Four Consecutive Mothers' Days: A Conversation With Voices of ID ...

Paul Sax: [00:00:12] Hi everyone. This is Dr. Paul Sax. I'm the editor-in-chief of Clinical Infectious Diseases. And welcome to the Let's Talk ID podcast. Today we are joined by Dr. Gretchen Arnoczy. She's a clinical ID physician in Pinehurst, North Carolina, at Firsthealth of the Carolinas, where she covers four hospitals. She's another one of our talented authors in the Voices of ID series, that we've be featuring on this podcast, with her contribution called "Mother's Days." I plan to ask her about that in a moment. But first, Gretchen, welcome.

Gretchen Arnoczy: [00:00:45] Thank you so much. It's really a thrill to be here.

Paul Sax: [00:00:47] So I'm always fascinated by people's origin stories, in particular with respect to how their interest in medicine arose. So we got here by different roots, all of us. So what's your story? How did you find yourself becoming a doctor generally, and an ID doctor in particular?

Gretchen Arnoczy: [00:01:04] It was a bit of a surprise to my family. I'm not going to lie. I often think about doctors as that, you know, stereotypical oldest child, very achievement oriented, you know, great student, valedictorian of the high school. That was not me. I love telling this story for everyone who has kids who maybe are not that person, because when I was in high school, I was not a good student at all. I really struggled in, especially freshman, sophomore year. I really thought I was going to be a writer, or maybe a history teacher or a poet or something like that. But I went to college and I went to a very small, much less competitive college than my high school. And really like the small pond kind of made me into a bigger fish. I got a job at a bookstore because, again, I thought I was going to be a writer or English teacher, but I loved my freshman biology class, and I'd finally, like, figured out study skills. So I was doing better in college, and I started reading all of the books at the bookstore in the biology section. And one of those books was The Hot Zone, about the Ebola epidemic, of course, and another was Deadly Feasts, about the mad cow pandemic. But then the third one that I read was And The Band Played On and it just sucked me in. It hit me like a lightning bolt. I said, oh my goodness, I think I'm going to do things a little differently. And I was killing the curve at my freshman biology class, so I decided I was going to maybe, maybe look into medicine as a career instead.

Paul Sax: [00:02:18] That's a great story, and I agree. And The Band Played On was a really terrific book and I read it as well. So you applied to medical school and obviously you got in. And how did you sort of make the decision of internal medicine and ID and also I always interested in in second choices or runner ups and career trajectories.

Gretchen Arnoczy: [00:02:40] I got into medical school probably because I got a part time job at the Centers for Disease Control again, because I was an ID geek and I was really interested in it, and then get into medical school. And then my third year doing the clinical rotations. I liked everything, like everything was interesting to me. I felt like I could have done just about any of it, except maybe surgery, just because I'm clumsy. I really liked it. But every at the end of every rotation, after I decided I was going to be a pediatrician, or I was going to be a ob gyn by the end of it, I'd had some interaction during that rotation with infectious diseases, and it always was like, oh, right, I forgot, my first love. Yeah, I'm going to do this. And so it just sucked me into, you know, doing infectious diseases. So then I went to residency and then fellowship at Chapel Hill and then just went from there.

Paul Sax: [00:03:23] Any second choices?

Gretchen Arnoczy: [00:03:24] Oh, yeah. I went to this talk about careers. And I remember, you know, all of us were full doctors in residency at that point, and someone was just saying how, you know, I'm talented and hard working, and I'm fully trained. I can get another job. I could do something else. I could have done psych was honestly my second choice. I got an award for excellence in the rotation of psychiatry. Like, I could have done psych, I really liked psych, but ID, I mean, for me, again, HIV, vulnerable populations, interesting diagnoses. You know, the zebra hunters, that just pulled me in.

Paul Sax: [00:03:58] One thing we have in common with the psychiatrist are these very detailed histories.

Gretchen Arnoczy: [00:04:04] [laughs] Yes. And writing. Writing four page notes. Yes.

Paul Sax: [00:04:08] Focusing on different populations. What I'd like you to do is tell me about your day to day life as an ID doctor pre-pandemic. So what was life like for you in 2019?

