March 27, 2020
The new decade is off to a dramatic start. Across the globe, Australia was devastated by wildfires, and hitting us much closer to home, Nashville was simultaneously struck by four tornadoes, and Utah was shaken by earthquakes.
Now we are faced with an invisible foe—COVID-19—which may have seemed far away to many of us at the time of the STS Annual Meeting in January, but now has turned into a worldwide pandemic. As of March 27, 2020, there have been more than 575,000 confirmed cases of disease, which has claimed the lives of 26,000 people and rising.
The coronavirus fully consumes us at home and work, and as health care professionals, we are at much higher risk of contracting the virus as we continue to care for patients. Anxiety and stress are palpable in the hospital—practitioners worried about their patients, their own safety, the impending shortages of basic supplies—all while we brace for the full impact of the pandemic.
For early career surgeons, this can be incredibly overwhelming. Transition to practice is hard enough. We currently are facing a health care crisis that is taking over all aspects of human life, and many of our mentors have never experienced anything of this magnitude.
We were compelled to write this blog article after speaking with friends and colleagues who felt like they were struggling to find firm footing. By no means do we have all of the answers, nor can we predict what the future holds. However, we hope to share some recommendations that we have found particularly helpful for staying grounded during the pandemic.
Expect change and shift expectations
Within the last week, many of us have transitioned the outpatient portion of clinical practice to telephone and video visits. We have been tasked with canceling elective cases, personal protective equipment is being rationed, and we are being required to use special screening entry points at work. Modifications are happening quickly everywhere, and every morning marks additional changes to our practice and patient care.
Rather than worry about trying to predict all changes, we have found it helpful to be proactive when you can and work through the surprises. Understand that you may be working with new or different team members, and you may only have a skeleton crew. Hospital coverage may look different with partners rotating for inpatient rounds. You also should expect potential verticalization of the OR schedules. Don’t be afraid of halting your practice temporarily to allow resources for the hospital during this crisis. Importantly, do not hesitate to contact colleagues or leadership to clarify changes or ask for help with implementation.
We currently are facing a health care crisis that is taking over all aspects of human life, and many of our mentors have never experienced anything of this magnitude.
Having a daily routine of getting up, eating, showering, and putting on work clothes, even if working from home, can help maintain a sense of purpose and normalcy for each day.
Set realistic goals and be sure to take breaks
When we heard that we were going to have to cancel cases, our nature as surgeons was to think about how we might dramatically ramp up research and start a number of new projects. As it turns out, our administrative burden has increased dramatically as we transition to telemedicine, daily COVID-19 conference calls, education modules, and more. If you’ve made yourself an overwhelming task list, revamp it to create clear and achievable goals each week. This will help you maintain momentum without adding stress. Don’t forget to celebrate accomplishments and victories along the way.
Set time aside for self-care
Everyone copes with stress differently, and it will be important to rest and decompress from work. Take time to enjoy hobbies, learn something new, exercise, and check in with friends and family. We are fortunate to have technology that allows us to see our family even if we are separated by one mile or even thousands. Some fun ideas that leverage technology and help keep you connected to friends include hosting happy hours via video chat, planned at-home workout classes “with friends,” social media cooking tutorials, and exercise challenges. Even while social distancing, you can get fresh air, stay healthy, and remain engaged with the people you’d normally see “in real life.”
Set boundaries for the negative news
If you turn on the news, for every hour of negative headlines, there are only seconds dedicated to featuring stories of hope. While it is essential to stay informed, it will be necessary to limit screen time and its constant barrage of negativity in order to avoid burnout. Choose high-value, reputable news sources for updates. Be sure to find stories of hope and connectedness as well.
Let go of the guilt
For those of us with partners, children, or other members of a household, we recognize that we may be their greatest risk factor for becoming infected. This is a heavy burden to bear, and it’s essential that we do not allow that to prevent us from being effective at work. It is important to remember that our roles provide enormous benefit to our families. They love us. They are proud of us. They will not hold it against us. So, we cannot hold it against ourselves. That being said, please do everything you can to create layers of protection between your home and the items that go in and out of the hospital (see below)!
Everyone copes with stress differently, and it will be important to rest and decompress from work.
Make your home as safe as possible
Follow all of the normal standard precautions: wash your hands, don’t touch your face, maintain distance of 6 feet when possible, wash your hands, and wash your hands some more. But given the high risk that we have of being exposed at work, what else can you do? We’d recommend wearing clothes into the hospital that do not require dry cleaning, and if possible, change your clothes when arriving to the hospital and prior to leaving work. Leave shoes and bags in a garage, mudroom, or other decontamination area at home. Consider showering as soon as you get home. Always sanitize your hands after touching public items and before touching your phone! Consider stocking up on basic flu diagnostic gear and treatments like a thermometer, sat/heart rate probe, over-the-counter medicines, etc. Set up contingency plans now for yourself and your loved ones in the event that one of you becomes infected. Where will you quarantine? Who will you go to for medical help? Plan this ahead of time, and it will reduce stress and anxiety.
Delegate non-essential tasks
The world is changing, but we all still need to eat, clean, renew prescriptions, and take care of everyday needs—including finding toilet paper! Many of us have aging parents who require additional support or young children who are now out of school. Trying to balance career and life can be a challenge, especially in times like these. Remember, it takes a village. There are a number of emerging resources to help run errands, deliver groceries, and even provide education and entertainment. Leverage any and all of these to help you. Be sure to sanitize deliveries to your home as much as possible.
Team is more important than ever
Remember that we are all in this together. Emotions will be high. People may behave in manners that are not their norm. Be understanding, forgiving, and kind. Be aware of your own feelings and anxiety as well to avoid taking out stress on those around you.
Recognize signs of burnout
Health care providers around the world are describing physical and mental exhaustion. All health care providers during this time are at risk for depression and burnout. If you are feeling overwhelmed by emotions of sadness, anxiety, and worry, or if you are having difficulty enjoying activities or eating and sleeping, please ask for help.
The end result
This is a scary time for all of us. No doubt people are already longing for the moments when we can talk about the pandemic in the past tense.
Our hope is that despite the tragic loss of lives, we will come out of this stronger from a medical standpoint—better emergency preparedness plans, more experienced airway protocols, as well as more robust ECMO programs and telemedicine options. We also hope to be stronger from a societal standpoint—unifying against a cause, redefining bravery, and celebrating forgotten heroes. Certainly, being front line practitioners during this pandemic will make us all stronger as individuals.
To all of our readers—please be safe, be well, and don’t forget to be a helper.
When I was a boy and I would see scary things in the news, my mother would say to me “Look for helpers. You will always find people who are helping.” To this day, especially in times of disaster, I remember my mother’s words and I am always comforted by realizing that there are still so many helpers – so many caring people in this world. –Mr. Rogers
For more information, see the STS COVID-19 Resources page.