Mask. Shield. Gown.
6:30AM – with the sun still not up and the sky a dark abyss – I step out of my car, put on my face mask and start walking from the parking lot towards my first rotation at Masonic Children’s Hospital. As I course through the frigid morning air and enter the peds inpatient unit, my glasses fog up. I pause, wait for the fog to clear up, adjust my glasses, and retighten the mask around the bridge of my nose. As I walk past the double doors of the peds unit and the colorful backlights, I perk up and make my way towards my unit’s workstation. After settling into my workspace where myself, the other medical student, the intern and the senior resident are all spaced apart as far as we can, we await the sign out from the night team. Post sign out, we discuss the plan for the day and divide up the patient list amongst ourselves. I quickly call and check with the nurses on my patients to see how the night went before starting pre-rounds. As I start gearing up, I mutter to myself…“Mask, shield, glasses. Check. Pen, patient list, pager, unit phone. Check.” By the second week of this rotation, it almost seemed like a new dance that had its own rhythm.
I stopped outside the room of my first patient that morning—a 14 year old male with an eczema flare and possible skin infection. I read the “contact isolation” sign and don yet another layer: the gown. As I get ready to knock and enter the room, I wonder……Behind all of this gear, what part of me can the patient truly see? He certainly can’t see the expressions on my face, the color of my skin, nor the badge that states my role on the team. These days, behind all this gear, am I just another set of expressive eyes on his care team. How do I connect with him?
During these strange and trying times, the COVID pandemic has brought to light so many important and previously overlooked aspects of medicine – simple things like facial expressions (a warm smile), body language, gestures (a warm touch on the shoulder when providing reassurance), and skin color. All these simple yet essential aspects of connecting with patients seemed to be stripped away and hidden under layers of PPE. Although all practiced in good measure for the safety of everyone, I cannot help but wonder: Where is the human connection behind all the PPE? Where is the medicine that I once knew of—the medicine that relied on your expressions, body language, and gestures? The medicine where the similarities in the color of my patient’s skin and my own skin brought a sense of commonality and understanding of experiences? The medicine where handshakes were the means of introductions and brought with them a certain degree of warmth in the patient-provider relationship? I yearn for that medicine again – that art of medicine that goes beyond tests, procedures, and medications and the art of the medicine that gets to know the shared humanity of the patient in front of you.
Given the uncertainty of the times we live in today – I’m not quite sure how long this new norm will last or if it’s here to stay. Therefore, as we keep everyone safe behind those masks, shields and gowns, we must also continue to practice the art of medicine. Room-to-room, patient-to-patient, I find myself resorting to new and creative ways of keeping that humanity and connection alive in medicine. I take longer to introduce myself as I say my name and role on the team; I share something I have in common with the patient – whether it be the language we speak, our favorite color, or our favorite food. I write the names of all the team members on the whiteboard in the patient’s room and our treatment plan for the day. Despite being just another set of expressive eyes behind all the PPE gear, I hope these little gestures go a long way in building a connection with our patients. The pandemic has taken its toll on us, but it cannot take away the art of medicine. The medicine that is so profoundly rooted in connection and human interaction – the medicine, that like our bodies, depends on our senses such as sight, sound, and touch.
As I walk out of the patient’s room and take off my gear, I reflect on the changes over the past year since the start of the pandemic. Some good, some bad, and some that we have yet to make up our mind on. I see the restrictions on patient/family visitors even on hospice floors, I see loved ones grieving from afar due to restrictions on travel and funeral gatherings, I see the scars and bruises on the faces of overworked, tired healthcare workers as they take off their N95s before returning home. But amongst all of this, I also see the transition to telehealth and the ease of accessing healthcare—especially for the elderly, the immunocompromised, and those from rural areas. I see the reduction in healthcare costs that come with telehealth especially for services that can be provided over the phone or computer without inconveniencing or jeopardizing the patient. I see new platforms of communication and connection in the community. And most importantly, I see a more resilient and stronger community in medicine.
6:00 PM – As we finish signing out our patients for the day, I look outside the windows lining the hospital hallway; I see the sun setting in the distant horizon and feel the warmth of the golden rays hitting my skin. I smile as I walk past the double-doors of the peds unit and the colorful backdrop of lights near the entrance. These little touches to the environment are a constant reminder of practicing the art of medicine that not only centers around the patient but their comfort and their connection to the healthcare community.