Trying to find new perspective in a time of stress and uncertainty
As a result of the coranavirus, everything that I have taken for granted – community, society, recreation and healthcare – has been suspended, and more than likely, changed forever.
Although medical training prepared us, conceptually, for the possibility of a pandemic, let's be honest – nothing could have prepared us for the actual experience of living through one: the adaptation of our healthcare services, the stresses and uncertainty of the future when jobless claims climb to a historic high, the new day-to-day routines of a physically distanced world, the anxiety of living with a virus we still don't fully understand.
As we wade through an unknown pandemic together, we now know that the SARS-CoV-2 virus does not discriminate by age, race, gender or wealth. At the same time, the coronavirus has revealed that the systems within which we live continue to discriminate. Reflecting on this can be emotionally difficult to parse – I'm not experiencing the worst pains of this pandemic, for which I'm endlessly grateful, but life is different and stressful in the COVID-19 era, and work-life integration, avoiding burnout and even just adjusting to this new reality is nothing short of a challenge.
Our academic group practice is purely reconstructive. My last routinely scheduled O.R. day in early March was a delayed autologous breast reconstruction. After I finished the case and talked to my family, I sat down with a cup of coffee and caught up on email. It was decided that our research lab would temporarily close. The hospital opted to cancel all elective procedures through mid-April and allow selected cases, following formal review from a Division of Surgery Task Force. We were coming up on spring break, so my days were filled with second stage breast reconstructions, breast revisions or lymphedema operations – none of which could be argued to the task force as necessary under the circumstances. So, we started calling patients. Cancelling a lymph node transfer and bypass meant that I was free to do a chest wall reconstruction for inflammatory breast cancer. Although I saw the volume of cases pared down in these last couple of months – allowing only the most urgent cancer-related operations – my clinical practice has not stopped.
One morning as I drove to the hospital for a case, I saw a woman out for a walk. I was at the stoplight, she was at the park across the street. She pushed a stroller with a little girl who looked a little younger than my daughter, while a dog trailed not far behind. Even knowing nothing about her, I resented her. I envied that she could spend a beautiful day isolated at the park with her family. I then felt shame for that resentment. After all, so many of my friends and family were faced with the unknown that comes with not working. I felt guilt for still being able to do a job that I loved but now somehow feared. I worried about the health and safety of my loved ones, threats to financial stability and an uncertain future.
Schools, day-care centers and many childcare services have closed. My husband, Nick, an orthopedic surgeon, and I had to craft schedules that allow one of us to work from home with our daughter while the other goes to the hospital for clinic or call cases. Initially, we did all the wrong things. I watched way too many press conferences for my own good and felt stressed by the lack of control or understanding of this virus. My daughter spent far too much time with the iPad and as a result, a Yoda Chia Pet from Amazon showed up at our door. Of all the things she could have somehow one-click ordered, I suppose we could do worse. I needed a different approach. I tried to organize to-do lists to keep us on track. If I wasn't operating every day, and I couldn't go to the lab, I was going to write, cook, exercise. I could approach this "down time" with organization and purpose.
Soon, however, the stress I felt turned into overwhelming anxiety. There was new information coming out daily on COVID-19 and we really didn't know what we were up against. As an academic surgeon, I am essential, but I am not a front-line provider. I was not in the trenches of the E.D. or ICU like so many of my colleagues, taking care of patients who were SARS-CoV-2 positive. My exposures to the virus were "after the fact," meaning I would receive a call from employee health or the lab with notification of a positive contact and a series of questions to follow. Because I never developed symptoms, I didn't warrant testing.
I struggled with this every time I drove home from work. Was I unknowingly carrying the virus into our house, putting my family at risk? We were both still working, so trying to keep our daughter isolated was not realistic. As it turned out, we would each have our turn at self-quarantine and the challenges of single parenting. I ugly cried after Nick sat at the top of the steps and joked, "This really doesn't work without you."
At the time of publication, the number of cases in the United States topped 1.6 million (with more than 5.5 million worldwide), with more than 98,000 deaths. The curve is flattening, but many of us are still in a state of flux. States such as Texas are starting phased re-opening of businesses and non-emergency cases are being scheduled, but other states remain on hold. I only hope that, as you're reading this, we aren't reverting or experiencing a second wave already. None of us are sure how this will evolve or what will be our new normal.
I have found the good in so many of the things I had taken for granted: the free time to go for a walk with my family; a virtual way of re-connecting socially with friends; appreciation of colleagues who have become like family. I'm proud of how our community of plastic surgeons has responded. I'm grateful for the resilience of my friends, partners and family during this time. We are taking care of each other just as much as ourselves. The micro-adjustments that we make to keep from listing are necessary, now more than ever.
We'll all experience this pandemic in different ways – and too many will unjustly face the most devastating impacts – but none of us will escape untouched by uncertainty, stress and pain. Be well, stay safe.