A frontline caregiver stays the course

Life was hectic before COVID-19 for Dr. Amanda Preimesberger, her firefighter husband and their four kids.
Dr. Amanda Preimesberger (right) with her husband, Casey Preimesberger
Dr. Amanda Preimesberger (right) with her husband, Casey Preimesberger
Photo by Errin Hiltbrand

By Amanda Preimesberger

I crave simplicity and deep-rooted connection. Simplicity is forever a work in progress. Parenting four active boys while juggling the competing demands and schedules of a family physician (me) and a firefighter (my husband) doesn’t scream simple on an average day. “Who’s home tomorrow?” is a regular bedtime inquiry. Staying rooted as a family requires intention.

Like so many other dual-careered families in medicine and public service, we had an imperfectly perfect groove at home and work. We had this life gig (mostly) under control. Community members had come to know what to expect from us. Then came SARS-CoV-2.

The what-ifs start flowing through the heads of those of us trained to think three steps ahead of worst-case scenarios. Our job is to beat fate at its own game. The planning starts. An unsettled feeling lurks. At 2 a.m., distressing thoughts drift by, such as needing to update our will and power of attorney for health care in case one or both of us should get seriously ill from caring for our community. We discuss where and how self-isolation will occur if one of us gets sick — how we will likely be unable to visit our parents if they fall ill. I find myself watching a refresher video on ventilator basics from fellow physicians in a COVID-19-related Facebook group and spending hours reviewing the stories from physicians across the world facing the virus a few weeks ahead of us. Anything to stay a step ahead.

My husband and I devise a plan for removing and washing scrubs and firehouse clothing in the mudroom immediately upon arriving at home. We discuss what protective equipment we each have available, or unavailable, to us at work. We will question every scratchy throat and cough for the next several weeks. I will no longer wear makeup to work, as it will dirty the mask that I must reuse for at least three shifts. We worry about keeping our kids caught up with online schoolwork when we’re both away as essential workers. How do we avoid a widening gap for one of our boys, who has dyslexia, already working to catch up?

We are met with teen eye rolls and a smidge of fear as we tell our kids there will be a no-tolerance policy for hanging with folks outside our immediate family. We explain that if one of us gets sick we are unable to help our community when they need us most — and that is what we do. Kids are inherently inquisitive, tender and self-centered. They at once inquire whether we could die from our work, and are also crushed and frustrated that they’re distanced from their friends and grandparents.

I question whether I should tell them that I am on the list to help at the hospital if needed when a surge hits, or that I will see suspected COVID-19 patients while working at the clinic. They already know that both their mom and dad see people when they’re sick, and usually before knowing just how sick they are. It’s a fragile balance ensuring they understand the gravity of the disease and the need for caution, while also protecting them from undue anxiety and stress. We remind ourselves: Keep it simple, stay connected.

As COVID-19 symptoms escalate in our community, a range of emotions, constant workflow changes and a new perspective on barriers to care present themselves in our workplaces. There is an eerie but beautiful stillness initially felt in the clinics, hospitals and fire stations. People are staying home to keep one another safe, and they’re accessing services only when necessary, not sweating the small stuff. We have more time for meaningful conversations with those in need and with our colleagues. While anxiety is high, passion, purpose and cohesion are renewed. This was the calm before the storm, which we hoped our efforts would quell.

In the overscheduled, overhurried medical culture we’ve created, an opportunity has arisen to reinvigorate grassroots leadership. Coordinated local, state and federal responses are crucial but often slow-moving. In the face of this virus, time is pressing. Many health care workers and first responders start using social media platforms to share science and emerging recommendations on a real-time, personal level. The community response is overwhelmingly grateful, and people are yearning for information from those on the frontlines they know and trust. We understand our ability to make a great impact and directly flatten the curve in our communities.

Dr. Amanda Preimesberger with a mask on

Photo courtesy of Amanda Preimesberger

Guidelines and workflows will evolve continuously, but we start by contacting patients to offer telehealth visits or encourage them to postpone non-urgent appointments and procedures. We know this could significantly affect our personal incomes. But it’s the right thing to do to safely care for our patients. It’s a grassroots decision in line with our values. This pride is followed by a sense of grief and guilt, when I have to explain to my obstetric patients that after nine months of navigating pregnancy together, I will not be present at their delivery, nor will I be able to do their newborn’s first checkup. This creates a necessary fracture in my care for them.

At the same time, I will have my temperature taken when arriving at work every day and will be screened for COVID-19 symptoms before being allowed to care for others. Healthy patients and those with respiratory symptoms or fever will be sorted. They’ll be sent to separate parking areas, entrances and clinic spaces. My team and all our supplies move entirely to a new floor over the span of a weekend. Our personal schedules will be in constant flux as we pivot to meet the needs where and when they arise. But we will adjust.

While the focus shifts to having adequate resources for those at the peak of the COVID-19 curve, we do our best to care for everyone else, too. There are preexisting issues in health care that this pandemic will shine a bright, stinging light on.

Who will steer clear of this virus but have a cancer diagnosis missed because they’ve been laid off and lost their health care benefits? Who will have delayed stroke care because emergency services and ambulance availability are “lean”? Who will die of suicide or addiction while under immense stress because they can’t afford or have already been waiting months to access mental health services?

Our frontline providers, already facing unprecedented levels of burnout and loss of autonomy in their jobs, will now face post-traumatic stress disorder, anxiety, grief, survivor’s guilt and the urge to dilute our own fears and sadness as we compare our circumstances to those of colleagues who have seen worse.

What we have to do is keep it simple. And stay connected.

SARS-CoV-2 will leave a costly path — and it will also remind us of the value of opportunity and resiliency. We will better understand barriers for our communities, health care workers, public servants and families. We’re reminded of the value in slowing down. Keeping it simple. Connecting with our families and all of humanity. We can do this. We will do better.

And all the while, some things will never change. “Mom, who’s home tomorrow?”

Dr. Amanda Preimesberger is a board-certified physician in family medicine with obstetrics at SSM Health Dean Medical Group.