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December 31, 2020

COVID, Clinic & Community

Sometimes it's hard to admit you have thoughts that conflict with your perception of yourself. As a person generally optimistic about humanity, it's hard to admit that COVID has made me frustrated and depressed about people. A person intentionally wasted vaccines that could have protected 500 people? Anti-maskers have shamed their medical providers so much that they have left their jobs? The person who knew he was COVID positive and got on a flight anyway? I've put considerable effort into contemplating the conflict of emotion and sacrifice surrounding decisions, and don't expect that people give up everything or continuously (I certainly haven't). But the degree of active harm and division in the midst of a crisis that calls for coming together--it really blows my mind and hurts my core.

When confronted with differences that are hard for me to understand, I rely on the philosophy that we're each given different resources to come to who we are. I consider mine, and remember how incredibly lucky I am to have them. This year, I am especially grateful to my colleagues. When COVID started, I was driven by a need to care for our communities; as COVID continued, the only thing that kept me going was wanting to be accountable to my co-workers. Because they never stop asking: What are the needs? What's missing? How can we change that? Which is an incredible approach in any time, but in a time in which so much is being asked of them, it means so much to continue to ask about the needs of others.

It is hard to describe all the ways in which I saw courage and commitment from our clinic. Without complaint our medical assistants took on completely new skills, and applied the same level of meticulous diligence to their new roles despite the difficulty and ever-changing protocols. The community is indebted to my own medical assistant, whose job changed radically and several times, due to my evolving involvement in the COVID response. She basically ran one of our testing sites, and I don't underestimate the immense value of being able to entrust her with that.

Our providers quickly identified the gaps in care that happen with tele-health and every day found ways to bridge them. Every level of care was augmented with another need, like groceries with home COVID testing. Early in the pandemic when public health departments were shellshocked, providers volunteered their time on the weekends to help with outbreaks - obviously not on any predictable schedule, but within hours of notice on Saturday mornings. Any time I wondered how something we'd never done before could happen, dozens of people offered ways to help and the coordination of individual sacrifices made systems happen in a way that no existing leadership team could.  A street medicine team was developed in the throes of COVID, and they made possible the crucial testing of people in shelters and encampments. People worked so many extra hours developing protocols for which we had no precedent or experience. Then changed those protocols the next day. They called out any steps where we needed improved oversight; no matter how high these steps stacked up, they didn't stop finding them and bearing responsibility. No work was beneath anyone. They drove labs between sites, picked up medicines at pharmacies, figured out what to do with biohazard trash.

Always people asked, who are the most vulnerable and how can we reach them? All this on top of the regular hard work of primary care for patients with insecure housing and employment, for patients who rely on steady support for substance use and metal health, a structure that didn't entirely collapse during COVID but one whose core heaved under this weight. 

Somehow these colleagues also remained people. They remembered my birthday, we had book clubs and exchanged pet photos, we raged and laughed at the absurdities together. Because of them, I can say I've seen the very, very best people can be. For all the injustice and tragedy of this year, for all the injustice and tragedy of all years past that this year simply brought to the forefront, for how tired and aged I feel, 2020 has above all brought me the strength of these incredible caretakers. You do so much and you are so, so much more than even what you do. 

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