COVID-19 Diary Day 2: Insomnia -- The Mark of Medical Practice

Don S. Dizon, MD


April 07, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

I've never been a deep sleeper, typically waking at 4 or 5 in the morning. I usually get up gradually, lingering in bed for a few minutes, checking what's happened on Twitter, and then moving things along.

That's all changed.

Don S. Dizon, MD

These days, I bolt upright at 5 AM, heart racing, eyes dilated, as if someone's trying to break into my house. It takes a couple of minutes of breathing to adjust to my surroundings—quiet and dark—and remember that I am at home and my family is safe.

My new routine consists of checking Twitter to see what has happened overnight. I've become obsessed with COVID-19 and the devastating impact it has had globally. I look at the Financial Times' Coronavirus Trajectory Tracker, tweeted each day by John Burn-Murdoch, hoping to see a global flattening of the proverbial curve. But for the past week, the news has been consistently bad.

America has the most cases of COVID-19 in the world, and the death rate has now surpassed that of all other countries except Spain. I read about the surge in New York City and, as I scroll down my Twitter feed, about those who have died. A virtual obituary board for social media aficionados.

It would be easy to pack it in and decide to stay home. But that's not an option. Despite COVID-19, people still need care, chemotherapy needs to be administered, and new patients are still coming in for evaluation. As head of outpatient services at my center, Lifespan Cancer Institute, I've also been involved in planning for the surge—not what we'll do if it happens, but when it happens.

At first, it was making sure our visitor policies were understood by everyone, including our patients, who would now be asked to come in alone, with very few exceptions. I feared their reaction and wondered whether we abandoned a basic tenet of oncology: to teach and to comfort not only the person with cancer, but his or her family. Thankfully, our patients understand the risks of COVID-19; nearly all have followed the new regulations.

Insomnia has become the mark of medical practice.

Next came the conversion to virtual visits, asking providers to shift as many of their patients as possible out of the clinic. We now rotate clinicians so that each one won't have to be in clinic for more than 2 days a week. We encouraged our faculty to work from home and moved multidisciplinary cancer conferences on to web platforms. I couldn't help but think that any one of these changes would have typically taken months to roll out; we'd have been crazy to ask our faculty to adopt so much change at once. But that was then; this is now.

Each day I also listen to the daily briefings from our governor, Gina Raimondo, where she outlines the projections, the need for personal protective equipment and more ventilators, and about the field hospitals currently being set up.

I also anxiously await the report that comes from the leadership of our organization each day. This week we were tasked with a plan for coverage of patients who need hospitalization, and what we are planning to do if we have to take care of them without the aid of interns and residents.

And all the while, I think of those in our faculty with young kids and those who are over 60 years of age. How can I minimize their risks and still keep the cancer center going? What about our nurses and advance practice providers—how can we minimize their risk? Fortunately, I am not alone in this; my colleagues are also friends. We share our fears, anxieties, and our commitment to our patients.

I come home exhausted, my body desperately needing sleep. Yet I know the next morning I will once again bolt awake. On Twitter I have found others who experience the same thing, as if insomnia has become a mark of medical practice.

Somehow I find this comforting, knowing that I am not alone in dealing with the anxiety of this pandemic. It reminds me of what I often tell people who are experiencing deeply private side effects of cancer treatment, like those involving sexual health and intimacy. Often, they are embarrassed to talk about it. But when I tell them how common it is, how I see people dealing with this issue in my sexual health clinic, and that things will get better, they often leave with less of a weight on their shoulders. I like to think it's because I've helped them see that they aren't alone, that the hard time they're having adjusting after cancer isn't abnormal, and that there is hope that things can get better.

They have to.

Don S. Dizon, MD, is an oncologist who specializes in women's cancers. He is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital.

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