“COVID-19: A Doctor’s Perspective” – with Dr. Sam Bender

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, we’re here with Sam Bender. Sam, welcome back to the “Healthful Woman” podcast. 

 

Sam: Hey, Natey, great to be here. 

 

Dr. Fox: Sam and I had this on our calendar for a little bit now to podcast together because our schedules rarely converge with an hour of free time that’s shared between the both of us. We were trying to figure out what to talk about and Sam, you had the suggestion to talk about COVID and to reflect a little bit over what’s been going on the past six months. 

 

Sam: It’s actually seven months now. But the thing that’s, you know, that strikes me trying to come up with a topic to talk with you about and talk to everybody about is kind of, you know, how has this changed what we do? How has it changed how we relate to our patients, how we get through our days, how we practice medicine, how we do basic things? As a delivering physician, what does the delivery room look like now? And how is this changing patient experience, doctor experience? 

 

Dr. Fox: It’s really interesting because it’s also evolved from when it started to now. I mean, all these issues about healthcare in general, and about medical care, and how we take care of patients both in the hospital and in our office, I don’t wanna say it’s radically different because I think essentially we’re doing the same thing but it looks radically different, potentially. And that’s also changed from, you know, February, March, and April to now. In some ways, it’s evolved and in some ways, we’ve just sort of gotten better, in some ways we’ve just gotten used to it, I think. But it is from an outsider’s perspective, it looks very different from how it was pre-COVID. 

 

Sam: Oh, without a doubt. I think you’ve touched on all the different things. Initially, the question was, you know, sort of emergently how we were going to try to do things to stay safe, to keep our patients safe, and what things we should shut down immediately, what things we had to do, and how we were gonna actually do that. And now, fast forward to October and the questions that we’re asking is, or the question I’m asking now is, how exactly does this look? This has become…you know, for using an overworked phrase, this has become our new normal. 

 

Dr. Fox: Right. I don’t know which is more overworked, new normal or unprecedented? 

 

Sam: Yeah, it’s our unprecedented new normal. 

 

Dr. Fox: You’ve been practicing as a doctor and as an OB-GYN for a while, you’ve been in many institutions, and you’ve, you know, taken care of thousands of patients. So, I’m curious, just, from your perspective, sort of as an overview as someone who’s, you know, done this for a long time, what was it like in let’s just say, you know, February March when this hit? Have you ever experienced anything like this or similar to this in your career? 

 

Sam: Oh, never. One of the beautiful things about obstetrics and gynecology is the camaraderie that one develops with a patient over an entire pregnancy in terms of obstetrics, and with my OB patients that become my gynecology patients, it’s years and years. The visits are medical, they’re professional, but there’s a social element that’s stuck in there too. I find it in many ways, practicing over the years that I get to grow up with my patients. I started off, the bulk of my patients work roughly my age or a little bit younger than me having maybe their first baby. And now I have patients that have traveled with me for 20, 25 years, and even longer. Practicing medicine has always had that nice connection. It allowed me to interact with people, to do my job professionally, but also to have an element that was past just the medicine. That was ranging into not necessarily a friendship, you know, but it wasn’t just an anonymously practicing medicine, it was connecting with patients differently. 

 

COVID hits and the immediate concern is minimize all contacts that are unnecessary, and frankly, you know, to make sure that the patients don’t get sick from the doctors with the staff and the staff don’t get sick from the patients. That we’re all, you know, wearing various different levels of gear to protect ourselves, whether it’s N95 masks, face shields, or less, it’s still some physical barrier is now between me and my patient in our relationship. 

 

Dr. Fox: I found that so jarring at first, that idea that you mentioned that we’re, sort of, separated from the patients and they’re separated from us. I know an ultrasound…normally every single person has an ultrasound. So, she would, you know, come to the front desk, see a person there, then come into the ultrasound room, see the sonographer, then I would see her, the doctor. But here now, she comes to the front desk and there’s a big plexiglass shield between her and the front desk like it’s a bank. And then she comes in and the sonographer, you know, looks like they’re in a hazmat suit because the poor sonographers are just exposed to people all day and, you know, they have to be right next to them. They have no idea if, you know, patients are sick or not so they’re wearing a lot of gear. And then they’re not really seeing the doctors, and it was weird. It was really strange to take care of people either not seeing them at all or phoning into the room. Obviously, we would see them if they had to be seen or if they really wanted to be seen, but that was a very abrupt change in how we practice medicine and you lose so much when you don’t have that personal connection with somebody. 

