Two red lines: A retrospective

March 17, 2020 through Oct. 21, 2023. 1,313 days.News that the WHO had declared COVID-19 a pandemic reached the California desert on March 11, 2020. Within hours, the mad scramble of itinerant vacationers to evacuate to their places of origin began. Those who’d driven to the desert oasis from the northwest U.S. and Western Canada gassed up their SUVs and with worldly possessions carefully stowed, accelerated to what was perceived to be a safer haven. Dependent on air travel for our extraction, we began the frustrating online and mind-numbing telephone process of securing a flight back to Canada. Word on the street, in our case El Paseo, was that “the border will close,” imminently. Our flight, originating in Palm Springs, took us to Denver and finally Toronto, arriving late evening on March 16, 2020. Pearson had been ghosted! An Uber delivered us to our Vaughan, Ont. doorstep within minutes. Highway #401 appeared post-apocalyptic, a vast expanse of emptiness. We had entered the uncharted world of SARS-COV-2.Early the following morning, March 17, the Premier of Ontario declared a State of Emergency. We were in “lockdown.” It took some time to process the true meaning of this unfamiliar term and the global implications that would play out in real time, changing almost hourly. A novel and rapidly replicating virus demanded an extreme and proportional response. Think back to the myriad mitigation measures we all were consumed by; masks and face shields, hand sanitizer and antiseptic wipes, vinyl gloves, washing fruits and veggies, and of course, our hands until they bled, avoiding the downdraft of a jogger’s COVID cloud while walking on the street if one actually dared to leave the protective confines of the home, maintaining the mandated 6-foot distancing demarcated by the colourful discs affixed to pavement and flooring and all public surfaces. And, don’t forget the “self-imposed” isolation of families and friends, the driveway and sidewalk faux hugs, the precipitous transition to remote learning for our kids and embedding into newly configured home offices for ourselves. We could definitely accommodate in the short term, but this was never to be short term. In fact, remote, online and home office functioning have become integral to the way we still do business, communicate and educate. And in the professional world where I worked for 49 years, medical practice, this hands-free relationship, a new and reluctant normal for some, continues to this day, embraced and accepted, out of necessity for the patient and as an imposed serendipitous convenience for the doctor. As I isolated in my office on March 17, 2020, alone in a vacuous space that would not see a patient cross the threshold for months, I realized the need to secure connectivity with my patients. I tweaked the telephone message to include an email address, fax number, a guarantee that all calls would be answered “same day” and all prescriptions confirmed with pharmacies by fax or phone on demand. I initiated a pseudo-telemedicine phase of practice in which rules had yet to be established. In time, the “rules,” such as they were, would be defined. They were, however, vague, unfair and inequitable, at least in the infancy of organized medicine’s attempt to meet the basic needs of a public struggling to source compassionate care in an atmosphere of confusion and despair. The sparsely occupied parking lot, the eerie echos of the building’s empty corridors and the stillness and silence of an office unaccustomed to inertia, all contributed to an atmosphere of displacement and foreboding. Each day was the same as the preceding one, reflexly structured and responsive to the ever-changing demands of a public consumed by fear, looking for answers to logistical questions never previously considered. Every message received a call back from me. Patients expressed both thankfulness and aimlessness. Their support system, such as it was, wasn’t. And it wouldn’t be, until COVID-19 was better understood, and that would take time, and time was quickly becoming the enemy. We became obsessed with numbers; positive cases, hospitalizations, ICU admissions, respirator-dependant patients, institutional outbreaks, and deaths. The numbers increased exponentially, every day, every week. We were but a microcosm in a catastrophic global pandemic, engulfed and in some cases, consumed by the dread of disease and demise. And then, a true miracle, a vaccine. Never in the history of mankind has a vaccine been developed so quickly, manufactured and delivered to a public that had almost given up hope. The frenzied fervour created distribution challenges, manifested by lengthy lineups of impatient and occasionally, combative individuals intent on self-preservation and survival. Over the coming years, vaccines would be widely available as would the boosters, in response to the unique peculiarity and evolution of viral variants. Although “vaccine fatigue” would evolve in time, the combination of vaccines and COVID disease would ultimately result in rendering this pandemic less virulent, more easily contained and controlled. Severe disease and death were replaced by “just a cold” symptomatology. We stopped being numbers-dependent, COVID-focused and slowly became confident in measures of mitigation as a pathway