Fear Before & After COVID19
Dr. Claudeleedy Pierre is a faculty physician and director of perinatal services at the Family Health Center of Worcester. Aside from full-spectrum family medicine practice (which includes prenatal care), Dr. Pierre has advanced obstetrics training. She completed an OB fellowship and is therefore privileged to do Cesarean sections, tubal ligations and external cephalic versions for family medicine patients at UMass Memorial Medical Center. As a faculty member, she works with residents and precepts in the clinic as well as on the labor and delivery unit at UMass.
During the COVID19 pandemic, Massachusetts focused all of its efforts in caring for patients infected with COVID19 and preventing further spread in the communities. During June 2020, as COVID19 was nearing its peak and prospects were good on the slow of its spread, the entire nation was thrown into action on the Black Lives Matter movement. Dr. Pierre reflects on both the Pandemic and the BLM movement.
Path to Family Medicine
“I grew up in Brooklyn – I’m the child of immigrants. Since I was five, I wanted to be a doctor because I thought it was the best way to help people. My mom always tells the story of when I was five I said I wanted to be a doctor, either a pediatrician or deliver babies like Bill Cosby because I didn’t know how to say obstetrician. And with all my money I was going to build a big building and put all the homeless people in it. But clearly one big building isn’t enough for all that, but clearly I didn’t know that, being five. So I always wanted to be a doctor, leaning towards a pediatrician or obstetrician, because I didn’t know what family medicine was growing up in New York City. It wasn’t until college that people said if you want to do both, you can do family medicine. To care for whole families and generations from pregnancy to baby to grandparents…who wouldn’t want to do that?”
“Because of my upbringing and background, I always knew that I wanted to work with a culturally diverse and underserved area, and I knew I was going to be working in a federally qualified health center. And I always knew that I wanted to do teaching, so I knew I wanted to be associated with a residency to work with residents and medical students. That’s always been my path and career goals, so I’m happy that I’m doing that.”
Taking Care of Families
Through family medicine, “you’re able to care for whole families and so through that, you’re better able to understand the psychosocial dynamics that affect their health and further aid them. I believe that’s the ideals of family medicine. Knowing that you’re taking care of the whole family, the different generations in the family, you’re also aware of the psychosocial dynamics to better take care of individuals of the family. That’s what I thought family medicine was, and that’s what I feel like I’m doing right now.”
“Getting to where I am – I am the first doctor in my family – I always felt like I was sacrificing a lot, family-wise. I missed out on weddings and family gatherings because I was in college, then medical school, then residency. At one point I actually started feeling like a stranger in my family because I was the last one to hear the latest family news.. Now, as a physician mom, it’s very tough because you’re trying to balance home and family and your career – and worrying that you’re not giving enough time to your family because of all your work responsibilities but you want to uphold the quality and professionalism that you’re doing with your job as well. It’s really hard to figure out that balance and it’s really, very exhausting. Like most healthcare workers with the Coronavirus aspect – all healthcare workers have fear of bringing it home. So that was the latest new fear that I had…that my career or job was affecting my family.”
A Family Doctor in the Times of COVID19
Family physicians are primary care doctors, and we remained primary care doctors in the face of COVID19. While the face of a frontline worker was one wearing a mask and handling patients who were hospitalized, family physicians were frontline workers in their own way. Clinics were transformed and tents were built in order to continue caring for people out in the community.
“I know a lot of healthcare workers who are not as frontline. Doctors who are not ED doctors or ICU doctors. We talk to each other about our feelings of guilt that we’re not more on the frontline. But I try to tell my colleagues who feel such guilt that people still need to take care of the patients who are not in the ICU or the wards – who are calling to know whether they need to go to the ER because of their chronic conditions…I do prenatal care, which has to go on. So I try to feel that I am still doing something during this corona epidemic even though I am not in the ICU or ER, on the medicine floors – because I’m still checking in on my chronic disease patients and making sure they have their meds, how their blood pressure and blood sugars are doing to make sure their HTN and/or DM are still controlled. And taking care of them remotely, making med adjustments. Prenatally, we had to make adjustments. I’ve been seeing prenatal patients in the office as well as L&D. Everyone at UMass had to make all of these COVID changes and adjustments too. The big goal of the maternity community is that all of these women still get a good experience in this Pandemic. For some women, this is their first birth and now they have to worry about some fear that “I have to do it alone. Do I have to wear a mask? What if I’m positive, will my baby have to be taken away?” One of the goals of maternity care providers is that women still get the best experience that they can, and that they don’t feel alone. The nurses are there with them, the doctor is there with them.”
