Covimpostor: Impostor Syndrome in the Time of COVID-19

I pulled the covers up to her chin and leaned in for a good night kiss. “Mom,” she whispered looking away. “I don’t want you to go to work tomorrow. You’re so brave.” Without knowing it, my 13 year old had ripped off the band-aid that was holding my fragile psyche together. I was an impostor. She had found me out. She might tell others. I mumbled something about being safe and walked out with tears in my eyes. She’s old enough where she knows what’s going on. She sees the healthcare workers on the news and social media selflessly working to save lives affected by COVID-19 side by side with stories of doctors and nurses dying and pleading for personal protective equipment. She sees the commercials on television with dramatic music promoting healthcare heroes while encouraging you to buy their brand of hand soap or coffee.  “Mom is a doctor. She must be a hero too,” I imagine her brain working. But I’m no hero.

Long before the COVID-19 pandemic reared its ugly head, impostor syndrome was a daily battle for me like many women in medicine. Despite a pretty typical academic career path of publications, grants, promotions, and leadership roles, I never felt like I was good enough to be in the room. I was constantly expecting my supervisors to come to their senses and ask me to take a step back. I’ve learned to suppress these feelings over the years and counsel junior women how to do the same.  I realize I’ve earned my seat at the table. But my place has changed during the COVID-19 pandemic. Thankfully, children have not been severely affected overall with COVID-19 although there are exceptions. As a pediatric nephrologist, I’m now relegated to the kid’s table while the healthcare heroes do their work saving lives at great personal peril. I’m not a real doctor. My impostor syndrome is back.

My colleagues in the trenches really are heroes. The adult nephrologists and their dialysis nurses seeing double or triple the typical number of patients in a day while trying to get dialysis to the patients who will benefit the most before they run out of supplies. The emergency room doctors and nurses who have to expect that every patient is infected and may infect them. The intensivists and hospitalists who provide day to day, face to face care. Even the researchers working endless hours to write grants and protocols for clinical trials to develop novel (or any) therapies for this ugly new adversary are heroes. The healthcare workers at the front line of the pandemic have upended their lives to live in the garage or in a hotel to avoid infecting their loved ones. They’ve chosen to provide care to the sick, even though they themselves may fall ill or even die. They are truly heroes.

The changes in my life due to the COVID-19 pandemic have been relatively minor. My clinics have converted to telehealth to keep people at home. I’ve had to learn new technology (gasp!) in the process. My children complete their distance learning from the living room, but are old enough where I don’t have to watch over their shoulder to ensure the work is getting done. I empathize with women colleagues bemoaning their new role of homeschooler or day care provider in addition to doctor that doubles their workdays, but that hasn’t been my experience.  I haven’t seen a COVID-19 affected patient. My rounds have been painfully short due to lack of elective procedures and desire by patients and families to stay out of the hospital at all costs. Although pay cuts may be looming, my job is secure and I can still put food on the table. But I feel guilty that I’m not doing more. It’s the most important medical event in my lifetime and I can’t contribute. The worry, however, is real. If I could generate RVUs for worry, I’d be rich. Worry about my older colleagues’ health, my immunosuppressed patients, my children’s mental health, my husband’s business, and so much more. When the history books are written about the COVID-19 pandemic, my work won’t even be a footnote.

Not surprisingly, it was one of my children that snapped me out of it. As I was hanging my “Do Not Enter: Telemedicine in Progress” sign on the home office door, she walked by and said, “Mom, you’re a good doctor.” Our patients are fighting their own individual front lines of illness every day. While I may not be in the ICU adjusting ventilators, I can help on this front line. It’s as important, maybe more important, for me to be there for them now as it was 6 months ago. The fear they feel is real and I can help with that through the relationships I’ve built over the years. They trust me to do the right thing with their child’s health and it’s a responsibility that I don’t take lightly. I realize I contribute by keeping them out of the clinic and the hospital. I trudge forward with planning for my research that will start up again when this is all over. Pediatric kidney disease will still be around when COVID-19 fades into the sunset and my patients will still need new and better therapies. I stay home when I can. I convince my father to wear a mask. Am I a hero? Still no, but I’m doing my best at the things I do best. I no longer feel like an impostor. I’m a doctor.