Cats on Zoom and the Big Ugly Truth

Living in the time of layers of crises, I’m left wondering if cats on Zoom are a rebellious act and sign of a culture shift in medicine. Perhaps this is a shift in the balance between the professional and the personal, the perfect and the messy, the comfortable and the uncomfortable.

Being personal has an important place in health care, especially in family medicine where I spent most of my time. However, professionalism certainly has remained the focus and established norm. For me, this professional distance has placed my colleagues, residents, and mentors on a sort of mysterious and admirable pedestal, untouchable and nearly perfect. I was afraid this was a level of perfection I could never achieve. Still, I noticed the professional separation between myself and my patients and it was exciting to grow in my professional identity. I felt myself fit into my white coat more easily and walk around with some confidence with a stethoscope around my neck, no longer just a strange prop.

Then came COVID-19, and suddenly I was home in my pajamas scrambling to find a corner of my home that would be a suitable background for the onslaught of Zoom meetings ahead. My partner and I would compare schedules for who was going to need to be on audio because our shared space was so small that it would be hard to avoid hearing the other person in the background. I would just be getting off of a phone call with a crying loved one who wanted to talk about COVID19 conspiracy theories. Quickly turning on my camera for my Zoom meeting, I’m sure my lack of sleep was written on my face as I smiled, “hello, how is everyone?” I never realized what a loaded question that could be.

Many emails came about the importance of wellness and encouraging students to speak up when they were overwhelmed. In the past there were real or perceived obstacles in admitting to poor mental health, a temporary need for rest, a need to be late on a deadline, or an excuse to say “no” to something in the endless stream of responsibilities. Suddenly struggle was expected and part of casual conversation. Many meetings were held about ways forward, well-intentioned, but often too eager to skip to tying off lose ends and finding the teachable moment in chaos. Fellow students would share intimate struggles in the chat on Zoom. Silently, we held pain together without further motive around seeming impressive or resilient.

Other norms changed too. Zoom lectures with doctors in casual business attire would be interrupted by their half-naked toddlers. Quickly the doctor would rush to mute themselves and then gracefully announce that it was a good time to take a five-minute break. There was no loss in admiration nor trust in their abilities, but instead I found myself more comfortable and engaged in the rest of their lesson.

The all-mighty structure of medical education was once an immovable mountain. With the new authority of a pandemic, I turn to see Step 1 and other requirements kneeling to announce their farewells. I forgot that the system was built by regular people, perhaps when they were at home in their pajamas or with their half-naked toddlers. The system was not carved from stone by the force of nature as it had always appeared to me. Seeing behind this veil did not make the structure seem more flimsy, but more adaptable and trustworthy. Not a mountain, but a machine that we have all built and maintained and still have the tools to change.

Around the same time, a different sort of vulnerability was shown in the midst of the Black Lives Matter uprisings. Anger, normally an ugly-appearing emotion, became honesty. Political discussion became moral rather than unprofessional and irrelevant. Residents that I had been intimidated by as I practiced my oral presentation skills were now people I was partnered with in working on issues that were bigger than either of us. We were people hurting and spending their weekend holding trash bags for each other as we cleaned up glass along a burnt street.

Racism in healthcare was once a luxurious hour or so discussion or perhaps an extracurricular interest. It transformed to be one of our most pressing responsibilities. Racism and white supremacy showed itself in the bones of medicine as we analyzed the growing body count. My own colleague defaced the memorial. I think of the years my peers of color discussed race with me only to now watch the shock on white faces. As the owner of a shocked, white face this was a time to lean into every bit of discomfort I could and to not hide this journey through a glorified and idealistic lens. Now was not the time to be perfect, now was the time to embrace the ugly and uncomfortable and messy.

The importance of professionalism is not diminished. However, vulnerability is also key to my own confidence and identity in health care. While we will clean-up, organize, and systematize our approach to this new world, I wonder what messiness should remain. What will be swept back under the rug or, with all the best of intentions, be set on a display shelf to collect dust and call no attention to itself or what it once stood for. I wonder what the future has to say about the professionalism of cats on Zoom.