My “post-mortem” file made this Covid-19 surge very personal – fr

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My “post-mortem” file made this Covid-19 surge very personal – fr


EEvery morning when I arrive at my primary care clinic, the first thing I do is open the electronic medical record and search my inbox. It’s a mishmash of records – patient calls, patient messages, external messages, contact center messages, staff messages, prescription messages – that often overlap and are often overloaded with the medical equivalent of spam. . But there is one dossier, Postmortem, which is unambiguous in its content and purpose.
As the pandemic raged from the winter wave through spring, Postmortem lit up with disheartening regularity. I opened it in dread as it revealed which of my patients had perished that week.

The first wave of Covid-19 last spring had been blurry. Although some of my own patients have contracted the disease, the massive waves of patients passing through our medical system and national news carried a patina of anonymity. The death and suffering were palpable, but they also seemed strangely left behind; almost everything that allowed human connection had been razed to the ground.

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The surge that started at the end of 2020 and spread into spring was completely different. This wave of Covid has been extremely personal for me, as the dramatic increase in Covid in the community meant that every day more and more of my own patients were falling ill. With each new diagnosis, my patient and I would embark on a journey – often trying – through the disease. We knew perfectly well how the Covid-19 results were a dice game, as the Postmortem dossier regularly reminded me.

When a new message arrived at Postmortem, I tried to clear my desk and my mind before making that heavy phone call to the family. We talked about their loved one, shared our memories and our grief. For many of my patients, our relationship went back 10 years, sometimes 20 years. We were connected for a significant part of our lives, often through difficult health setbacks and extremely vulnerable times. Saying goodbye to them through conversations with their spouses, children and parents was heartbreaking. Much like Zoom’s funeral, which, in bitter irony, the pandemic made it easier to attend.

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There is also the uncomfortable bureaucratic part of dying. For my patients who died outside of our hospital system, I should “notify” our electronic medical record of this turn of events. I would first write a note in the table detailing the circumstances of death, awkwardly titled “Expiration Note.” This is the language of medicine.

Then I should take care of the “Patient Status” field. When our electronic health record debuted two years ago, I remember how strange this field was, as everyone’s status was listed as “alive”. (“Well, what other would they be? I remember thinking about every patient who walked into my office. “They are here, no? But the pandemic has pushed back its target.

With a single melancholy click, I would change the status from “Alive” to “Deceased”. And it was this mundane act that always made us cry. The ridiculous equivalence of a stupid computer click with the loss of a human life has kind of dissolved the last of my nerve.

” Are you sure? The system would scold me, knowing that changing that particular status is different from changing a patient’s marital status, or even their Covid-19 status. I know why the system includes this second step warning, but it still felt like salt on the wound.

And of course, the minute I had duly certified my patient’s deceased status, the Postmortem record would instantly light up. Yet another alert to be aware of. Another dose of salt. “How many… times,” I shouted into the computer, “do you have to remind me that my patient has passed away?”

The cruelty of Covid’s destruction hit the hardest when it crept in out of the blue, when I called a patient for a scheduled televised appointment to learn from the family that they were in intensive care in a other hospital, or that he had just died of Covid. pneumonia. I would be ready to discuss high blood pressure and cholesterol levels and suddenly we would be engulfed in existential terror and gross grief.

When the Covid-19 vaccinations were opened to the general public, I emailed all of my patients, explaining how to get an appointment. “Thank you very much for this information,” was one of the first responses. “But unfortunately our father died of Covid two weeks ago. “

The last time I was faced with this blunt death and devastation was during my residency, when HIV struck patients with a savagery from which I will never fully recover. But the patients usually did not live long enough for us to develop prolonged relationships. Maybe that’s why I’ve spent the past 25 years as a primary care physician, nurturing long-term bonds over years of seemingly mundane blood pressure checks, drug refills, vaccinations, management of diabetes and countless episodes of tendonitis and lumbago.

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