As the COVID-19 pandemic began to take off in Texas in March, Waco family physician Tim Martindale, MD, wished out loud for a way to end all the uncertainty it was causing.
“My wife and I joked that we should just go find a COVID patient, hug them and let’s just get this over with,” he said. “If we die, we die. If we live, we’ve got this behind us. We’re not living in fear, not worrying about the possibilities of how bad it might be.”
As an overweight 62-year-old with a history of heart trouble, Dr. Martindale understood perfectly well that he was the last person who should deliberately try to get COVID-19. As the sole physician at Martindale Family Medicine Clinic, he knew getting sick could also trigger a financial crisis for him personally.
So when symptoms appeared around 6 pm on, April 5, the joke seemed to be on him.
“It hit me hard,” he said. “It was a feeling of ugly illness, and I immediately began to hurt from head to toe.”
During the next four miserable weeks, Dr. Martindale almost went to the hospital, but never did. Instead, he stayed in touch with his primary care physician and his cardiologist.
“The next 12 days were horrendous – blood pressure irregularity, oxygen dropping, choking cough, shortness of breath, headaches, terrible body pain,” he said.
Practice shutdown
As the threat of COVID-19 grew in March, Dr. Martindale’s clinic responded as others did by drastically slowing in-person visits and switching to telemedicine.
“We were being extremely cautious in the clinic,” he said. “We were taking temperatures, we were watching [staff and patient] symptoms, not letting anybody with symptoms come into the office.”
Nevertheless, Dr. Martindale and a nurse became ill at about the same time. Following guidelines laid out by local hospitals, the Waco-McLennan County Public Health District, and the U.S. Centers for Disease Control and Prevention, Martindale Family Medicine Clinic took the following steps:
• The clinic shut down for two weeks for cleaning by a professional service and to let the rest of the staff of eight quarantine.
• Dr. Martindale’s office also alerted public health officials, who then notified 25 patients who had visited the practice over the previous couple of days. He says as far as he knows, no other staff members or patients have become ill since.
• During the closure, Dr. Martindale’s advanced practice registered nurse (APRN) continued seeing patients via telemedicine while consulting with him.
• The clinic reopened to staff within two weeks and to in-patient visits within five weeks, when Dr. Martindale returned.
• Currently, all staff and patients wear masks in the office, and anyone who conducts COVID-19 testing wears an N95 mask, face shield, gloves, and a gown. All staff and patients get temperature checks as they enter.
Even though Dr. Martindale was back at work, he was so weak that he could not keep a normal schedule at first.
“You’re not contagious but you have some weird stuff, and a lot of it is mental – overwhelming exhaustion, sense of despair, and a lot of things like that,” Dr. Martindale said.
Even before this, he had sought to limit the pandemic’s financial impact on the practice – about $100,000 in losses during March and April. In April, while still desperately ill, he and his staff filled out the paperwork needed to apply for a loan from programs like the Small Business Administration’s Paycheck Protection Program (PPP) and other federal aid.
Dr. Martindale kept his staff on full pay and benefits throughout this time, and he resolved to find a way to absorb the losses if necessary. But he was glad when, while he was still battling COVID-19, the PPP check hit his bank account.
“I was really grateful that they helped me through a tough time,” he said.
When he first returned to work in May, he and his APRN saw up to 12 patients a day. As of this writing in late July, they are back up to the pre-pandemic level of about 30 patients a day. About 20 are in-patient and about 10 are by telemedicine, though almost all of the telemedicine visits are requests for testing – which the clinic does after hours in the parking lot.
COVID counselor
Throughout the illness, Dr. Martindale kept up a daily blog for a local TV station (tma.tips/MartindaleBlog). He wanted to combat the constant stream of misinformation about COVID-19 reaching the public. He knew that required more than reposting articles he liked on social media.
“Either I’m that guy [the public] can listen to, or I’m finding voices that are trustworthy and promoting them,” he said. “All of us need to make sure there’s a voice out there that’s answering questions effectively.”
Dr. Martindale’s also taken on the role of counselor. When he was sick, family members and fellow physicians helped him talk through the diseases’ psychological symptoms – panic attacks and depression – as well as fears spawned by isolation. Since getting well, he’s done that for other people battling the disease.
“I have 10 to 15 people all the time the last several weeks where I talk to them about how they’re doing, whether they’re my patient or not,” he said. “And then they’ll tell their friends, ‘If you’re going through this, call Tim because he’s coached a lot of people through it.’ So I have quite a few every day I talk to. I’ll reassure them and remind them what’s necessary.”
But that’s just the start of the broader and deeper psychological fallout from COVID-19 to come, Dr. Martindale says. All physicians should be planning for something much bigger in the near future.
“We’re going to be seeing people’s marriages breaking up,” he said. “We’re going to see people going bankrupt and their businesses failing because they went too far into debt. ... We [physicians] need to be gearing up to think, ‘How can my clinic or the network I’m in prepare themselves to help our patients on the broader scale of all the implications?’”
Physicians may need to help patients obtain counseling, social services, or financial resources – things that are not traditionally seen as a physician’s duty, he says. That planning may be difficult precisely because so many physicians are so busy on the front line against COVID-19. Yet the pandemic presents physicians with a unique opportunity to lead and a chance to remember why they entered medicine to begin with, he says.
“Going through this makes me feel more alive,” he said. “It makes me feel more that I’m where I’m supposed to be. So there’s a real sense of joy that we’re at this place in our lives in this time of our history. And as physicians, we can play a role that helps people through such a hard time.”
Tex Med. 2020;116(9):30-33
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