Gretchen Arnoczy: [00:04:21] Pre-pandemic. So I'm a clinical infectious diseases physician at a community health care system. And there was one other ID doctor at the time in 2019. So me and him and we had an app. And so I was on call 50% of my life. And my day to day job is taking care of patients, which sounds miserable if you're at a place where call is very taxing. But actually it was a nice life. I mean, you know, we have a good team, we've got good relationships with our hospitalists and I just come in to work, take care of patients, see people when I'm on call, see clinic patients. I also oversee antimicrobial stewardship, OPAT and clinical trials, if we're doing any clinical trials, which we're not always. And so it was a very day to day trying to figure out people's problems and make them better day to day life of just just being a basically a clinician, but also the person on call for anything infectious disease related. I really love the recent podcast that you did, talking about being the only ID doctor in town, and even though I was one of two, I really I really identified with that because you kind of you have to be a jack of all trades.

Paul Sax: [00:05:21] So that's one of the really interesting differences between community based ID practice and academic medical centers, because obviously in the latter, people are so hyper specialized, you wouldn't have someone who's doing both antibiotic stewardship and necessarily HIV care and OPAT, all of them together, you know, um, although we do have someone on our faculty who is sort of a jack of all trades, but most people, it's one or the other anyway. So back to 2019, 2019 turns into 2020. And all of us kind of remember when we realized that this Covid 19 thing was going to be a very big deal? When was that moment for you?

Gretchen Arnoczy: [00:06:00] That moment for me was during that press conference by Nancy Messonnier when she said, this is going to disrupt your lives, because I'd been paying attention to public health since 1998, when I first got my summer job at the CDC, and I'd never heard anyone say anything like that before. And I thought, oh dear, this is going to disrupt our lives. She was correct. She was correct.

Paul Sax: [00:06:21] I mean, it ended up pretty much costing her job. As you as you might have remembered, this was not well received.

Gretchen Arnoczy: [00:06:27] No, there was a lot of downstream effects from that statement, but she was correct.

Paul Sax: [00:06:31] Yes, she was absolutely correct. That's that was a very memorable moment. It sort of was watching what was going on in other countries and realizing, you know, we were lucky with SARS and that wasn't going to be the case here. Now onto your piece. I have to tell you, it was really beautifully done, a personal favorite of mine.

Gretchen Arnoczy: [00:06:54] Thank you.

Paul Sax: [00:06:54] It was so well written and so moving. I could see that, you know, writer, English major. I don't know if you were a biology major and English major, but you certainly can write. I think it was interesting how you structured it around four consecutive Mother's Days, which of course happened in May of 2020, 2021, 2022 and 2023. So how did you come up with this idea?

Gretchen Arnoczy: [00:07:15] Part of it was you put out a call for writing pieces. I think it was in early May? The way I process grief or big emotions are really, I don't know anything is I write about it. I love to write, and it's kind of how I process things. And I've been thinking about how, you know, if I wanted to try to publish more, if I wanted to try to actually put something out there. So you had put out this call that you were looking for pieces from ID people, and right on Mother's Day is actually I remember being in my, you know, room with my daughter breakfast and looking at my old social media and how it will say like, oh, a year ago today or two years ago today or three years ago today. And it suddenly made me realize that, oh, right, Mother's Day 2020. That's when Jenny went into labor and Mother's Day, you know, 2022. Oh my gosh, I was isolated in this room and I had Covid and then even the year before, you know, in 2021, remembering that what had happened right after that, we had just gone through this kind of ordeal with Jenny on Mother's Day and I just and then even now, as I was, you know, the fourth one, when I was coming back thinking about how I'd had four very eventful Mother's Days and thinking about, again this particular tragedy that we'd experienced and how it was so focused around motherhood, and then the fact that it all happened on Mother's Day, it just felt very poignant. So I wrote it, and then I sent it to you, which was great because it got well received.

Paul Sax: [00:08:30] So let's start with that 2020 Mother's Day. I know it was kind of painful, but tell us about this character Jenny.

