Telemedicine blossomed into an essential tool in health care overnight due to the surge in COVID-19 cases. It is a long lost innovation at the forefront of our battle. Telemedicine is especially valuable for our frail older adult patients. At the initial phase of the pandemic, a quick decision was made by fellowship program leaders to transition to telemedicine in an attempt to decrease the number of cases, help protect our geriatrics patients, team members, and families. We brainstormed ideas to implement inter-professional telemedicine care using telephone/video encounters on different platforms. These platforms included the long term care facility setting, clinic setting (including geriatrics assessment clinic), and inpatient consultation setting.
As a geriatric medicine fellow two months away from graduation, I did not know what the future held. I live alone in Seattle, away from my husband and my family, who live in Canada. I was also faced with a second miscarriage and family emergencies during this challenging period. These new circumstances caused me to be skeptical about the “new transition.” I wondered if I could make it all alone in this ghost town that became my neighborhood. My isolated personal situation might have affected my objectivity about telemedicine. But who wasn’t emotionally affected by this pandemic?
I was filled with anxiety and self-doubt. I repeatedly questioned my colleagues and supervisors. I wondered if we could truly be successful managing patients remotely. I was also concerned about patient satisfaction, the specific needs of our dementia patients, and the reliability of the technology.
When I reminisce about the first few weeks of the COVID-19 pandemic, my very first patient encounter comes to mind, Mrs. J. Mrs. J is a wise, pleasant, and complex case of internal medicine at its finest. She often requires frequent face to face visits and continual reassurance. Our long term facility welcomed the idea of virtual visits, starting with Mrs. J, with enthusiasm and collaboration amongst nurses, social workers, and physicians. It was a heartwarming collaboration in a time of necessity. On the day of the visit, I was anxiously waiting in front of my personal phone, dressed professionally, and sitting at my semi-clinic looking office at home. I thought about the possible answers to my wise patient’s pandemic related questions. Suddenly, I saw a big smile on Mrs. J’s face greeting me on camera, asking, “How are you doing, doc?” It was as if she was as worried about me as I was worried about her.
Once we began our conversation, I realized it was just like our regular visits; I found myself answering her questions with confidence. The video was an opportunity to visually assess her leg edema and erythema, which was her main medical concern and change the management plan. When I looked at her facial expressions of fear and frustrations – I realized we were feeling similar emotions. I empathized with Mrs. J and related to her situation. I was distant from my husband and my family, matched only with tremendous grieve for the loss of another little soul. Through loneliness and despair, Mrs. J and I connected at a deeper level than we ever did before. During our meeting, we had technical challenges that included Mrs. J’s hearing loss and repositioning of the iPad camera multiple times where I could not see her face. This made us both laugh. At the end of the visit, I sensed her relief – her worries disappeared. So did mine, especially when she said, ”Take good care of yourself, doc.” That made me realize that a patient-doctor relationship can be a strong pillar not only for the patient, but also for doctors. The success of this new experience was therapeutic for both of us.
The emotional and physical suffering of a second miscarriage impacted my daily motivation to work, help, create, and to be innovative. Being forced to be away from family only made it worse. On the other hand, doing challenging virtual visits with challenging patients diverted some of the self-attention into skepticism regarding telemedicine. Dementia patients with BPSD, in particular, were challenging. Their isolation and distance from loved ones escalated their behavior. During our virtual meetings, some patients were crying and irritable, unable to understand the chaos around them. Initially, I failed to help them feel better. I could not reach out and touch a patient’s hand or even be a physical presence near them. I felt helpless and disappointed. Managing BPSD in older adults is challenging, but managing it virtually is impossible.
The virtual visits continued, mostly successfully. We moved from one platform to another, tackling challenges and building protocols. Our team, which consists of social workers, behavioral health specialists, pharmacists, attendings, residents, and two fellows, managed to continue our mission in helping our patients during the pandemic. We addressed their concerns both medically and mentally, help them navigate through the chaos. Weekly we met on Zoom to discuss and regroup. Sometimes, talking about personal struggles such as being isolated and in physical and emotional pain. These team meetings were extremely supportive. Coming together in times of uncertainty, interacting with each other was therapeutic for most of us who missed the human factor.
In medical school, I was taught to always separate personal from professional life. I have always tried to do so. During the pandemic, I realized that is not possible. We are working from home, inviting patients into our homes and personal lives, and they invite us into theirs. I have uncovered and accepted a previously unrecognized support system: my patients and my team. This support system guided me through it all.
In conclusion, telemedicine can be challenging but may offer successful experiences in different geriatrics health care platforms. Success is only possible with inter-professional and interpersonal collaboration. I recognized that my patients and my team can be my therapy in times of uncertainty and struggle. This is how telemedicine led to my personal and professional growth during the COVID-19 pandemic.
Nadeen Audisho is a geriatrics fellow.
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