A physician deals with uncertainty during the pandemic [PODCAST]

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“Despite forces not within our control, namely the thoughts and actions of others, headway has been made in my local practice area:  the decline in mortality, the advances in clinical knowledge about the pathophysiology, more efficient testing, more PPE, an uprooting and great revealing of the need for prioritization of health care worker wellness, the impact of stress and isolation on health, the magnification of health care disparities, racism, and sexism, an opportunity for the interweaving connection of humanity for some, along with the stark divisiveness that continues to exist.  But we get to choose how this pandemic plays out for us.  I choose extreme caution, gratitude for this opportunity for temporary seclusion, an opportunity to recharge while reconnecting.  I wait in the uncertainty.”

Ni-Cheng Liang is a pulmonary physician and founder, the Mindful Healthcare Collective.

She shares her story and discusses her KevinMD article, “A physician waits in uncertainty.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today, we welcome back on the show Dr. Ni-Cheng Liang. She is a pulmonary physician, and she wrote the KevinMD article “A physician waits in uncertainty.” She’s also founder of the Mindful Healthcare Collective, and she is the co-host of the Mindful Healers podcast. Ni-Cheng, welcome back to the show.

Ni-Cheng Liang: Thanks so much for having me again, Kevin.

Kevin Pho: So for those who didn’t listen to your previous episodes, can you briefly introduce yourself, tell us about your practice, and then tell us about your new podcast?

Ni-Cheng Liang: Sure. I’m an adult pulmonologist practicing out of San Diego. I’m also a cancer survivor and, as a result, a mindfulness teacher. And having had conventional medicine save my life, it was integrative medicine approaches that helped maximize my quality of life, including to this day, including mindfulness.

Our new podcast is basically about the ways mindfulness can help decrease the struggles among healers. It’s really meant to help heal the healers using mindfulness, and especially during the pandemic, a lot of health care workers are undergoing a tremendous amount of stress.

Kevin Pho: Now, what are some of the things that you’ve learned from a mindfulness perspective over the past year?

Ni-Cheng Liang: Over the past year, uncertainty has been a main theme of the pandemic in general. From a mindfulness perspective, paying attention on purpose to the present moment without any judgment goes hand in hand with how human beings can deal with uncertainty. And so that’s probably been the most helpful tool: to ground myself back into the present-moment experience, however uncertain the future is.

Kevin Pho: So let’s talk about your most recent KevinMD article. This was written back in November. It’s titled “A physician waits in uncertainty.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Ni-Cheng Liang: I decided to write it because the fact that I had to get tested because of a potential exposure or positive COVID diagnosis came up for me, and how uncertain that was. Just sitting with the uncertainty brought up a lot, and I just wanted to highlight the realities of a day-to-day health care professional dealing with the uncertainties of testing.

And now, since then, in total, I’ve been COVID tested four different times, and I feel like every single test has been an evolution of how the U.S. has progressed in its efficiency of testing, as well as its accessibility and the timeliness of results. So it’s been an interesting progression of medicine, really.

Kevin Pho: So tell us a little about the story of how you were potentially exposed to that patient. What exactly was the exposure, and what happened next?

Ni-Cheng Liang: I’m usually called into the inpatient consult service. Initially, we had started off separating the teams into non-COVID versus COVID patients, and so I was assigned, as usual, to the non-COVID service. That was earlier on in the pandemic, when the non-COVID service, quote unquote, was still primarily, mostly non-COVID patients, but that has flipped since then.

And so there was this patient that I had a very high index of suspicion for, even though she had two negative PCR tests from her nasopharynx, knowing that most of her symptoms were gastrointestinal in nature. Holding that high index of suspicion, given her history of recent travel from Europe and also the pulmonary infiltrates, I held the order discontinuing contact precautions and respiratory isolation precautions, trusted my gut on this one, and got the COVID antibody test on her. And sure enough, it was positive, and so then she went on to the COVID service.

So the exposure there probably wasn’t an exposure, because of the PPE that was available and how there was no break in the order to keep her on respiratory isolation. And of course, though, within two days, I started developing a sore throat.

What I find interesting is that in the past, as physicians, having a sore throat or a runny nose, no problem; we wouldn’t have thought twice about going to work. And now, if we have any sort of upper respiratory symptoms or anything at all that might signal the possibility of COVID-19 infection, it behooves us to try to make sure that we don’t have COVID at the very slightest sniffle. So I think that there’s this paradigm shift of health care professional well-being that is being addressed, perhaps not in an ideal way, but it is definitely getting magnified.

