The COVID-19 Chronicles by Dr. Courtney Schiefelbein

A New York orthodontist’s personal pandemic journal

by Dr. Courtney Schiefelbein

March 1: We’ve heard whisperings of the first case of COVID-19 coming from the suburbs of Manhattan. I’ve read about schools closing and big changes happening on the West Coast, but in New York—“the city that never sleeps”—it seems to be business as usual.

March 10: Schools and universities have closed and pivoted to doing online classes. Many of my patients have asked if I’m planning on closing, too; my response is that if I can still go to my SoulCycle class and my Equinox gym, my practice will be open, too. When they close, I’ll close.

March 17: I woke up to emails from SoulCycle and Equinox saying they’re shutting down. I can’t believe it. What is happening out there? I guess we’re shutting down, too.

I immediately start to call patients on the schedule for the last two weeks of March to rebook them to the first week of April. (Using our online scheduler, Schedulista, made it very easy, and manually canceling them off our appointment book on topsOrtho created an accessible recall list.)

I’ve got to be honest: Right now, I feel like it’s overkill to shut down, but I figure we’ll be closed for about two weeks, let this blow over, and be back in business. I decide to make Wednesday, March 18, my last day with patients. I also decide to keep two of my hardest working staff members on payroll.

Quarantine Week 1

March 23: When I first shut down, I tried to be proactive about getting patients more of their clear aligners. I inventoried all the aligner cases we had in the storage closet and shipped out what we could. Becoming our own little Amazon assembly line proved to take a lot longer than I anticipated.

As I spend hours in the office putting together aligner packages, I come up with the idea to send care packages to my patients. The name of my office is Smile Pop, so I get creative and think, “I’ll mail out some Smile Pop[corn] and put a label on it referencing ‘Netflix and chilling,’ because that’s what a lot of people will be doing while in quarantine these next few weeks.” I’ll also ask patients to tag me or the practice on Instagram, and will select a few people to win a Sonicare electric toothbrush.

My fiancé helps package them and we slip a few scratch-off lottery tickets under the popcorn label to make it even more fun for 100 special patients. I wish I could say they’re placed totally randomly, but the truth is, if my patient’s name makes me smile when I come across it, they’re getting one.

I make a few extra care packages and drop them off at a local hospital in the Village to hand out to first responders.

It ends up costing me just under $1,000 for supplies and postage. To spend that kind of money on something so frivolous during a time when no money is coming in seems irresponsible, but I would do it again in a heartbeat.

Quarantine Week 2

April 2: I’m typing this from a beach house in Narragansett, Rhode Island.

My fiancé and I left New York almost a week ago; President Trump was expected to announce whether there’d be a mandatory stay-in-place quarantine in New York, so we knew we had to get out before we didn’t even have the option.

In addition to the president’s orders, the state of Rhode Island was talking about closing its borders to New Yorkers, too. We felt kind of bad-ass trying to sneak in! Turns out, neither governance was issued, but we had been told that if we did come to Rhode Island, we would need to self-quarantine for at least 14 days. I papered up the windows at Smile Pop and left town.

I was very thankful we had the option to leave New York, because we spent the first week of quarantine walking to and from our offices in what felt like a ghost town. It was depressing. We started carrying mace because the streets were eerily empty except for homeless people who were urinating just a few feet away from their camps set up under scaffolding. One guy literally grabbed me on the street while I was walking with my fiancé, who had to push the guy off me. I no longer felt safe and decided I really didn’t want to be in New York for this.

Today, the “Stay in Place” rule has been extended in New York until at least April 15. Immediately after this, I decided that I need to develop a little more structure in my life at this beach house. I need to pause, too, to recognize and celebrate the many things I’ve accomplished since I closed Smile Pop 15 days ago:

• I negotiated with my landlord to draw down my April 2020 office rent (and most likely May) from my security deposit and allow me to slowly replenish the security deposit over a six-month period. I also was able to defer practice loan payments until August 2020. This was Step 1 to keeping capital available for when we reopen.
• I applied for the Economic Injury Disaster Loan and Paycheck Protection Program from the Small Business Administration as part of the CARES Act. This will help me continue to pay Eve and Alli, my two employees. This may come back to bite me in the butt, but I will reevaluate this decision every week.
• I sent out more than 250 care packages to my patients. It felt great to send people a cute package to let them know I was thinking of them during this crazy time.
• I finally hired someone else to look at my books. I’ve been keeping track of my own expenses on the Wave app since 2017, but if applying for those EDL and PPP applications has taught me anything, it’s that even I, who am already organized, can be more organized.
• I’ve made the “look” of my Instagram, YouTube, Facebook and LinkedIn profiles more consistent and cohesive.
• I began doing virtual consultations and virtual check-ins with patients via Zoom. Patients schedule through our online scheduler. While I’m not sure if I’m actually doing much, I can tell the patients like it and feel like they’re not forgotten during this time.

