Category: Reflections on Life, Being Human, and Medicine

Reflections on a variety of topics. My hope is to stir your thinking and perhaps even give you things to talk about in regards to what it means to be human, about life in general, and often times on the practice of medicine.

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Being human Medicine Reflections on Life, Being Human, and Medicine Updates on my health

A COVID 19 Diary: What Was It Like For Us?

My Apple Watch vibrated my wrist. We were at home at dinner, but I looked anyway. A new MyChart result was available. I pulled out my phone and clicked on the alert and the app opened. I was nervous. I waited for what I had thought would be reassurance.

COVID 19 PCR: Detected.

You have got to be kidding me. Really? 

Now what? This led to a whole cascade of thoughts and events. But let’s go back a few days.  

On the weekend before I felt good. I was busy and active. Sarah was feeling sore and achy. She had however had a good workout via her trainer (virtually over zoom) on Friday. Sometimes she pushes it too hard and she can feel it for a few days.

Monday evening the temperature outside dropped. It felt chilly in the house. That is not unusual with a sudden shift in the temperature. I put on a sweatshirt. When I went to bed I still felt a bit chilled. I was happy to be under the covers. I slept fitfully but that also is not unusual with my adrenal insufficiency. In the morning I pulled out our thermometer and checked my temperature.  98.0 on my forehead and 98.6 in the ear.   I was fine.  I completed my hospital questionnaire. Muscle aches = not new, usual. Fatigue = not new, usual. No fever. All was good.  I was careful to distance myself from others. As usual I used hand cleaner on my hands obsessively all day. I was also careful to not have close exposure to patients. I of course wore a surgical mask all day.

Tuesday night I got the same sweatshirt out of the closet and put it on. At bedtime again I felt chills (this time worse) and pulled the covers up to my chin. Could this be COVID? Or was this just a minor cold virus or even just my adrenal insufficiency? In bed I grabbed my phone and scheduled a COVID test for the next morning. That next morning, I felt about the same. My temperature was 98.6 on my forehead and 99.0 in my ear. The questionnaire again: Green checkmark (good to go to work). This time I wore an N-95 mask plus a surgical mask over the top. I did even more obsessive handwashing and use of hand cleaner and efforts to distance myself. I left the hospital briefly to drive to the testing location to get my COVID test and then returned to work. When I had the option, I closed myself away in a private office space, just for an added level of safety.

One of the hard parts of this pandemic is the constant worry. 

Minor symptoms suddenly made me worry that I could have the virus. Could I be the one to transmit it to others? Every cough caught my attention. Should I get tested? Or was I wasting resources getting the test done? Or should I have had the test done the day before (after the first night of feeling chilled? Should I be at work? The questionnaire told me I was ok. But what if I really did have COVID?

My biometric tracker (Oura) told me that I should be taking it easy. It had noted that my average temperature while sleeping was 2.1 degrees above normal. It still did not meet the criteria (temperature 100 degrees or greater) from the screening questionnaire from work. 

That afternoon, I called to check on my mother. My father had died the week before after a long fight with cancer (not COVID related). I wanted to see how she was doing. She told me that my niece who had come for the funeral had been having chills and feeling feverish. She was being kept in isolation in one of the upstairs bedrooms in the farm house where I grew up. I reassured her. Our symptoms seemed pretty minor. I told her that I had been tested that morning and I would let her know as soon as I had a result.

This was actually my 3rd COVID test. I had been through this routine. I knew how it went. 1. Anxiety and questions and decision to get tested. 2. Waiting for the result. 3. The vibration on my Apple Watch or my phone and then 4. The feeling of relief when the test was negative.

But not this time.

Really? Really?

I spoke with Margaret and Sarah. They too were having symptoms (achy, tired, not sleeping well, and some minor cold like symptoms).  Probably all 3 of us had it.

What next?

