Lessons From The Front Line

I just completed a week of attending on the acute medicine wards in the COVID-19 era. Needless to say, nearly everything about the workflow and environment was different. We are fortunate to not be inundated with cases the way many jurisdictions are, but the impact is still tremendous. Below I detail a few things I learned from this experience.

Uncertainty is the greatest fear of all. 

Even in normal times, we have a desire to know how things will go. Students want to know what’s on the test. Partners want to know how their counterpart will respond when they share something emotional. Children want assurances about how much playtime they will be allotted. We feel that knowing will alleviate our anxieties, convincing ourselves that some other unknown won’t simply take its place. 

During COVID-19, uncertainty is top of mind. The word, itself, is everywhere in news headlines. Health care workers are feeling fearful because they don’t know the risk to their personal safety, the state of the supply chain for masks and gloves, if their families will be in jeopardy, if they are unknowingly spreading the virus to vulnerable patients. Despite this, they show up. But the stress of the fear of uncertainty is obvious, representing an additional toll on our critical service-providers. 

Crises reveal the true nature of our leaders.

Left to themselves, particularly when told to isolate, the fear of uncertainty will mount on almost anyone. It takes good leaders, who understand people, to communicate effectively and consistently in order to alleviate (at least in part) the suffering of their constituents. These leaders are required at all levels of the workplace, politics, community organizations, families. In politics, especially, we don’t have to look far to see examples of good or exceptionally poor leadership right now. It’s easy to complain about leaders, but crises teach us how badly they are needed, and how important their skillsets are. None more important than the abilities to maintain humility and strength of conviction, helping those who follow believe that there is some semblance of a direction and vision. 

Patients in hospital feel the impact of loneliness.

During the pandemic, policies have quickly shifted from a focus on the individual to a focus on protecting the many. From an infection control standpoint, this makes perfect sense. Individuals give up some of their usual freedoms, doing their part to benefit society. Any ensuing feeling of loneliness is, for the most part, up to each person to reconcile. It is their responsibility to be aware of and address their own experience. For hospitalized patients, however, there is an important difference. 

Patients in hospital are, by their nature, dependent on others for the protection of their health. This dependence for health easily extends to a perceived dependence for overall well-being. Protocols include keeping patients alone in rooms with the door closed, minimal contacts with staff each day, and no visitors. This, all in the name of reducing the risk of spreading the virus, results in near total isolation. We support what they need for the recovery of their physical body but deprive them of any sort of socialization required for overall well-being. 

The patients with whom I interacted in this situation were, simply put, sad. It is difficult to imagine that this does not adversely affect their recovery from illness, COVID-19 or otherwise. Patients entrust us with their health. The impact of this type of isolation needs to be examined and mitigating strategies planned as the pandemic evolves. 

There are a lot of lessons to be learned from this experience. The ones I’ve highlighted here or only what immediately came to mind. What gives me optimism is knowing that humans are able to adapt quickly, finding ways to protect the most vulnerable, and humanity in general. 

Be well.

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