The Covid Manager

by Anne-Marie Dany

I come home every night and pour myself a drink before I do anything else. A large glass of wine or a double shot of Jameson with Diet Ginger Ale and lime juice. Anything to calm my nerves. I go outside, sit and stare into the woods, and wait until I can breathe again without having to remind myself how to do it. I wonder if this is how it feels to be an alcoholic, this absolute need to have a drink in order to survive.

I’ve hidden in a hotel room in Amarillo, Texas, while tornadoes encircled the town. I have held the fiercely shaking hand of a woman while strangers performed CPR on her husband who’d had a massive heart attack in the middle of the interstate. I have prayed, or something like it, as a boat the size of a small yacht slipped off the trailer attached to the car in front of me, and flipped, flipped, flipped until it was hovering directly above me, missing my car by a literal inch. I’ve had relationships end, watched friends die, family die, dogs die. But none of those events compared to the chaos, the insanity, the stress created by the pandemic.

This is my Covid.

I manage a small, independent family medicine office in North Carolina. We are “independent” because the doctor who works here is also the owner. Medicare defines a small practice as one with fifteen doctors or less. We have one. She’s joined by a nurse practitioner, a nurse, a medical assistant, a receptionist, and me, and we’re all tasked with keeping almost 1600 people healthy, or at least as healthy as they’ll allow. I have been here since the doors opened ten years ago, and with the exception of the nurse practitioner, everyone has worked for me for at least six years. They are my work family. They are also, in my mind, my responsibility.

The year of Covid, 2020, starts innocently enough. In January, there are rumblings of a mysterious virus, far, far away in China. But everything is global now, and soon this mysterious virus had spread into Europe and the United States. By mid-March, amid talk of sealed borders and wearing masks and practicing social distancing, our local health department announces the first case has reached our county. Everyone is ordered to “shelter in place.”

Let the panic begin.

I wake up each morning. Take a shower. Get dressed. Eat breakfast. Go to work. I’m deemed an “essential” worker in Covid-speak, which means I’ve the luxury of going to work while everyone one else is at home, in “lockdown.” No one thinks of it as a prison yet. They’re busy with the house projects they’ve never before had time to start, binge-watching shows about tigers and kings, trying to find toilet paper, and making bread. I create ID badges for everyone in the office, in case they’re stopped by whatever authority might feel compelled to stop them, and they need to show proof that, “Yes, I am allowed to be out in this world.” And also, because many businesses are giving free swag to healthcare workers, but only if you have an ID.

When people hear I work in healthcare, they thank me profusely, as if I’m a Marine who has returned home from war with one less leg. I tell them I manage a small medical office. I’m not on the front lines or anything. They thank me anyway. I feel guilty. No one’s coming to see us in the office now. We don’t even bother to unlock the front door in the morning.

The phones though, they’re relentless. We’re pelted by a thousand questions at once. How do I know if I have Covid? What should I do if I get Covid? Do I have to wear a mask? Why do I have to wear a mask? Will you write a doctor’s note for me so I don’t have to wear a mask? Can I go outside? Should I wear a mask if I’m outside? Why can’t you refill all my medicines? Why can’t you unlock the door? Why can’t you answer my questions? Why can’t you? Why can’t you? Why can’t you?

We create new signs, new policies, new workflows. The rules change daily, sometimes hourly. I’m mostly notified via email from health departments, insurance companies, CMS, OSHA, CDC, and dozens of other acronyms. Then everyone discovers Zoom, and I find myself connecting every morning at seven for the latest episode of “Managing a Doctor’s Office Through a Pandemic.” I don’t recommend binge-watching this. The morning Zoom ritual is helpful and confusing at the same time, because no one has stepped up to create one set of rules for everyone to follow. Everyone is creating their own rules, and right now, every damn one of them is different. I pull out some of my hair, but it’s okay because it’ll be a long time before I’m able to schedule a haircut again.

I buy another bottle of Jameson.

