A holiday greeting card from the land of primary care

I wish you and your family a safe, healthy, and happy holiday season. I hope your new year is bright and better. And in the campy spirit of the family newsletter some folks send out each year (which I love to read), here is one from me to you.

This year as a family doc was challenging. Again.

At times it was inspiring, frightening, and exhausting. I started the year with a vaccine in my arm, among the first 1 percent of humans on the planet fortunate enough to receive the Pfizer shots.

You may have read that primary care doctors early in the pandemic were dying more than any other specialty. We made up 27 percent of the deaths of health care workers. Compare this to what you might think of as the front line — emergency medicine, critical care specialists, and anesthesiologists — who comprised 7.4 percent of the early deaths. Family docs work in small examining rooms, with potentially infected asymptomatic patients, and are only provided surgical quality masks. I’ve worn my own N95 supplies at my own expense since this whole thing started. You might recall me even wearing a surgical cap for a while. If nothing else, it was fun to pretend to be a surgeon. But the emotional and physical toll of the hospital front line mentioned above has been much worse than what I’ve experienced. We should still be banging pots and pans, and making appreciative noise at 7 p.m. each night for them.

I thank all of you who respectfully kept your masks above your noses, and who stayed home when you were sick, and who graciously adapted to video visits. I got over the few who came in sick with COVID despite our pre-visit screening questions, those few who sneered that we were all “rolling up into the fetal position,” and accused us of being part of some sort of hoax. Some of us got very sick along the way, and lost family members, perhaps like you. The vast majority of you helped us tremendously with your caution. For that, I extend my deepest sympathy and love.

Each day for me was a sprint, from the alarm in the morning until I took a deep breath in bed to calm my heart and mind at night. School was variably open, my child variably OK, my family life and weekly schedule anything but predictable. But it was certainly better than last year, and by the time I got my second shot, I was feeling good sitting next to you in the examining room again, hearing your lungs breath in luxuriously, your heart beating dutifully. You started to show up first with one vaccine, then two. I saluted you, celebrated with you, and by early summer the pandemic was a weakened beast. I dreamed of a roaring ’20s about to start, like my grandparents danced in a hundred years ago.

I don’t recall a year in my professional career in which I lost more people. Some were claimed by COVID. Others died of conditions exacerbated by prior infection or fueled by the disruptions and stresses of living while others are sick and dying. We all got older. The isolation we endured to keep hospitals and supply lines from collapsing and buy time for science to complete a Manhattan Project chipped away at our humanity and left many suffering with mental illness and even accelerated cases of dementia.

Fires burned across the country, exacerbating respiratory conditions. Philadelphia and the Northeast flooded. Variants like Delta and Omicron appeared like nightmarish hurricanes with Greek names that were never supposed to have been born.

Working in the office behind masks and goggles tethered us to some human connections, although I am now surprised at what my colleagues and fellow staff look like when I capture a full view of their faces. My office brain recognizes the pattern of eyes and foreheads, and is surprised when it sees a naked face.

And while COVID was the shiny new knife carving away our attention, I tried to remember that I was still in an armory of age-old clubs. Ailments of the heart, lung, kidney, brain, bone, muscle, blood, skin, and gut remained the majority of our fight. I doubled down on weariness, started a letter, and paradoxically found more energy and connection in writing it.

I have eaten most of my meals outside, in the parking lot behind the office, free of my mask for a few glorious minutes, through the freezing winds of February and the broiling heat of August. There are tens of hawks that fly around the water tower. Squirrels eat fallen walnuts from the mangled trees next to the power lines. Ants are ever busy carrying away the crumbs that fall from my plate, and there are a pair of ducks that visit the water drainage pond. There are wildflowers back there. The Montauk daisies my mother gave me, which I planted among the sterile landscaping, feed countless bees and pollinators. When I stay late to finish charts and calls and results on warm nights, a midnight chorus of frogs ribbit in the soft rains as I get ready to drive home.

And so it’s somehow been a good year of sorts. A year of significance, made stronger by our mutual will to survive, and by the basic goodness of the people I have the privilege of serving. I’m still trying to push the rock up the hill, convince the unvaxxed to get vaxxed, and best manage the realities of diabetes and heart disease and dread and fear while keeping my own anxieties in check. And as we face down the coming double wave that’s crashing on Christmas, I ask you all to keep holding on, to not break the line or the faith against our oldest enemy, disease.

I hope you can safely embrace those you love, and that your health endures, and that we meet again in this little office, and get to talk about our trivial yet beautiful little joys before tending to what ails.