  1. Notifications: Openness and honesty is always the best policy. We systematically notified everyone we had been in contact with over the past few days, even if those contacts were “safe” (both of us masked and at a distance.)  That included notifying my division chief and those responsible for finding people to cover for me at work plus everyone I had worked with.
  2. Where? Obviously we began trying to figure out where, when and from whom we contracted the virus. This is not easy. The true answer is that we will never know. We did not have any high-risk exposures that we were aware of. We had thought we were being careful. Maybe my father’s visitation or funeral?
  3. What next? This is of course a bit scary. Were we going to have mild cases? Or would we get very ill? I got on Amazon. I thought someone would have put together a COVID kit. Here is what I would put in a COVID kit: Thermometer, pulse oximeter, Zinc, Vitamin D, and maybe some Vitamin C and an incentive spirometer? I didn’t find any COVID kits. I ordered a pulse oximeter. I am not trying to give advice on this, but our approach was: Rest, trying to get up and walk around regularly, Tylenol or naproxen as needed for fevers and myalgias, monitored pulse oximetry on all of us and consider: Vitamin D, Zinc, aspirin. I called my mother and sister and gave them the news. Ultimately we decided that my niece very likely had COVID. The smartest thing then would be to bring her to our house so that she could isolate with us rather than exposing my mother and sister and brother who were staying at my mother’s house. 

The next day we all felt worse. Every muscle in my body hurt. I was exhausted. It was a challenge to get off of the sofa. Each time one of the dogs wanted to go outside or come in, it was an event. We would decide which of us would take the energy to open the door. Sarah and Margaret did put together a wonderful Thanksgiving dinner for us. While the turkey cooked we remarked how wonderful it smelled. Sarah suddenly couldn’t smell it. She went to the oven and opened the door. The heat and steam from the turkey hit her in the face. She still couldn’t smell the turkey. Fortunately, she said that she could still taste it when we ate but over the next few days she noted things either not tasting or tasting, “off.” 

My Oura ring told me I had fevers for a full 10 days after that. I was in isolation at home. The next week I did virtual visits (computer office visits with patients) from home. Fortunately, the schedule was light. I would see a patient and then lay on the sofa and nap. I went back to the office 2 weeks after the start of my symptoms. I had never truly had a fever (nothing above 99 degrees). My Oura ring indicated that my temperature was back to normal for at least 48 hours before I saw any patients. 

For me the worst of it lasted for a total of about 3 weeks. My first week back at work I was still very tired. I napped before work, at noon and immediately after work. I went to bed early. By the following weekend I was feeling better. Oddly, I have been doing reasonably well since, at least compared to my chronic adrenal insufficiency symptoms. I have sometimes wondered if the COVID made my right adrenal gland finally wake up? I continue to take my usual steroid replacement doses but have been functioning fairly well over the past several weeks now.

Sarah still is not herself. Her sense of smell has not yet returned. Her sleep patterns are disturbed. She wakes frequently and struggles to get a good night’s sleep. She is trying to be busy and active but finds herself getting tired very quickly. She is still achy. They talk about “long COVID.” This is apparently the observation that for many people recovery can take weeks to months. We continue to pray that she (and Margaret) would return back to normal.

I have had some benefits from having had COVID. It is reassuring to think that at least for a few months I am likely immune. This is not absolute, but I have told people that at least for now I am probably the safest physician at work. I am very unlikely to get COVID or transmit COVID to anyone. I of course still wear all the PPE. It is however reassuring when I am in an exam room with a patient and their mask inevitably drifts down onto their chin that I am not likely at risk. It also seems inevitable that patients will wait to mention COVID like symptoms until the end of their visit (after I have been in the exam room with them for 20+ minutes). It is also nice when I feel the familiar adrenal insufficiency symptoms of diffuse muscle aches and fatigue. At least for now, I am reassured and don’t feel like I need to go and get a 4th, 5th or 6th COVID test. 

I got my COVID vaccine on December 22. I wondered whether or not I should get it. I tried to research it. Most experts say that the protection from the vaccine (because it is against the spike protein) is probably better than the protection that I have because of having had COVID. I asked if I should wait at least 3 months. Some health systems are doing that. I also wondered if others should be a higher priority than me. I was told that our health system’s policy is that I should be vaccinated now. I got the vaccine. I had a sore arm for a couple of days (kind of like after a tetanus shot). On Christmas eve, after a very long day and pushing harder than I should have, I felt chilled. I was fine the next morning. 

I have asked myself, what are the lessons I have learned? What would I do if I had it to do all over again?

