I wrote my April article on sentinel events before the COVID-19 pandemic became “our” pandemic here in the United States. By early March, we, as health professionals, started to really pay attention to as much information as was available on SARS-COV-2 virus and COVID-19. So, when I was asked to write an article addressing how physicians can find support during this crisis, I was more than ready.
For about 14 continuous days (including four call days over a weekend, doing emergency cases before testing or clarity on what PPE to use was available), I had felt increasingly overwhelmed, with no sense of control, as if I were standing at the bottom of Niagara Falls drowning from information overload and tasks that required completion yesterday.
I was not alone. One of my anesthesia colleagues who’s Italian and whose entire family lives in Italy, became extremely anxious as we saw the horrific reality unfolding there. Our advanced practitioner from Iran also shared realities from countries with the highest infection rates. Until our organization definitively cancelled all elective surgeries and clinics on March 17, there was heightened fear and anxiety among all who saw the epidemic “train” barreling down on us.
Most of us who work in hospitals and medical centers have likely shared the same experiences: daily incident command messages, constantly evolving PPE protocols, clinical practice changes, transitioning from personal to virtual meetings, social distancing while at the hospital, canceling all clinic appointments and elective surgeries. While I knew I had to focus on the logistics of getting every provider trained and transitioned to telehealth, I was also keenly aware of the catastrophic financial impact we’ll face. Learning that our specialty, patients, and case types are at highest risk due to “aerosol generating procedures” and “superspreaders” created a constant level of anxiety that I’ve never experienced before.
Then there was additional stress on the home front. It helped that the week when all hell broke loose was when Florida schools were on spring break. (In hindsight, our decision for my husband to leave a start-up company back in September has been a blessing, as we didn’t have to worry about child care.) I was so focused on work that by the time I went to the store there was no more toilet paper.
It has been the most wonderful gift being part of the Pediatric ENT Chiefs group that communicates daily by email and weekly by conference calls to leverage our collective expertise and knowledge in real time, along with our ASPO leadership and those ahead of us in the pandemic in the epicenters of Seattle and New York City. I knew I was never alone—and that’s exactly the point.
I realized that I’ve always managed my stress and anxiety best by “doing”—developing and executing a strategy, then doing more. After all, “doing” allows me to believe I’m “fixing” whatever needs to be fixed. That formula has worked for me my entire life (although at the cost of a high degree of burnout before I became self-aware). But “doing” alone wasn’t enough during a pandemic. Doing the wrong things, at the wrong time, and not doing what was needed in alignment with our hospital incident commanders and those in charge, wasn’t helpful.
How humbling it was to learn that some of my perceived “stress” in the past few weeks was really just a matter of inconvenience when compared to some of our clinical staff who are single parents without family support and worried daily about being able to work. Learning to think outside the box to ensure that I supported their needs as much as possible, as well as observing physician colleagues’ conversations, emails, and behaviors, has given me the opportunity to reflect on my own emotions, anxiety, fear, and mood, and how they affected my team and my family. It was only later that I was able to articulate to myself who I became during this early and critical phase of the pandemic—I had to in order to help others manage their emotional and mental health needs.
Increasing Your Well-Being
Those who know me know I’d rather give up a kidney than not be able to hug someone. Refraining from hugs and handshakes and using human touch to convey care and love took a great deal of self-restraint, but it was necessary. Words are more important than ever before.
Perhaps even more infectious than COVID-19 are our negative emotions—pessimism, hatred, anger, anxiety, and depression. It’s critical to choose positivity, laughter, patience, and forgiveness to help us experience a sense of calm, control, connectedness, kindness, and love.
There are many things you can do for yourself to increase your own positivity and well-being during this time of crisis:
Observe your own moods and emotions. There’s no better time to try journaling: Write down your greatest concerns at home and at work, and steps you can take toward each concern. If there are none, shift your focus and energy to something within your control that you can act upon.
Learning that our specialty, patients, and case types are at highest risk due to “aerosol generating procedures” and “superspreaders” created a constant level of anxiety that I’ve never experienced before.
Recognize how you deal with anxiety, fear, and not being in control. I usually go into a “mega-operational mode”—logistics, planning, communicating, and doing. However, I’ve realized that this is when I must listen deeply and generously to my spouse and others at work. It’s important to acknowledge others’ fears and anxiety without absorbing them as your own, and to express gratitude and infuse positivity as much as possible, both at work and at home. Learn to meditate, take deep breaths, and listen to “healing music” at 432Hz, or “positive energy” sound at 528 Hz frequency.
