Pandemic Induced Decision Making Catalepsy

The Queen of the clinic Seraphina

I am at the point within this pandemic that I have decision making catalepsy. I am paralyzed by each new decision. The dilemma lies within being almost empty on identifying right versus wrong, or, bad versus worse, or even when to intervene any more. I am at heart a pragmatic decisive democratic leader. I got here from spending four years at a federal military academy, and then a decade serving in uniform in the private sector where rank determines everything from where and when you sleep, to where and when, you eat. I have for most of my life been embroiled in leadership roles. I am also a veterinarian. I am wired to care more about those less fortunate than I am my fellow human beings. This pandemic has forced me to reconsider, and, perhaps even abandon, each previous decision making argument as I attempt to decide how to navigate these ever emerging uncharted waters. The entanglement of my decision making process has become the angles of individual alliances and personal motivations that have been so unprecedented I almost can't tell myself where to settle my soul of indecision and burgeoning heart of consumed worry.

Remy. A little nervous at first, a marshmallow at "hello."

This COVID decision-making jungle began in March. The forced closure of most businesses left us with a simple question? Do we dare deem ourselves "essential" enough to stay open? Put the staff at risk of, well, ventilator dependent coma or even death? Am I that arrogant to consider my job that necessary? Is the pride going to come before the fall? I dug deep. Initially I opened the decision making process in true democrat fashion with querying the entire staff. We offered free passes with an indefinite leave of absence to any and every staff member who wanted it. They could play it safe. Stay home. Insulate themselves with their families. The safest maneuver possible. All were promised full acceptance and support to whatever decision they felt best suited them. I pledged to keep their position open until they deemed themselves ready to return. I secretly prepared myself for a skeleton crew. Endless days of paltry appointments from only the most dire cases to be shuttled in by their masked, socially distanced pet parents. We would sacrifice our bread and butter routine spays, neuters, vaccines, well visits, and, just buckle down for the most darkened days of our 80 plus year existence. Even at this bleak unknown place I believed we would get through this. Perhaps scarred, scathed, nearing bankruptcy, whatever may come, I would not let this ship be lost on my watch. If I could keep myself off that COVID causing ventilator I could go on, even alone if need be. I truly went there. Imagined myself in this place. Alone and yet still having my neon sign burning as an "open" beacon to the rest of the world huddled within their isolated and hidden homes.

The decision to stay open, with the Governors blessing, turned into a weeks long hysteria about whether our pets could contract, or even transmitting, the bug. The paranoia that this brought to each phone call was unsettling. The pictures of people in the COVID birthplace throwing pets out of high rise windows to eliminate the baby with the bathwater. That lecture of quelling paranoia was left to my previous 15 years of dealing with zoonotic disease. I wasn't going to fall into that rabbit hole of fear. I knew my enemy well enough to not placate to personal paralysis because it was simply a novel pandemic. I know corona. It's been around my office forever.

My Jitterbug. Always on duty, never under command.

The first round of COVID forced decisions left us down about 25% of our staff. Which was about the amount of business we saw decline.

March 2020 also coincidentally delivered us the ability to start our long awaited hospital expansion. It had been ten years in the making and waiting. A decade of hoops to jump through. A decade of personal saving and planning to allow us to grow into the clinic we had outgrown 15 years ago. A building permit was finally granted. The clock to begin, and complete, the project started ticking as the personal promissory bond was deposited. I had voted to wait the construction out and let the pandemic pass. In doing this we were risking a rare chance to do what we had been told over the last 10 years that we could not. We took a big chance, dropped a million dollars we had spent my whole career saving for, and jumped in. It has made me sick with worry every single day since. Every nail and every excruciating decision. I didn't know what the future held and yet here I am putting all my chips in the game. To this day, mid January 2021, I still think/fear, that I just put a bigger anchor around my exhausted neck to sink into the abyss of bankruptcy both deeper and faster. The dizzying list of decisions that a huge construction project brings are daunting. Some I made by the bottle, others I made by coin flipping. Most were whatever the builder wanted. I couldn't focus on them, so, I didn't. Not the way to spend a million.