 

Sam: Oh, without a doubt. One of the handy ways that computer systems allow us to see our patients and review their records that our office employs is actually including a snapshot of the patient. And for me, you know, a lot of my memory is very visual. Having that picture of the patient in front of me the night before or the day before I actually am seeing the patient while I’m reviewing my charts allows me to remember who they are and to, sort of, set myself up for what our interaction is gonna be. And that’s probably the least important component in our medical record at the moment because the patients come in wearing masks and the pictures, you know, aren’t helping me, you know what, except for maybe some of my distant memory. 

 

Dr. Fox: It’s really weird and, you know, when people are coming for medical care, and when we’re taking care of patients, you sort of think it’s the medicine, you think it’s the science, you think it’s the intellect, it’s the decision-making, it’s the tests we run, and obviously, that’s a lot of it. But so much of it is also understanding a person, who they are, what they want, what are their likes and dislikes, what are their needs, what are their personalities, what are all of, you know, our various…everyone’s got our own psychological uniqueness, each of us. But that’s such a huge part of taking care of people and it gets lost with a lot of these restrictions. And again, they’re obviously there for a reason. It’s also not good if people start getting infected but it really was difficult. 

 

We were doing some of these visits that we could virtually, which ironically, even though they were farther away, they felt a little bit closer because you can actually see their face. And it’s one of the few times I actually saw patients without masks on. Because you know, they’re home in their living room, I’m in my office, my door’s shut, my mask is off, her mask is off. And so, we can actually see each other or also her partner can get on at the same time, whereas we weren’t having them in our office. So, in a really strange way, being 50 miles apart felt much closer than even sitting in the same room with her with our masks on, which was a little bit strange but such an interesting twist to what was going on. 

 

Sam: You’re absolutely correct. It’s something that struck me as, you know, sort of, an important positive of some of the virtual visits as well. One of the unique things that happens in our practice is that at the time of a prenatal visit, it’s not uncommon, in a more normal time, to have partners present for the visit, depending on what the level of concern with, you know, COVID infection rates in the New York City area happen to be. Our office, you know, will flip between having partners present and social distancing and mask-wearing versus actually asking partners not to be present for routine visits just to keep the volume within the practice smaller and create a safer environment for both patients and staff. 

 

And trying to have, sort of, a combination of obstetric visits where I have the patient in a mask in a seat across from my desk and the husband, you know, virtually added to the visit, you know, on a phone I found to be, sort of, one of the more challenging events. It’s hard for me to figure out where to look and my routine is a little bit messed up. And so, you know, it started as almost a joke, but it’s become my common practice now is to have the husband present, you know, by Zoom, you know, or FaceTime. And I literally have the patient put her phone with his face in the chair that he would have been sitting in it. And it makes for a very amusing optic. But I find that, actually, I can look at them both normally, you know, with this bizarre setting. And if people saw me doing this, I’m certain would just laugh. 

 

Dr. Fox: It’s so true. And I think, you know, we really struggle with these decisions because we’re trying to balance so many things. And at the same time, each practice has to make individualized decisions about partners, for example, based on what kind of medical care we’re providing. Meaning so when we’re doing pregnancy, it’s something that you’re more likely to want a partner present because they’re really involved because they’re part of the decisions and, you know, people rely on each other. And so on the one hand, we really, really want people to be there but another hand, with pregnant patients there’s a much, sort of, higher level of anxiety over infections because potentially the mother could get sick or, you know, she’s pregnant carrying a baby. 

 

And on top of that, you know, you have to figure out how many staff do you have, right. So, a practice like ours, there’s a lot more staff, right. A lot of people if you’re just seeing a regular medical doctor, you’ll see the doctor, maybe one person, the front desk, maybe one nurse. But we have, you know, sonographers, and front desk people, and medical assistants, and nurses, and multiple doctors at different times. So, we have a lot more people walking around. And also, how much physical space do you have, you know, how big are the rooms? How big is your waiting room? And also, what’s the level of infection at that time? 

