Imagining A World Post-Covid

Written by Dr. Dalilah Restrepo

We (healthcare workers) were already suffering the consequences of “moral injury”, working for years in a broken health system, going home at the end of the day knowing the 15 minute visit is not enough because people need more time to get to the root of problems.

That the endless documentation of irrelevant facts to comply with a billing system or liability defense was occupying the core of the note instead of the medical documents’ intended purpose which is to describe an illness and communicate it to other treating clinicians.

That despite us being the ones who understood the disease best, our power to choose diagnostics and therapies was controlled by insurance companies willingness to pay for them and so our job became more that of advocating and fighting for our patients behind the scenes, this while being the face that delivered the news and for this, we took all the punches meant for another.

Moral injury results in feelings of hopelessness, negative self thoughts, guilt and shame, basically the “imposter syndrome’s” building blocks.

To that backdrop, along comes COVID, highlighting every fault and exposing the inadequacies we have been talking about ad nauseum but that has fallen on deaf ears.

We were already overcrowded, working at capacity, underfunded and resources were scarce.

How we deal with COVID-19 will determine whether we emerge victori ous, i.e. ‘post-traumatic growth’ . I am optimistic that the private sector will become interested in science again and that this collaboration can result in in novation so that our hospitals will have better equipment. This social distancing can be training for reinventing the ar chaic 9-5 schedule; perhaps work shifts will be staggered and less rigid in order to accommodate workers’ different life styles and family dynamics.

This crash course in public health and microbiology will reinforce basic concepts of preventive medicine, the importance of vaccinations, of hygiene

Babblings

UNTIL THE CURTAINS FALL.

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Some days are filled with lighthearted discussions allowing smiles to naturally emerge. Other days they don’t come as easily. Being a physician is different than what I thought it would be. I didn’t know that it would also require the art of acting.

The clinic, the hospital, our stages. Our patients, the audience. Corporate healthcare, our director. The practice of medicine, our performance.

Most of us who go into medicine do so for the love of science coupled with a desire to give back to our society. We spend years learning basic sciences ome days are harder than others.and then further our education by mastering the disciplines of anatomy, physiology, pathophysiology, etc. We are given no time to learn the art of acting yet our performance heavily depends on it. This is where our directors have failed us as they dictate our actions yet do so without any valuable direction.

For me, today’s performance consists of many acts, twenty-two to be exact. There will be no intermission. I go from room to room each as a different character. The director has me assigned to play every character in this performance. I wish I had more supporting actors however my director tells me I

PHOTO am enough and so I must morph myself into the image my patients require. The hallway will be my dressing room. I will have mear minutes to complete each costume change as I go on and off the stage, from exam room to exam room. All the while knowing that with each movement I make, my audience is judging my performance. Knowing that with each decision I make, my director is evaluating my craft.

The first patient is ready. I walk into the room, the curtain goes up. The performance begins.

COURTESY OF INGRAM IMAGES 20 | APRIL/MAY 2020 chemistry major, this class was meant to be easy, chosen to fulfill a random undergraduate requirement. The irony, it actually was one of the hardest classes I remember taking. My professor was a self-proclaimed B-list actor who had his first break in the mid 70’s with a recurring role on Charlie’s Angels. He would later go on to tell us that the death of his character would foretell his future as an actor. Luckily he was an excellent professor with a doctorate in filmography and found a nitch teaching those who had aspirations to be either on the stage or in Hollywood. Many times he would say, “To be a good actor is to be the ultimate pretender. So much so that one is able to convince others not that they are an incredible actor but that in fact they have become the character they are portraying.”

Act One: The Depressed Patient Scene: Patient in the exam room alone with increased psychomotor agitation. She is laying on the exam table uncontrollably crying. Her mother recently died in a car accident. Enter my character: The Empath

This patient needs time. A fifteen-minute visit will not suffice. My director will not allow me more time, however. I pretend this time is sufficient though I know it is not. I move through the visit, through my performance, as best as I can all the while wishing I had the time to sit and be a shoulder for this patient to cry on for however long she needed. My director would never allow such a thing. I can hear him in my mind as if connected to him through an earpiece, You must move on, you are moving too slow.

Act Two: The Uncontrolled Diabetic

Scene: Patient in the exam room with a 64-ounce cup of Pepsi sitting next to him. He acts sluggish though completely unaware of the ever-increasing ketones in his blood. Enter my character: The Jack of all trades.

This patient needs… everything. This act should be an hour-long but like

Act One I do not control my time, my director does. I have eight minutes because the patient was seven minutes late. I pretend that I am not rushed. I try as hard as I can to perform the role of physician, nutritionist, pharmacist, social worker in the allotted time but it is impossible, I run over. This man will avoid the ED, and further, avoid the ICU and will go on to live but the consequences of my running behind will be that soon my audience will become impatient.

Act Three: The Man Cold

Scene: Patient in the exam room with a runny nose, no fever, and normal vital signs. Symptoms started one day ago. He is visibly upset due to waiting thirty minutes. Like the audience in Act One, he too has psychomotor agitations but for different reasons. Enter my character: The Apologetic One

This patient needs to be a telehealth visit but my director will not permit such a thing. I am running behind due to my previous performance running over and now he is mad. I have to pretend to be sorry. But I am not sorry because this is not my fault. I wish I could tell him that I just spent the last thirty minutes teaching a man how NOT to die from diabetes. I wish I could tell him to take a Benadryl, a shot of whiskey, or a bite of wasabi, anything he wanted to clear out his sinuses and be done. I wish I could tell him that either way, it didn’t matter to me because he suffered from a man-cold, nothing that Google couldn’t have told him. I breathe. I take one, long, deep breath. I can’t tell him that. I can’t because my performance is judged by my audience and he is my audience. What he says determines my worth and ultimately my paycheck. While I want to be frustrated at this patient, it is not him I am mad at. It is the system. It is my director. It is my forced performance that has me upset.

Act Four: The Pregnant Teenager

Scene: Patient in the exam room sitting stoically though on the inside feeling uncertain as the pressure comes from the boy who does not love her to do what she is unsure of, all the while feeling judgment from her parents who don’t know she is waiting to speak to someone. Enter my character: The Maternalistic One

This patient needs guidance. She needs to be reassured that it is okay to be unsure. She needs a system that supports her, one that supports women and their autonomy. My director will not allow our system to provide her with what she may need. I must pretend that this does not infuriate me. I must pretend that despite the scientific data saying otherwise and my system stuck with backward beliefs that a God leads the decision making though corruption is deep within, that I am not enraged. I must be there for her as she is all that matters.

This continues all the way through until Act Twenty-Two when the performance is over. Each act requiring me to jump into a different character. This continues until finally, the curtain falls and I no longer have to act. I no longer have to pretend.

I want to be me: the physician with no strings attached without any costumes or make-believe characters. I don’t want to be the actor required to morph into someone new because the system that employs me does not value who I am or the education that has made me. I want not to be on a stage nor my day to start behind a curtain waiting to rise. I just want to practice medicine.

But for today the performance has ended and I get to be me.

Until tomorrow I will do it all over again and will continue to do so until the curtain falls once more. 1

Unsettling Revelations Emerge

WITH WALGREENS AND LABCORP