As COVID was settling in with her 24/7 news coverage of bodies being amassed like war torn canvas clad victims housed in portable freezers, March also brought the news that my mom was now terminal with breast cancer. Fear took her over, the cancer ate away the rest. I had to choose between seeing her, assisting her with trying to function at any kind of basic level, and the exposure my job left me open to bringing back home to her. I took time off. I decided the little time I had to advocate for her was not worth the limited appointments the other vets could see without me. Of all the decisions I have faced within the last year this was the easiest. For three months we faced COVID and her debilitating disease that stole everything she had and left. We all faced decisions that left only two options with every decision. She was either sent away to die in some patchworked mandatory isolation from us, or, suffer at home as cancer insidiously pilfered the rest of her. Trying to find in home care options in the early days of a pandemic was impossible. No one would help us. I moved in to live at my parents house. It was quickly apparent that she needed more than this one human could manage. Three times we had to send her away to try to save her a few more months of time. Each was excruciating to debate, and final in its potential consequences. Every time she was taken anywhere we knew it might be the last time we might see her. How do you weigh that? In May 2020 my mom died in hospice hidden away, and still very much afraid, at home with her family. We have never had any closure after her final breath. I'm not sure we ever will. It's dull and faded and blanketed in an anger I still can't resolve. So many of the decisions I faced outside of taking time off for her were fraught with coffin calling cards. I have no idea if any of them were right? But we made them. Twisting her arm to get in an ambulance as C-diff ripped her guts out in a bedpan her frailty wouldn't permit her to get to. She fought the interventions and surrendered to the terminal.

Three months in, June, 2020, and the phone began to scream incessantly. The holed away humans began adopting pets in record numbers. These humans also began to place a much higher value on their pets who were at home with them and now their only source of companionship in keeping them company. The business surged and the risks of contracting COVID followed. As the novelty wore off the fears abated a little into monotony. Life was soo busy we couldn't watch the news with the same fervor. A sliver of silver lining found us.

Six months in, September 2020 and the staff, and world began to grow restless. You can only stay quiet for so long. People started traveling. Families began to scatter. By this point we had at least a half dozen self-quarantine 2 week hiatuses to disrupt the scheduling obstacles. We had at least 2 dozen people pending tests, some of which took almost two weeks to return. We had dozens of near misses. We were due, and our numbers were too big to insulate us from the bug forever. We split into teams to try to lessen the contact of the blow when our luck faltered. December advent delivered our first COVID positive staff member. The rest of the team went home with quarantine induced fear and chaos. The fear led to real-life mortality concerns. It was the harsh slap in the face that reminded us we were still vulnerable regardless of the masks, hand washing and curb-side service.

I had to decide what to do about a positive employee? I took the safest route I thought possible. We sent everyone who had been in contact with them home to isolate and hopefully contain the spread. We paid everyone, as we had done before. We calculated how many more home stays we could afford? We called the health department, our legal counsel and scoured the CDC for guidance. The NY Times had just run a section long special eulogizing the huge number of landmark businesses across the country who fell to the pandemics passing. Was I going to follow?

Where has paralysis cornered me? Here;

The vaccine is now eminently at our doorstep and another series of questions that need to be asked. How do I handle vaccinations? Silly, stupid me thought this one would be easy? We are all medical professionals? Aren't we? Isn't that our pitch to stay open as we call ourselves "essential"? Don't we all want to get out of this fearful place where a virus still has us by the neck? We are the vaccine giving kings of the world. Right?

Turns out a significant portion of the staff doesn't want to be vaccinated.

So,, do I take my personal opinion and force it upon others? Do I stay true to the devote liberal I am and let you do with your body what you want to? Isn't that what I stand for?, (well, as long as it doesn't hurt others. Isn't that caveat pertinent? And doesn't it apply?).

