Comfort, Always.

To cure sometimes, to relieve often, to comfort always.

Early in medical school, newly minted doctors learn this phrase. It's reassuring to young physicians at a time in training when all we know how to do is comfort - before we learn all the fancy terms and diagnoses and treatments we'll soon have at our disposal.

It is meant to be a guiding principle in the care we give to our patients. But judging from the recent attitudes in the time of COVID-19, I'd say that doctors need a reminder that even though much of what we can do is to relieve, or merely comfort, it's still a lot - and part of our job as physicians.

Because there is no cure for COVID-19, the current advice is to stay home if you are sick, and only present for medical care if you are in need of oxygen or hospitalization. When it comes to going to a hospital or emergency room - that's true!

But those of us who went into primary care presumably did so to be on the front lines of people's lives 27/7. We chose to get to know families personally over years of care. We chose to cure and to comfort, to rise to big challenges but also to cradle every minor concern and fear. We chose to treat anxiety and diaper rashes and insomnia and mild allergies with as much attention as a neurosurgeon gives to each major surgery.

Yesterday a parent called me because her husband had been very sick for two weeks and "nobody would see him." His doctor told him to go to urgent care and urgent care told him to stay home. His coworker had a confirmed case of COVID-19 and although he was isolating, he was scared because he had never been sick for so long or felt so awful. No one would test him - would I test him???

I did next what I do so often in medicine. I backed the conversation up. I said that yes, if he really wanted a test I would test him, but that there were several important issues we needed to discuss first.

First - was he ok? His wife said he had been in bed for almost two weeks. Okay right there I told her that we needed to make sure he was breathing okay, didn't have a treatable pneumonia or other illness and I would see him and make sure of that. Step one - back up, forget about COVID-19 for a minute and assess the person. There's a lot going around besides COVID-19!

From his symptoms she described over the phone I felt that he might indeed have the Coronavirus. I've been masking and goggling and gloving with every patient, but I added a patient gown over my clothes, just in case. I asked him to stay in his car and when he mistakenly came into my office, even though it was after hours and no one was there and he was wearing a mask, I reflexly said with alarm - GET OUT!

He went back to his car, and first thing, I checked his pulse-oxy......98 percent - awesome! I told him he was getting plenty of oxygen and even under his mask I saw his face soften and relax a bit.

Next I listened to his lungs - all clear. I did a flu test because he wanted to know - normal.

To me he looked pretty good. Yes, he was quite fatigued, yes this had gone on a long time but his fevers were down and his shortness of breath had not gotten worse. In fact, despite feeling afraid, he noted that he might be getting a little better.

Next came the topic of testing. He was frustrated that he couldn't get a test. I told him that I was frustrated too, and that I would do it. However, only having 24 vials of transport medium and no word on when I'll get more, my supplies were limited. So we discussed whether knowing would change anything for him personally, or for any of his contacts.

After ten minutes, he said he didn't think he needed a test. The family was locked down, they had all had some degree of symptoms already, and he thought maybe he might be getting better. The exam had helped him to realize that.

I prescribed a Zpack because with two weeks of up and down fever and fatigue and chestiness, that's what I'd normally do. I might get a chest X-ray first, but in this setting exposing too many people wouldn't be worth it. Plus, the outpatient X-ray down the street decided to cut their hours in the shutdown (don't get me started on that).

I was able to tell him anecdotally that Azithromycin even helps with Coronavirus. One thing I learned from a brilliant comforter in medical school, an oncologist, was always to give some shred of hope. Don't lie, but it's okay to highlight something small. So I chose to highlight this as a prudent step, which I felt it to be.

He asked me if he got worse, if I'd still be willing to test him and I said yes. He needed to know I'd be there for him if he didn't improve. And only when I said yes, was he ready to drive home.

This isn't the first parent I've seen because their own doctor wouldn't, or didn't have room for them. Pediatricians are like that. Our doors are often more open and I can only imagine it's because we take care of kids, our most precious resource. But adults are precious too. Everyone needs good care.

I'm alarmed that in this pandemic, sick patients are told to stay home. I remember Jim Henson, the creator of the Muppets, and how he died from curable pneumonia because he didn't go to the doctor. So for that reason, we should be seeing sick people, same as always.

But I'm also alarmed that we have forgotten how to comfort. Comfort isn't offering empty reassurances over the phone. Comfort is the laying on of hands, the careful evaluation of a patient, the attention to detail and the honest feedback we can give.

In this case, when I said, "I think you are okay, and you are probably getting better," I was able to comfort. He could believe me because I had taken the time to see him and to make sure.

I am not writing this to toot my own horn. I'm writing this to remind patients to insist on appropriate care. He could have had a raging pneumonia. And I am also writing this to remind doctors to do their job.

To cure sometimes, to relieve often, and to comfort always.