Over the din of the negative pressure machine, I shouted goodbye to my patient. I zipped my way out of one of the little plastic enclosures in our emergency department (ED). With disgust and a bit of fear, I carefully shed my gloves, gown, and face shield. Only my precious mask remained on my face. I thought, This is a whole new world, and I hate it.
I can master fear of dying from COVID-19. I have the proper equipment and I use it well. My work still brings meaning: I serve those in need without hesitation. So, what’s the problem?
The problem is that I’m losing that deep feeling of connection with patients, which is such an important part of this work. A few weeks ago, the intricate fabric of what it is to be human tied me to patients through the basics: touch, facial expressions, a physical proximity, and open-hearted, honest dialogue. Much of that’s gone with the new measures we need to take to protect ourselves from the disease. I can carry on, but I will surely burn out if I can’t figure out how to get back at least some of the connection that feeds my work.
In the first weeks of the pandemic, I had not been thinking about how it affected the interpersonal side of the work. I was overwhelmed by the amount of information I needed to process daily. But that morning and later that day, as I left the ED, I felt a sense of loss. I felt it again with Ms. Z, who was not even suspected of having COVID. She was a 62-year-old I interviewed with the help of a translator phone. At the end of our encounter, she asked, “But doctor, will you make my tumor go away?” From across the room, I said, “I will try.” I saw her eyes dampen as I made a hasty exit, following protocol to limit time in the room with all patients.
Typically, leaving a patient’s room, I would have feelings that could range, depending on the situation, from joyful levity to a sad sense of meaning. How did I feel as I left Ms. Z? In that moment, I was mostly ashamed of my lack of compassion. On further reflection, I realized that I just felt tense from all things related to COVID-19!
We connect best when our parasympathetic nervous system is predominant. That’s when our heart rate slows and our muscles relax. But, when gloves and face shields cut us off from other humans, we lose so much of the contact we need to activate that part of our nervous system. Having an amped-up sympathetic nervous system—the one that activates in dangerous or stressful situations—is understandable, but it’s not conducive to compassion.
There is a virtuous cycle, much of it unconscious, where something positive leads to more positivity, which is crucial to meaningful patient encounters. We read each other’s facial expressions and we hear the tone of voice. As we pick up these subtle cues from our patients, our nervous system becomes more engaged with them, and our hearts open even more.
Perhaps because we’re so cut off from patients, the specter of COVID-19 has us battling a negative spiral of stress and fear. For the most part, I keep that from consuming me, but it saps my energy during encounters. That’s why I need to actively engage prosocial elements of providing care to maintain my compassion, in the same way we need to marshal our resources to battle both the stress and the disease itself.
Clearly, after my meeting with Ms. Z, I needed a more concerted effort to kickstart this virtuous cycle of compassion.
My next patient was Ms. J., a 55-year-old with advanced chronic obstructive pulmonary disease (COPD), who came in the night before with shortness of breath. Her slight frame shook from coughing as I entered the room. I did not think she had COVID-19, but we needed to rule it out.
We reviewed how she felt since admission. I performed a hasty exam and stepped back across the room. She coughed again and said, “I feel so weak, and the world feels so crazy.” She looked into my eyes: “Tell it to me straight. Am I going to make it, doc?”
I took my cue from her. I walked back to the bedside, placed one gloved hand on her shoulder and the other on her hand. I bent forward just a little. Making eye contact and attempting a comforting tone of voice, I said, “Everyone is a little scared, including me. We need each other more than ever these days. We will do our best for you. That means thoughtful medical care and a whole lot of love! And, truly, I don’t think you are dying. This is just one of your COPD flares.”
“God bless you!” she said, squeezing my hand as a tear rolled down her cheek.
“Bless you, too,” I replied. “We all need blessing with this madness going on.” Despite the mask, I am sure she saw the smile in my eyes. “Thanks for being the beautiful person you are and opening up to me. That’s the way we will make it through this. I will see you tomorrow.” Backing away, hands together in prayer, I gave a little bow and left the room.
With Ms. J.’s help, I began to figure it out. To tackle the stress of COVID, we need to be very direct—almost to the point of exaggeration—to make sure our words and actions convey what we need to express.
William James, the father of psychology, believed that if you force a smile, your emotions will follow. The neural pathways could work backwards in that way. He said, “If you want a quality, act as if you have it.” The modern translation would be, “Fake it ’til you make it.” You may be feeling stressed, but with a deep breath and a moment’s reflection on the suffering of the patient you are about to see, you can turn the tide on anxiety and give those under your care what they need.
These are unprecedented times. Anxiety abounds. While we can aspire to positivity, there are times when we simply can’t muster showing it. Alternatively, as I experienced with Ms. J., honesty and vulnerability can open the door to meaningful connection. This can be quite powerful when we, as physicians, open up to our patients.
People are yearning for deep connection, and we should attempt to deliver it with:
- Touch (as we can) to convey connection.
- Body language that adds emphasis to our message and our emotions that may go above and beyond what we are used to.
- Tone of voice that enhances our words.
- Talk that emphasizes the big stuff, such as love, fear, connection, and community.
With gloves, masks, distance, and fear between and us and our patients, we need to actively engage our prosocial tools to turn the negative spiral of fear into the virtuous cycle of positive emotions. This will help to promote healing in our patients and emotional engagement for those providing their care.
A different version of this essay originally appeared on The Hospital Leader, the official blog of the Society of Hospital Medicine.