Are We There Yet?

At one time or another, all parents have shared in the universal, yet painful, experience of hearing the words “Are we there yet?” It is typically uttered roughly 379 times, in a shrill, whiny fashion, before we lose it a tiny bit with whichever child cannot help themselves but ask, yet again. So it is in that spirit, that I also dare query whether or not we are there yet. Are we finally through with this discombobulated, chaotic, mass casualty dumpster fire that is 2020? Perhaps not, but like all the countless, persistent children, I cannot help but ask. 

Recently I took some time to reflect a bit more on the irony of hosting a conference on adversity and resilience during the most collectively adverse year in either recent or distant memory. For many of my patients and families, as well as many of your own families, 2020 has underscored the acute on chronic nature of adversity and trauma. 

Many have experienced job loss, food and housing insecurity, loss of loved ones (and the added grief of knowing some of them passed alone), illness, including COVID, and in some cases, long term sequelae–the aptly-termed “long-haulers.” 

In addition, there has been loss of insurance and/or other benefits, lack of access to medical care or understandable fear of accessing care, limited ancillary support services (such as physical or occupational therapy or mental health services), especially those previously provided through schools, and lack of reliable, safe transportation.

Even for those fortunate enough to retain employment, there have been professional hurdles—especially for those working from home while moderating virtual learning, the inherent stress of homeschooling—with its tech/wifi issues and lack of available space, childcare issues for those who cannot work from home, the risk of COVID exposure as essential workers, and the very real fear of becoming ill and/or exposing others.

There are those who, like me, have not seen extended family for nearly a year, those experiencing caregiver fatigue while caring for family members with COVID or chronic illnesses (further exacerbated when trying to limit other in-home caregivers/nurses). Then there is the loss of connection with community, reduced access to green spaces, or risk of COVID while visiting them, the pandemic 15/quarantine 19 (depending upon your level of stress eating), and extreme physical and social isolation.

And while it is unfathomable that we add to this already daunting list, I would be remiss to not highlight the toxic stress manifested in times of political uncertainty, as well as violent conflict in other countries, and the 400 year war of racism that continues to wage in this country. 

However, this seemingly exhaustive list of stressors is not meant to overwhelm or cause despair. Though I would be lying were I to say that there aren’t some days in which it does feel overwhelming. Honestly, there are days in which the political, social justice, and medical victories feel overshadowed by hundreds of thousands of lives lost to COVID…overshadowed by the loss of George, Breonna, Ahmaud, and countless others. But for those times when resilience feels almost unattainable and reparations seem to not be actualizable, I hope we can reflect on those who have passed and allow their memory to fuel and energize the fight ahead of us. Because in order to tackle not only the acute, pandemic-related adversity, but dive deeper to address the adversity caused by structural racism and poverty, we will need every bit of that energy.  

So rest up and stock up, as masks and vaccines (not toilet paper) will be your ammo in the fight ahead. And while we aren’t there yet, I believe we will get there. 

#DoctorsSpeakUp

As both a mother and pediatrician, I am pretty comfortable in my bad cop persona. I have fully embraced the fact that I may never be the “fun” parent, nor will I likely be perceived as the “fun” doctor, as I spout such popular and well-received kernels of information, such as “no, it’s not healthy to play Fortnite 8 hours per day….yes, you should still be in a booster, I don’t care if your seven-year-old-friend rides in the front seat…no, cake is not a healthy breakfast… and no, neither candy corn, nor regular corn for that matter, count as a vegetable.” Thus it stands to reason that I should be unfazed by having to dispel various anti-vax-manufactured urban legends that have zero basis in either reality or evidence based medicine. 

You know what though? It actually does bother me. I know that I “should” have no issue sharing unpopular, yet scientifically sound, vaccine information. However, I am going to admit that doing so can be exhausting. But why?

First off, it is winter. While to the blissfully unaware non-primary-care-physicians out there, this may mean merely colder weather, holidays, ski season, snow shoveling, and hot chocolate, this season has a different connotation for those on the medical front lines. Pediatricians are typically exhausted during the respiratory season, and this season has been rougher than usual due to the high volume of influenza in the community. Now enter stage right, COVID-19,  and our bandwidth is dipping even further below where it was in January, when we found ourselves looking longingly toward April or May. But such is the seasonal nature of pediatrics and medicine in general. Most of us either knew what we signed up for in that regard, or quickly realized about two weeks into our first “respiratory season.” And certainly, this seasonality is something with which any parent of a small child is well- acquainted!

But one thing that no winter can fully prepare a doctor for is having to continually defend science to the general public. Now here is where I will admit that I am extremely lucky and have a really fantastic panel of patients, the majority of whom are fully vaccinated. So I am grateful that I spend very little time having protracted discussions about vaccines, beyond the standard anticipatory guidance. I rarely have to discuss Andrew Wakefield, the UK “physician” who lost his medical license for fabricating research positing a link between the MMR vaccine and autism. I also rarely have to address the lack of evidence that vaccines are unsafe or non-evidence-based alternative vaccination schedules. I only occasionally have to mention that there is far more formaldehyde in a single pear, than in the entire childhood vaccine series. At times I may need to mention that the entire childhood vaccine series contains a much smaller volume of antigens (portions of a virus or bacteria that stimulate the body to make protective antibodies) than that door handle you just touched. But even that conversation is not common in my daily practice. That said, for the occasional vaccine-hesitant or questioning parent, I can certainly engage in this discourse in the interest of health and well-being for my families and the community at large.

However, what I do not have much bandwidth left for is fighting the fear-mongering and ant-vax trolling practices that have become far too common and lead to a deleterious public health crisis. Some of us have almost become immune, ridiculous pun intended, to receiving yet another public health communicae regarding yet another case of measles or pertussis (whooping cough). I would be hard-pressed to think that any of us knew, when we took on $200K of medical school debt, that the medicine and science we learned would be publicly ridiculed on a nearly daily basis, and by people with zero training in science, research, medicine, or public health. In fact, in pediatrics, there is really little else that has such a robust body of evidence to support it. Yet here we are, arguing with conspiracy-theorists on social media. Who knew? 

On March 5th,  in the midst of an unrelenting flu season, and between answering questions about COVID-19, we will pause as a pediatric community to remind you that we will continue to fight the good fight. We are tired. But just as we used to rally in the 29th hour of a 30 hour shift in residency, we will dig deep. We will continue to support our patients, our families, and those in our practices and communities who are unable to receive vaccines or whose medical conditions put them at higher risk (such as cancer patients, transplant recipients, and those with weakened immune systems, including my youngest child). We will continue to engage in discourse and spread awareness to combat misinformation. We will persevere, to the best of our abilities, in trying to protect the community. All we ask in return is for you to vaccinate, wash your hands, and cover your cough. Also, we would like a nap…or two. 

#DoctorsSpeakUp #Vaccinessavelives #Vaccinescauseadults #Vaccinate #WashYourHands #CoverYourCough #supportdoctors #weneedsleep

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