While I was pulling late nights in the Wills Eye Hospital ER as COVID-19 shut Philadelphia down, my aunt's body also began to shut down half a world away. She was 2 years into her battle with breast cancer, but suddenly began to lose the war. Further exacerbating the sense of defeat was the distance separating us. My residency schedule already limited the amount of time I could travel to be with her, and the advent of COVID-19 eliminated any opportunity I had to see her again.
It's a tenuous balance: grieving for your impending loss and accepting the uncertainty of the world around you, all while attempting to stand by your patients when your own sense of confidence has been shattered. The experience has forever affected how I approach medicine and the world around me.
Parallel to the rise in number of COVID cases around me, my aunt's vital signs began to fall precipitously. I tried to stand by my family virtually, mostly by facilitating conversations with my aunt's oncologist. In between patient encounters, I would squeeze in a quick check-in call with her doctor.
Despite the "MD" tacked to the end of my name and the reputation of a solid training institution behind me, I was still nervous to reach out to a fellow physician: nervous about their judgment, about bothering them, about the repercussions of potentially being perceived as overbearing for asking questions about a field that was not my own.
And let's face it, I am probably not the only one who has had these worries. They stem from the fact that there are significant time constraints on us as providers. At the end of a long shift, as much as we wish we had the emotional bandwidth, the work can seem endless. Because while we're answering patient questions, in the back of our minds we're also processing the paperwork, the charting, the phone calls, the patients yet to be seen. These time constraints point to a broken system — a system that breaks doctors down to better serve the interests of insurance companies than of patients.
I entered medicine so I could be there for my patients, fully. And yet sometimes, on the other side of medicine, I feel a pull between being present and just trying to make it through my day. As trainees in particular, we have to make the constant choice between fulfilling the basic duties of being a resident and spending the extra time to be present with our patients (an immeasurable and often understated task). We reason that we should see more patients to learn more and see more and do more. We skimp on interactions and connections because we falsely assume that the learning is not there. We lose the time with our own family because we have convinced ourselves of this urgent need for busyness. In the end, our patients lose. And we lose ourselves.
My aunt Samar died shortly after I started writing this. I did not get to see her again. My saving grace was that I could channel my grief into being fully present for my patients since I could not be there for her. The reduced clinic volumes required for social distancing actually allowed me to connect and communicate with my patients in a way that I simply did not have time for before. I now see each of my patients in the way that I hope my aunt's physician saw her: as a person with a family and a life outside of those hospital walls and not as just her disease.
COVID-19 has highlighted the immense pressure we physicians face to not only care for patients during stressful times, but to also stay afloat despite the rigid administrative responsibilities assigned to us. We have witnessed how, as a society, we have allowed for those who care for our well-being to have their time and attention stretched so thin that their own well-being may become compromised. We were also assigned to restore and preserve sight at a time when the world around us was precarious and uncertain. In that moment, we all had to make the decision of whether we would recoil in fear of the virus or stand strong alongside our patients despite the risk. We chose to be there for our patients.
In ophthalmology, we are lucky to have high rates of both patient and physician satisfaction, but that does not mean we cannot strive to be even better. The COVID crisis can allow us to identify what artificial barriers exist between us and our patients, which will allow us to return to clinical interactions that are patient-focused and rewarding. I presume this will not have a quick remedy, but I hope we move toward creating a system that allows these two aspects to complement — instead of compete against — each other.
Opinions expressed are solely Cherie's own and do not express the views or opinions of her employer.
You can connect with Cherie on Twitter: @CherieEyeMD
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Cite this: Cherie A. Fathy. Hindsight Is 20/20 When It Comes to COVID-19 - Medscape - Oct 22, 2021.