 

And so, like you said, when we started, partners were coming, and then they weren’t coming. And then the infection rate drops and we said, “Okay, everyone can come but wait outside, don’t be in the waiting room.” And then the infection rate goes up a little bit. And so, patients, I think they’ve been very understanding about this because they also recognize the need to adapt based on what’s going on. But it’s very hard for patients to find out two days before their appointment that, you know, infection rates are up, we can’t have partners in the office. And that’s tough, it’s tough for us too, like, we don’t wanna make those decisions. 

 

Sam: And you’re absolutely correct, we have just a whole lot of people behind the scenes. And you and I may be the face that the patient experiences on that day, so to speak, I guess, based on the mask. And we may be one of only two people that that patient may even see on that day. But we still have all these other concerns that are part of our bigger picture. In obstetrics, as frontline providers, we find ourselves in sort of a unique situation. For the most part, our patients are younger, healthier, with way fewer comorbidities than our staff, our nurses, and our doctors. And that holds true both in our practice as well as on our services in the hospital. It’s sort of the nature of obstetrics is that patients are younger and, for the most part, healthy. 

 

The pandemic as it presents to hospitalized patients on the medicine service is a completely different story. The patients that are coming to the hospital requiring care on the medicine service typically are significantly more ill and likely more contagious, and the staff taking care of them tend to be younger, healthier, and with fewer comorbidities. Essentially, it’s sort of reversed, you know, in our field. It’s one of those interesting things that also makes some of the statistics that we follow in the New York City area a little bit misleading is that admissions in the obstetric service tend not to be sick patients, they just tend to be positive patients. Whereas the admissions on the other services are patients that needed to be hospitalized for complications likely coinciding with their COVID infection. 

 

Dr. Fox: You know, at any given time, we typically will have, you know, about 600 or 700 patients who are pregnant under our care. We do about 1,000 deliveries a year and, you know, it’s about 9 months or so plus-minus, okay, at any given time, about 600 or 700 patients. And during that, you know, one to two-month span where infection rates were pretty high in New York, and we were in touch with every single one of those patients, and at the time, we had just under 100 who were either definitely positive or almost certainly positive based on, you know, their symptoms, not everyone at that time got tested. So, you’re talking, you know, it was we had, like, 10% to 15% of our patients are positive, which is huge, but none of them were sick, you know, to any significant degree. I think one ended up in the hospital for a couple of days just to get oxygen, she wasn’t intubated, and she had some other medical issues on top of that. One had oxygen at home, but the rest were just okay, like, they’re fine. 

 

And at the time, if we’re thinking, you know, 10% to 15% of our patients are sick, or have this infection, as you said, we have staff members in their 50s, 60s, 70s, and we’re worried about them getting ill and going out of work and being potentially hospitalized themselves. And, you know, we had some staff members…and on the labor floor it’s the same concept, the labor nurses and the postpartum nurses, and the people who work there tend to be older than the patients and have more morbidities. And so, it was such an interesting phenomenon that I found that there was a bigger fear, I would say, amongst the staff at certain times than there was amongst the patients. 

 

Sam: Without a doubt. And you still see that, you still see that in the practice now and perhaps a slightly different level. There is a certain level of when the staff or the doctors have been working in this area with these constraints with the pandemic going where you simply get used to it. And there’s most definitely still a group of patients that think that because they knew so very many people that were positive in the past that somehow the peak, you know, of the pandemic is over and that they have nothing to worry about. The staff though when you see small spikes on the labor floor, entire labor floor tests every single patient that’s admitted, including all their partners that come with them. Whenever there seems to be, you know, a couple of newer positive patients, you can see that same level of anxiety increase among staff members. I think that we’re all better at following the rules, donning and doffing our PPE appropriately and that nobody on our service certainly takes everything for granted, even if you are getting a little bit numb to, you know, to the process. 

