The COVID-19 pandemic has brought with it a slew of challenges that were previously unimaginable for many of us. Social isolation, separation from beloved family members, the daily struggle to juggle work, parenting, and teaching in times of economic and generalized uncertainty – these are just some of the difficulties arising from the current situation. Feelings of fear and anxiety stemming from uncertainty are, however, a pre-pandemic reality for some of our most vulnerable populations, including children living in poverty, victims of domestic abuse, and seniors who suffer from loss of autonomy, chronic illness and/or loneliness.
I am a pediatrician whose community practice has been significantly impacted by the current pandemic, with a large decline in patient volume. The city I live in, like many others across North America, is grappling with the dire situation in seniors’ long-term-care facilities. Many of these facilities face a critical shortage of personnel while the virus spreads like wildfire. Workers are absent for a multitude of reasons: they themselves are infected with the virus or fear contracting it; workers who are also parents may not have other childcare options; some workers are burning out from the physical and emotional toll. It is in these harrowing circumstances that as a pediatrician, I found myself in a seniors’ long-term care facility, offering my services to help bathe, mobilize, and feed the vulnerable elderly.
One morning, while sitting with one of the residents (an 84-year-old woman), I had an “aha” moment. The morning routine of toileting, bathing, and feeding the residents was over, so I decided to go and just sit with some of the residents. I walked into the woman’s room with no specific task assigned by a nurse or orderly. She was cognitively intact and shared fascinating stories from her life; she had lived through the war in Eastern Europe, came to Canada to work in a military hospital for a year, and then married and had two children. While she was speaking, my mind wandered for the briefest moment, just long enough to be fully cognizant of the fact that I was absorbing all these details of her life, much more fully than I would have is she was a patient under my care. Why? I was there with one sole purpose: to listen. I wasn’t worried about asking specific questions for my review of systems or charting information to comply with legal responsibilities and billing constraints. My mind wasn’t wandering thinking about the ten other patients to round on, the five prescriptions to update, and the research collaborator whose e-mail correspondence was still unanswered. I was able to be fully in the moment and listen to this woman’s life story in her own words, with no agenda of my own. It was only after the encounter that I realized how valuable the information gleaned from that experience would be if she were, in fact, my patient and I were her treating physician.
You see, I forgot to mention that I am not only a pediatrician, but also a pediatric palliative care specialist. My palliative care physician colleagues know how critical rapport building and empathic listening are to the therapeutic relationship. The rushed DNR discussion in the ER with a patient and/or family you’ve never met is suboptimal at best and can cause irreparable damage at worst. Palliative care physicians (and all compassionate physicians for that matter) realize that in order to best engage in true shared-decision making and goals of care discussions, you must take the time to get to know your patient. You can only guide discussions and make treatment decisions that respect and honor a patient’s values, wishes, and (ultimately) life if you know have intimate knowledge of what those guiding values are. That is not to say that patient-physician boundaries should not be respected, but there is a way to maintain a professional distance while still holding space for a patient’s narrative, which can include joy, sadness, and fear.
I have managed to find a silver lining in this pandemic, as I’m sure many of my colleagues have. I imagine those working in the ER, ICUs, or COVID wards are hanging on to the moments of joy and triumph that are scattered throughout the daily hardships; a patient on a ventilator is extubated, another is discharged home, the medical team comes together in ways it never has before. I am grateful for the reminder and lesson that in order to be a better doctor, I need to stop being a doctor for a while. Every once in awhile, it’s important to interact with our patients with the weight of the “doctor stuff” stripped away. When we take a few minutes to ask a patient how they feel about what’s going on, when we ask about their children, when we bear witness to their fear and sadness (and take the time to listen and sit with the emotion), we are recognizing the humanity we all share and come out the other side better for it.
Silvana Barone is a pediatrician.
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