How I Got Stuck Treating Patients Online Throughout COVID

Struggling to find a way to doctor from a temporary home office in the midst of rampant censorship

We were living in Jordan when the pandemic hit and my wife told me in no uncertain terms not to leave the country.

I knew she was probably right - the imminent border closure had just been announced for 2 days out, and we had no idea when it would be lifted again - but I went anyway and ended up trapped in the US with my wife and kids stuck back in Jordan.

I didn’t see them again for over 6 months, but it felt a lot longer at the time because no one had any idea how long it would be.

My daughter was about a year old when I left. She used to sleep on my chest at night. For some reason she liked to be pounded quite firmly on the back which would calm her down and put her to sleep, something my wife balked at doing, but that I thoroughly enjoyed.

Then, while we were apart she kind of forgot me (despite daily Skype calls), which was kinda heartbreaking.

She was very hesitant when we finally met again and even though she just turned four recently and things seem almost normal, she still shies away from physical contact sometimes - especially at night, in favor of sleeping on my wife (she’s fast getting too big for that though, so she’ll be on her own soon enough).

Anyway, the reason I left my family was because I had scheduled a 1 week hospital shift in South Carolina months before, and was loath to cancel on them at the last minute.

I actually changed my ticket to leave earlier than scheduled so I would get out before the border closure.

I could have canceled and the hospital would have understood, but last minute schedule changes like that are so painful for the rest of the physician team - if there aren’t too many patients someone else picks up the slack and sees your list, but o oftentimes someone else has to be brought in from their scheduled break.

I just wasn’t raised to skip out on work, even when the “commute” was a 16 hour flight and the pandemic was just swinging into high gear leading to travel shutdowns worldwide. 

After that 7 day shift at the hospital I got set up to travel to NY to help out on the front lines in the first COVID wave, but that job was canceled at the very last minute - they called and told me not to get on the plane the night before I was to leave.

So at that point I couldn’t go back to Jordan and I had nowhere else to go - I cast about for hospital jobs, but they had all quite unexpectedly dried up.

One of the many viral videos of doctors dancing in empty hospitals

There were a few COVID hotspots, but most of the country was shut down with everyone at home afraid to go out. People preferred to stay home with their mild heart attacks and ministrokes rather than brave the deadly gauntlet in their local ER. 

I loved hiking and nature so I ended up gravitating to North Carolina to a small city nestled in the Smoky Mountains where I had vacationed a few times in the past.

I got an Airbnb and holed up by myself to start doing telemedicine.

At the time I wasn’t even licensed in North Carolina, so I couldn’t have helped out in the local hospital even if they had needed me (which they didn’t - it was dead empty).

I had worked part-time with the largest telemedicine provider in the US for a few years at that point.

The work was perfect for me because I could log in any time and see patients and log out when I had had enough. There was no set schedule and no expectations and I could see patients on my laptop from anywhere in the world. 

So I started seeing patients from all over the country via telemedicine, but didn’t get a whole lot of COVID patients until later in the summer.

By then I had learned about off label treatments like Ivermectin, and started recommending them to patients.

Surprisingly, I found that less than 1% of patients were interested in taking the recommended off-label prescription (most had never heard of ivermectin as it’s very rarely used in the US - I had only very occasionally prescribed it for scabies).

Presumably one of the reasons they were hesitant is because they were meeting me online for an urgent care visit for the very first time (not established patients), and they thought they had drawn the tele physician equivalent of the short straw - the loony tune who thought some weird sounding drug worked against the novel coronavirus when obviously that was crazy talk since if if such a thing existed it would have been trumpeted from the rooftops to great fanfare, it would have been all over the internet and on every new station and proclaimed by the pandemic authorities from the Oval Office. 

The borders finally opened in the summer and we decided to move everyone out of Jordan to NC where we bounced around amongst various expensive Airbnbs for a few months looking for a long term rental until eventually we found something in our price range and settled down in a charming 100 year old remodeled Victorian in a picturesque historic district.

It had a little room upstairs with a solid wood desk by the window and a little red futon for naps - perfect for my telemedicine office. 

The pandemic seemed to pass us by, but everyone still acted like it was 1918. This was a true blue downtown and you couldn’t go anywhere without a mask on (when Trump lost everyone in the neighborhood went out to party in the streets, and some neighbors were actually congratulating us - I guess just assuming the brown folk would have voted Biden). 