 

But there still is an underlying level of anxiety, fear, you know, maybe anger sometimes that coincides with living, sort of, in this moment. In the last seven months, things have not gone back to the regular level of concern that one has on the labor floor where you have acute medical issues that are constantly being followed. There’s this extra level of anxiety that’s just been there constantly as a result of this that isn’t going away, that you’re reminded of every time you come to the labor floor. A standard morning, when I arrive on labor and delivery in our New York City Hospital, is stopping before you enter to have people take your temperature, coming through our doorway, gathering together all the different masks and headgear and footgear that are required to start my day on that floor. And it just wasn’t that long ago that this was not the way our labor and delivery functioned. I mean, we still were concerned about handwashing, we still were concerned about sterility for procedures, we still, you know, wore appropriate protective gear, you know, for things, but it was simply different. 

 

Dr. Fox: Yeah, I mean, I think that when just every single person wearing a mask at all times, at all times, and there’s so many people who come through, is an odd visual because usually people would have masks on during the delivery, during the C-section. You know, a patient comes in and she’s coughing, like in very sort of specific circumstances, but now everyone has that. The meetings we used to have together, the gatherings to talk about, you know, what’s going on the floor has been altered because we can’t fit 30 people in a tiny room anymore because that’s not appropriate right now. And so, those have to be changed, scheduling has changed. I mean, and that’s now when things have calmed down a lot. And I think, like you said, right now the level of anxiety amongst the staff and patients about COVID is present, but sort of a low rumble. 

 

When this hit, I remember you were on the labor floor nearly every day for several weeks. Just because one of the strategies that a lot of staffs employed was, you know, not only are we worried about patients being sick, or staff getting sick and actually being sick, right, we’re worried about people being ill, we’re also worried what if people get ill and they just can’t come to work and there’s no doctors, there’s no nurses? So, one of the strategies employed was have the same people in the same place every day, right? So, if there’s a breakout in one place, it’s confined to that team, so to speak. So, you have a team in ultrasound, a team on the office, a team on the labor floor. And if one of the sites has spreading, you can sort of limit it to those groups. So, you were one of the people on the labor floor. I’m gonna ask you to tell me what it’s like but one of the things I remember vividly is that N95 mask chewed your nose up, you know, like a badger went to work on you. 

 

Sam: Oh, without a doubt, you know, that… 

 

Dr. Fox: There was a big cut on the top of your nose. 

 

Sam: No, it looked like a horror movie for a little bit. Anyone that’s been properly fit-tested for an N95 hospital-grade mask and worn one realizes that it’s just not a lot of fun. Literally, the first two weeks putting one on was breaking through the laceration that I had on the bridge of my nose. I hadn’t seen anything look like that since following the Bears in the ’70s, you know, when Dick Butkus used to hit people so hard that they would be bleeding. But after about two weeks, the scabs, you know, turned into calluses and you can actually wear this. I think that at the end of all of this, you’ll be able to tell the hospital workers and the frontline people that had to wear this gear because we all permanently will have marks on our face from it. Not to mention the permanent N95 mask acne, you know, that you get at the borders of the of the mask that I’m certain are probably never going to completely resolve either. 

 

Dr. Fox: Well, what was the mood like on the labor floor at that time? I mean, there was a lot of…it was very stressful, I know that. 

 

Sam: There were two things happening at once. On the one hand, things were extraordinarily stressful. And there are some people that actually do not perform well in that environment. And thankfully, either they had enough wherewithal to get themselves out of that environment and get themselves in a safer, healthier position for them to be able to function. And so, initially, there were a number of people that you saw that got sick that really raised the level of concern amongst everybody quite a bit. But at the same time that you saw, sort of, the escalating fears and the concern and, you know, a few people choosing not to participate in that environment, you also saw a heightened level of camaraderie that all the doctors that may be working in completely different practice models from doctors that are there simply to supervise the resident physicians to doctors that are in private practices that never, you know, seem to be available to help with anybody else’s things and were just, you know, laser-focused on taking care of their one patient while they were in the hospital to groups like ours that are a little bit bigger and have always had a presence on the floor. 