Gretchen Arnoczy: [00:08:39] So Jenny is a friend of mine. She's a pharmacist who works with my system, and she had worked with me during her residency. So we knew each other. And then we're in this kind of group of people who all have kids, who go to the daycare at the hospital. So we'd been at like birthday parties together. Um, and we had, unfortunately, Covid outbreak within our pharmacy system. And then some people had, you know, downstream cases and we were investigating and figuring it out. And Jenny was pregnant and I think she was in the early 20 week area when she tested positive. And I remember, you know, kind of talking to her and saying, oh gosh, I know this is really stressful. And we didn't know anything, right? This was still in May of 2020, who knows? But I'm an optimist and my default is usually reassuring. Like, well, you know, we'll weather this. We'll figure it out. I think I said something like, I mean, I know this is scary, but I bet you're going to be okay. We're going to get through this. And that's not what happened at all. So she went into pretum labor. She delivered a child way too early. You know, the baby, she was in isolation. The baby was helicoptered to our academic center. The baby spent a month in the NICU and then unfortunately, passed away. And it was just the most tragic, horrible experience.

Paul Sax: [00:09:49] You know, it's really, uh, and of course, the women who were pregnant, who got Covid in that first year, they were sick. They were really sick.

Gretchen Arnoczy: [00:09:59] And Jenny and I really follow the literature about about pregnancy and Covid after that. And just seeing the specific risk to pregnant women, which still exists.

Paul Sax: [00:10:08] So you write about it, I'm going to quote you, you say, "I get back to work. [This is after hearing about the baby's death.] In between clinic notes and consent forms, these giant hiccuping sobs keep erupting out of me. They each last a minute or two. Then I angrily wipe my eyes, shake my head, and get back to work." Wow. What was your preparation? Either in medical training or in life to handle moments like this

Gretchen Arnoczy: [00:10:34] I do think everyone in medicine has an experience like this. Because of the nature of our work and the fact that even as we experience the worst event in someone's life, we also have to get up and go to the next room and we have to keep the lights on. We have to keep going and do the next thing and and take care of patients. So I do think everyone in medicine has had a situation like this, had an experience where you have overwhelming grief, but also you still got to keep feeding the cat. You got to keep do the next thing. I just felt like during the pandemic, especially for infectious diseases providers and people, that was every day, I mean, it just happened all the time. We just got hit with grief, but we had to keep doing three times of our usual workload, and that was my experience of 2020.

Paul Sax: [00:11:16] Well, the next year, 2021, was much happier, wasn't it? What happened?

Gretchen Arnoczy: [00:11:20] I was one of the people who was recklessly optimistic about. I expected that with people getting vaccinated and then even people who weren't getting vaccinated, but who had already had the infection. I was really hoping that this was all just going to kind of crescendo into us being done with it. So I was very optimistic. Also, Jenny got pregnant again. She told me in December of 2020, and then her due date was in June of 2021. Her request to me was figure out what we're going to do so I don't get Covid, or if I do what we're going to do about it. And again, being the optimist, I was like, oh, you're not going to get it. You're going to be fine. It's going to work out. But then in Mother's Day 2021, it's just my memory of the fact that she did get exposed from her own child right around she was 25 weeks pregnant, which was absolutely harrowing for all of us. But she decided that she was going to get vaccinated. So she did. And for once, I was right. It all worked out. She did fine and had a beautiful, healthy baby girl.

Paul Sax: [00:12:15] Excellent. Well, I you know, I have my own May of 2021 overly optimistic memories, which is, you know, the CDC comes out and says vaccinated people don't need to wear masks. And I remember thinking, well, I'm maybe not that optimistic, but we were optimistic enough to have a sort of a landmark birthday party for my wife, you know, which we had 50 people in the house. It was kind of like, okay, you know, this is going to come to an end. Didn't work out that way. I mean, the vaccines ended up still protecting us from severe disease, but not from infection, unfortunately. Speaking of, I transition now to 2022 and Mother's Day of 2022, you find yourself with Covid 19. So now that most of us have had it and some of us multiple times, I wonder how did you feel when you tested positive both physically and emotionally, and how did your family respond?

