2021 John Henahan Prize

What Have We Been Missing?

By Dr Diana Dragnea

HAS COVID-19 CHANGED LONG-TERM CLINICAL PRACTICE? Definitely, at least on an individual level. Over the past ten years, I have noticed a gradual and striking change in myself. I became aware of many things I had learned in the previous years and often wondered: How come I didn’t know these obvious things before? But in 2020, I initially thought that my personal development had stopped.

WHEN THE BODY PUNISHES YOU I was in a constant loop. Waking up > driving to the clinic > driving back > having dinner > working on my computer > going to bed > waking up... I was stuck in a constant state of fatigue and stuffiness. My body began to protest giving me neck and back pain. I ignored it. It increased. After a while it turned into a kind of numbness mixed with episodes of severe ache. The problem worsened on OR days, as in full concentration I would completely forget the pain which helped me to hold whatever position I wanted. Immediately after surgery, my body would start screaming.

A friend said to me one day: “Just because you have a Ferrari doesn’t mean you have to drive it full speed.” Very slowly I came to realise that working at that pace was making me sick and this was also affecting the quality of care I was giving to my patients. Finding peace of mind even in hard times is crucial. But this is a long process.

DEATH During the first lockdown I realised that as ophthalmologists we are far from being exposed to death. I only spent a week in a COVID ward and I still remember vividly the first patient who died. I was standing in the staff kitchen, staring at the monitor and suppressing as much as I could. The monitor showed from above a man who was agonising alone in his bed. I was somehow calm as this was a story from another dimension that I could turn off at any moment. The black and white screen was also helping. All the actors from black and white movies are dead by now and I feel no tragedy in that. But the thing that really saddened me was that his family decided not to pay him a visit. They were given the option of going in with full protection for a short time or staying with him as long as they wanted, but to remain in quarantine as well. The answer was no. I became much more aware of my patients’ fears and anxieties and decided to listen more.

YOU DON’T KNOW WHAT YOU HAVE UNTIL YOU LOSE IT It was never difficult for me to distance myself because I was never particularly “that warm” with my patients. Not because I didn’t want to put my hand on their shoulders, but because I was taught that it might be inappropriate. In the midst of the pandemic, while accompanying an 88-year-old lady who thought I was a student, I witnessed a somewhat natural lapse that reminded me of what I had been missing even before that. She was abiding by hospital rules and, despite her age and the sudden onset of double vision the previous evening, had brought no relatives and remained alone in the waiting room with her mask fallen under her mouth. The moment I asked her to follow me for consultation, she immediately approached and slipped her hands under my arm as if it were the most natural thing in the world. My righteousness was instantly disturbed. But I immediately began to feel an immense warmth fill my heart as I slowly guided her to the doctor’s room. She said smiling to me: “Don’t worry, I had my injection this morning.” ...She must have felt my rigidity.

Since she had partial gaze palsy in downward direction, I called my orthoptist colleague to do a full examination of her eye movements. During the examination, the lady reminded me that if I hadn’t started university yet, I should consider staying in the department as it is a great place to learn. With the suspicion of a brain stem insult, she had to be sent to the emergency department for possible admission to neurology. Instead of calling the transport service, I decided to personally bring her down two floors so I could enjoy a few extra minutes arm in arm with her.

Maybe this pandemic is a reminder of what we missed long before it started. Some of our humanity and care for ourselves and others.

Because of my upbringing and exposure, I never paid much attention to small physical closeness with patients (except when a Polish patient wanted to kiss me for joy), but now I long for it and want to experience it more once our lives are safe again. As well as taking better care of myself and listening to my patients more. These will be long-term changes in my individual clinical practice. And perhaps in many others.

Dr Diana Carmen Dragnea is the winner of the 2021 John Henahan Prize is for her essay What Have We Been Missing. Dr Dragnea received a specially commissioned trophy created by Irish designer Shane Holland.