I don't like masks

I don’t like wearing a mask.

It makes my face hot and gets snagged on my whiskers. It tickles my nose. My glasses get fogged up when I wear them. I can’t see the facial expressions of others who are wearing masks. I really enjoyed my surgery rotation in medical school except for having to wear a mask for hours at a time in the operating room.

But here’s the thing – it is one of the few effective measures we currently have to help keep from spreading a potentially deadly virus to each other. Masks aren’t perfect, but the mounting evidence shows that they decrease the spread of SARS-CoV-2.

We have all been wearing masks all day in our office for months now. I wear one whenever I am indoors in a public building, except occasionally when I am in a room by myself. I don’t wear it when I am outside unless I am in a crowd of some sort or visiting outside with particularly high risk people. So if I am working outside, or running or hiking or fishing, I don’t have one on but I stay away from other people.

Since we know that it is possible to have the novel coronavirus and not know it, wearing a mask not only protects me but those around me. In fact, the evidence suggests it protects others even more than it protects me. The person I walk by in the grocery store could have a medical problem that I can’t know about by just looking at them. Wearing a mask is an act of compassion. It is a tangible way to love your neighbor as yourself.

For 99% of us, wearing a mask is a minor inconvenience. If masks work, I can potentially help save lives by wearing one. An itchy nose seems like a small price to pay. If it turns out we were wrong and masks didn’t really help, is it really so bad to have inconvenienced myself a little bit in an effort to protect my fellow human beings?

Running Red Lights

There is a Subway just up the main road from our office and one day last summer I went there to get a sandwich for lunch. There is a traffic light almost immediately after turning left out of the Subway parking lot to head back towards the office. Sometimes I am a bit absent-minded and thinking about other things and I was most of the way through a red light when I realized what I was doing. Since the intersection was empty I proceeded on through instead of stopping in the middle of it.


Almost immediately I saw blue lights flashing behind me. My first thought was “Well that was really dumb of me. I hope I can just pay a fine and not have to go to court.” I pulled over and the officer came up. I handed him my license and told him I needed to find the registration.


As I rummaged around in the glove box, he asked me why I ran a red light. I told him I didn’t know, that I had just screwed up. He asked where I was going, what my job was, etc. After I found my registration, he looked at it and my license for a while. He handed them back to me and told me to be more careful. And that was it.


I had clearly violated the law and was expecting a ticket and a fine. And there was nothing.


This morning I read a story from an African-American professor who had not done anything wrong but was still detained because he “matched the description.” He spoke of his fear and how the incident left him rattled afterwards. His experience and mine bore little resemblance to each other. I was actually guilty and he wasn’t. But I was never frightened.


I know some police officers and I think the ones I know are good people. And I think I am a basically decent human being as well. But years ago I read some data about the differences in medical treatment of white children and African-American children with respect to pain control, etc. It was jarring and I began to examine myself. And one day in the office, I realized I had a white patient and a black patient with pretty much the same issue, and I had provided a more aggressive evaluation for the white child. I could rationalize why I did that. But there isn’t a good reason.


I hope that doesn’t make me a bad person. Both of the children were fine and the white child got more evaluation than was needed. But I think it does show that I am (was?) a biased person. Both mothers were worried about their children and I did more to allay the fears of one than the other. And only by knowing and admitting that about myself can I do anything to correct it.

Is this Covid Information Reliable?

It seems like every day there is a new video from a doctor claiming some special insight into Covid-19. I have a few thoughts about how to approach these.


I think it is important to remember that being a doctor can mean a lot of different things. If you have a sick three year old, I am your man. That is why I am here. That is what I do. But you should worry if you are sixty years old and possibly having a heart attack and I show up to take care of you. That is not what I am trained to do. I could maybe muddle my way through and help some, but you would have a much better chance with an ER doctor or cardiologist caring for you. For information on Covid-19, I want to hear from virologists, epidemiologists, and the ER physicians, intensivists, and hospitalists caring for patients with the disease.


It is also important to remember that even doctors in the same field can have varying levels of expertise. This can vary based on intrinsic abilities, where someone went to school, where they did their residency (or if they even completed one), whether they are board certified, how much experience they have, if they did fellowship training after residency, etc.


Some mechanics are better at fixing engines than others. There are some basketball players who are more likely to make a clutch shot on the last possession in the championship game. Some carpenters build a more solid house than others. Some people make tastier, more nutritious food than others. No matter what field you are in, I am sure there are people who you recognize as being more competent and trustworthy than others. In the same way, some doctors are better positioned to speak about Covid-19 than others. Being a doctor does not magically imbue one with wisdom on all things medical.


Medical progress is plodding. It is based on rigorous evaluation of data and attention to detail. I am not aware of any significant medical insights to ever first be released via You Tube or Facebook. They are much more likely to be on page 38 of The New England Journal of Medicine. Some of the videos I have seen in the past few weeks have some basic errors that are easy for other doctors to spot. So just be cautious about jumping on bandwagons, unless you are fine with me treating your heart attack.

Covid-19 and the General Pediatrician

I am not an infectious disease specialist, epidemiologist, or someone who works in the ER or ICU but I am certainly paying attention to what they are saying about the novel coronavirus (SARS-CoV-2) and the disease it causes, Covid-19. I have seen some folks making comparisons between this and the H1N1 pandemic in 2009. I remember the H1N1 pandemic as being a busy time with a lot of sick patients and one child who was hospitalized with it but did fine. From my perspective, the H1N1 pandemic was busy but it wasn’t scary.


As a general pediatrician, my interactions with patients not infrequently involve flying saliva and mucous from uncovered coughs or sneezes or resistance to a strep test or flu swab. And there is always a toddler who grabs the otoscope right after smearing snot all over his or her face with the same hand. That’s just the way kids are and their innocence about these things is part of what makes it entertaining to be their doctor.


Sometimes after a child sneezes all over me, a parent will ask “How do you not stay sick?” My half-joking answer is that “I wash my hands a lot and get a flu shot every year. And I have already been exposed to everything.” During flu season, I am exposed to influenza multiple times each day and have not historically been wearing any protective equipment during those visits. And I have never had the flu or, if I have, it was never bad enough to recognize it as such.


But to the best of my knowledge, I have not yet been exposed to SARS-CoV-2. If I do get it, am I going to be one of those folks who doesn’t even realize they have it while potentially spreading it to others? Or am I going to get really sick and possibly die like over 60 doctors in Italy already have? Like I tell 13 year old boys who want to know how tall they are going to be, “Come back when you’re 22 and I will tell you.”


Fortunately, children seemed to be mostly spared from the worst of this disease and for that we are thankful. And I am thankful that Augusta Health has been working hard to prepare for what may come and that across the mountain at UVA they have already been able to develop their own test which they are providing to other hospitals.


But I worry about my parents and my in-laws and everyone I know with medical issues or those with the highest risk of exposure from their jobs. And I worry about people who are losing their livelihoods and the folks I know here and in other parts of the world who are wondering how they are going to feed their families if they can’t work.


So we prepare for the worst while we hope for the best. We take a walk, exercise, or pray to alleviate our anxiety while still maintaining vigilance. We don’t hug our loved ones or even see them face-to-face just in case, but we stay connected as best we can. We recognize the value in each person we meet and do our best not to put them at risk. And we continue to care for each other’s needs – physical, emotional, medical, and spiritual. And I think that is all we can do.