Since I started in my office on Shelter Island, I have had seven patients die. Having never started an essentially new primary care practice location before, I have no idea how that number compares. I just know that, in the context of a year full of more suffering and death among those for whom I am privileged to care for, those seven names stand out.
All were older and-or had chronic medical conditions. None had Covid-19. But they stand out for me, not just because to some degree I carry all of the patients who I have ever cared for and who have died with me, but because some of those seven reflect the larger group of the unseen deaths caused by this pandemic.
You may have read about these unseen deaths, those who suffered from interruptions in care or, in the most dire situations and places, could not access acute care because of strains upon health care systems that Covid-19 had caused.
In some places, those numbers included patients who were scared to go to specialists' offices or a hospital out of fear of contracting Covid-19. Some had seen their general regular care interrupted, particularly in the early part of the year when lockdowns changed the face of the world in terms of social and medical interactions.
Some of my patients who died this year reflect this. I had several of them and-or their family members express concern about leaving their homes in the midst of the pandemic, so we did the best we could by combining home visits, telehealth, and frequent communication.
It's not just that we're scared of the virus but also that we fear the effects each little bomb of a Covid-19 diagnosis has upon local medical ecosystems.
We were lucky to have not gotten to the level of severity locally where even those options were curtailed by a pandemic raging out of control at the highest levels. I have colleagues in other places, though, who write and speak in recent weeks of having emergency rooms overrun with Covid-19 to the point that more "typical" emergency patients suffered from having to wait.
This is, in so many ways, what I and the medical community have struggled to explain clearly — it's not just that we're scared of a virus that affects so many body systems, that is without a doubt deadlier than influenza and spreads so easily, but also that we very much fear the ripple effects each little bomb of a Covid-19 diagnosis has upon local medical ecosystems.
Each older patient with a history of heart attack who puts off their follow-up with their cardiologist so they're not exposed in a waiting room.
Each medical system, like those in Los Angeles County last week, having to discuss rationing of oxygen in their ambulances, a scenario I never imagined I'd see in the United States.
When we, as in the medical establishment, beg and plead for you to wear masks and wash hands and socially distance, it's not just to protect everyone, especially the most vulnerable, against the virus itself -- it's also to stop the ripple effects. To ease the strain on systems so close to bursting in so many places.
To prevent the unseen deaths.
Right now, we are fortunate not to be in such a position locally: Stony Brook Southampton Hospital, for example, is open and still has the capacity to care safely for patients.
However, if we continue to see local case numbers rise, we might get there, which is particularly frustrating to imagine because at long last, after almost a year of this fight, we have finally started to see the distribution of the long-awaited vaccines. I received my first dose of the Moderna vaccine three weeks ago, and I can honestly say that I have rarely felt such relief in my life, not because of my own protection, although it is hard as a father and husband and physician not to be grateful for that, but also because it represented a concrete step toward the end of this pandemic. The light at the end of the tunnel, as it were.
As the weeks stretch on and we continue to see the vaccine roll out, I hope you all can keep that light in mind. As I think about those patients I've lost this year and all those my colleagues have lost as well, I know I will.