“What do you mean you won’t sell me medical gowns? We need protective gear so we can see patients,” I incredulously ask our supply vendor, the one I’ve worked with for ten years, the one I’ve given thousands upon thousands of dollars of business. He tells me all offices are now subject to purchase allotments based on their previous purchase history. “You’ve only bought a minimal number of gowns from us over the years,” he tells me. “So your allotment is zero.”

A scream lets loose inside my head, bounces around my brain like a pinball, but I stay calm, sort of. “But we didn’t NEED them before. We do need them NOW. Have you SEEN the news?”

Sorry is all he can muster. I call multiple times, have multiple conversations, all leading to the now familiar chorus of “Nos.” I open new accounts with other vendors, check in with other offices, hospitals, the medical societies, to no avail. “No, No, NO, NOOOOOOOO,” sings somebody on the radio. I’m suffocated by the negativity.

Finally, I learn about an import company in Nebraska selling the gowns we require. It sounds shady, but the girl on the phone is nice enough, and I’m that desperate. I place the order, give her our business credit card number, and contemplate if I should call the bank now or later to cancel the card. But she comes through, and one hundred gowns show up at the office door. I pay two hundred dollars for them. Two weeks ago, they would have cost me fifty.

Nebraska girl is making money selling gowns, but we are not. Despite what some believe, there are no checks from pharmaceutical companies when our doctor prescribes their medications. Nothing from the government to subsidize our rent. No bonus checks from the medical board. We get paid by two entities—insurance companies and patients—and only when those patients have face-to-face, office visits with their doctor.

On the news, essential anchormen remind viewers to call their doctors and request three months’ worth of their medications so they can avoid the doctor’s office during the lockdown. People who have been yelling “FAKE NEWS” at their TVs for years suddenly believe again. They call us, request their medications, and cancel their live, face-to-face office visits with a doctor, the one way we are paid. I look at the bank account, at the zero-dollar deposits, at the bills that have to be paid no matter what, at the employees who need their paychecks.

I try not to cry.

I’m determined not to lay off any employees. I tell them I’m working as hard as I can, trying to get a Paycheck Protection Loan, the forgivable loan offered by the government for the express purpose of keeping employees on payroll and off unemployment. We meet all the qualifications, but I won’t believe it’s real until I see the money in the bank. I tell everyone to keep their fingers crossed, their toes crossed, hell, their eyes crossed, as if that might help. I call our bank. They’ve given out all the money. I call other banks, but they’re only taking applications from existing customers. I set up accounts at the other banks, only to find out they’re out of money too. I contact start-ups, and even reach out to the bank where I worked more than a decade ago, but the available funds are long gone. One of the start-up companies tells me to apply anyway, because they’re certain a second round of money will be forthcoming. I gather the Everest-sized mountain of requested paperwork from file cabinets and computers—payroll forms, tax forms, income forms, rights-to-my-first-baby forms—and go home for the night.

My spouse also works in healthcare, and understanding what I’m going through, greets me at the door with a newly opened bottle of wine. We drink in silence, then go out to the garden to begin breaking up the annual gathering of the weeds, our normal form of stress release when things are normal. We work on opposite ends of the yard, and when we meet in the middle, we head to the porch for another glass of wine. We listen to the birds, hold hands, and simply exist in the comfortable silence of our two-decades-old marriage.

At least I don’t have to drink alone.

Everyone is so obsessed with Covid they forget about the medical issues they actually have, as if their diabetes or hypertension or cancer has been put on hold while the pandemic rages. No one wants to come to the doctor’s office, because that’s where all the Covid germs hang out, as if we’d invited them in for a party. We start insisting people make virtual appointments or what we’re calling car-side appointments. With the virtual visits, we find we have to add more time in the schedule to account for all the patients who want to give us a “tour” of their home. It’s a touchingly sweet gesture for them to give us this glimpse into their real lives. We also learn which patients are technologically savvy, or neat freaks, and/or fans of Thomas Kincade.

