Doctors Can Help Doctors Manage Despair in the Coronavirus Pandemic
Although we might not have seen anything like this Pandemic or our global response to it before, we do have experience and perspective we can bring to bear on this challenge and help each other cope.
A couple of weeks ago, a young surgeon in her fellowship training expressed in a NY Times opinion piece her fear about the pandemic, its scope, our lack of preparation and supplies to protect front line health care providers, and the possibility of contracting a life threatening disease in the course of service. She bravely articulated her vulnerability to the very real threats of COVID-19. She said, more than once in her essay, “THE SKY IS FALLING.” This was a distress call, one that should be responded to by those of us who are more experienced and have weathered other storms. Our ability to register her distress and respond to it is not only decent, it could be instructive and help mitigate suffering even if we can’t make it all go away. Our response is also essential to our own wellbeing and performance. How? Because there is evidence that being paralyzed or feeling helpless in the setting of major stress or trauma is associated with greater difficulty recovering from it (see The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma by Bessel van Der Kolk M.D. and Waking the Tiger: Healing Trauma by Peter A. Levine). While we may need physical distance, social isolation and emotional disconnect are decidedly not helpful. In fact, these are also both characteristics of post traumatic stress disorder and are thought to perpetuate it.
It can feel like the sky is falling.
Photo by Ashley Bean on Unsplash
At the outset, it’s important to acknowledge when fear is based in a shared reality and to note that fear can be protective and a valued teacher. The coronavirus pandemic is posing substantial risk to our health and survival: physically, psychosocially, and economically. It’s a tsunami. We also recognize that fear itself is exacerbating aspects of the pandemic, as is the mind-boggling uncertainty that seems to permeate every layer of this experience, from pathogenesis, clinical course, appropriate treatment, and infection control measures to problems with supply chains and mobilization of clinicians. All of these aggravate feelings of threat, helplessness and chaos. Since the modus operandi of physicians is creating order out of chaos, whether that’s converting an alphabet soup of seemingly unrelated symptoms and signs into a diagnosis, initiating resuscitation as an assessment takes place or doing a damage-control laparotomy, uncertainty can confound our professional operating system. In addition, our capacity to serve the sick and our personal risk providing that care are adversely affected by suboptimal coordination of resources and lack of supplies. We typically avoid Overwhelm, and in our health care system, we are not used to having to improvise or to ration care or triage patients.
As many of the external and internal structures we depend on fail in one way or another, it can feel like the sky is falling, but it is vital to recognize that it is not. The sky is still there. Remembering that can help restore perspective and ward off incapacitating meltdown. One of the advantages of having longer experience is that we’ve had the chance to see what’s unfamiliar or unexpected become known. As a younger surgeon, it is hard to know how things turn out. Often we only know what happens if a patient is discharged uneventfully or dies during our time on a given service. It takes a very long time to see the entire course of care and outcome for patients who have serious illnesses and injuries. Even as junior attending when there is longer continuity of care, it can still take years to understand the efficacy—or lack of efficacy—of our care. Other experience that can help provide perspective about the amazing resiliency of patients and the force of life in all of us is having worked in low resource areas. This is where we learn how far supplies can be stretched and how to make due with what we have. A “ventilator” for a patient with tetanus or a depressed skull fracture is an ambu bag and a relative. Unused suture is autoclaved, and gloves are reused. DVT prevention and treatment in a young person with a pelvic fracture can be two ace wraps and aspirin 4 times a day.
Even for seasoned physicians, there is a lot of room to cultivate acceptance and and choosing action, even imperfect action. Doing what we can is another way to offset complicated, lingering distress. I’ll say more about that in the next post.
The whole wide world is around us, even as it feels that nothing is the same. Photo by Colin Watts on Unsplash
A version of this was first published on LinkedIn on March 22, 2020 Here
