How COVID Made Me Not Go Gently into My FIRE Goodnight

Part One:

Difficult Decisions at the Start of a Global Pandemic:

I want to share with the physician FIRE (Financial Independence Retire Early/Recreational Employment) community what my thinking was to leave FIRE and return to work.

In 2019, I resigned from the VA when we moved to Medellín, Colombia, for the summer. After we got somewhat settled in Gainesville in August of 2019, I half-heartedly applied for a part-time position at a local hospice.

But after exploring it, I sensed it was a chaotic work environment and knew my heart wouldn’t be in the job. For that reason, I ended up turning the position as a Hospice and Palliative Care physician down.

I intended to let my medical license lapse while I walked away from medicine completely. One thing made me renew my license, though. Now, this next bit sounds a little woo-woo, but in the interest of authenticity, I’m going to tell you.

In October 2019, I got this weird, gut feeling that the universe was shouting a message to me:

“B.C., wait until March to make up your mind about leaving medicine.”

When I told a psychiatrist friend about the strong impression, she said, “Maybe in March you’ll be in a different frame of mind about medicine.”

Well…we all know what happened in March 2020.

March 11^th 2020: Las Vegas

I landed in Las Vegas for a conference, a bundle of shattered nerves. While I was mid-flight from Atlanta to Vegas, the WHO had declared a global pandemic.

Although terrified of possibly being separated from my family if the country shut down, I was determined to see my obligation through. I would speak on a panel I’d been invited to at the conference.

After that, if I had to drive back across America to Florida, I would.

The doctors at the conference all huddled—albeit six feet apart—and discussed our fears. We knew from our training that a possible tsunami of death was headed for us. But in those first few days of the global pandemic declaration, we were uncertain.

How tall could that tsunami be that was about to engulf us?

We knew we were possibly looking at mass casualty protocols and “death tents”—units where people with no chance of surviving COVID would be sent.

How big would those units have to be, though?

None of us knew. We’re used to being experts. But we were uncertain about this new disease killing our colleagues across the world. The lack of knowledge terrified us.

What was real, and what was being blown out of proportion by the media?

It was unsettling to see my colleagues—highly trained specialists who were normally calm and unflappable—now alarmed.

You know something is real bad when even the doctors panic.

Questions of mass casualty death protocols soon turned towards me, one of the few doctors who had advanced training on dealing with death and dying. America only offers about 141 Hospice and Palliative Medicine fellowships a year.

As a fellowship trained physician, I had a unique skill set that shouldn’t sit on the sidelines during a global pandemic. And I’d already worked on the front lines as a hospitalist during the last global epidemic.

But H1N1 in 2009 had been a much smaller scale.

Sure, I had the experience, but did I have the courage to come out of FIRE?

It was more comfortable to stay home—away from the chaos and the PPE shortages—safely ensconced, caring for my family.

Soon, repeated, frantic calls for medical personnel to come out of retirement and help during the global pandemic echoed across the globe.

I recalled the oath I had sworn at medical school graduation. And how I’m directly descended from ancestors who fought for survival in the Revolutionary, Civil, Spanish-American, and World Wars. Endurance and strength are engrained into my very DNA.

Those genes challenged me to be better, to rise up to my generation’s challenge.

Alone in my hotel room in Las Vegas, my bowed spine straightened. I knew what I had to do—even though it terrified me.

My answer became ‘yes.’

“You don’t have to do this,” my husband told me over the phone.

I knew. And I’d be lying if I said I wasn’t afraid to go back. In truth, I was petrified, barely able to sleep or eat. FIRE was why we worked so hard and sacrificed so much for the past two decades. So we could opt out of work if we wanted to.

But despite that—and regardless of how flawed and broken we are as a country—I still had hope for us as a nation. I felt it was my patriotic duty to help.

Still, when I thought about what I’d possibly be called upon to do, I clutched my arms around myself. I could handle a fourteen bed inpatient hospice unit.

But what if it was fifty patients? Or a hundred? All while wearing stifling hot PPE gear—if we could even get our hands on those airless, hazmat type suits, the cumbersome headgear, and an endless supply of gloves?

I wasn’t sure I could handle all that. My whole body trembled beneath my hands, trying to hold the terror inside that wanted so desperately to escape.

After the shakes subsided, I sent an email to the only contact I had at a local hospital back home, asking if I could be of service. Then I started to repack my bags so I’d be ready for an early exit from Vegas.

On Friday, March 13^th, I walked up on stage while Trump finished up his first remarks to the nation about the global pandemic.

Sweat dribbled down my back. I’d meant to wear my cool, new suit jacket. Instead, I forgot it off stage and tried not to look like a deer in the headlights. While I was speaking, I desperately hoped Trump wouldn’t declare he was shutting down the airports.

As soon as I was done, I confirmed the airports were still open, snatched my suitcase, and fled to the airport to plead to be put on the next flight out.

Before I flew to Vegas, my cousin, a nurse, had gifted me an N95, but it was a size too small. I didn’t care. I wore that teeny sucker plastered to my face the whole, red-eyed way back across America.

While the flights out to Vegas had been eerily empty, the return flights were jam-packed with people fleeing back home. The horde of collected strangers stuffed into the planes were more silent than usual—like we all were contemplating one thing: the impending global tragedy.