 

But I think that the doctors and the residents that I worked with for, especially, you know, the first two months of this pandemic, really were awesome in the way they just bent over backwards to help each other get through the things that you had to get through. It was clearly a challenge to be able to take care of patients, to even be able to transport patients. You know, for small things that you never really thought about, moving a patient from the triage area to a birthing room or from a birthing room to a delivery room, you know, from the operating room to recovery areas. Each of these steps when your patient was positive requires just a huge number of people to help out, you know, to make sure that you’re not potentially spreading the virus from one space to another. That everybody was super in learning how to do these things and how to do them effectively, but also helping help each other have in ways that you just don’t usually see, you know, in a city hospital with each practice sort of siloed, you know, separately. 

 

Dr. Fox: Yeah, it’s so interesting. The labor floor is normally a place of, sort of, high acuity and there’s the potential for emergencies and high stress and, you know, a lot of stuff going on. And I think what’s so fascinating is you see people who professionally function in that environment every single day. Like, they’re there with patients and they know that at any moment’s time, things can flip from going fine to be a complete emergency, and they’re very comfortable in that environment. But then when it, sort of, gets turned the other way where there’s the potential for something to happen to you, the doctor, you, the nurse, clearly, we’re not at risk on the labor floor normally. Some people are comfortable with that as well and others just aren’t. You know, the way they function in their own lives is different from how they function with patients, which number one, it’s just interesting from a human psychology perspective, just how people react. And number two, it actually makes you more impressed of how well people who do have fear and anxiety over their own health and over this, maybe more so than others, are still able to function so well as doctors and nurses taking care of others. It’s just how they’re able to, sort of, divide that normally. And so, I thought that was just really interesting to see that. 

 

And what you mentioned about the camaraderie is so true. I mean, I remember when this was first starting, there was so much information we didn’t have, right? So, we knew this was a virus that’s here, it’s prevalent, it’s contagious. It has the potential to be ranging from completely asymptomatic to lethal, right, which is basically anything, it could do anything to anybody is, sort of, what we knew. But no one really knew the numbers or anything like that, how many patients are gonna come in? Is it gonna make our pregnant patient sicker? Is it not? We just didn’t know. And under those circumstances, I remember, they’re trying to figure out, how do you function? How do you process? How do you do all this? And I mean, the things that happen are so amazing, you know, the first couple of anesthesiologists who got sick with COVID, because these are…you know, they’re the frontline of the frontline. They’re intubating people, they’re like, literally…you know, I always say we’re like the second line. They’re like the frontline. And they’re… 

 

Sam: They’re on the wrong side of the page. 

 

Dr. Fox: Yeah, I mean, they’re right in there. And so, the first ones who got sick, you know, a week-and-a-half later when they came back, they said, “We’re gonna take care of all the COVID patients.” Because they said…they’re saying, “We figure we got sick, we have antibodies.” No one knows this, we still don’t know it in October, are you really protected, are you not protected? But even then, they said, “You know what, whatever it is, we’re more protected than our colleagues who’ve never gotten this. So, whether it’s, you know, gonna be bad for us and not bad for us, the odds are we’re better off.” And they said…and they would just sit in that operating room and every COVID-positive patient who needed a C-section, they did their anesthesia. 

 

And what an amazing thing. I mean, they’re not asking to rotate, they’re not saying, “Hey, I got sick, you know, put me somewhere else, that was really horrifying.” It’s like the exact opposite. They said, “I don’t want my colleagues to have that, so I’m gonna work there, I’m gonna take care of those patients.” And, you know, it’s just one little example but you wouldn’t even think of that. And it was really just…it was pretty amazing to watch. And that was, sort of, the attitude pretty much everywhere, at least the places I saw. And that’s what I heard from around the hospital as well that everyone really just tried to do whatever they could to help the patients and also to help their colleagues, the staff. 

 

Sam: That’s exactly it. It made me proud to come and work to be part of, you know, a team like that. In medicine, we’re stuck in our bubble, you know, a good bit of the time, we’re responsible for our patients, which is a major focus. It’s not often that you get to see the whole bigger picture and something like this, I think, really showed it to me. 

 

Dr. Fox: The applause was nice at 7 p.m. That was pleasant. 