Be aware of symptoms of overload. Remember, there’s only one of you, and you can focus on only one issue at a time. When I tried to multitask without taking deep breaths and having an invisible “barrier” between myself and others, I found that negative energy became amplified and both my team and my family didn’t get the best version of me. Managing my own reactivity, frustrations, and impatience with others was critical.
The news and social media are needed sources of information, but at times they only amplify fear and anxiety, especially over what we can’t control. Be mindful of what’s helpful and what’s not amidst information overload. Decide what to read and what to ignore. Every morning upon awakening, manage your compulsion to check the total number of COVID-19 cases and deaths globally, in the U.S., and in your state. Instead, take a few deep breaths and affirm your gratitude for another day with health and the opportunity to work, serve, protect, and love.
Consider mental health counseling. This is an extraordinary time for those of us who care for others, and it may drive some of us to think about dire options that may never have even crossed our minds before. Consider New York City emergency room physician Lorna Breen, who, after caring for COVID-19 patients and even after recovering from her own bout of the illness, succumbed to depression and took her own life. For so long, the public didn’t know or appreciate the crisis of physician suicides and lack of mental health care before COVID-19. Now there’s a better understanding and true appreciation of the value of all healthcare providers.
The news and social media are needed sources of information, but at times they only amplify fear and anxiety, especially over what we can’t control.
If you were already undergoing mental health counseling pre-pandemic, please continue—healthcare providers can use all the help we can get. If you were considering counseling, it’s a good time to start. It takes courage and self-love to understand that getting help isn’t a sign of weakness. Look for a mental health counselor in your area who has experience working with physicians. (You can also reach out to the National Suicide Prevention Lifeline at (800) 273-8255.)
Take care of yourself physically. Create good physical habits that strengthen your health and mental outlook. It’s so important to move because we’re home-bound—instead of rushing from one exam room to the next during clinic days and walking nonstop between cases during OR days, surgeons are now sitting like everyone else. Walk daily with your family, pets, or neighbors, practicing safe distancing. Be out in nature if possible, to remember that there is life beyond the virus.
Monitor your eating behaviors as well. The more time we sit in front of the TV watching Netflix, VUDU, Disney+, and HBO Prime, the better the chance that mindless snacking may occur. Your behavior and actions are influenced by your inner voice. For example, I ate ice cream with my husband and daughter every night for 12 days in a row. My inner voice apparently decided it was necessary to indulge in something I rarely eat regardless of my lactose intolerance and mindfulness about sugar and fat—being a physician didn’t make me immune. That same inner voice also told me that due to an extremely high level of stress, I somehow have a new lowered threshold to enjoy alcohol in order to relax.
Enjoy and embrace your downtime. Celebrate the fact that life has slowed down—so many hours have been reclaimed from driving children to soccer, piano, and sports lessons. Be creative about reaching out to family and friends. There are many ways to stay connected in our technological world:
- My sister recently sent video of my 3-year-old niece washing and cutting asparagus stems, as well as folding laundry Marie Kondo style.
- Our neighbors had their school-aged children make beautifully painted and decorated rocks and leave them all over our neighborhood. Those who saw the rocks while walking took photos and then posted them on Facebook. It created an amazing sense of connectedness.
Control your words to control your mind. Speaking positively to yourself can have immediate calming and wellness benefits. Take deep breaths frequently and often in your office, between telehealth sessions, at the hospital, when you’re on call—over and over. Tell yourself that you love who you are and offer yourself the same kindness and compassion you would to others. Each of us can do only so much for our patients and their families, colleagues, hospital, spouses/significant others, children, neighbors, and loved ones.
Accept that there will be new norms. We don’t know what each day will bring or how long this will last. There will be unprecedented change to the U.S. healthcare system that wasn’t coming fast enough on its own. But we can commit to be our best selves each and every day, in words and actions. If you’re able to, be part of the change by volunteering for discretionary committees or groups at your facility to contribute to efforts to develop protocols or solutions for PPE, surgery, or clinic recovery plans.
Acceptance may also mean being realistic about your own COVID-19 risks. If you have risk factors based on age or health conditions, and/or you live with families who are at high risk, speak up and let your physician or hospital leader(s) know. This is not a time to be stubborn or have something to prove. Stay home and opt out of the crisis management workforce labor pool.
As we all face this uncertainty, we can take comfort in knowing that we have each other—we are not alone. Together we will get through this and hopefully become a smarter, stronger, and possibly even a better version of ourselves.
Dr. Wei is division chief of pediatric otolaryngology/audiology at Nemours Children’s Hospital and director of the Resident and Faculty Wellbeing Program at Nemours Children’s. She is also a member of the ENTtoday editorial advisory board.