Isolated, Not Alone

Charlie Parr’s folksy voice and plucky 12-string slide guitar warbled through my old record player: “You know exactly what’s lurking out there, it’s all on the news every night.”I frowned. Reset the needle. Listened to the song again. Although ‘Over the Red Cedar’ was released in 2015, the lyrics had a prophetic accuracy for events on and directly thereafter March 11th, 2020. I am, of course, referencing the COVID-19 pandemic and subsequent social upheaval as America continues to enact social distancing measures. Social distancing (while necessary to prevent transmission of this dangerous virus) has taken a psychological toll on Americans laboring through prolonged isolation.

Social isolation has incited or magnified adverse psychological consequences for many Americans. One recent study that measured American wellbeing during quarantine found that the incidence of anxiety is as high as 32% and depression as high as 34%.^[1]  Among those who reported worsening psychiatric symptoms, low-income individuals were noted to be most at risk.^[2]  In my own correlative experience on an inpatient telemedicine psychiatric rotation, the data metamorphosize from arbitrary numbers to tangible people, people with unique experiences and struggles. One such patient I encountered was a recent ED admit, on the unit for suicidal ideation. I was tasked with doing the admission H&P, which is a challenge with any reluctant patient but downright formidable when the most soothing bedside manner I could muster was dampened by a grainy Zoom video. Despite the barrier of online communication, I coaxed the necessary information out of the patient. He was a homeless veteran with pre-existing Major Depressive Disorder and PTSD. He had recently lost the tent that served as his home in a fire. He then turned to a local shelter for housing but found it inaccessible due to quarantine restrictions. He could not self-isolate for two weeks because of the social stressors that surround chronic homelessness. In his words, “I had no decision left to make” and was brought to the ED after a failed attempt to jump in front of a train.

My H&P list of questions exhausted, I thanked the man for his time and concluded the interview. I was left to ponder questions only half-formed, new issues that I had never expected to encounter before the COVID-19 quarantine precautions became part of our  daily lives. It was obvious the patient was suffering psychological consequences amplified by Covid-19 restrictions . Even my virtual interaction with the patient posed a barrier. It is certainly harder to display empathy through a computer screen. How can physicians provide care for patients, despite this newfound separation? As any good student of medicine would do, I consulted my attending the next day with my concerns.

He thoughtfully considered my request. We began by discussing the staples of any good patient-clinician relationship: teamwork and communication, among others. If fostering a patient relationship was like baking a cake, there was a set amount of ingredients that matched every unique person’s needs.  Such as: one-part empathy, two-parts listening, a dash of skill. If any ingredient was missing, the cake wouldn’t rise. If there was too much of another ingredient, the cake would become misshapen and lumpy, a less-than-ideal form. Unfortunately, it became harder when trying to bake the cake remotely. We had a slimmer margin of error to form meaningful relationships with patients. That made our training even more important. Virtual interactions were a new and unknown ingredient. It shook things up. Out of necessity, physicians pioneered virtual medicine.

The last few months have highlighted the astounding tenacity of physicians. If this pandemic has taught me anything, it’s that hardship can bring out the best in people. Collectively, the healthcare community rose to the challenge of the COVID-19 pandemic. We researched our knowledge gaps, adapted to ever-changing policy updates and treated our patients, sometimes at personal expense. We collaborated with one another to develop groundbreaking new treatments in record time. We learned to navigate virtual mediums with our patients while retaining the humanity that blends medicine into art and science. The landscape of medicine has changed dramatically since the pandemic began, but healthcare workers across the world have united to tackle this challenge head on. Now more than ever, I have a newfound respect for the field of medicine and am excited to one day enter my own practice and contribute to the field’s resilient legacy.

The music from my beat-up record player faded away, the folk album was complete. In my musing, I hadn’t realized it had still been playing. It is true that Americans everywhere are isolated right now. Despite the isolation induced despair that has befallen our nation, there are great people in medicine, armed with science and compassion, working on a cure for both the physical and psychosocial woes of COVID-19. A smile split my lips before I could help it. Yes, we were all isolated. Temporarily, but not forever. That sure as hell didn’t mean we were alone.