 

Sam: It was interesting. I live near the hospital. I live, you know, walking distance and anyone that’s ever been to New York City prior to February knows that there are certain areas of the city that are busy. And there’s certain areas of the city that, you know, you probably, you know, can walk faster than you could ever drive. And there was virtually no traffic, you know, in Manhattan for that period of time. Nothing just looked like New York, you know, it looked like something out of a movie or something. 

 

Dr. Fox: Yeah, it was weird. 

 

Sam: There were times walking home from the hospital where I literally did not see a car on the street. And you’re talking walking 12 blocks in Manhattan. I started actually picking routes…I would see no people and no cars. I started picking routes that sent me by, sort of, fancier apartments, way fancier than mine that have, you know, doormen just to know, you know, that there were, like, people around and awake, you know, sort of, somewhere near where I was walking. Having the 7:00 pots and pans banged out of the windows, you know, was interesting. In our neighborhood where our offices are, you know, there’s a church that chimes at noon and chimes at 6:00 p.m. And so, I had a, you know, a third marker for me. I now knew when… 

 

Dr. Fox: Your circadian rhythm was still in check. 

 

Sam: Exactly, I knew when it was 12, when it was 6, and now when it was 7. It was interesting. 

 

Dr. Fox: During that time, you know, I commute from Jersey, and the time it takes me to commute is 100% dependent on traffic, right? The minimum time is 18 minutes from door to door, if there’s no traffic. You know, 3 in the morning, let’s say I get called in for a delivery, it’s 18 minutes from my house to the hospital. If I miss 2 red lights, maybe it’s 20 minutes, and then it could be an hour-and-a-half, right, during rush hour. And during that time period, it was 20 minutes all day, every day, no matter what time I came, that was number one. Number two, I could park anywhere I wanted. It was like I drove an ambulance, it was crazy. Because they told us, they said, “Doctors, health care workers, we’re not ticketing you. Like, don’t park in front of a hydrant, please, otherwise, you’re good to go.” And so I would just drive in, plop my car anywhere, and just get out and there was no cars anywhere. I mean, I could probably park my car in the middle of Madison, nobody would notice, it was really like a ghost town. 

 

That…not the applause, obviously, but just that notion that at the time, everyone was so thankful for what health care workers do. And that’s a very wide net, health care workers. It’s not just doctors, it’s anybody who came into the hospital. The people who sweep the floors in the middle of the day to keep it clean. I mean, they’re taking the same risk that the rest of us are, and they’re frequently different health potentially and, you know, different health care that they have. And it’s everybody who showed up was really appreciated, which I thought was pretty cool. Because that doesn’t always happen for obvious reasons. It doesn’t mean people don’t appreciate us, but it’s not thought of in that sense. 

 

Sam: No, in fact, the people that do these tasks, what you really learn, a couple of things, one is that you can’t do anything unless you have your support people around for you. 

 

Dr. Fox: Oh, yeah, we’d fall apart. If doctors had to take care of this stuff, forget it. 

 

Sam: I mean, you know, once in a while… 

 

Dr. Fox: We couldn’t open the door in the morning. 

 

Sam: When things are backed up and you actually, you know, help turn over a room so that you can do a procedure, you know, you’d spend the next month telling all the people about how you did that. Whereas these other people are doing it every day for every case. And frankly, they were doing it at a time where they were risking, you know, big-time exposure themselves. 

 

Dr. Fox: Absolutely. 

 

Sam: You know, in ways that, as the physician, I was not. I mean, I was wearing my gear and doing my procedures and leaving my room. And then they had to actually go in and turn it around, sterilize it so that it could safely be used for for for the next case. And most of our staff that come and work at Mount Sinai, you know, don’t live all that close, you know, to the Upper East Side of Manhattan… 

 

Dr. Fox: Yeah, they’re commuting. 

 

Sam: And they’re commuting and frequently commuting with multiple trains to actually get there and putting themselves at commuting risk of picking up a virus. And it’s a group that all of the staff, especially those of us that were stuck in the hospital during these last few months, I think we’ve come to appreciate them on an even higher order. They didn’t necessarily have to do this, they might have actually gotten benefits that would have matched their salaries or close to it. 

