Valley of the Shadow of Death

“Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me; thy rod and thy staff they comfort me.”

Psalm 23:4

I’ve always known that being an emergency department physician was not the safest job in the world. Oftentimes I have to deal with violent patients, some drug induced, some with psychiatric disorders, and others who become flat out angry and aggressive because I refused to give them the prescription they coveted, usually some kind of controlled drug. With that in mind, once I asked a police officer in the emergency department what I should do if someone pulled out a gun, pointed it at my head and said, “I’m going to kill you.”

With a concerned look on his face, he said, “Let’s do a demonstration.” Seeing my nod, he jabbed his right index finger into the middle of my forehead and said, “Pretend this is a gun. Now, the hand is quicker than the eye, so as fast as you can, reach up and grab my hand with your opposite hand and twist it as though you were removing a gun.” After doing what he said, the officer nodded. “Good. If you move as quickly as you just did, he might blow off one of your ears, but at least you’d live. Also, make sure a nurse isn’t standing beside you, or otherwise the bullet might hit her.”

Yikes, that was comforting, I sardonically thought before I thanked him for his time. While in retrospect, it seemed like an odd question to ask, given the gradual uptick of violence in the emergency department over the years, why wouldn’t I?

Besides dealing with violent behavior, another risk of being a healthcare provider is contracting a disease from a patient. Caring is sharing, but not in medicine. I’m very fastidious about protecting myself from infectious secretions, and the truth is that being overly clean in the emergency department is an oxymoron. There’s no such thing, and I’d rather not bring infections home to my family.

The coronavirus, also known as COVID-19, is a whole different animal, unlike anything I’ve seen before. The problem is that while the patient may have symptoms such as a cough, fever, diarrhea, fatigue and/or shortness of breath, some have no symptoms at all and can be contagious at the same time. Besides that, the virus can survive and still be infective on a hard surface for up to three days, and while the mortality rate with influenza is around 0.1%, that of the coronavirus is close to 0.5%, about five times higher. In addition, older patients who contract this illness are far more likely to have bad outcomes. At sixty-seven years old, much as I’d like to believe otherwise, I am no longer a spring chicken, and along with those who are immunocompromised or have other serious medical issues, I am at high risk should I become infected.

Nowadays, when I go to work in the emergency department, I have discovered that I am more-than-a-little fearful of contracting this dreaded virus. What if I place my hand on a contaminated surface and inadvertently put it to my face? What if my defenses against infection are somehow breached? Let’s face it, I work in a high risk area, and social isolation is simply not possible. But neither is it for the nurses, physician associates, nurse practitioners, x-ray, lab and ultrasound techs, and countless others who could be exposed to a potentially fatal illness. And what about paramedics and EMTs, policemen, firemen, and all those whose job is intervene outside the sanctuary of the hospital? All of us walk in the Valley of the Shadow of Death, and we have no choice but to resolutely step forward and do our jobs, much as we’d like to hunker down in our homes and protect ourselves. I’m proud to say that I work alongside heroes, those who are willing to risk their lives in order to help humankind.

I have also noticed that when I return home from a day in the emergency department, I am much more aware of the preciousness of life, realizing that the possibility exists that my Earthly existence might be taken away from me sooner than I had planned. I pay close attention to the look of love on my wife’s face, the conversations we share as we lie in bed and listen to music, the smiles on the faces of our dogs Karma and Buddy, treasured moments talking with my ninety-year old father, who I have playfully nicknamed “The Top Rooster,” precious communications with my daughters,  and of course, cherished times spent with dear friends.

More than ever, I focus on little things, savoring the cup of honeyed Earl Grey tea I have in the morning, reading about the Oklahoma City Thunder in the Sports section of the newspaper, sitting quietly in meditation, watching colored birds as they flit in and out from the feeder, playing ball with the dogs, enjoying good food and drink, and so many other countless pleasures.

Sigh . . .

I want to live to a ripe old age and fully enjoy my time on Earth, but because of the coronavirus, I feel like I’m teetering on the razor’s edge, and there’s nothing else I can do other than to protect myself as best I can, experience each moment as completely as possible, and know that God is at my side. Whatever the outcome of my life – and there are no guarantees – I can ask for no greater blessing than that.

May the Divine be with us all during these challenging times.