Kevin Pho: So when you had this patient who previously tested twice with a negative PCR and then all of a sudden was discovered to be positive, and you were treating this patient in the non-COVID service, what exactly was going through your mind at that moment?

Ni-Cheng Liang: That I kind of expected it, that of course she would test positive. It just goes to show that the PCR isn’t super accurate in settings where the primary symptoms, where initially the presenting symptoms, were GI-related. And so there’s something to be said about clinical intuition and the limitations of science.

Kevin Pho: And I think, the story that you tell, health care workers across the country are dealing with that same uncertainty. Did I get exposed? Was I wearing PPE properly? Are the symptoms that the patients are showing COVID or not? Now, from your experience and what you’ve learned over the past year, what are some techniques that you could recommend these physicians take to help address and handle this uncertainty that they’re feeling?

Ni-Cheng Liang: One is, dealing with stress or uncertainty or some anxiety-provoking situation, I like to resort to some of my handy mindful acronyms. The RAIN practice has since been made popular again by Tara Brach, who is a world-renowned mindfulness teacher and psychologist. So R stands for recognize the uncertainty, the stress, or the anxiety. A is to allow and accept that particular situation in the present moment, just as it is, without trying to resist it. I is to investigate, so being curious about what you’re feeling from an emotional standpoint, as well as naming your body sensations. Oftentimes, we’re so in our heads, making thousands and thousands of decisions in our clinical workdays, that we forget to check in with our bodies.

And then N is for not taking it personally and then nurturing yourself. So reminding yourself that that particular stressful situation is probably not going to be a defining moment for you as a human being, and that really that situation is not personal and usually is not a direct attack on your humanity. And then N is to ask yourself, “What do I need in that moment to help myself, to serve myself? What is it that I need in that moment for kindness?”

Kevin Pho: So when you had this potential exposure, and health care workers across the country, they always have potential exposures, what kind of support services did you have? Did you have anyone to talk to, to really help support you during this time of absurdity?

Ni-Cheng Liang: Yes. So our employee assistance program and our chief medical officer have been very accessible and transparent with what to do in this situation, because I’m sure it happens multiple, multiple times a day. And now, on my fourth COVID test during the pandemic, it’s becoming more commonplace. And so I was able to contact a specific triage line made for physicians with a potential exposure and then basically get fast-tracked into a drive-through testing facility within 12 hours of the sore throat onset. And so it’s been really streamlined, a lot more streamlined, I would say, than my first COVID test back in March.

Kevin Pho: We’re talking to Ni-Cheng Liang. She’s a pulmonary physician, and she wrote the KevinMD article “A physician waits in uncertainty.” Ni-Cheng, this is the third time that we’ve been together on this podcast, and each time, we’re at a different point of the pandemic. We’re now speaking in the middle of February. Has anything surprised you in the evolution of the pandemic?

Ni-Cheng Liang: What has surprised me has been the pathophysiology of COVID. I think we are much better at treating it. In my hospital, I sense, from the outpatients that I do see from all walks of life, that the mortality is decreasing, because physicians are getting better at treating it, and we have available drugs that are now FDA-approved. So I think that the rapidity of the development of treatments, and also the vaccine development, has been surprising.

And yet, despite the vaccines being more available now, almost a year into the pandemic, I kind of expected that at least the first six months of 2021 were going to look very similar to 2020, because of the vaccine distribution not being as effective in getting a vast majority of the population vaccinated. However, that being said, it is significantly increasing, and vaccine superstations are opening up everywhere now in San Diego County. And so that’s been a pleasant surprise, to see that ramp up at much higher rates over the last few weeks.

Kevin Pho: And hopefully, when I have you on next time on the podcast, we’ll be in a better place than we are now as it relates to the pandemic.

Ni-Cheng Liang: I hope so, Kevin.

Kevin Pho: So my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Ni-Cheng Liang: Take-home message is to expect the uncertain, and that it’s OK for there to be uncertainty. So my invitation for all of you is: Can you sit with the uncertainty of COVID and use that as an opportunity to look within and ask yourself, “What is it that I need in this moment?”

Kevin Pho: Ni-Cheng, thanks again for returning to the show. Best wishes on your podcast, and thanks again for your time and insight.

Ni-Cheng Liang: Thanks for having me, Kevin.

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