Ready, willing and able

The pandemic arrived just as we switched EMRs and lost our provincial patient portal—both victims of tech turnover. As we climbed the steep learning curve, the pandemic shut down direct patient care. Virtual care launched rapidly to create safe access for both patients and doctors. We scrambled to set up secure video visits and asynchronous visits with our new patient portal. The first waves of COVID wreaked havoc locally and globally—death, illness and despair were everywhere. As healthcare providers, we recognised our high risk for exposure and subsequent morbidity and fatality. We also risked bringing it home to our families. Read: Zeposia approved for treatment of moderately to severely active ulcerative colitis This reality ripped open my thin veil of desensitization, and I fully embraced my mortality. It was no longer life as usual. If you have a limited time to live, which is fundamentally true, how would you choose to live? Nothing that you’ve gathered, wealth, status, even your very body, goes with you. You leave it all behind. You also leave behind the fruits of your labor; be it your children, relationships, work or ideas. I decided, I would no longer wait to do the bold or risky things I’m passionate about. The present is all we have, and I decided to inhabit it instead of my mental construct of the world. I would choose to do that which lit my soul on fire. This led to my reaching out to help a rural community that was going to lose their family doctor. I had a full practice and could not offer care, but I have skills in digital healthcare. I could create a virtual network of care providers assisted by medical students and tech tools like auscultating stethoscopes that can transmit the sound of a beating heart across vast distances. This is how the idea of Geo-view, a Geographical Information System (ArcGIS) based innovation evolved. I also engaged with Industrial Engineering students at Dalhousie and Geoview dashboard was created. We were set to change our corner of the world. Next, good news in the form of mRNA vaccines against COVID arrived. Masking and social distancing were in place and testing was more available. Even as the world rejoiced, I was filled with concern. I suffer from an auto-immune skin condition that flares with vaccinations. The mRNA vaccines were not going to be tested on people with auto-immune conditions and I would not know the potential risks I would face. Making the choice between life-threatening infection or facing unknown risks from a protective vaccine is not difficult. I received my first dose in May. Within days, my skin condition flared and was more severe than with previous vaccines. But nothing prepared me for June 1. I was asleep at 2 a.m., and suddenly the world started to spin vertically and horizontally, while my eyes were closed. Next came severe vomiting and retching. I needed assistance to stand up, since I could literally not tell which way was up. This severe, bidirectional vertigo did not ease with multiple medicines, and I was seen in Emergency where a CT ruled out stroke, but the neurologist advised me it was impossible to tell if this was a central or peripheral nervous system issue. I was then admitted to hospital for investigation and treatment. The diagnosis was vestibular neuronitis and presumed to be viral. Prednisone did not have evidence for this presentation, and I was discharged home with Zofran. For the next six weeks, the world spun uncontrollably with movement, the light hurt my eyes, I could not tolerate sound and my world shrunk to my bedchamber. I couldn’t sleep at night, since turning brought on the vertigo and kept me awake. My symptoms were so severe that we had to wait to start rehabilitation. My recovery was slow. When your inner ear isn’t available for keeping you upright and functioning in a three-dimensional world, your eyes and proprioceptors work overtime. Minimal movement led to needing hours of rest to recover. I used my nordic poles to assist my walking around the yard as my eyes hugged the path, to keep me upright. I was too ill to direct my staff to inform my practice and my attempts to get locum coverage were in vain. Four months later, the vertigo at night had not abated and I remained disabled. The vestibular therapist got me in with an Otolaryngologist. He listened to my history and was persuaded to give me a week of prednisone. Three days later, the vertigo at night stopped. But a week after the course, my skin erupted, and the other vestibular system was affected. The world started to spin just like in June. This time, with informed consent, he decided to treat me, longer with a higher dose and remarkably, my symptoms responded! At that time, there was no evidence available on vestibular neuronitis caused by mRNA vaccines. I was told to get a second shot and simply treat the aftermath with prednisone. I had lived through agonizing days of disability, my family suffered in silence as they watched me and I was not yet recovered. I decided to not follow this advice. I was aware that my symptoms did not match a viral neuronitis—they were far more severe and prolonged. The concurrent skin and vestibular reactions post-vaccine suggested they may have a common cause. I was convinced the mRNA vaccine was the cause and that it would be recognized with time. Meanwhile, vaccine mandates and passports had been introduced and a battle was raging across the country. Five months later, public health confirmed the condition was caused by the mRNA vaccine and not to have further doses. I recovered enough to offer virtual care to my patients, and gradually increased my hours of work from home. Colleagues stepped in to assist with patients that needed in-person care, and I am deeply grateful for their support. Read: Prescribing or dispensing Paxlovid? Here's what you need to know So now, I’m under vaccinated and will continue to avoid events and locations where transmission risk is high. To comprehensively practice medicine, I must offer in-person care. I will use PPE and implement strict rules of distancing from staff at work. I intend to use Sanotize, a Canadian innovation that uses nitric oxide to eliminate viruses like COVID and influenza from the nasopharynx. Eventually, antivirals will be in greater supply for use when needed. The current waves of the pandemic also appear to cause less severe infection, but my own risks remain unknown. It feels as it did at the beginning of the pandemic, when I realized that my mortality is real. I intend to continue to do work that sets my soul on fire. I will do my best to protect myself, as the pandemic waxes and wanes. Despite the restrictions in my life, I remain hopeful and optimistic. I am alive, present, ready, able, and willing to continue; grateful for the chance to live and contribute. Dr. Ajantha Jayabarathan is a family doctor in Halifax.

Ready, willing and able

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