Before COVID-19, meal planning and grocery shopping were the most time-consuming tasks of my life as a physician and mother of three young children. Now, meal planning is an indulgence compared to “COVID contingency planning” — the taxing brainwork of imagining multiple possible scenarios and following them through to the end with every iteration and its possible consequence accounted for. Add to this the need to insert updated but easy-to-misinterpret weekly Centers for Disease Control and Prevention (CDC) guidance and the current size of the rapid antigen testing stash in the closet. It becomes the ultimate neural networking of my days.

Life as a physician is not conducive to contingency planning, even without a pandemic. I don’t recall my husband, a pulmonary critical care physician, or me, a public health/preventive medicine doctor, ever taking a sick day in 14 years of medical training and practice.

Although a physician’s salary helps make possible a cadre of reliable helpers — first-line nannies, second-line nannies, night and weekend sitters, college students for school drop-off and pickup, summer nannies, house cleaners, and take-out meals. But over the past two years, those contingency plans have become liabilities.

The more help you accept, the more risk you take on for everyone in your family. One day you realize that you’ve taken on all of the roles listed above in addition to being a physician, and the decision to walk away no longer feels like a choice.

Despite how long I’ve been perfecting the art of COVID contingency planning, only recently have I realized how much it had taken over my regular mental processes.

A couple of days ago, I called a physician colleague who had recently quit his job assisting the pandemic response for a large university, a job that I had helped him acquire years earlier. I called to understand why he left, but I also had it in mind to gauge whether he might be right for a job opening in my department that would be available soon. Perhaps I felt partly responsible for his leaving since I had put him up to such a task in the first place.

After spending some time catching up, I told him I understood and was ready to launch into my recruitment mode when he interjected.

“I think this needed to happen.”

I waited for him to explain.

“I’ve never seen my wife so happy. She’s like a new person. Like a weight has been lifted, and everything is going to be alright. We are finally going to be alright.”

As he said it, my whole body relaxed.

The verbalization of something I could relate to so well was therapeutic to hear from a real person, a resilient person in a dual-physician household who had balanced residencies and military deployments for years. Now, we were just two of many doctor-couples during COVID-19 trying to hang on to jobs we sacrificed so much to get in the first place.

As all parents of young children, uncertainty dominates every aspect of our lives. But the margin of error for physicians who spend their days with COVID-19 patients and their nights with unvaccinated infants is too tight.

Every window of time feels like it’s actively closing — my time to work, the children’s time to be in school, my husband’s time at home before he’s paged back to the hospital. I don’t respond to the kids’ birthday party invitations but let them linger as irritating tabs in my browser window, stalled by the uncertainty of “the COVID situation” at the specified date and time. I try to schedule work meetings over nap times in anticipation of unexpectedly having to do childcare and work. With my jaw clenched, I brace myself for the crack of our structured routine, the abandonment of our color-coded schedule, the vacant checkboxes left next to my tasks.

Every phone ring, every visit to my bedside at night from a child, every email from school or an unknown call on my cell phone is the one I’m waiting for. My gratitude grows with every day that I squeak by, while my fear escalates with every day that I escape.

“Right,” I said to my colleague, “You are now the contingency plan.”

“Exactly,” He replies, “And now my wife can actually be a doctor.”

His last words stung, reminding me that I am a doctor, too, but not really right now.

I am a contingency planner — for my own family, extended family, friends and neighbors, for my children’s school. As a public health doctor during this pandemic, it is the only thing I am good for.

I have fantasized about quitting my job, not relying on childcare, on school, on the fact that elementary school children appropriately wear masks, but I have loans to repay, and I wouldn’t want to leave medicine in the long run. I just like to feel that glimmer of relief that comes with imagining life without a multi-pronged and complicated contingency plan. What if there was no plan? What if I were just present and available, open and free?

Like so many other physician-couples have done already, my husband and I have decided to leave good jobs in a city we love to move closer to family. Our aim is to develop a multi-layered contingency plan that will allow me to be a doctor again and allow him to keep being one.

I suspect that some of the nearly 20 percent of physicians who have quit their jobs during this pandemic needed to feel this relief, too. They needed to feel the relief of having no plan. No “if this, then that.” They needed to just exist in the now. Because who knows how long the now will be around anyway? Will we wake up one day and find that years have gone by without knowing it because we were so busy planning ahead for scenarios that never occurred?

This is not something that worksite wellness programs can provide or resilience training can foster. It is a reality of COVID-19 when you are caring for anyone who needs you, as much as (or more than) your patients. The miracle is that there are so many of us left in the workforce at all, riding the waves of uncertainty feeling like the only COVID contingency plan we can depend upon is ourselves.

Margaret B. Nolan is a physician-scientist.

Image credit: Shutterstock.com