Informed Consent: Returning to Martial Arts After Fighting a Pandemic

March 31st, 2020
20 Days after WHO declared a pandemic

There is a moment that is seared into my memory. I know it is so because while it was happening, I kept repeating to myself “Don’t forget this. Don’t ever forget this moment. Don’t forget how this feels.” It was May 2019, and my daughter, Lily, was maybe three weeks old. I was bottle feeding her and rocking her back to sleep after one of her many wake ups. The acoustic version of “Everlong” by the Foo Fighters was playing. Leah was busying herself a few feet away from me in the nursery, folding baby laundry– and with a 3 week old, there was no lack of it. It was evening, and dusk light was coming through the blinds. It was a wholly unremarkable scene in the grand scheme of things, but I was visited by a calm and a happiness greater than any I’d ever felt.

I remember that moment as I sit with Lily now in the dark nursery. I’m trying to put her down for the night. Normally my wife does it, but she wanted me to have the honors since this is my last night with her. Certainly for a while. Maybe, if I get as sick as I worry about getting, my last night ever with her. Probably hyperbole, but it’s hard to find optimism these days, especially since my wife and daughter are leaving me.

Don’t get me wrong, it was my choice. Saturday I got word that we had gotten our first confirmed COVID-19 cases on the unit. We’ve been waiting for it for weeks, and finally, the storm was finally making landfill by me. We went to my parents’ house for dinner and I was a nervous wreck. I suffered from pretty bad depression in my 20s that I was able to overcome with years of work, but anxiety is newer to me. I was afraid to get near people. Sitting at dinner, very close to everyone, I tried to breathe downward into my lap and hide my panic. I did a bad job. It was written all over my face. Come Monday I will be definitively, positively exposed to COVID-19. We can’t pretend this isn’t happening anymore.

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Last day with my daughter for a month

As the day turns into evening, and our plans have fomented (the wife and baby will stay with my parents until we feel it’s safe for them to come home), I’m able to get close to putting the baby down, and my wife comes and helps. We stand over a very sleepy baby (“defeated”, as we say once she finally stops fighting going down and falls fast asleep). I go to kiss her on the head and lose it again. I hug my wife and she comforts me. She’s always been stronger than I was. I take melatonin and go to bed, knowing that when I come home tomorrow it’ll be to an empty house. I don’t know what I’m going to do or how I’m going to manage. I just don’t.

June 5th, 2020
86 Days since WHO has declared a pandemic

I’m laying on the ground. I’m burning up. Sweat pours from my head. I feel like I can’t stand up. I definitely can’t catch my breath.

Well, I think to myself. You knew this was going to happen.

No, I don’t have COVID-19. I’m back at Jiu-Jitsu, doing speed drills, and I’m exactly as out of shape as I thought I would be.

But let’s back up a little bit here.

How my April and May elapsed is a story for another post and, honestly, probably a different blog. I’ll sum it up by saying that if you’re wondering how I found living alone while on the front lines of a deadly pandemic, I did not care for it one bit and I do not recommend it to my readers.

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This is Major Tom to Ground Control

A lot of my coworkers got sick, though thankfully none had to be hospitalized and all recovered. Our PPE was lacking. We ran out of supplies. All the things you read in the news about how bad it was for healthcare workers was true, and we didn’t get hit nearly as hard as New York. But we got through it. And I didn’t get sick, despite being tested twice. My antibodies test (suspect though they are) was negative. Either my lackluster PPE worked, my immune system is amazing, or I just got lucky. My guess is the third option, since I sat next to people at work, unable to social distance, who tested positive days later. Sometimes you get lucky, I guess.

My wife and daughter moved back in at the end of April right as our governor decided against all guidance and current evidence to reopen the state. We realized that while it wasn’t 100% safe, it wasn’t going to be, and we would do our best. I needed my wife and daughter home and, as wonderful as my parents were and are through this ordeal, my wife wanted to be back home as well. We were willing to assume the risk, even though the future was uncertain. So they came home and we decided to distance from my parents, as we waited for the other shoe to drop.

Amazingly, it didn’t. Hospitalizations in my state (1666 at its peak) dropped by half over the month of May. Cases and deaths remained flat, which, when you consider how many cases were missed when there wasn’t testing available, is its own miracle. Sometimes you get lucky, I guess.

Near the end of the month I began assessing my own physical and mental health and, in short, found them lacking. My coworkers and I joked about putting on “The COVID-19 lbs”. Stress eating, gyms being closed, and a lot of free food being delivered to the hospital by our wonderful community meant we were all looking a little more rotund by the end of May when things were getting, mostly, back to normal. I finally stepped on the scale and found that I was 15 pounds heavier than when I competed in February. I had tried to keep up working out, but not having Jiu Jitsu and adding depression and generalized anxiety into the mix meant my workout schedule was inconsistent at best.

Depression is no stranger to me. I struggled with it in my 20s and was on medication for two years before I was able to find coping strategies that put me into a good place where I could come off of it. But the anxiety was new. I actually got my COVID tests because I felt short of breath. But I wasn’t having symptoms of Coronavirus. I was having panic attacks. I realized in that time that my coping mechanisms were my family and Jiu Jitsu. I had access to neither, and the amount of scotch I was drinking was becoming pathological, so I started taking Xanax in Mid April. I don’t love it and I don’t want to stay on it; although peoples’ experiences and symptoms vary, for me medication was always a bridge, not the solution itself. My family came back and I still felt anxiety. So as cases stayed flat and hospital resources recovered, I had to figure out when it would be safe, or safe enough, for me to go back to training.

