Caring in the time of COVID-19

by Chris Ha, DO and Josh Romero, MD

As we sit down to write this, there are 1.9 million confirmed COVID-19 cases in the world, 572,000 of which are here in the United States. 118,000 people have succumbed to this virus worldwide. There have been 7,300 deaths in New York City alone. Michigan, Illinois, New Jersey, and Louisiana all have active hot spots. Coupled with these statistics, the daily news reports, press conferences, graphics and social media posts circulating information about COVID-19 have been overwhelming. Amidst all of the buzz, one thing remains clear: we’re not through this yet.

Johns Hopkins University. https://coronavirus.jhu.edu/map.html

This has been a hard reality to wake up to every morning. Stripped of our routines, our social relationships, and any semblance of control, we are left to stare into uncertain futures. In Minnesota, we have been under stay-at-home orders for the last 17 days, though it has felt like an eternity. It’s hard to imagine one month ago the two of us were hanging out poolside at a Universal Studios resort down in Orlando. The coronavirus was just starting to develop in Italy and South Korea at that time, but life was business as usual in the states. It’s bewildering how rapidly things have changed.

As people working in healthcare, it’s admittedly a strange feeling to watch our profession be thrust into public attention during this pandemic. Consumed by the demands of residency training over this past year, it’s been easy to feel separate from the events of the outside world. We had become citizens in the city of medicine, imbued with a new language, new rituals, new rules; a new normal. Time moved in a blurry and binary fashion: there were innumerable hours spent in the hospital or the clinic, and then there were those slivers of time where we reentered society, if only for a moment. We learned to keep our heads down and focus on our patients and our training. By January, we were getting accustomed to the routine and rigor of intern year. Spring was a few months away. But then the coronavirus unfolded. The outside world stopped and shifted its gaze to the world of healthcare, which began to spin faster and faster.

We watched colleagues and hospital leadership share their expertise on national news outlets. Mentors were honored in their local communities for their commitment to patients. We received texts and phone calls thanking us for our service and heroism. Local companies donated food to hospital units. We felt pride.

Healthcare workers across the country were bravely coming out of retirement to join the fight in NYC. Specialists were increasingly redeployed to inpatient wards, the ED and the ICU. Communities were rallying together, sharing resources, contributing however they could to support hospitals and clinicians. We felt empathy and solidarity.

Clinical duties and processes of care were changing at our hospital, much like they were around the country. Our workspaces were transformed. Daily educational conferences were canceled. We became one in a sea of masks and scrubs. We operated in unfamiliar territory. We felt lost.

The world was suffering. People were dying. Reports trickled in of healthcare heroes on the front lines becoming severely ill. Some were younger than us. The plea for more PPE (personal protective equipment) was growing across the nation. We felt grief and fear.

Dr. Victor Montori speaking at our virtual book club on Why We Revolt. (April 2, 2020)

The COVID-19 pandemic brought a swirl of emotions hard to process. Moreover, it awoke us from our slumber and caused us to pause and reflect on the work that we do. No doubt healthcare was entering an unprecedented time. What will it look like after this pandemic is over? What could it look like? We turned to a book written by Dr. Victor Montori entitled Why We Revolt to help make sense of things. Dr. Montori is an esteemed physician and researcher here at Mayo Clinic, and in Why We Revolt he identifies the big problems plaguing our industrialized healthcare system — cruelty, greed, dehumanization among others — and argues for a revolution towards compassionate and deliberate care. Once we started reading, we couldn’t put the book down. We hosted a virtual book club over Zoom alongside our colleagues and with Dr. Montori to help unpack these ideas, and what fruit they could bear in the time of COVID.

We talked about the ways in which the pandemic was seemingly renewing and changing healthcare. A call to action brought solidarity among the professions; rather than finding identity in the divisive silos of title or specialty, we began to identify together as clinicians. In addition, the realization of our own frailty and interdependence united us with our patients. Staring in the face of economic precarity and an immense lack of resources, healthcare also began to put mission before money to serve patients. Profit was no longer the pressing issue. Emboldened by the daily threat of the pandemic, we were innovating, fundraising, sharing resources, disseminating research, and experimenting with new ideas like never before seen — and not for riches or recognition, but because it was what was right. We were seeing integrity return to healthcare. In these extremely isolating and uncertain times, we are beginning to see with new eyes the importance of human connection, of conversations, of careful and timeless care. The virtual book club concluded with a sense of cautious optimism for the state of healthcare. We each committed to do our part to turn these conversations into actions we could carry forward as we practiced medicine.

It’s crazy to think less than a year ago we were students, and today we are among the many essential workers contributing to the efforts of helping fight COVID-19. Looking back over this year, there have certainly been difficult and stressful times as a trainee in healthcare, but in this moment, the “calling” of being in medicine seems deeper than ever. Now more than ever, compassion and excellence is needed from healthcare workers. The clock is ticking, those with chronic medical conditions at home are struggling, and people coming into the hospital are desperate and scared. We are seeing that the years of schooling, sacrifice, commitment, and growth have prepared us for this time. We openly embrace it, cling to it, and will work tirelessly to provide hope and healing to our patients.

Today, the hospital feels vastly different from what it did one month ago. Patients are alone in the hospital without a family member by their side as no visitors are allowed. It is a lonely place to be. Multiple people rush in and out of patients’ rooms, poking and prodding at them behind gloves, masks, and gowns. They cannot feel the warmth of our hands or see the expressions on our face. We seem to resemble more of a robot rather than a human being. There is an unspoken understanding among healthcare workers when walking around the hospital or emergency department these days. Despite a mask covering the facial expressions of our fellow colleagues, their eyes tell the story. We are each struggling in our own way, whether we have lost family members, jobs, social connection, or our normal routines. Despite this, we come together day after day to stand as a united front.

We are doing our best to predict how long this will last but we are not sure the prediction models will tell the full story. They may tell us when we will hit our “peak” or when we can lift the stay at home orders. But can they tell us when the fear will subside, how long the financial impact will last, or when a sense of “normal” will return? As we embrace the uncertainty that we face both day-to-day and long term, how do we move forward with hope? There is no simple answer to this question as what brings each of us hope is unique. However, the unifying idea we can all cling to is that there is indeed hope, better days will come, and we will rebound from this as a society. Life may look different in the future, but sometimes it takes monumental moments such as this to create a “new normal”. Let us stand together (yes, Facetime/Zoom/etc count), find the good in each day, and grow as we take steps forward, no matter how small a step it may be.

Chris Ha and Josh Romero are PGY-1s in the Department of Physical Medicine and Rehabilitation at the Mayo Clinic. Follow them on Twitter @ChrisHaDO and @JoshuaRomeroMD

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