Short abstract
Prioritizing self‐care over the ever‐present to‐do list is important, especially during the COVID‐19 pandemic, as this narrative describes.
I was once again short of breath while going upstairs in my house. A few weeks ago, I was riding 12 miles on my bike daily, working 12 hours almost daily, and keeping my e‐mail inbox at “zero unread messages”; all of these gave me a sense of pride and accomplishment. Everything changed when I developed a dry cough on one Thursday evening in October.
At the time, Wisconsin was seeing rising cases of COVID‐19, so it was the first thing I thought about. However, I told myself, “You had similar symptoms before.” Early during the pandemic, I had upper respiratory symptoms and was tested negative for COVID‐19 each time. Still, after awakening the next morning with a headache, I decided to get retested. Not feeling well, I switched my clinic to a virtual format and, following that, drove to our employees’ testing center. There, I met Joy, the nurse who had tested me on previous occasions. She was friendly and funny as always and asked why I was back.
Swab retrieved, I returned home to finish notes and answer messages and e‐mails, determined to leave zero messages in the electronic medical record In‐Basket before the end of the day, no matter how late the hours ran; that was my goal each day. By the end of the day, I was tired, but that was more of a familiar feeling after a busy week. At 10 p.m. that evening, the results came in; I tested positive for SARS‐CoV‐2. I ran upstairs to tell my husband from a distance. We executed the contingency plan developed months ago: we will sleep in different rooms, use separate bathrooms, and avoid each other in common areas in our house. He has a history of a compromised immune system, so we were prepared. Instead of finally deciding to rest, I ended the day by sending an e‐mail to my division chief, explaining the situation and describing my contingency plan to move everything to remote work. I made sure to note that I was not too concerned about the situation—the symptoms were mild, and I felt confident that I'd be okay.
I spent the next several days aiming to keep up my usual activities. I spent that first weekend working on an upcoming Grand Rounds presentation. After 9 hours, it was done; however, any sense of pride in this accomplishment was complicated by my first fever (101°F) and news from my husband that he too had tested positive for COVID‐19. The guilt encompassed me—it was clear that as a health care worker, I had brought this home. In the next few days, my fatigue and fever worsened. Still, I was determined to push through—maintaining my professional activities as much as possible. This meant attending another virtual clinic—despite finding it harder to talk on the phone—answering patients’ messages and all my e‐mails, and I even recorded a podcast despite my progressive shortness of breath. Still, with each day, it was becoming harder to speak. So much so that even taking a shower was a task that required mental preparation and a break afterward due to exhaustion.
A week into my infection, it had come time to give the presentation that I had worked so hard on. I put every little piece of energy I had into that presentation, ignoring my health, and everything went as planned. Later, my fever spiked to 102°F, and I experienced my first fall due to severe dizziness. I was so weak that I remember crying at the bottom of the stairs. The following day my shortness of breath was worse; it was present at rest, and the dizziness was limiting my activities. I was even afraid of standing up. That morning I called my primary care doctor; she understood what had happened, and for the first time, I admitted that I had neglected my health for work. She diagnosed me with pneumonia; my oxygen saturation was borderline, and I was subsequently started on steroids, and I required i.v. fluids. I had to face my reality: I was not getting better. The fatigue was so significant that crying felt like an impossible task, and for the first time since I can remember, my to‐do list did not matter; I did not check my e‐mail or respond to messages. I wrote a message to my colleagues explaining that I had underestimated my symptoms and needed help.
I found myself asking for advice from colleagues who had faced the virus; I still remember a dear friend messaging me: “You need to stop, or you will be admitted.” After reading that message, a sense of guilt came around; I was worse because I failed to prioritize my health over other things. Why didn't I cancel some activities? Why did I push myself, even as I felt more ill? I think the fear of missing opportunities, not delivering as expected, and my high expectations guided many of the decisions since getting sick.
I searched for reasons to explain my actions—why work and profession came before my own health. I grew up seeing my parents work through holidays, sickness, and civil unrest in Venezuela. As my parents were surgeons, this was the norm in our house; when the hospital calls, you go. No complaints. The desire to persevere could also be explained by medical residency. It seemed that positive reinforcement only came when you prioritized work above all else. I remembered having a sense of guilt when calling in sick and the unnecessary information I provided to my chief resident after my father suffered a hemorrhagic stroke and needed to leave the country. These were things I could point to as explanations of my behavior, but in the end, they were my actions, not my parents’, and I was no longer a medical resident. I was the only one pressing to meet standards set by nobody but myself.
The following days were challenging with my symptoms, the side effects of the steroids, and the self‐imposed guilt of being responsible for my clinical deterioration. I canceled some meetings and postponed others. I placed others in control of my In‐Basket and requested extensions for upcoming deadlines. I missed an e‐mail from an editor who, in reply to my request, had asked for “one more thing,” but a few days later, I learned that “one more thing” had been taken care of without me. It was another reminder of the subjectivity of the urgency that I once put on such e‐mails. Instead, I rested.
The fevers have dissipated, and I am slowly recovering. The mental “fog” is clearing up and allowing me to share my experience with my academic family. After a 10‐minute humbling walk (due to the remaining shortness of breath), I know that recovery will take time. Still, this experience has helped me become a better human by understanding that I lived to expectations based on items on a to‐do list and not my values. I will no longer be afraid of prioritizing self‐care and rest. Today for the first time, I refuse to feel guilty for saying no, because, in the end, it all can wait.
Disclosures
Narjust Duma: Pfizer, AstraZeneca, Neogenomics, Inivata (C/A).
(C/A) Consulting/advisory relationship; (RF) Research funding; (E) Employment; (ET) Expert testimony; (H) Honoraria received; (OI) Ownership interests; (IP) Intellectual property rights/inventor/patent holder; (SAB) Scientific advisory board
Disclosures of potential conflicts of interest may be found at the end of this article.
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