  1. COVID fear: I now recognize how this has been hanging over all of us. It is a huge burden. It has multiple aspects to it. We are afraid that we might get COVID and get very ill or die. It is also however the fear that we may be a person who spreads it to others. Do I need to get tested? Is this COVID or is it allergies or something else? Being human means that we have a variety of respiratory symptoms and aches and pains and tiredness from time to time. This past year has been an added burden because we cannot just shrug it off and assume it is nothing. I don’t have an answer for the multifaceted COVID fear other than to acknowledge it. Maybe that makes it a little bit better?
  2. Testing: In retrospect I should have gotten tested that 1st morning after my night of feeling chilled. Clearly I was concerned. The fact that I got out my thermometer and checked my temperature (this was before it was required for us to do so) should have been enough of a clue that I was concerned. 
  3. PPE / social distancing: I thought I was being careful. With my family for my father’s funeral, I thought that I was one of the “safe” ones. While many of my family members wore N-95 masks I wore a standard surgical mask. I have heard so many people talk about how they don’t know where or how they caught COVID. In retrospect I could have and should have been even more careful. With the spread of the new, more infectious strain, this is even more important.
  4. It is real: I have never doubted this, but it bears repeating. While for many COVID might be an asymptomatic or minor disease process, for a lot of people it is really nasty. Those 3 weeks (and for Sarah and Margaret the ongoing symptoms) are no fun. If you can get vaccinated and never get COVID that would be a very good thing.

As usual, this blog is written to share my personal experiences and thoughts. Many have had different experiences. For those of you who have suffered loss and for whom this has been even worse, please know that you have my compassion and (if I am aware of you) my prayers.

Having been through it, I would say:

  • Avoid it if you can. It is no fun.
  • I am happy to have survived it and be doing ok now.
  • Be safe.
  • Get vaccinated if you can.
  • The vaccine is a light at the end of the tunnel for us. Brighter days are ahead!
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Being human Reflections on Life, Being Human, and Medicine Reflections on the Christian Life

Reese’s Peanut Butter Cups, a 7-Year-Old’s Dreams, and a Glimpse of Heaven

It was lunchtime. I was sitting in my 2nd grade classroom eating from my Snoopy lunchbox. I was only 7 years old. I was with one of my best friends. In my lunch that day I was fortunate to have a Reese’s Peanut Butter Cup. 

It was amazing.

In that moment, my friend Mike and I dreamt of the future. I told him that someday I wanted to be so rich that I could eat Reese’s Peanut Butter Cups every single day. I would have them all over my house. I would just be constantly eating them. My greatest aspiration was to be able to eat Reese’s Peanut Butter Cups constantly. 

I still love Reese’s Peanut Butter Cups. They truly are amazing. I especially love the various holiday ones. I think they have a bit more of a peanut butter to chocolate ratio? 

So, how have I done in life? The good news is that I can now afford to be able to buy as many Reese’s Peanut Butter Cups as I would like. I could indeed fill my entire house with containers of them. No one would stop me from having a peanut butter cup breakfast, a peanut butter cup lunch and a peanut butter cup dinner. I don’t do that, of course. 

But to a 7-year-old sitting in lunch in the 2nd grade, that was the ultimate dream. 

Why do I tell this story? 

In this world there are Reese’s cup eating moments. They are truly wonderful. The only problem is that these moments do not last. I could try to just sustain them all the time. This seemed to be the answer to 7-year-old me. I could become a Reese’s cup addict. I could just eat them all the time until it takes over my life and my health. 

But even if I tried this it would not satisfy me.  

That is the problem with these moments. No matter how good they are, they do not last and cannot be sustained. And efforts to try to sustain them generally are not only ineffective but destructive.

Nonetheless, we get glimpses of really good things in this world. They are but a moment and then we get pulled back to other things. Most of the other things are mundane. Some are painful. This world and this life are not just Reese’s cup moments. There is a lot more to it. It does involve times of eating bran, oatmeal or even spinach. Sometimes it is having to swallow nasty tasting medicines.

But what about those Reese’s Peanut Butter Cup moments? 

C.S. Lewis talked about something that he called, “joy.” He used the word “joy” for lack of any other word to describe something entirely unique. He described this “joy” as the experience “of an unsatisfied desire which is itself more desirable than any other satisfaction”.[1] These were, he thought, glimpses of the eternal. What he talked about was of course much more complex than eating a Reese’s cup. Lewis himself explains that “Joy is distinct not only from pleasure in general but even from aesthetic pleasure. It must have the stab, the pang, the inconsolable longing”.[2]

It is the idea that within this life we get glimpses of things that are amazing and filled with glory and wonder, but then which leave us yearning for more. There is in this life a sense of the incomplete.

It may be in the experience of the love of another person. It could be in the glory of music. You can feel it in the glory of a sunset. The beauty is intense. You do not know what to do with it. It makes you feel like you should somehow hold onto it but then it is gone.