I think of the car-side appointments as a reverse drive-in. Patients drive up, park, and we go out to them, but instead of taking their order we take their vital signs. It’s awkward for us and them, but it’s our way of protecting everyone. One patient leaves with a free thermometer when our medical assistant, using the roof of the car as a countertop, forgets about it. We’ll spend a solid hour looking for it until she realizes what she did, but we’ll never know if it survived the drive home. Another patient jokingly asks for French fries. We bring them a Vitamin B12 shot.

This isn’t McDonald’s.

As Covid makes the turn to becoming a complex political disease, some feel the need to show us which team they play for. A fairly new patient wears a homemade shirt that reads “Masks don’t work.” He puffs out his chest, making sure I know that he knows that I see it. A few call us sheep because we’re pro-vaccine. One family is so adamant about the shelter-in-place rule they wouldn’t leave their home for the next two years. Another regularly berates me for going to the garden center to buy mulch.

Even friends think they know all the answers. “When did you get your medical degree?” I ask one.

“I read a lot,” he replies in a manner that suggests his answer is enough and he should be subjected to no further questioning.

I ignore his tone and continue an argument I’m well aware is unwinnable. “Did you read it on the internet?”

“No,” he scoffs. “Books. I read books.”

“So you have a hidden medical library in the house you’ve been saving just for this occasion?”

He changes the subject. “Ivermectin is the answer…”

I cut him off. “Ivermectin is for horses. Don’t buy medications made for horses. They already postponed the Kentucky Derby this year.”

He laughs out loud, but I know he’ll buy it anyway. Everyone thinks they’re a fucking doctor now.

Then there’s Taylor. I’ve seen her at the office once a month for the past ten years. We talk about movies and dogs and life the way you talk with someone you see all the time but don’t really know. One day she comes in for an extra visit because she’s not feeling well. She brags about having ignored the lockdown to have lunch with a group of friends and thinks it’s funny that one of them turned out to have Covid, and they all probably have it now. I don’t get the joke. She tests positive, ends up in the hospital and dies two weeks later, hardly the punchline she expected. She is the first patient we lose to Covid. The first person I personally know. I will lose sleep over this for a long time, wrestling with thoughts of what I could have said or done to make her take it more seriously. To follow the rules. Stay in lockdown. Not meet friends for lunch.

To not die.

Thankfully, there are good stories and good vendors and good people. One patient has a 3D printer, and he makes face shields for us. A couple donates all the N95 masks they can find. Our liability insurance, our largest monthly expense outside of rent and paychecks, gives all their clients the option to pay their bill later. Our doctor gives up her paychecks. The employees I’ve been working so hard to keep fully employed are working just as hard for me. Lots of people bring food. Lots and lots of food. The medical societies begin to track down protective equipment—gowns, masks, gloves—and give us as much as we need. I won’t have to call Nebraska girl again.

I attend a Zoom meeting with a handful of other office managers from around the state, the Governor of North Carolina, and someone from the White House who isn’t the President. It sounds more impressive than it is. “We just want to thank you for the work you’re doing out there,” I hear from each and every speaker on the call. I think they really mean it, and I accept the praise willingly. Sometimes you need to hear you’re doing a good job, pandemic or no.

A tunnel appears, the faintest sliver of light visible at the end of it. Our Paycheck Protection Loan application has been approved! I check, and it’s all there in the bank account. Tens of thousands of dollars to keep us going, to keep everyone employed, to pay the now-exorbitant prices for the everyday supplies we need, to take the proverbial weight off my shoulders. So, on this night, I will smile as I turn off my computer, switch off the lights, and lock the office doors. And at home I will work out in the garden, play with the dogs, make dinner, and sit on the porch with my spouse, breathing in the evening air and talking about anything except Covid.

And, finally. I won’t need that evening drink.

Anne-Marie Dany is a creative nonfiction essayist and columnist who lives in Weaverville, North Carolina, with her spouse, two dogs, cat, and a menagerie of wildlife who turned her front yard into their personal playground. She graduated from Florida State University and spent years as a newspaper copy editor before delving into an IT and healthcare career from which she recently retired. She is a non-dues-paying member of the Sarcasm Society and has been described by friends as both prickly and a vehement Pollyanna.