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OPINION

On the front line of the coronavirus and breaking the rules

On this new battlefield, doctors are being asked to defy one of the basic oaths we took when first putting on our white coats: ‘First, do no harm.’

The decontamination station that Boston Medical Center's Dr. Elissa Perkins created in the garage at her home in Milton. She said her husband constructed has constructed a reusable face shield from household items and that friends have sent her N95 respirator masks.
The decontamination station that Boston Medical Center's Dr. Elissa Perkins created in the garage at her home in Milton. She said her husband constructed has constructed a reusable face shield from household items and that friends have sent her N95 respirator masks.Craig F. Walker/Globe Staff/The Boston Globe

There is a well-loved, worn copy of the book "The Library Lion” by Michelle Knudsen on my children’s bookshelf. In it, Knudsen weaves the tale of a very orderly, law-abiding librarian who likes her library to be — well, very library-like.

One day a lion walks off the streets of New York City and, loving the feel of the library, quickly learns the rules, befriends people young and old, and even becomes quite helpful to the librarian. He suppresses his lion-like roars until one day a crisis strikes. The orderly librarian falls and breaks her arm and asks the lion to get help. He does the one thing he knows — roars — and is kicked out by others for breaking the rules. Lying on the ground, the librarian says sadly to her co-workers, “Sometimes there is a good reason to break the rules. . . . I think I have broken my arm. Now please go call the doctor.”

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This children’s story has stayed with me in the countless days and hours since COVID-19 started its plight in Massachusetts. As a physician working on the front lines and also responsible for training primary care physicians, I am working ceaselessly with my colleagues to respond to protocols that are in flux daily and sometimes hourly — protocols for who should be tested, how best to treat some of the symptoms, and which protective gear to don. Tests are taking days to come back, and protective gear is at a minimum.

On this new battlefield, we are being asked to defy one of the basic oaths we took when first putting on our white coats: “First, do no harm.” The lack of protective equipment for medical professionals is placing us in harm’s way. The lack of adequate testing is placing thousands of potentially infected patients in harm’s way. And as a residency director, I have to make decisions about who should go bravely into battle and who must stay back in the trenches, waiting for their turn to be deployed. These are not the rules of medicine that we signed up for. But now we must break them in order to save lives.

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We who practice medicine in Massachusetts are grateful that we work for hospitals and a state that are among the most advanced in the world. But with further surges of patients and a continuing diminishing supplies of protective gear, we may face perilous choices about who should live and who should die, who can be protected while seeing patients and who will need to see patients without the appropriate masks or gowns.

We know that there is much to be done. But one thing is clear: We need others — businesses, production companies, and individuals — to break their normal operating rules to help us. To contribute equipment and supplies, to innovate in labs, to donate blood for those who need it, to hold back on personal purchasing of large supplies of medicine that might be needed on the front lines, and to advocate for local and federal policies that put more stringent guidelines on all of our lives to stop the community spread of COVID-19.

We cannot do it alone. We must all be willing to break rules of how we have lived to date. There is no time to waste.

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Dr. Katherine Gergen Barnett is the vice chair of Primary Care Innovation and Transformation and residency director in the Department of Family Medicine at Boston Medical Center and Boston University Medical School.

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