“A personal patient of mine – the support person is supposed to stay the entire time, but they’re normally the ones who also help take care of the other kids. So this patient knew her husband would have to stay home and take care of the children. So she was going to come in by herself with the car seat and all of her things. And I made a point of letting the labor and delivery team know that so that they would give her extra care and support. And I think healthcare workers have been working hard to make patients feel this extra support, but patients themselves have been stepping up. Patients have also been impressing up. They are coming to us early in the Pandemic wearing their own masks. They knew the importance of that. It’s definitely been amazing to see both sides – healthcare workers and the patients, themselves, have been dealing and striving in this Pandemic…because we have to.”
MICROAGGRESSIONS and SELF-DOUBT
All physicians have a long road to and through medicine. Hands are stretched out to mentor and guide us, but there are also hands that can hold us back. As easily as we can be shaped through positivity and encouragement, we can be misshapen and undone by a society and people who contribute to our own self-doubts.
“Any person of color has experiences of microaggressions or aggressions from childhood on. I remember growing up in my apartment building in Brooklyn…there was this known racist couple. We lived above them. And they would call the cops on us for noise complaints that were non-existent. One time they [the police] came while we were all sleeping…because the neighbors had a noise complaint. One time they [the couple] filed a complaint that my parents were abusing us. I remember as a kid, my dad talking to the police, lifting the back of my shirt to show that I didn’t have any marks on my body…that was as a child. As a person of color, [aggressions] happen long before you get to your training, your career.”
“When you get to school, you actually do well – but then you have other things come up. I remember in high school, in particular – when it was college acceptance time, you hear people saying “well, they got into these Ivy leagues because they’re black,” or because of affirmative action. Just devaluing these academic achievements from me and my fellow people of color. And these comments were coming from our fellow white or Asian friends, supposedly. And this is the beginning of my road to my career. And you always have that nagging thought. That, you know, are all of my accomplishments really my own? Or is it [my acceptance] just to fill a quota? Almost everyone’s college experience – some incident will occur. Like security harassing black male students. There’s just too many.”
In modern medicine, we talk about the importance of checklists – so that we don’t forget things – which help to improve the care of our patients. Dr. Pierre has her own checklist as a physician of color.
“As a black woman I always worry about things like the way I speak. Am I articulate enough? Am I dressing professionally enough? I happen to have natural hair. Is that okay? Is my hair acceptable. And then, of course, it’s the comments about my hair. At a residency graduation, I had a white colleague ask me if she could touch my hair “oh, it feels like straw.” I had a male, white doctor ask me “oh, you must know about dreads,” (maybe it’s because I’m black, but I don’t have dreads, my hair is natural) – he was asking me about a patient he had with dreads and had a hair issue of some kind.”
“When I was an attending, I was with a resident (who was also black) – we were in the education room using the computers, wearing our blue scrubs, I had a hoody on. And a white woman (I think she was a nursing supervisor) – not one I knew – came in to ask who we were because they got a complaint that the cleaning staff was using the computers. Maybe it’s because I’m older, and I’ve already been through this – but it really affected the resident. These are incidences we have. I remember a male Sri Lankan student, wearing scrubs, got harassed by security to prove he was a resident (maybe because he wasn’t wearing his ID). But we have to worry about that. If I don’t have my ID, I could be mistaken for someone else. I could be mistaken for cleaning staff. Or, should I even be on this floor? Or, when I pull into the OB on-call parking slot, I had a woman question me once – that patients can’t park there. Because…there’s no chance that I’m a physician that had any right to park there.”