I was able to start five new Invisalign cases while in quarantine! I followed up on some past consults and let them know I’d be able to re-treatment plan their cases so we don’t have any attachments initially, and they can at least start some orthodontic teeth movements while they were in quarantine too.

Quarantine Week 3

April 7: Yesterday, we were alerted that the stay-at-home rule in New York has been extended until at least April 29. This means I won’t be seeing patients for the entire month. While I’m not happy, it’s harder for me to face the reality that I’ll most likely be here in Rhode Island rotating through the same workout pants and hoodies. I packed for a week, thinking I’d be back in business by the first week of April.

OK, back to structure and goals. I decide I need to structure the rest of my month. What do I want to achieve? What will be my action plan? A few thoughts that come to mind:

• Exercise. I find myself running a little over 2 miles every few days. I need to do this daily, but I hate running. The weather here is colder than ideal, but I guess I can layer up and get it done.
• Social media. Thankfully, I’m not drowning in the depths of Instagram, but I do want to figure out how to improve my social media presence.
• Scheduling my office. Moving forward, things are going to change. I can’t see as many patients as I’m used to, so I need to design more buffers in our daily schedule. This requires me to design buffers in the back end of Schedulista, then implement those changes in the topsOrtho appointment book.
• Going virtual. What can I do now that will reduce required doctor/patient time (or assistant/patient time) when we’re back in the office? I’m thinking about making videos that show what to expect at a new patient consultation, at an Invisalign start appointment and as patients progress through the office.

I’m a strong person mentally, physically and emotionally, but I have to say that some days I struggle with keeping a good attitude. Then I remind myself that things could be so much worse. Maybe one of my goals during all of this is to continue to help and inspire people, to remind them that we will all get through this—and that if you are alive and breathing, it’s a damn good day.

April 9: Have I necessarily been “in quarantine” in the same place the entire time? Meh. I’ve crossed a couple of state lines, but more or less the answer is yes. It’s been more than two weeks since I saw my last patient and I find myself wondering, “Am I losing my hand strength or is that just my imagination?”

That high of sending out care packages to patients was quite awhile ago. I’m now getting a few emails a day from patients asking if I can send them more rubber bands or aligners. That’s good and all, except now I need to be more organized about it because I’m four hours away from my office. Thank goodness for Alli, my front desk staffer, who is braving the New York subway system into the office once per week to ship out the items.

Quarantine Week 4

April 13: You have to apply for PPP relief through the bank you have a business account with, not a personal account.

I run Smile Pop out of my business account with PNC, but for my independent contractor job I deposit the 1099 stubs into my Chase personal account. I explain that I’m an independent contracted orthodontist and my paychecks get deposited into my Chase account but I’m unable to apply to the PPP because I don’t have a business account with them, so I’d like to open one. However, PPP applications are open only to those who had a business checking account before Feb. 25. The second set of quarantine tears starts to form. (The first set happened when the website kept crashing while I was trying to apply for the PPP loan for my business.)

Long story short: They advise me to file for unemployment as an independent contractor. I ask if that’s right: I’m still paying staff at a newly opened private practice, but I’m going to be filing for unemployment?

If you’re going to dip your toe in being a business, treat it that way. Open a business checking account right away if you start receiving money as an independent contractor. Get advice from a trusted financial person and not, like in my case, your dad.

Quarantine Week 5

April 22: I found out a few days ago they ran out of money for the PPP loan and I didn’t get it. But Ruth’s Chris steakhouse did? Hopefully, I can afford a steak when this thing is all over. [Editor’s note: The steakhouse ended up returning its $20 million loan.] I’m still paying my employees, and to say I’m disappointed would be an understatement. I also found out a few days ago that the stay-at-home order in New York has been extended to May 15. A few four-letter words came to mind.

These past few days, I’ve been waking up feeling “meh.” I think it’s because right away I wake up and am busy, but not the same kind of busy that I typically like. Things I normally pay someone else for or simply don’t normally have to do are eating up a lot of my daytime hours.

Here’s a simplistic breakdown of my days:

• Zoom checkups or consultations with patients.
• Ordering new or replacement clear aligners.
• Posting to Instagram and YouTube.
• Zoom meeting with an orthodontic social media group.
• Running 3–4 miles. (Ick, I hate running.)
• Cooking breakfast, lunch and dinner. Then dishes, dishes, dishes.
• Pondering if it’s too early to have a Bud Light Seltzer or if I should have one at all.
• Read a little bit for fun. Go to sleep. Do it all over again.

I think the hardest part for me during all of this is the emotional time and energy I spend trying to decatastrophize this whole pause on life with my patients. I don’t have the answers, but I can tell you what I think about it all: We’ll come back. It’ll be different. But we are all trying to figure out how to manage it.