 

Dr. Fox: The level of devotion that people have is sometimes not seen. Right, just people are doing their jobs and then when something like this happens, you see how many people really care. And they know that what they do is important for patients to get the care they need. And they came in. I mean, I always said that, you know, when our office was open every day…we had to be, right? We’re not the type of medical practice that can shut down for two months and say, you know, it’s all elective. Wait, pregnant patients have to come in. And so, we’re open every day. And people are like, “Oh, that’s so amazing that the doctors are coming,” and I said, “Forget the doctors. People work at the front desk, you know, they’re seeing every single patient, you know, comes in, they commute, they greet them with a smile, even though you can’t see because of the mask. Our nurses, our medical assistants, our sonographers, I mean, everybody. They’re really…you know, we’re, like, last.” 

 

Someone comes up, you know, comes in coughing and this or that, they’re not even gonna see us first, they’re gonna get, you know, taken care of by our nurses before anybody. And it’s just when you get to, sort of, learn a lot about people and what their characters are when things get a little more complicated. And it was really impressive how amazing all these people are at that time. We’re definitely quite pleased to reaffirm how wonderful the people we work with are. 

 

Sam: Oh, without a doubt. As awful as this pandemic has been it’s, you know, you’ve gotten to see how people can rise to the occasion and really, really perform even when things don’t appear to be, you know, easier or safer, they’re still able to do that. And that’s a testament to each and every employee, you know, that we have within our practice, as well as all the people we get to work with and alongside of, you know, at the hospital. 

 

Dr. Fox: Right. So, fast forward to October. So, you know, we’re recording this in middle of October. What’s it like now in terms of, you know, when you see patients in the office, are they talking about COVID? Are they asking, or is it just sort of the new norm? And in the hospital I know we mentioned, sort of, everyone’s, sort of, used to that level of anxiety. But is it just, sort of, there and everyone knows about it, or are there still active discussions about what’s it gonna be with infection, am I at risk, and the same day-to-day talk about COVID? 

 

Sam: No, it still comes up, it works its way into almost every patient interaction I have. Whether it’s something simple like, “Are there new policies in the hospital I need to be aware of?” You know, if somebody is about to be having a baby soon, they wanna know what the hospital rules are, just like they wanna know if our practice rules are changing. And it probably comes up in every conversation I have, even with patients that are there for a routine annual visit or a gynecologic visit. Nearly always when I ask a patient…you know, I’ll start off with, you know, a blanket statement like, “Have you been well? You know, did you or anyone in your family, you know, get the coronavirus?” It’s rare that somebody tells me that they don’t know anybody that they’re directly related to that got it. It’s frequent that somebody has a family member that actually died from this virus. 

 

And there’s different things that I gained from making that, sort of, a standard question even for a routine annual visit, which a number of these patients really are not getting the kind of counseling that they might require to actually deal with some of these things that in their lives they never had to deal with before either. And so, we used to have blanket questions that you would ask people, you know, to ascertain whether or not you thought, you know, that they were under stress or could potentially be showing any signals of depression. And now, actually, you just mentioned coronavirus, and it launches you into nearly all these conversations that could be there. You know, the questions that used to come up are questions that almost never come up. You would ask patients about, “Have you gone anywhere? Have you have been on any nice vacations?” 

 

Dr. Fox: I got to go to the supermarket last week, which is amazing. 

 

Sam: Do you have any trips planned? It’s like, you know, I struggled to remember the word airplane. 

 

Dr. Fox: Yeah, your trips and summer camps is big for you and it’s like, nope, and no. What are you telling patients? I get a lot of people asking me, should they delay pregnancy until this is blown through? I must have someone ask me that every day, you know, generally not even patients, I mean, friends, family, like, “Hey, you know, we’re thinking, are you telling people to wait?” How are you advising people when they ask you that? 

 

Sam: You start off with the science, you start off telling patients that there are so many people in the world that were pregnant or giving birth, you know, during this pandemic that, you know, you give them the basic information that we know about the rarity of vertical transmission and the lack of associations with certain pregnancy problems. But you also take a step back and you try to figure out what this patient’s really asking you. And so, in typical fashion, I turn that question around with a question, which is, you know, “Gee, what were you guys, you know, thinking?” Just to get a gauge of, you know, the urgency, you know, how pressing it is. If your patient happens to be, you know, 40 years old and they were really planning on, you know, seeing if they could conceive right now, waiting an additional year isn’t medically going to necessarily make a world of sense in terms of, you know, potential issues surrounding fertility. 