My coach’s new gym, originally slated to open April 4th (talk about bad timing), had instead opened in Mid May. They initially did socially distanced solo drills, with everyone occupying a 6 foot square, 6 feet away from anyone else. They live-streamed these to members, and I joined in. It was a nice bit of normalcy, but it’s not the kind of thing you can do forever, and as cases remained flat, they moved to their next phase: small, temperature screened classes and an assumption of risk.

The issue with this disease is that, three months in, I’m not afraid of it harming me anymore. While I’ve seen how horrible it can be, after being around it so much, it’s lost its power over me. Like death, it’s scary to think about it happening to me but it’s just part of my job in the ICU. But it’s not just about me. My primary concern remains unchanged: the safety of my wife and my parents and the rest of my family and friends. I decided I wouldn’t go back to training until I had their blessing, and I told them that in writing. I made it clear that there were no strings attached to their veto power, and if they wanted me to wait a day, a month, a year, or longer, I would do it. I always knew I would go back to Jiu Jitsu, but it wasn’t up to me as to when, and I wanted it that way. In this new normal, anything anyone does besides stay in their house carries some risk. What I was doing carries risk to them, and I wanted them 100% on board before I would assume risk on their behalf.

To my amazement, over lunch they all agreed that they were on board. They understood that there’s some risk (asymptomatic infection rate is somewhere between 2 and 10%), but they also understood that my physical and mental health had suffered over the past several months. They encouraged me to go, and be safe as I could, and get tested if I felt I should. I realized that there was one other person I should ask: my Professor. I messaged him, explaining that I hadn’t personally had a Coronavirus patient in almost a month and hadn’t gotten sick, but that it was his gym and his business and if he wanted me to wait, I wouldn’t come back to training until he felt comfortable.

“Of course man,” he responded. “Come tonight, 6 pm. Waiting for you.”

So I found my way back to the gym. It was great to be back, though it was, admittedly, weird. We had small classes with no rolling. I worked with a guy who had gotten blue belt right after I started and then quit (like ya do). This was his first time on the mat in over a year and one of his first times leaving the house in almost three months.

After almost three months of staying as far away from everyone as I possibly could, it was incredibly weird to have someone that close to me, breathing on me. At one point, he coughed. Then he coughed again. The look on his face is one I’d describe as “loud fart in church”.

“I swear to God I’m not sick,” he said. I took a deep breath, nodded, and we got back to work. I believed him. I had to.

I realize that this reads like a long apologetics essay of me trying to justify unnecessary, risky behavior in the time of a pandemic. I’ve seen firsthand how devastating this disease can be. I’ve seen the pain on peoples’ faces as they struggle to breathe and go on ventilators. I’ve seen families, unable to enter the hospital, say a final goodbye to their dying loved ones via FaceTime. But I’ve also seen a lot of people recover. I’ve watched the world try to come to grips with this disease and, in the absence of a coherent federal or state response, decide for themselves what’s best for them and theirs. I’ve tried my best not to be judgmental, even when I vehemently disagree with the way people are conducting themselves. Even if I feel they’re being socially irresponsible. Even if I feel they’re being paranoid and overcautious.

In the hospital we talk about “informed consent.” Google defines this as

“Permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.”

People have messaged me and asked my professional opinion on when the time is “right” to do certain activities: go to the gym, get a haircut, etc. My answer, which I figured out for myself, was:

There is no “right” time. There is a “right” time for you. Figure out your comfort level and your risk stratification, discuss what you’re planning to do with the high risk people in your life, and then, if you’re willing, assume that risk. Understand that the more people you are around, and the closer you are to them, elevates that risk. Understand that masking is helpful but not a substitute for social distancing. If you feel willing to take that risk, then do it. Otherwise, wait until you do.

Be aware of the risks and, if the benefits outweigh the risks, choose to proceed. Informed consent is the best any of us can do right now.

Like many people, 2020 was going to be my year. I was going to compete six times. I was going to update this blog more often and had a ton of ideas for articles. My physical and mental health were as good as they ever were. I was firing on all cylinders.

Instead, my one competition at blue belt saw me get tapped in under a minute, and I don’t know when I’ll get to compete again. I gained 15 lbs and rediscovered my depression and made a new friend named Anxiety Disorder. I stopped writing except to journal my depression and everything I was going through at work.

I understand that some of my friends may disagree with my choice to start training again. I understand that some of the relationships I’ve tried not to take for granted since March may be strained, or irreparably damaged, as people feel that I’m being irresponsible or putting them at unnecessary risk. If that’s the case, I can only say that I don’t judge them for it and I hope they don’t judge me too harshly. I’m hoping, as the prayer goes, for serenity to accept the things I cannot change, the courage to change what I can, and the wisdom to know the difference. I’ve learned courage, both on the Jiu Jitsu mat and on the frontlines of COVID 19. I’ve gathered wisdom as I understand what I can and cannot affect in an increasingly chaotic world.

Now it’s time for me to find that serenity again. The places in my life I’ve found it have historically been in the company of the people I love, and the physical and emotional toil of the mat. If you decide not to go back to the mat or your life as it was, I hope you find happiness and peace somewhere else because at the end of the day, that’s all we have. But my happy place has always been on the mat, and if/when you feel safe, I’ll see you there.

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