March 14^th 2020: Gainesville, Florida

As soon as I arrived home, I self-isolated in our new place and joined in on the weekly Zoom meetings for my new hospital department. I got to work on gathering information on mass casualty protocols.

Oddly enough, despite my VA background, the most useful contact came through the Florida Writer’s Association. A British member who had helped me publish my Spending Habits for Professionals Who Want to FIRE put me in touch with a retired U.S. Brigadier General.

After reading the emails, I tipped my head back and closed my eyes, the tension in my body finally releasing a little. The Brigadier General turned out to be invaluable, giving me guidance on how to access military help, should it be needed.

While I watched with horror the events unfolding in Italy, Spain, London, and New York, I tried to stop worrying about my sister, a nurse in the UK.

Private, international Facebook groups sprang up so physicians across the world could pool our knowledge and troubleshoot with what little information we had.

I sent out feelers to see—if we absolutely had to—could we commandeer a local dorm to use? (Tents aren’t practical options for hospice units in Florida due to air conditioning needs) And through the Brigadier General, I figured out who I’d contact locally if I needed to call in the military. I also continued studying what had happened during the Spanish Flu, hoping to learn from their mistakes.

Meanwhile, my husband’s hospital erected tents in their parking lot in anticipation. He and our other front line doctor friends shared any information with each other as we came across it.

What even were the laws surrounding mass casualty situations? None of us had experience doing this.

Despite the reassurance of assistance if needed, I felt unprepared, overwhelmed, and inadequate at the thought of it all. How could I possibly prepare to do something I’d never wanted to do—run a mass casualty unit for the dying?

The more I learned, the more I realized that if we entered a mass casualty situation, a family member of mine with a life limiting illness would be last tier for ventilator access if they contracted COVID.

I tearfully relayed that information to my family to prepare ourselves and come up with a care plan, should that be needed. Wiping away tears, I resigned myself from staying away from my family member for the immediate future, for their own protection.

What if they died before I could see them one last time?

I tried to shove that kind of thinking away, but those days, thoughts of death seemed to hound me every waking hour. One of the hardest parts of reading the private, international doctor Facebook posts were the increasing number of medical deaths posted there.

Soon, it felt like my Facebook feed had become a memorial wall to the dead and dying. To protect my mental health, I had to decrease the amount of time I spent on social media.

March 22nd 2020: Lockdown in Alachua County

Adding to the stressors was home schooling and the contractors fleeing our doctor household. While having to resort to washing dishes with a garden hose, I also had to sweet talk contractors to return to finishing installing bathrooms and our kitchen.

I reassured them that yes, my husband, the very front line doctor, was in fact residing elsewhere until they finished their work.

When my husband came for visits, he made sure to stay outside of the house, at least ten feet away. At first, our sons were confused.

Why couldn’t they play with Daddy? And why was he sitting on the ground outside the fence? Couldn’t he come in and wrestle with them?

It was gut-wrenching to not be able to take solace in his arms nor kiss him.

Looking back on those difficult days, I remember how stiff I was, as I carried stress and tension everywhere. While I acted as our general contractor, I brushed up on inpatient medicine. I also dealt with the mountain of paperwork and background checks needed for credentialing.

On top of all that, I started writing a medical fiction book. Before the world had gone sideways, I somehow was granted a coveted spot in an incredible writing program guided by the amazing writing teacher, Donald Maass.

While a fantastic opportunity, it was more intense than I had anticipated. I started to feel truly swamped, but I was determined to not drop out.

I never said I was the wisest doctor out there—especially when it came to a balancing act during a global pandemic. 😉

Those were some seriously tough times. Splintered in every direction, I tossed and turned at night and lost eight pounds before I eventually gained the COVID fifteen (pounds).

For a while, to deal with the stress, I became a streaker—a person who runs at least a mile a day. When out, I’d test my olfactory nerves to see if I could still detect the fragrant flowers. Smelling the azaleas I ran past always reassured me I didn’t have COVID.

Yet.

May 2020

Then, as the days marched on, things calmed down. No massive hospice units were needed.

My muscles finally felt like they could relax just a bit. But the COVID anxiety of being married to a doctor directly on the front lines was still ever present. We worried he’d bring it home and infect us. As a valiant provider and steadfast protector of our family, this was immensely rough on my husband. 

We tried our best to hide from our stress from our children, but it showed through the cracks.

Doctor friends texted me pictures of lungs full of holes, blackened and ravaged by COVID. They told me how people languished on lung transplant units, praying for new lungs that never came.

And how their patients, who never had emphysema before on their CAT scans, suddenly showed it after surviving COVID. My inbox started to overflow with stories of patient’s hearts trashed by COVID and friends suffering from long haul COVID.

If my husband and I got COVID, would our lungs look like those wretched pictures. Would we also get heart damage?

Finally, I got the call. I had cleared credentialing. After months of departmental meetings on Zoom, it was time to leave the safety of my home and venture back into the hospital.

Goodbye, FIRE.

Hello, PPE.

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Also, how did you handle the stress of the starting days of COVID-19? If you work on the front lines, what’s been your experience?

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