to normalcy. By June of 2020, the solitude of my self-induced silo was disorienting. There were patients in need of hands-on care; comprehensive well-baby exams, chronically ill patients needing routine monitoring and those requiring therapeutic injections and immunizations who could not be managed in a remote telemedicine vacuum. The loss of human touch was taking its toll. And so, I gowned up, masked, face-shielded and gloved until I was no longer recognizable. And, I started to open the door, one patient at a time. “Call from the parking lot, mask up, knock on the door, the doctor will admit you, and, you will be the only patient in the entire office at your appointed time.” It worked, although it was not the most effective business model. The bottom line was subterranean. With glacial speed, the numbers increased but were limited by the inordinate amount of time required to wipe down every surface after every patient visit. Lysol ruled and turnaround time was the enemy.And, I was retiring! Almost forgot. Nine months B.P., (before pandemic), I decided to formalize my retirement dreams and set the date for June 30, 2020. The timing, however, sucked. The letters announcing my retirement were literally sealed and stamped and ready for distribution to 1,600 patients on March 30. Not happening! The decision to ‘MacGyver’ my retirement plans and reset the date was an easy one. My patients would need guidance and support in the process of securing continuity of care for their future. And so, it happened. I’m not going to say that it was a seamless transition, far from it. No one likes change, least of all patients who had long-developed a dependency of care, realistic or otherwise. On Sept. 30, 2020, I turned out the lights and locked the door. Retirement began 3 years ago. It’s been a mixed blessing, a melange of good, bad and some kind of ugly. The pandemic cloud has never really lifted, persistent in its all-encompassing sphere of virulence. Our first bucket list vacation following retirement was vacated, by the organizing tour company four months prior to the anticipated November departure date. The South African adventure tour and safari was replaced by a months’ long North Kawartha cottage expedition with much less interesting flora and fauna. Later that same year, a mortality check, a prostate malignancy, upended my life. ‘The Patient Doctor’, a 6-part series featured in the Medical Post, chronicles my journey from the biopsy suite to the linear accelerator and beyond. So far, so good. Sensitized by circumstances, we continued to sanitize, avoiding the risk and uncertainty of selective social interactions. Congregate and congregational gatherings were replaced by Zooming and streaming. Once the pandemic began to officially wane and societal norms began to once again flourish, we slowly and cautiously reintegrated into community activities. Restaurants were once again patronized but, on open-air patios only. We expanded our bubbles, careful not to over-inflate or overexpose. If there lurked a cold or cough, we respectfully declined the invitation. If others had travelled recently, especially internationally, we demurred, anticipating that they were in the process of viral vectoring. And, we were persistent in our protective obsessions. Somehow, through it all, we were able to dodge a barrage of overt and covert COVID exposures. On Sept. 25, 2023, we departed Pearson Int. en route to Johannesburg, South Africa via Newark, N.J. Incognito in our KN95s, we finally realized our initial bucket list aspiration. We returned to Toronto on October 8th, shaken by turbulence but unscathed. Once the “lag” lifted, we embraced our family and friends and regaled them with stories of our travels and close encounters with the magnificence of Kruger National Park’s indigenous inhabitants. After a busy stretch of brunches and walks and dinners long-overdo, we returned lakeside to our cottage. On Thursday, October 19th, the dry cough began. The following day, the cough continued without distress but disruptive just the same. A dismal day of rain, blustery winds and the classic subdued dull browns of fall set the stage for what would follow. Saturday morning, Oct. 21, brought forth more cough and copious catarrh. We were expected for dinner that evening at cottage neighbours and given their specific pandemic aversive behaviours, I decided to crack open a COVID rapid test kit before morning coffee. I carefully followed instructions, although the print is a bit too small for my liking, mined the deep confines of my nares and placed the probe in its receptacle, stirred and squeezed and dropped the sampling into the tiny depression of the testing kit. My wife and I hovered nervously over the kitchen counter. I won’t repeat our vocal response but I’m certain the cottage country neighbours heard our collective and synchronous epithet. POSITIVE (expletives left to the imagination). We packed up and returned to the city where isolation from each other would be more easily facilitated. Didn’t help. Three days later, my wife Ellen tested positive. Two red lines! 1,313 days. It was never a matter of if, always a matter of when.

Two red lines: A retrospective

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HOWARD GOLDSTEIN

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