Gretchen Arnoczy: [00:13:08] When I threw myself into the fray in March of 2020. So I was working in a I was one of three ID providers, and I was the youngest and I was woman, and I don't have any medical problems. So I just kind of said, okay, hey, look, I'll be designated Covid person. I'll just be the person. And I kind of, you know, did all Covid stuff for a little while until eventually we all of course, we were all doing it. But I remember thinking like, at some point I'm probably going to just get this, you know, and I kind of resigned myself to that. And I was trying not to, but here I went two and a half years and I never had it. And I was seeing at one point every Covid patient we had. PPE is amazing. It works fine, really, after Omicron happened, I have a distinct memory of being in front of my board at my system as I was talking about the data out of South Africa, and someone asked me like, what? What are you telling us, Gretchen? And I said, I think we're all about to get Covid. Like, I think this is a different thing. This is just a different thing now. And so the fact that I went all the way through May of 2022 and it still hadn't had it, you know, getting testing positive, it was a bummer. But it was also kind of like, okay. Yeah. I mean, I figured at some point, even you, I'd be careful. I do all the right things. I'm vaccinated to the hilt, but so many people who I know had it even though they're careful.

Paul Sax: [00:14:24] So it's so funny. The other day I was on a family conference call where we were talking about someone who recently had Covid and then someone asked the question, you know, how did you get it? Or where do you think you got it? And there's no answer to that question anymore. It's absolutely everywhere. Omicron changed everything as those incidents curves showed. And now we've got more than 95% of the US population has had Covid 19. May 2022, you had Covid, but May 2023 you're having what you describe as a very normal experience. You're at an indoor water park with 40 to 50 Girl Scouts. I think it's Girl Scouts is that, right?

Gretchen Arnoczy: [00:15:09] It was Girl Scouts.

Paul Sax: [00:15:11] So you wrote on our troop's trip. There were no masks, no distancing, no vaccine card checks, no photos of negative test results. There were water slides, dancing and sticky fingers from all the sweets. It felt like 2019. It felt like the opposite of the pandemic. So yes, it does. I mean, I agree with that. That's very well said. But we've changed, haven't we?

Gretchen Arnoczy: [00:15:34] Right, right. And even as we, you know, we've gone through this enormous ordeal and even as we're back to, yeah, indoor water parks, which I'll admit, a lot of ID doctors would not do. [laughs] I'm a sucker for my Girl Scouts. But we also have this grief and still this. We're still recovering and we're still remembering. And, you know, the close of that piece was yeah, we're kind of back to normal, but we're not. You know, Jenny is still celebrating Grady's birthday, and we're still grieving and still recovering.

Paul Sax: [00:16:08] You know, I think we have collective PTSD from the experience. And that's one of the reasons why we started this Voices of ID series. You know, it won't just be about Covid, but the first batch were. What do you do to cope?

Gretchen Arnoczy: [00:16:23] A lot of the things I do is actually writing. I've always I've always written, I am a huge person who, when I'm having a big feeling, I will mark out 15 minutes, sit down and bang something out. And again, I don't usually publish, I just, I just don't, it's for me, it's personal.

Paul Sax: [00:16:38] You should.

Gretchen Arnoczy: [00:16:39] Maybe I should, maybe I should do it more, but I write a lot. The other thing that I was really struck by at IDWeek this year, I didn't go last year because my group, we rotate, but this year, every single person at IDWeek, if I sat down with them and had anything more than a five minute conversation, you know, if I said, okay, let's get a coffee or let's, you know, meet for a drink or something, they would tell me a heartbreaking story. Everybody, everybody in that whole conference center had some story which was just, you know, it could be personal. It could be something they experienced peripherally from the patients, but just from the pandemic, everybody had just. And I think that's true of the world, like ID has, but also all my neighbors, also all my Girl Scout parents. So one of the things I like hearing them, you know, like I've loved your Voices of ID series. At my own system, after you had you published this piece, you know, I sent it to my people and said, look, hey, look, I got a journal. I'm really excited. And, you know, they said, oh, hey, guys, you know, read this. Gretchen wrote it. And actually, a couple people have already come up to me and said, like, we would love to write something for like First Health. I mean, maybe we could even do, you know, just there's so much, there's so many stories. And listening to other people's stories has been really helpful for me just to process it together.

Paul Sax: [00:17:53] Once again, thank you for submitting it and for coming on the podcast today. I got to tell you, you have a lot of writing talent, so I would hope that some of that banging something out is can find its way to be published. So once again, I've been talking with Dr. Gretchen Arnoczy, who is an ID physician in North Carolina, and she has written a beautiful piece called Mother's Days for Clinical Infectious Diseases. I highly recommend it. Gretchen, thanks so much.

Gretchen Arnoczy: [00:18:21] Thank you.