COMMENTARY

COVID-19 Diary Day 4: Am I Losing My Humanity? Already?

Don S. Dizon, MD

Disclosures

April 09, 2020

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

What a difference a week makes. Four days ago I wrote about the surge that we were expecting and how our institution was preparing by restricting visitors. Still, I was able to bend the rules and get an anxious father into the clinic so he could hear his only daughter's cancer prognosis and the treatment I was recommending. There are times when people need their family, and I was in a position to make that happen.

That was then.

Don S. Dizon, MD

As predicted, the number of people infected with COVID-19 is rising in Rhode Island, where I practice. A month ago, only two people had tested positive; as of April 7, 1229 are infected and 30 have died.

Given this increase, mandatory changes to our visitor policy were made: No visitors are allowed—a "zero tolerance" policy. I can no longer advocate for my patients or their families in this respect. Those admitted to the hospital because of a complication of cancer will be isolated; those nearing the end of their life will not get the chance to physically be with their friends or family; they will have to make do with video visitation. I understand that it's necessary, but this doesn't stop me from being deeply unsettled.

Perhaps it is because I feel that the art of medicine is under direct assault with these barriers. I pride myself in meeting someone's gaze, engaging them in conversation, and communicating with the power of touch. Whether it be a physical exam, a pat on the back, a firm handshake, or a hug at the end of a visit, these are bonding moments between a person seeking help and their doctor. At the end of life, the art of medicine is being in a room with your patient, their friends, and their family, and speaking the words that many are not prepared to hear:

"It's time."

"There's nothing more we can do."

"You're dying."

There is a solemnity to these conversations, an intimacy, and I've always felt the importance of being physically present for them. Communication, communion, and touch—these are the pillars of medical humanity.

I am struggling to maintain that intimacy now. I speak the same, but from behind a mask. I can only hope that my eyes reflect my tone in these serious conversations.

My video visits, whether they be routine follow-ups or to review patients' CT scans, feel short and impersonal. Often I resist the urge to check email or my smartphone—things I would never do in an in-person visit.

We've only just started our conversion to telemedicine. Is it possible that it's changing me already?

At the end of the day, there's no time to dwell on it. Cancer has not taken a holiday or sheltered in place. People continue to show up with a new cancer diagnosis; others are experiencing the devastation of relapse. The infusion unit continues operating and all service lines continue as well.

We will get through this. I am certain of it. But I'm less certain of the aftermath for those of us on the frontlines. Whether COVID-19 will have changed us—changed the way we empathize with and care for our patients—remains to be seen.

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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