Leana S. Wen is an emergency physician and visiting professor at George Washington University Milken Institute School of Public Health. Previously, she served as Baltimore’s health commissioner.
As an emergency physician, I’m trained to think in terms of worst-case scenarios. As an expectant mother, I had nightmares about all the things that can go wrong in pregnancy. But there was one thing about giving birth during the covid-19 pandemic that I didn’t anticipate: how I would become scared of, and also scared for, my health-care providers.
The obvious differences I was prepared for, of course, and they were apparent in an instant. Everyone wore masks. The halls were empty except for essential staff. Our temperatures were taken in the lobby, where a large sign explained a new “no visitor” policy. Fortunately, there was an exception for laboring women, who could have one person with them.
The nurse doing my intake looked exhausted. It had been a busy night, she told me. The ward was filled with women seeking to deliver before the hospital went over capacity with covid-19 cases, and they were short-staffed. Another nurse and a doctor had just tested positive for the virus. At least six people were out and under quarantine.
As she took notes, the nurse rubbed her face through her mask. The staff had been issued just one mask to last them a week. It was only Day Three, and her mask was already damp and fraying. I felt for her — I knew she was making do with the limited gear she had — but also wondered: Could the mask, worn so long, harbor viruses?
A resident physician came to do an ultrasound. She sat down just inches away on my bed, exactly how I was taught to do a bedside ultrasound. But I felt an instinct to move away from her. What if she had last been in the ER doing a consult? What if the white coat she wore had recently brushed against someone with covid-19?
The hospital had clearly been proactive about infection-control protocols, even as the staff was making do with insufficient personal protective equipment. The nurse explained that the iPad used for consents had gone through UV sterilization. When a tech came in to place my IV, she took great pains to avoid cross-contamination, wiping down her gown as she entered and then wiping down her pen before handing it to me.
And when it came time to push, the doctor, nurse and tech all put on N95 respirator masks and full face shields. My doctor explained that this was new hospital policy, too. Laboring women focus intently on their breathing, and the PPE served to protect the staff from respiratory droplets. But a terrible thought crossed my mind as my contractions built. I was aware that I was breathing right into my nurse’s face as she coached me. I had no symptoms and no known exposure, but as we all know, that’s no guarantee with this virus. How awful would it be if I infected my providers?
Moments later, Isabelle was delivered, a healthy 7 pounds, 2 ounces. As I held her in my arms, I felt great relief and overwhelming, instant love. But also I felt anxious for the providers who took care of me. Some, I knew, had young children of their own at home. Others were older, and many likely had underlying medical conditions.
They all must have seen reports of pregnant patients who had covid-19. They all must have known about the father who sneaked into a labor ward in New York despite having symptoms. My providers never wavered in taking exceptional care of me — just as they did two years ago. But just as I saw them as potential asymptomatic carriers, they saw me as one, too — someone who could make them ill and endanger their loved ones.
And that, sadly, is the deeper shift at work in our health-care system. Covid-19 is forcing a change in the provider-patient relationship and creating a tension that must be navigated with empathy, by caregivers and patients alike.
Perhaps this will ease once there is finally adequate PPE and widespread testing. Perhaps what is needed are wards or entire hospitals that can be reliably separated to care for patients with covid-19 and those without. But for now, both sides must struggle to reconcile our desire for closeness with the fear of what that closeness brings. Patients and providers inhabit a new normal in which we worry about — and for — each other.