In this weirdly quiet professional interlude I decided to go back to school. I wanted to branch out from modern western medicine and learn Chinese Medicine.

I started doing some research and discovered that Chinese Medicine wasn’t a simple monolithic structure - there were innumerable schools of thought in this 2500+ year old tradition.

Many practitioners of old had learned by apprenticeship to a master, which didn’t seem at all practical for me, so I looked into various certificate and degree programs. 

I discovered that Traditional Chinese Medicine (TCM) was a formalization and some would say over simplification spurred by the Chinese Communist party.

Classical Chinese Medicine was an attempt by various proponents to return to the original roots of the tradition, but US schools, even the ones that purported to teach a classical version, were still locked into the TCM curriculum.

There were a couple of practitioner training programs meant to teach acupuncture techniques as an add-on for western docs, but these weren’t the real art - they mostly focused on pain management - and anyway they were shut down for the pandemic. 

There were some interesting online programs that taught mostly Chinese herbology, but an essential part of Chinese medicine involves pulse diagnosis and the courses for that were also closed for the duration of the pandemic. Even had they been opened I knew that I would need a lot of practice with pulses, not just a standalone workshop. 

I did end up signing up for an online introductory course run by an MD turned acupuncturist, but I still needed something more intense and practical.

There was a Classical Chinese Medicine school in the town I was staying in that had been started by a master practitioner who had years ago treated a close family member of mine for breast cancer.

So I finally decided to enroll for the fall semester and spent a ridiculous sum on all the books and got down to the business of memorizing herb names and properties and learning how to do Gua Sha and cupping. Thankfully, as a licensed physician, I was able to skip the basic anatomy classes. 

An interesting aspect of the training that differed significantly from a western medical education was that they had a strong focus on self improvement - both physical and spiritual - primarily via the practice of Chi Kung - an ancient Chinese non-religious meditative movement that I already had some years of experience with. 

They considered it important for clinicians to walk the walk, not just talk the talk. The meditative practices were considered very important for both deepening the eventual healing capacity of the clinician as well as helping them deal with the stress of treating very sick people day in and day out.

The more I think about it the more I believe healers (as opposed to physicians that just blindly follow protocols, or even those who go beyond protocols but don’t help patients deeply heal) have to embody health themselves otherwise how can they heal others? How can they gain the necessary conviction in their own advice to convince others to follow it, if they haven’t proved it on themselves as well as others?

Soon enough I was busier than I had been in years - studying full-time while working part-time to support myself and family while paying for schooling. 

During this time a convincing study on Vitamin D and COVID was released and I sent it to the school wide mailing list with many positive responses.

I had known for years how important Vitamin D was and unlike 99% of hospital doctors would test it on every single hospitalized patient.

In one primarily black town out of hundreds of patients I never found anyone hospitalized with a normal vitamin D level. Every single patient was low and a significant percent were undetectably low. 

Shortly after sending the Vitamin D email I decided I should alert them all to Ivermectin also. So I put together a lengthy email explaining all the study data available up til that point and sent that out to all the students and staff. 

The feedback wasn’t nearly as positive and had significant political overtones and though Chinese medicine practitioners can’t prescribe ivermectin anyway, the response would mirror the response of much of the alternative medicine community over the next year or more - even those who were able to prescribe such as the “functional medicine” community.

I was honestly perplexed. Though I understood the mainstream pushback I couldn’t understand the hesitation of the functional medicine physicians who I had always thought lived on the cutting edge of medical research and practice. 

Anyway I enjoyed many aspects of the Chinese medicine training, but after a couple months I realized that the curriculum wasn’t as rigorous as I had expected or as “classical”: through no fault of their own, since they had to conform to certain standards in order to maintain their accreditation. 

I also met a number of advanced local practitioners and realized that apprenticeship was actually not as impractical as I had thought, and would be a far more direct and shorter path to learning practical skills. So I decided not to continue with school in the spring, and instead geared up to become an apprentice for the first time in my life. 

Then the ground suddenly shifted beneath my feet and everything changed … (to be continued)

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Next post: How The Stars Aligned and We Finally Broke Through the Ivermectin Censorship - and how I found all those patients in the vast online wilderness that needed my help with COVID, Long Haul & Vax injury.