What a surgeon learned from illness and grief in a pandemic year.
Sometimes new life lessons are learned in subtle whispers and gentle nudges. In 2020 my learning came more like a simultaneous punch in the face and kick in the stomach.
In medical school I learned that the foundation of everything we do as doctors is the doctor-patient relationship. Maintaining the sanctity of this relationship has been, and always will be, my highest priority. But the events of 2020 cast a new light on this sacred tenet.
Twenty-four years after medical school and 18 years into my career as an attending spine surgeon at Texas Back Institute in Dallas, I have seen more than 10,000 patients. Yet here I was learning how vulnerable patients really are.
In March and April the COVID-19 pandemic shut down my medical practice as we waited for guidelines for treating patients safely in this new environment. Two weeks turned into seven—the longest time I have not set foot inside a hospital to see a patient since the beginning of my third year of medical school in 1995.
For the first time in my career, life slowed down. I enjoyed the opportunities to love my wife and children more and to learn new skills like baking French bread and cooking pork tenderloin. I missed interacting with patients and the camaraderie of the operating room, but with patience everything would be OK.
May rolled around, and it was time to return to work. Life would go back to normal, I thought. But a few weeks later I woke up and felt like an elephant was sitting on my chest. My oxygen saturation was in the low 90s at rest, with dips to the high 80s when I tried to talk. Fearful of exposing my family any further, I drove myself to the hospital and knew what my diagnosis was the moment I saw the characteristic cotton ball images on my chest X-ray. The results of the painful nose swab were a foregone conclusion: COVID.
Anger, denial, bargaining, acceptance—all in 20 minutes. No time for depression; fear was setting in. Would the doctors be able to prevent me from dying?
My COVID experience taught me how patients feel when uncertainties surround their disease diagnosis and treatment. I was alone and I was afraid. I had a new disease for which there was no clearly defined treatment protocol, no certain prognosis, and no predictable disease course. All I could do was pray to God that I would recover and see my family again.
My starkest recollection is the personal loss of freedom necessary to maintain a safe working environment for the nurses and doctors who were taking care of me. Personal protective equipment was still somewhat scarce, and some of the staff wore the same masks and face shields every day. During my five-day hospitalization, I was strictly confined to my room. A converted old-school ICU room, it did not have a shower. I felt like a prisoner. But I was alive.
I tried my best to be a model patient, including coaching a young nurse on how to draw blood properly from my veins when she hit a valve by accident. I was a young med student once, and I remembered when patients showed me grace, back in the 1990s in Hyde Park.
Subconsciously, I competed with unseen COVID patients in other rooms, gathering HIPAA-compliant information from nurses to see where I stood with regard to oxygen saturation, medications, and even volume inhaled on an incentive spirometer. COVID hospitalization is a race to survive and leave the hospital. Losing means intubation, the ICU, or worse. Winning means going home. This was a race I was not going to let myself lose. So many people depended on me. My wife and I had plans for the rest of our lives.
All of that was now in doubt as we learned more than ever about remdesivir, steroids, convalescent plasma, and hydroxychloroquine. In this situation, knowledge was not power. Knowledge was paralyzing.
Over the next few days, I turned the corner. My voice improved from two to four to eight words at a time before coughing to catch my breath. I never got intubated, and finally I drove myself home. From the moment I arrived, I was exiled to the other side of the house. From 8 a.m. to 9 p.m., I stayed on the back porch to keep the air inside as clean as possible, interacting with my family only through the windows. I still felt like a prisoner, but at least I had a shower now.
With two weeks in quarantine waiting for my COVID status to change, I had time to reevaluate my life. After getting over a potentially fatal disease, I concluded that there is nothing in life that makes me happier than being a husband, father, and surgeon. God has blessed me with a family life and career that make me unbelievably happy and fortunate—much more than I deserve.
COVID was done. I had survived. Time to get back to work, right?
Just as my practice was getting back on track, my hands started falling asleep. In September I underwent carpal tunnel surgery on both hands simultaneously. I got better—again.
In the three weeks before surgery, though, I went through successive waves of thoughts and feelings: enthusiasm to feel better; uncertainty about complications and lost work time; rationalization, when symptoms were light, that I was getting better; intellectualization upon considering my classic disease presentation; and finally acceptance that surgery was the best choice for me. My experience is unique, but, like contracting COVID just a couple of months before, it gave me new insight into what my patients experience when they see me.
By now it was fall, and we all started looking forward to 2021. The vaccines would come and life as we knew it would return to normal. What else could happen?
Well, people I cared for started dying.
First, it was my beloved Aunt Elena in the Philippines, the matriarch of my mother’s family, from COVID. Then it was my father, Renato Sr., the quintessential selfless provider and expert grill master, from dementia. Then it was Berta, my medical assistant of 10-plus years, and KT, trusted friend and mentor, both of whom taught me about the importance of treating people right all the time, both from COVID.
I was forced to reevaluate my life for the third time in just a few months. This time I was awestruck by the legion of people who shaped my mind and showed faith in me over the course of my life: orthopedic surgery attendings; medical school, business school, and college professors; high school and grade school teachers; leaders and role models.
These people, especially my father, had invested time, energy, and love in me. Now he and others were gone. They had sacrificed for me, and there was no way to repay them. My only option is to pay it forward and invest myself in mentorship and fellowship. No one is an island, least of all me.
The unexpected obstacles of 2020 forced me to confront situations that were completely foreign. I experienced the unmistakable difference between looking at mortality numbers on a spreadsheet and learning that I would not ever again see someone I loved. My core beliefs and values were shaken, but the lessons I gained from grief and illness have become part of my continuing medical education—an education that began at Pritzker 25 years ago and remains an active, dynamic entity.
I probably still have a lot to learn.
Rey Bosita, MD’96, is an orthopedic spine surgeon in Dallas.