 

And by the very same token for my pregnant patients, you know, that are concerned about having a baby during the time of COVID, you know, one of the things I tell them is that, you know, after you have the baby, you are going to do the normal version of quarantine. And you’re probably the only one that’s gonna be, you know, sort of, you know, happy to be, you know, sort of stuck back into that world, you know, for at least a while. I think you have to be optimistic, I think you have to look at the science, you have to look at the world, you have to look at sort of a bigger picture and know, you know, that we’re living in a world where it’s possible that there could be, you know, a vaccine with some level of effectiveness that could become available in the next 6 to 12 months. There may be therapies that turn up being, you know, better for dealing with the virus if you are going to get it. 

 

And there are things, you know, that you certainly can do to keep yourself out of certain areas of risk. If this is something that you want to do, like get pregnant, and so you start focusing on behavior. It’s like, gee, if you’re gonna do that you really need to kind of play by the rules. You have to put yourself in as low-risk environment as you can. I think that we can be optimistic that at least in this city, you know, we’re not going to wake up and find out that we’re at a peak without having any idea that things had gotten so out of hand, you know, like what happened, you know, to this city at the end of March. There are a lot of tools that are out there that are helping the medical world track the virus a little bit. And, you know, we’re trying to use them to try to keep things as safe as possible and to remind people where we are. 

 

But at the end of the day, I think what I really need to do when I’m confronted with those questions is at some point in the conversation early, you know, earlier, you know, is always better, to look her straight in the eye and tell her, you know, I don’t know, I really don’t know. But these are the things that you have to put on your, you know, list of pluses and minuses if you are gonna head down this path right now. Even before a pandemic, there isn’t always the perfect time to have a baby. These are life events that occur sometimes when you don’t want them and don’t occur sometimes when you do want them. Whenever you’re there, you know, there are hurdles. There are things that are going to come up that are going to be part of the package. This, obviously, is a big thing that you know is out there that potentially is going to make a difference in what your prenatal visits are, what your pregnancy looks like, what your delivery looks like. 

 

On some level, I think that we all believe, you know, that COVID-19 is gonna be here, and it’s never really ever going to be gone. You know, it’s just going to be something different. I’m hoping that, you know, just turns out being a conversation down the road where we say to each other, you know, to our patients, you know, “It’s flu and COVID season.” We have the annual flu vaccine and every X number of days, weeks, months, years, you know, decades, we need, you know, to maybe give you your booster for COVID too. And when we’re in that world, you know, this becomes just part of how we move along. 

 

Dr. Fox: I tell people when they ask me that, the first thing is, fortunately, we’ve been pleased that it does not appear to be extremely dangerous for pregnant women, at least, as you said, what we know so far in terms of their own health during pregnancy and that of their babies. And so, that’s, you know, reassuring. Ultimately, you know, it’s a decision people have to make. I have not been, sort of, medically discouraging pregnancy. And the reason is, you know, I tell people that the order of magnitude of a problem from COVID happening in pregnancy, it’s present, right, but it’s probably in a low percentage. And if everyone knew all the other things that at a low percentage could happen in pregnancy to them, no one would ever get pregnant. I mean, there’s other viruses out there that cause birth defects. There’s viruses that can make mothers very sick. There’s things that are not viruses that could happen. There’s so much stuff, and it seems like COVID just going to be one of those things on the list that you sort of…it’s an accepted risk when you get pregnant, it’s a possibility. And people just have to decide for themselves, but it’s tough and we’ll learn more as this goes on. 

 

Well, Sam, thanks for coming on. This has been great. I appreciate it. Hopefully, in six months, we’ll be talking about COVID vaccines and pregnancy. That’d be great. 

 

Sam: Excellent. Good to see you again, Natey. Wear your mask and stay safe. 

 

Dr. Fox: All right. Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.