The most stressful part of my day is the Zoom virtual check-ins with patients talking about aspects of life other than their teeth.

The other hard part for me is that I’m using Instagram or YouTube as a creative outlet. I’ll post something educational, or funny, or break down a case for people. I enjoy it and it takes a lot of work, but I feel as if then a patient of mine sees it, comes out of the woodwork and says: What about meeeee? Why am I not that far advanced? Patients don’t always understand that, just like in life, everyone is in different stages and advancing at different rates. Looks like my next Instagram post is going to be a PSA about staying in your own lane.

April 24: It’s Friday, the end of another long week where I find myself cranking out 10–12 hours of work per day. How? No clue!

One thing I realize after a long week of virtual checkups and virtual consultations: I’m happy I’ve set boundaries.

The Zoom meetings are scheduled every 30 minutes from 9 a.m. to 1 p.m., which seems like a short duration but there are chart notes, treatment plans and follow-ups that need to be done.

I’ve made sure I set aside 1½ hours every day to do some type of workout, because my daily step count is down almost 75%. For a girl getting married in less than four months, that’s not good.

I find myself drained at the end of this week. I don’t know if it was the disappointment of not getting the PPP loan that did it, starting off the week firing a patient, or the constant cold, rainy weather in Rhode Island. Tomorrow is supposed to be the first sunny day of the week here, and I’m really looking forward to it.

Also, I am so thankful for my fiancé. He’s encouraged me to cast a wider net and apply for the second round of PPP loans to any bank, including through Square and PayPal (fintech banks), which gives me a little hope.

Quarantine Week 6

April 26: My front desk team has been super about going into the office once a week to ship aligners to patients. Turns out our UPS delivery guy, who has the key to my office and will drop off deliveries when I’m not in (after I turn off the alarm for him), tested positive for COVID-19.

I also finally recruited some help from my clinical assistant. (I should have done it weeks ago.) She is cleaning up all our patient charts and making sure any missing key data points are entered.

I’d been losing sleep about asking her to do it and found myself getting, dare I say, almost resentful. I think it’s because I’ve been paying my staff close to their normal pay. Thankfully, I just called her to let her know I was drowning and also that I really wanted to accomplish some things while we were out of the office. She’s a rock star and she was happy to comply.

April 27: I can’t believe it’s been 40 days. That’s a whole Lenten season! New York hasn’t extended the stay-at-home order past May 15, but I’m waiting for the ball to drop. Still, I’m gearing up for my practice to reopen by ordering the personal protective equipment and other items I think I’ll need to help ease back into whatever the new normal will be.

I’ve put together questionnaires each patient will have to fill out upon arrival. In addition to the standard COVID-19 questions, there’s a consent form that warns them that despite our attention to sterilization and disinfection and use of personal barriers, there’s still a chance that they could be exposed to an illness in our office. You would think that the mere fact that they showed up would be their consent, but not in 2020.

I’m gearing up to reopen, filling my time with Andrea Cook OSHA and infection- control videos and continuing to make checklists to make sure I have what I can at least get my hands on.

April 30: I’ve been paying my staff this whole time, but after a discussion with my fiancé this morning, I decide to look deeper into that decision.

I don’t mind paying them—there are just two, and they need it now more than ever—but with the extra $600/week stimulus boost each unemployed person gets, they might make more on unemployment.

I learn that my clinical assistant, who works part time with me in New York and part time at another job in Connecticut, has already filed for unemployment in Connecticut. Because she can’t file for unemployment in two states, I will continue to pay her. But Alli, who works at the front desk, is an independent contractor and works less regularly with me because she’s also really involved with the Broadway world and sets her own hours. Turns out, it’s worth it for her to file for unemployment rather than have me continue paying her—especially with the added $600 stimulus bump for unemployment through July 1.

As I write this (in early May), I’m expecting my first day back in the practice to be Monday, May 18. I’ll do a dry run with my staff the Friday before to get the office up, running and ready for patients. While we plan on only seeing one-third of our normal patient load, at least it’s a start.

I leave with these thoughts:

If this quarantine has taught me anything, it’s that life is fleeting. Take advantage of the opportunities presented and live your life knowing that it can be taken away from you at any moment.

Remember that love mixed with patience, empathy and understanding conquers all. As orthodontists, we’re fortunate to live our lives in service to others and making each day feel like a blessing.

I haven’t contracted COVID-19.

If I do, I’ll have to shut down for at least two weeks and be disappointed I didn’t spend these quarantine days already recovering from it.

What about my August 2020 wedding? Regardless of whether I can have my 300-person wedding happen, I’m thankful to be able to marry the best quarantine buddy a girl could ask for.