Lewis was truly a thinker. He became an atheist at the age of 15. Later in life, as he honestly sought to understand himself and this world, he noted a sense that there were deeper mysteries than the obvious realities of the physical world in front of him. Deep within him was a real and mystical longing for something more. These experiences of “joy” were to him secret clues to a deeper understanding of human existence. They were a linking back to his very creation and to one who created all things and who has known him (and each of us) “before the creation of the world.”[3] In this sense of “joy”, if Lewis truly was going to insist on being honest with himself, was a challenge to his long-held atheist beliefs. C.S. Lewis eventually came to faith as a Christian. To his rational mind the Christian faith was the only thing that ultimately made sense.

When we marvel and enjoy a beautiful sunset, the light passing through brightly colored autumn leaves, the wonder of a moving piece of music, the love of another person, or the joy of the taste of a Reese’s cup, we are experiencing a bit of how God created us to be. He wanted us to enjoy His creation. More than that, He wanted us to enjoy Him in His glory and wonder.

Someday He will restore us and all of His creation. That He has promised. He has a plan in place to do that. The Scriptures teach the story that starts with creation, detours off through sin, brokenness and separation and then the path back to restoration through Christ.

But for now, we see glimpses of what God’s real plan for us was and is. These glimpses come and go.

C.S. Lewis captures some interesting ideas well in his book, “The Last Battle.” This is the last in his series of books about the “Chronicles of Narnia.” In that book his characters reach the new heaven and the new earth. In that story, however, heaven is not a bunch of people floating on clouds in long white gowns. It is instead lush grass and hills and trees. The place is familiar. They see the home, the places, and the people that they have loved in this life, but they are better. They are perfected – or better described – they are as they were intended to be rather than in the flawed (good mixed with bad) manner that we experience them now. 

Imagine getting to heaven and finding it to be like your home town, or your favorite places to go, or places where you often had glimpses of “joy”.

His characters can feel the grass and run through the fields with joy. They run “farther up and further in” and as they do, they experience more and more of the things that meant so much to them in life, but which are now “better.”

“I have come home at last! This is my real country! I belong here. This is the land I have been looking for all my life, though I never knew it till now. The reason why we loved the old Narnia is that it sometimes looked a little like this.”[4]

They then find, greet and experience one after another of their dear old friends and family that had gone on before them.  As they do, it is described:  

“And there was greeting and kissing and handshaking and old jokes revived, (you’ve no idea how good an old joke sounds when you take it out again after a rest of five or six hundred years)…”[5]

Aslan, the lion then explains:

“The term is over: the holidays have begun. The dream is ended: this is the morning.”

“And as He spoke He no longer looked to them like a lion; but the things that began to happen after that were so great and beautiful that I cannot write them. And for us this is the end of all the stories, and we can most truly say that they all lived happily ever after. But for them it was only the beginning of the real story. All their life in this world and all their adventures in Narnia had only been the cover and the title page: now at last they were beginning Chapter One of the Great Story, which no one on earth has read: which goes on forever: in which every chapter is better than the one before.”

Recently my father passed away. In working through my grief, memories of him keep coming to mind. As a child I remember how he and my grandfather would talk on and on. Some days as we finished working on the farm I thought they would never finish talking. We would be waiting to go home to dinner (or “supper” on the farm). Often I would give up on them and plop down on the grass of my grandparent’s lawn waiting for them to finish talking. Recently my mother told me that she was imagining my Dad greeting my grandfather and the two of them talking and talking again. In my mind I saw them by the picnic table and then walking together through the farm as they talked. Down the lane, up the hill and through the grass, looking over the orchards. “Farther up and further in!” 

Today I had a Reese’s Peanut Butter Cup. It was delicious. As I savored it I remembered.  A 7-year-old me was sitting with his friend Mike and eating a Reese’s Peanut Butter Cup. He was enjoying every minute of it and not worrying about the calories or whether he ought to be eating it. 

It was a glimpse of the eternal, wrapped up in a Reese’s Peanut Butter Cup.

[1]  C.S. Lewis, Surprised by Joy, pp. 17–18.

[2] C.S. Lewis, Surprised by Joy, p. 72.

[3] Ephesians 1:4

[4] Excerpt From: C. S. Lewis. “The Chronicles of Narnia.” Apple Books. https://books.apple.com/us/book/the-chronicles-of-narnia/id1509784076

[5] My father had a great sense of humor. He loved his “Dad jokes.” https://wordpress.com/read/feeds/90599897/posts/3032127408