There isn’t a person alive that hasn’t been affected by the COVID-19 pandemic, and I’d like to focus on a group that isn’t discussed much: the divorced healthcare parent.

Based on 2018 U.S. Census data, 41% of first marriages end in divorce, with physician marriages ending at a rate of 24%.

With over 1 million physicians in the U.S., and a staggering 18 million other healthcare workers including nurses, therapists, social workers, technicians, etc, this topic will likely resonate with many despite a paucity of literature.

Here’s my COVID-19 co-parenting story so far.

It was mid-March, and I was talking with my ex-wife about our daughters’ visitation schedule for the week, as we had for the past 3 years.

My two girls, ages 3 and 5, would stay overnight at my house on Thursday, as outlined in our custody agreement.

Just as we were about to hang up, I had a sudden thought to divulge that earlier that day I helped with an intubation of a PUI— “Person Under Investigation” for COVID-19.

As an anesthesiologist in a bustling metropolitan hospital, my department had been recently called upon to intubate all inpatients exhibiting respiratory failure in the intensive care units (ICU) and wards, COVID or not.

The pandemic was already approaching pandemonium in the U.S., and my institution was just starting to cancel elective surgeries and my department created an “airway team” dedicated only to intubations.

That day, even though I was not physically in the room during this particular intubation (I was the “spotter”—the doctor outside the room in case my colleagues needed help), the fact I was even in the vicinity of a PUI was enough to invoke fear when the words spilled out my mouth.

There was a moment of silence.

“I don’t think you should see the girls anymore.”

That was the moment I felt the pandemic truly invade my life.

I don’t mind inserting breathing tubes in COVID patients.

I don’t mind the painful indentations on my face or the lightheaded feeling from wearing an N-95 respirator all day.

I don’t even mind the burden of doubling the overnight calls.

After all, this is the profession I chose.

But in that moment, faced with the possibility of not seeing my girls indefinitely?

Now it was personal.

I agreed that isolating at the mother’s house would be best for the girls for now, since their mother was not working due to COVID and could spend time caring for them all day.

We agreed that our nanny should not work in order to minimize exposure.

We agreed to talk about the girls’ schedule in the coming week.

As we learned more about the virus and gathered more statistics, our plan was to make reasonable decisions on custody.

One week passed.

Two weeks passed.

Another week.

6 weeks.

Nearly two months passed before I was able to be with my children again.

Even though I knew my girls would be safe, so many thoughts raced through my mind.

Even though I’m a physician committed to helping others, I’m also a human with human emotions, and a father with a strong connection to my children.

During the ensuing months I must have gone through every Kübler-Ross phase of grief: denial, anger, bargaining, depression and acceptance.

I was angry because any solution I proposed to see the girls was met with strong opposition and what I perceived as lack of collaboration.

I knew my hospital’s personal protective equipment (PPE) supply was excellent and I was being extra careful in everything I did at the hospital.

I kept a mask on everywhere I went in the hospital.

I avoided group settings.

I wore a glove to open any door or push any elevator buttons and disposed of it immediately afterwards.

During intubations, I used what was essentially a haz-mat suit with a fan inside to prevent any unwelcome microbes from entering.

In addition, our hospital started getting more COVID tests, so we knew the status of every patient that rolled through our doors.

Granted, there is always the chance of false negatives, but I still wore full PPE regardless.

I felt like I was being as safe as I could be.

In my bargaining phase, I proposed seeing the girls every other weekend as long as I stayed symptom-free and continued safe practices at home and work.

I proposed seeing the girls in an outdoor setting where I could talk to them while still keeping distance.

I proposed getting tested.

The only thing we agreed on was FaceTime calls.

The word “selfish” was used to describe my efforts to spend time with the girls.

That made me feel guilty for wanting to see them.

I felt that the importance of the girls being with their father and my role as a father was marginalized.

I missed out on my oldest daughter riding her bike for the first time.

I missed out on being with my youngest daughter on her 4th birthday.

I realize that many of these negative emotions could be reflections of a bruised ego, and the girls never seemed unhappy not seeing me besides the occasional “I want to see you for REAL!”.

In the big picture, the girls may not even really remember this time apart from me—but I would be lying if I said it didn’t feel like a punch in the gut to miss out on their lives, from the mundane to the milestones.

To make matters worse, I didn’t have much objective data in which to bargain.

While I knew hospital-acquired COVID infection was zero in my department and less than 1% for my institution, I also knew national data had wildly varying ranges especially when accounting for New York City’s data.

While anesthesiologists were among those believed to be highest risk, there was little data to show actual nosocomial infection.

I found data from Medscape’s up-to-date memoriam of global healthcare COVID-19 deaths (a sobering exercise).

I tallied 22 anesthesia provider deaths globally, none in the U.S. (for those interested, the breakdown is as follows:  Mexico: 8, Iran: 5, Brazil: 2, Philippines: 2, Italy: 2, Ecuador: 1, Spain: 1, Venezuela: 1).

The Centers for Disease Control and Prevention (CDC) reported more than 60,000 health care workers infected and close to 300 deaths from COVID-19, and even these numbers are likely under-reported.

How do I interpret all this data and apply it to my situation?

All I knew was nobody in my department was getting sick, we had enough PPE and we tested every patient.

Most of my colleagues with kids were still going home to them—albeit after stripping down in the garage and showering immediately upon coming home.

I knew of one doctor that was temporarily living away from his family, but they still spent time with the kids on the weekend.

Some doctors that heard my story suggested the mother was leveraging fear to gain an upper hand in spending more time with the girls, others thought I should feel lucky to have the opportunity for the kids to be quarantined.

