The World Health Organization declared COVID-19 a pandemic on March 11th. Shortly thereafter, the governor of Massachusetts declared a state of emergency and recommended social distancing. Schools and daycares across the state closed. My hospital responded by postponing elective procedures and encouraged physicians to reschedule non-urgent patients in the clinic.

Across the country, within the span of a few days, people’s personal and professional lives were completely disrupted. As I scrambled to find childcare while deciding what patients could be rescheduled in the clinic and what necessitated an urgent visit, I felt as though all the careful order and control I had built into my life as a dual physician household with two young children had been wrested away from me.

So I decided to take back control of my life by potty training my toddler, because nothing restores control like dealing with a willful child. And what better time to potty train than in a pandemic where social distancing was becoming the norm? We were essentially quarantined, so now was the perfect time to practice the no-pants method of potty training.

Or so I thought. I had forgotten that my strong-willed child had to be sleep trained three times before finally sleeping through the night at 23 months of age. I was quickly reminded of this when my child peed on the floor, peed on my husband–essentially peed anywhere but the potty. I bribed her with chocolate chips each time she sat on the potty, but then we ran out of chocolate chips, so I went to the grocery store to buy more. I stood in a line 30 people deep just to get into the store and saw a man grab the last four bags of chocolate chips while I was stuck behind four grocery carts. (I hope he’s making the world’s biggest chocolate chip cookie, because otherwise there is no excuse for that kind of behavior.)

I returned home defeated by the savagery witnessed in the grocery store, only to find a trail of feces from my older child’s bedroom to the diaper pail in the toddler’s bedroom. The toddler meanwhile was standing in front of the diaper pail, a gleeful smile pasted on her face, scooping poop into the pail. She proudly stated, “I poop in the garbage!”

And back to diapers we went. Potty training was officially over, and the conclusion I came to was that potty training during a pandemic is not recommended.

The irony is that while things were literally covered in feces and falling apart in my house, it reflected what was happening in the world around me. Daily emails from the hospital informed me of the lack of testing kits, face masks, and gowns. The pile of poop needing to be scooped into the diaper pail grew exponentially larger nationally as social distancing was ignored, and people willfully continued to live their lives as though all was normal.

There’s a pile of poop on the floor, people. We are living through a pandemic. Nothing will ever be normal again.

Even before this pandemic, our health care system was struggling. We spend over 17 percent of our GDP on health care but consistently have worse outcomes when compared to other high-income countries. As an OB/GYN, I am particularly aware of the disparate rates of maternal mortality in this country compared to other high-income countries. Maternal mortality is a good benchmark for a health care system as it measures the risk of pregnancy and delivery in an overall healthy patient population. A professor of mine in medical school joked that pregnancy was a pathologic state; it is a joke that I have come to appreciate as containing a kernel of truth after witnessing so much pathology even in my brief career. Yet, that pathologic state is often balanced by the fact that pregnant women are generally healthy. In addition, modern medicine has provided us the knowledge and tools to make pregnancy and delivery much safer. We can never take away all the risks of pregnancy and labor, so the maternal mortality rate may never be 0, but we can get it as close to 0 as possible. Yet our nation has one of the highest maternal mortality rates among high-income countries and fails at making birth safer every single day.

Now we are taking a broken health care system and having it confront a pandemic. The health care system is struggling, but the test hasn’t even come yet for the vast majority of states in the nation. SARS-CoV-2 shows no signs of abating, and nationally, cases of COVID-19 have surpassed 51,000. The pandemic has exposed the failings in our system, the discordant, disparate, and ineffective response as each hospital navigates on its own how to respond to an extraordinary situation. Paraphrasing Dr. Bharel from the Massachusetts Department of Public Health: we are past the stage of containment and are currently trying to mitigate the pandemic. In other words–there’s poop on the floor, and we’re trying to clean it up.

As an OB/GYN, I may never be on the front line of this pandemic. We also don’t know how severe the pandemic will become in the United States, but as I read about the health care systems that are overwhelmed by the burden of disease in countries such as Italy and Spain, I cannot help but worry that soon we too will be facing a national shortage of ventilators, just as we already have a shortage of personal protective equipment.

While the opportunity for containment has passed, there’s still time for mitigation. Amidst these uncertain times, the only thing we can be certain of is that we must temporarily halt people’s normal lives in order to contain an invisible but potent enemy. And as we look toward the future, we can begin to think about reforming a health care system that has failed us yet again, unless we want there to be more poop on the floor.

Huma Farid is an obstetrics-gynecology physician.

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