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This COVID-19 Life: On Juggling Young Children and Telemedicine

​Editor's Note: As neurologists across the country made the transition to telemedicine, so too did they face new challenges in balancing the demands of work, home, and family life. In interviews with Neurology Today, neurologists shared their strategies for achieving that balance for a series of stories around life in the setting of COVID-19. 

Jori Fleisher, MD, MSCE, assistant professor in the department of neurological sciences at Rush University Medical Center, has been working from home since March 13 with her charts, her telephone, and her two children, ages 5-and-a-half and 2-years-old.  About 80 percent of what she does is research, studying interdisciplinary home visits for patients with Parkinson's disease, and she said it's been more of a change for her patients who are suddenly having to see their caregivers through the computer.

"It's better than nothing, and it's better than waiting for months to see the doctor," Dr. Fleisher said. "The priority for me is to keep my patients safe and aging in place for as long as possible."

She and her husband, who is also a physician, have an au pair who works 40 hours a week. Her husband is an OB/GYN and he is still going into the hospital, so she's handling most of the work-arounds.

Dr. Fleisher tries to make it to the spare bedroom by 7:30 AM, where she has a laptop, a "thousand" cords, and a makeshift dry erase board.  She's there until about 6 at night before handling dinner and baths and playtime and bed.

 Overwhelmingly, patients have been understanding.

"Every once in a while I can hear the 5-year-old screaming from downstairs, and sometimes a patient will make a face and I'll say, 'We're all in a bit of a crisis moment and sometimes you just need to have a temper tantrum."

What helps her keep her sanity she said, is her Peloton bike, riding at 11 at night.

"I was not a great exerciser and I felt guilty about it because I tell my patients how important it is, and to make sure they get good sleep. I'm a hypocrite because I sleep four hours a night," she said. "So it felt like a ridiculous amount of money to spend but that thing is my sanity. I'm a total convert and a zealot. I'm not in great shape but I will tell you I am in much better shape than I was, physically and mentally."

She Needs a Vacation After This

Amanda L. Piquet, MD, assistant professor of neurology at the University of Colorado School of Medicine, said it was after the first day that the five weeks of "stay-at-home" restrictions had been lifted that she realized she really needed a vacation.

Dr. Piquet, who has a 4-year-old and an 8-month-old child, is a neurohospitalist and works part-time in the hospital where she has inpatient duties. About half her time is in

outpatient clinics from home, and she said that her specialty in autoimmune diseases has made it easy to convert to telehealth, because a lot of what she does is counseling patients.

"Patients are thankful to be able to see their doctor, even if it is virtual," she said.

The kids were normally in daycare, and her husband is in finance, so they've been trying to juggle schedules, with most of his work taking place in the early morning.

"We're doing our best," she said. "At least I have the luxury of being in Colorado, and with sitting at a computer for so long, we make sure to get out for walks and we've been increasing the number of bike rides, and the time the baby sits in the trailer" of their actual bicycles.

One of the challenges is creating a separation between work time and family time, she said, adding that it's hard not to fall into working 24/7. So the couple made sure to create as much structure as possible, with some planned fun time. Now every Friday is family game night, which Dr. Piquet said they plan to continue when things revert back.

"My daughter used to take my stethoscope and reflex hammer to play doctor," said Dr. Piquet. "Now she takes her toy laptop and headphone and 'talks' to her patients.  When I ask her what she's doing she says she's 'taking care of her patients.' It's pretty entertaining to see how much they pick up on the changing times."

Learning More Through Telemedicine

Samantha K. Holden, MD, MS, assistant professor of neurology at the University of Colorado School of Medicine, encountered her first work-family challenge during her first week of full-time telemedicine at home. Dr. Holden had asked an older patient to walk around his room so she could examine his gait—when all of a sudden, a little 4-year-old face appeared behind her on the screen.

 "I'm thinking 'How do I get her out of the room?' and then I realized the patient wasn't wearing pants, and I hear my daughter, Eleanor say, 'Why is that man in his underwear?'" said Dr. Holden.

 Dr. Holden has been on lockdown since March 16. Her husband, a school administrator for Denver public schools, has most of his meetings in the morning, so she schedules most of her appointments for the afternoon and they switch off.

Working virtually has worked fairly well, Dr. Holden said. It's nice to see patients in their environments and view how their house is set up for them. But she is taking it one day at a time.

There are Zoom meetings and clinic and office time, and not much else in terms of papers or research is being done right now.

"At my office, I'd use open time to do research or write, but now if it doesn't have a set schedule on my calendar it's not getting done," she said. "Any open space is Eleanor time."

The couple tries to limit work to weekdays, keeping social media and news off limits. And while Dr. Holden enjoyed spin classes before the pandemic, she and her husband hesitated before getting a Peloton bike. No longer.

 "It's the best thing we've ever done," she said. "It's about what I'd be paying for a gym, and I'm on it for at least 30 minutes a day, and he rides it as much as I do."