One person even suggested taking advantage of the bachelor life.

While I appreciated the input, I was left feeling as uncertain as ever.

I felt very isolated in this time.

Was I the only one facing this challenge of involuntarily not seeing their children?

I was determined to find people that shared my predicament.

I scoured Facebook groups focused on healthcare workers like the Anesthesiologist COVID-19, White Coat Investor and Physician Side Gig groups, which have robust conversations about how physicians are dealing with COVID.

Whenever I saw a doctor mention that they sent their family away during the pandemic, I private messaged them asking about their arrangement.

What I discovered was that even amongst the physicians who said they sent their kids away, the ones I messaged still spent time with them on the weekends with social distancing.

I’m sure healthcare parents that hadn’t seen their kids for months existed, I just wasn’t able to find them.

Meanwhile, I started getting in my own head.

Is my throat starting to get sore?

What if I become critically ill and put in the ICU?

What if I needed to be intubated?

Which of my colleagues would I choose to intubate me?

What if this is just my allergies?

I wasn’t prepared to accept that my last day spent with my daughters was back in March.

Undoubtedly, these fears were instilled in context of what I was experiencing at the hospital.

The ICU attending would call me to intubate patients with increased work of breathing and oxygen saturation in the mid-80s.

Just before intubating patients, I’d see patients consoling family members via FaceTime, promising that they would see each other again soon.

They would not.

It bothered me that my voice was the last they would hear as the anesthetic entered their veins.

It didn’t seem fair that it was me and not their family, but I did my best to encourage the patients as they drifted into propofol sleep.

I would recite in a calm but nervous voice that everything was going to be okay and that we would take good care of them, knowing that the only promise we could fulfill was good care.

Without a doubt, COVID-19 is no hoax, and it is scary.

My acceptance phase started with the conflict that had festered for weeks.

I knew that my girls were safe in complete isolation at their mother’s house, but I believed it would be safe to see my daughters.

Maybe this is just how it was going to be.

With little hope of productive talks and so few case studies to find on Google, I finally decided to reach out to the person I was trying to avoid this whole time: my attorney.

Full disclosure, my attorney is great, but I avoided contact for two reasons.

First, I knew that seeking legal counsel was tantamount to advancing this case to court in front of a judge.

I had to be prepared to escalate.

Even if I win the case, the bitterness in our co-parenting arrangement would be damaging, and I desperately wanted to avoid my girls experiencing that.

Second, I knew that involving attorneys would be expensive, and with sweeping layoffs and salary cuts to physicians across the U.S., now would be a bad time to be embroiled in a costly legal battle.

What I discovered from my attorney was that the pre-pandemic legal orders still applied during the pandemic.

The rules did not change even though the world around it had.

The existing custody order was still in place and the ex-spouse did not have the right to decide how to exercise my time.

In fact around this time, I heard about a case that swept the front pages of national news outlets.

It was the stunning decision by a Miami judge against emergency physician Dr. Theresa Green, who lost custody of her 4 year-old daughter after her ex-husband filed the motion.

The reasoning was that Dr. Greene’s potential threat to her daughter’s exposure warranted a complete suspension of her custodial rights.

In essence, Dr. Greene’s choice to be an emergency room physician during the crisis disqualified her from seeing her daughter, despite taking proper precautions at work.

Was forcing Dr. Green to choose between her child and her Hippocratic oath based on facts, or was it purely speculative?

After a public outcry and intense national debate, the court stayed the decision and Dr. Greene regained custody of her daughter.

While I wouldn’t wish to go through what Dr. Greene went through, I was appreciative of her efforts and empathetic to her plight.

I personally felt some relief knowing that I wasn’t crazy for thinking 2 months away from my girls was extreme.

It turns out there was an analogous legal precedent set in 2008, with the Virginia Military Parents Equal Protection Act .

This act ensured that the custodial rights of military parents were protected even when they would be deployed, avoiding the service member to choose between their children and their oath to serve his/her country.

This reminded me of all the talk of being at war with COVID, and how healthcare workers are the new soldiers.

My last attempt before engaging my attorney was to come up with a plan, provide data, and collaborate towards something reasonable that made everybody feel safe.

This “Hail Mary” plan included a promise of communication if I encountered a COVID-19 patient, consulting an infectious disease physician, a negative COVID test for me, and a week long vacation.

After almost 2 months, we finally had a breakthrough.

A sense of relief overwhelmed me.

Would I finally be able to be with my girls?

Were my eyes watering from my allergies?

After an amazing week with my daughters, I was back to an empty house.

Strewn about books and stuffed animal foxes hidden under my pillow were reminders of how lucky I was to have healthy and active daughters.

I was back at the hospital treating those that needed help most, still uncertain of the next time I would be with the girls again.

I’m cautiously hopeful that we can figure out something safe and reasonable moving forward.

To be clear, I think my ex-wife is an exceptional mother.

I don’t think there was any nefarious intent or secondary motive to keep the girls during this time.

I was reassured multiple times that she was not trying to keep the girls away, and I don’t think she should be vilified in any way.

To the contrary, I believe she deserves praise for her vigilance for our children’s well-being and for her ability to juggle childcare 24/7.

Her stance will likely resonate with many parents out there.

We were and continue to be faced with a complex situation with no precedent, and the fear and uncertainty can be paralyzing.

I don’t know if I should have pushed harder or if I played too nice.

Either way, what I hope in moving forward is less conflicted co-parenting, and more cooperative co-parenting during these stressful times.

By sharing my experience, I hope others who are going through similar hardships are reassured that they are not alone.