Every decision up to this point has been based on others over self. My mom, the staff preferences to stay working or not, making sure they are financially secure for whatever time off they might need, the multitude of ways the business might suffer at the expense of treasuring and coveting life. And, here I am now. I can force vaccination to be a condition of employment and risk losing people I deeply care about as I force my firm belief that we have an obligation to eradicate disease with all measures available. Stop the spread of disease by the same means and manner we do, pitch, force, and testify to being effective to the staff who doles it out to our clients and patients. What if there are pregnant staff members who should not be vaccinated among us. What do i, we, owe them? What about the conspiracy theory staff who don't believe the virus is real. Is that a religious pass?

Here is my list of pro's and cons. The forces pulling me one way versus another. The network of squabbling synapses causing my current COVID catalepsy;

I find a few things odd and unreasonable. How can we be a group of doctors and medical professionals and not believe in science backed preventative care? How can we be the single greatest distributors of vaccines to others and not participate in being vaccinated ourselves? How can we not call ourselves hypocrites and cowards? How can I possibly protect the staff if the staff isn’t willing to protect themselves? I certainly can’t take the ostrich in the sand approach. Just not look, not ask, and not care, if this virus hits is like wildfire and mows out everyone it meets. 

When all else fails in medicine we often defer to what's the “worst case scenario”. Shouldn’t we always be talking about and prepared for that? Isn't it both helpful and insightful when stuck at a crossroads of indecision and perplexity? 

So, let's go there.

What’s worst case scenario for us? The collective group of jvc? My thoughts on this question is not that someone will get sick and have life threatening or even life ending complications. That’s what it was before we had a vaccine option. Mine now is that someone at jvc will get sick or pass on illness to someone else and that transmission will affect others. I now worry more about not the individuals who made a selfie choice, because they now have a choice, but the collateral damage to letting the choice be made. We have multiple staff members (3) who are pregnant. What would I feel like if I didn’t get vaccinated (and let’s be honest the only people who don’t here are doing so out of selfish fears) and then it affects the mom's fetus? I’m not living with that. Part of being in a society, a family, a group as tight as we are, is agreeing to go along with what is best for that society. So for as much as I too worry about the first generation of a population receiving a vaccine I worry more about it others than myself. I will be vaccinated because I care about my husband and you all more than my business and myself. This for me is yet another incredibly difficult decision in a years long list of the same and I am not putting me or the business first. I’m putting you all first. You can choose what you feel is right for you. But abandoning science and the best interests of each other is not how I vote. 

Do I split us up into “vaccinated” vs unvaccinated teams? Leave the expecting moms in the most vulnerable place? Just take the "don’t ask don’t tell" approach. 'Cause that never benefited anyone? Just keep hoping? Praying? 'Cause that didn’t work with breast cancer in 2020. I am not sure. What I do know is that not making a decision leaves everyone vulnerable. And like every other medical issue we face with our clients ignoring it doesn’t make it go away. It just leaves you a prisoner to fate. What good is any medical knowledge if that's your approach  to disease? 

So who is liable? Me the person who let the unvaccinated work with the vaccinated? Let the pregnant employees work with the unvaccinated? 

Do I give monetary incentives? What does that say about us all? Are we at that place in society where baksheesh is the only way to get selfishness to take a back seat to population protection? Have we completely abandoned the notion that the sum is a product of the courage of the parts?

My obligation to this place where so much good happens, so much love exists, and so much healing is given so unselfishly is probably where I need to focus my answer. The answer is that this, like all the rest of the decisions behind me, is just another test to see if I can adult harder? Can I salvage my liberal democracy where people can be confident in living their authentic life and not see it as the selfish, myopic, obsession with individual-above-all in America?

Take a minor risk, get the vaccine, require the staff to unless they have a valid medical exemption.

And yet I sit here torn. Catatonic to Covid.

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