Coronavirus and the Cancer Patient

We talked to each other at a distance of eight feet. She was feeling well, and fortunately her labs were stable. Not normal, and not even that great, but not worse, meaning the chemotherapy was still holding her leukemia at bay, and not so low that she needed a transfusion. We spent a few minutes discussing Covid-19, the precautions she was already taking, and what measures she could put in place to protect her further.

Then I washed my hands and began a weak approximation of a physical examination, to minimize the amount of time I had direct contact with her.

Whereas normally I cradle my patients’ arms and walk them to the exam table to make sure they don’t lose their balance along the way, I left her to her own devices.

Whereas normally I palpate a person’s neck, searching for lymph nodes, I tried to do this instead by “visual inspection”: look, don’t touch.

Whereas normally I gently grasp a person’s shoulder as I listen to her lungs and heart with my stethoscope, both to hold her steady and to let her know “I’m here for you, I’m on this cancer journey with you,” I didn’t.

I did ask her to open her mouth so I could shine a light in it and look for thrush or signs of bleeding; and I asked her to lower her shirt enough so I could visually examine the permanent catheter that we used both to draw her blood and to administer chemotherapy, checking for any signs of infection. Both looked fine.

She returned to the chair next to her daughter. I washed my hands again and sat eight feet away. We chatted a bit, even lingering, perhaps, so that our words, the eye contact that we made, our ability to laugh at each other’s jokes, would compensate for the lack of physical contact. We sat in silence a while longer, the three of us.

“I’m glad I came,” she said. “I feel better now.”

So did I.

Dr. Mikkael Sekeres (@MikkaelSekeres) is director of the leukemia program at the Cleveland Clinic and author of the book “When Blood Breaks Down: Life Lessons From Leukemia.”

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