hugging my daughters each night. I had hard conversations about end-of-life choices, just in case, with my 80-year-old parents who continue to work with the homeless in Washington, DC. Would they want to be intubated? Would my mother end up like my elderly Latina patient, dying alone? My heart was heavy, but the comradery of my fellow colleagues and the feeling of “we are all in this together” despite different practices and specialties, helped me fan the flame of optimism. There were puzzles, hikes, skiing, and virtual reconnections with friends, near and far. People were generous, and my cul-de-sac became our community. We found Zoom happy hours, and then a vaccine! The Health Department led by Dr. Anthony Chen has worked tirelessly to vaccinate the vulnerable first. And after over a year, I finally got to hug my parents. After relentless darkness, I now see light, and despite despair, we hold onto hope.
SPRING 2021
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