“These incidences do happen to me. Some are bigger. And some are microaggressions. They’re just part of my life.
HEALTH DISPARITIES IN PEOPLE OF COLOR
“I’m tired because this is not the first time. It is a huge cluster, unfortunately. People talk about George Floyd, but it wasn’t just George Floyd. It was George Floyd and Breonna Taylor and Aubery. And on a smaller scale the Amy Cooper incident. It was just a cluster of events that unfortunately happened when the nation was already on edge with Corona. And near the tail end of corona, it came out that the health disparities among people of color was seen more clearly during Corona…black people and people of color were being hit harder by Corona. So to have that be the backdrop that this all came about…made it worse….but this is not necessarily surprising, it’s now new. It’s just another cluster of incidents that has been going on for a long time that I think unfortunately is just worse when the nation is already on edge from Corona, and the last thing we’re hearing is that it’s actually affecting us [people of color] more. So we already knew, health-wise, we’re already at a disadvantage. And then we had to be reminded to not forget that police-wise, justice-wise, we’re also treated differently and worse. When it comes to healthcare, you’re at a disadvantage. When it comes to the legal system, you’re at a disadvantage. That’s exhausting. Hopefully this time, because it’s a little more heightened, a little worse, that it can be different…that maybe it will make for change…I hope.”
FEAR during COVID19
“I had a great moment of fear during this time. My four year old son developed a fever. Luckily he had no other symptoms and the next morning he started to have a sore throat, so I was pretty sure he had strep throat. But of course in the back of my mind, there was the fear that I brought Coronavirus home and that’s why my child has a fever. Thankfully, a colleague of mine who is also a physician mom suggested that I bring him through the drive-through to get swabbed for COVID and strep – the COVID was negative and he was positive for strep throat, as I suspected and knew in my brain. But in my heart, the thought that I could have brought COVID home to my family was very upsetting for me. And I know that is the case for a lot of physician moms.”
Reminders of the World we Live In – FEAR proceeding COVID19
“In some ways, it’s tiredness from the buildup. There are countless stories of police brutality against people of color, so people are just tired of that. But I’m also emotionally drained, but aside from tired I also want to say that I’m also scared, I’m also fearful."
"One of my first reactions when hearing about George Floyd, was crying – because I have a black husband and I have a black son. And my immediate thought was “My cute almost-five-year-old is cute now…but when do people stop seeing him as cute and start seeing him as a threat?” That literally was my first reaction – fear – not tiredness, not exhaustion – it was fear. Because I have a black husband and a black son. That is probably more of what people of colors’ reaction. Because there is microaggression and discrimination – but for most of us [people of color] – it doesn’t happen every day. But hearing stories like this remind us that this can happen to me – this can happen to my brother, my father. I think people think that people of color think about racism all the time and that we think everyone around us is racist…but we don’t. The problem is then we get reminders of it…that, oh yes, this can happen to me, it can happen to my family and friends. And that’s what’s exhausting, and that’s what’s fearful.”
As physicians, we take on the Hippocratic Oath when we first start our medical training. It is a tradition that has carried even into this millennium. To do no harm. To protect, preserve and respect life. Lives matter to doctors.
“I know people get upset by the phrase “Black Lives Matter” because all lives matter…which, of course, is true – all lives matter. But when people say that, they discredit the fact that that’s not really the case – that all lives matter. Because of the way people of color are being treated in so many aspects – healthcare-wise, legal system, professionally, economically. That’s why people say black lives matter. Because all lives, currently, are not being treated the same. We all hope that good can come out of a tragedy. So the only hope is that after this latest group of tragedies, there will be a difference…there will be a change…there will be something better. It is good that people are more aware – especially non-blacks and non-people of color. And a lot of them are standing with us. But hopefully it doesn’t stop after the protests all die down. Hopefully all these tragic events and protests will lead to actual changes.”
Claudeleedy Pierre, MD
University of Massachusetts
Physician Faculty at Family Health Center of Worcester
Associate Director of Perinatal Services at Family Health Center of Worcester