I am A Physician And I am Not Isolating Emotionally

I am a physician, and I am not isolating. Like the Vietnam War defined my parents’ generation and World War 2 defined the generation before that, the COVID-19 pandemic will likely define mine. My father and grandfathers went to battle – I am now called to be a soldier. My small group of orthopaedic trauma surgeons agreed this morning to rotate in and out of hospital shifts every two weeks. This model is built to allow each physician provider to get sick and then recover – while still enabling us as a group to provide necessary trauma care to the city of Atlanta. We built this schedule assuming the inevitability of us getting sick – and that is scary. I need social interaction and support now more than ever before.

By “not isolating,” I do not mean that I will contradict the Centers for Disease Control and Prevention guidelines to practice social distancing. I am following these recommendations to their fullest. I have set up a home gym to keep physically fit, I am ordering in all grocery delivery, and I am walking outside daily by myself. I am strictly avoiding in-person social interactions at all times when I am not at work, and I am washing my hands until they are raw. I am the poster-child for the CDC.

Social distancing, however, is very different than emotional distancing. One of the biggest struggles with coping with COVID is that we are uncertain how long this is going to last – but it is certain to be weeks or months, not minutes or hours. At baseline, physician mental health is a known issue – with the majority feeling overwhelmed or burned out before this pandemic struck. 35 percent of physicians don’t receive regular health care for themselves normally. Suicide rates are 1.4 to 2.3 times higher than the general population, even outside public health crises. I can’t imagine how this is affecting our workforce now.

In times of crisis – particularly for health care workers in the thick of it – we must avoid emotional isolation. Scientific studies of solitary confinement and its damages were first reported in the mid-19th century. Additional studies followed in a wave in the 1950s, as a response to prisoner isolation during the Korean War. Modern studies involve prisoners in solitary confinement.

Solitary confinement in prisoners worsens anxiety and panic attacks, and increases paranoia and hallucinations. Anger, despair, and depression are coupled with a high risk of suicide. Prisoners in isolation in California account for just 5 percent of the total prison population, but nearly half of the suicides. In addition, prisoners in isolation are found to have uncontrollable obsessive behaviors – perseverating over tiny details or personal grievances – without the usual mental checkrein provided by collaborative thoughts and discussions from social interactions. Prisoners say that they are afraid they will never be released and that they will die in solitary. Long-term, they are found to have memory and cognitive decline, and complete re-integration into society following solitary confinement is extremely difficult, if not impossible.

Because of all of these negative consequences, the United Nations’ Nelson Mandela Rules states that solitary confinement greater than 15 days constitutes torture.

In 2018, a poker player named Rich Alati accepted a bet for $100,000 that he could not last a month in solitary confinement. He was not allowed any human interaction, and could not have any light-emitting devices. Food was delivered to him in irregular intervals, so that he could not mentally calculate how much time had passed. Rich did not last the full 30 days – he quit after 20 days – accepting a payment of only $64,000.

Explaining why isolation is so damaging is complicated – but can be distilled to basic human needs for social interaction and sensory stimulation. It is known that reconnecting with humans reduces loneliness and helps restore good mental and physical health.

In times of crisis, Abraham Lincoln called his citizens to “listen to the better angels of our nature.” That is, we need to go beyond what comes easily or naturally. Choose kindness over meanness. Fight the lesser angels that may come more naturally, and seek alignment between tribes, avoid bullying, and don’t fight over limited supplies (whether it be toilet paper or Personal Protective Equipment). Lincoln was a president at a time when the country was in turmoil and was as divided as ever – North versus South, Black versus White, citizen versus citizen.

As a health care worker in the thick of this during a very uncertain time, I urge us all to emotionally congregate, while practicing social distancing. I am hosting a virtual dinner party for my medical school friends on Saturday night – and I encourage you all to do the same this weekend.

My best friends from medical school, and I have overcome a lot of hurdles together – anatomy lab, boards, marriages, children, etc. — and we will be getting through this together. I am so beyond proud of my best friends who are serving this week as the medical director of inpatient oncology at a major Boston institution, on-call for microsurgery/plastic surgery in a city on lock-down (San Francisco), inpatient endocrinology, and outpatient transplant medicine. I am on standby to cover trauma, and will be stepping in to do so if someone gets ill. We need this dinner party on Saturday to process and recover, combat the effects of social isolation, and enable us to re-enter the health care workforce stronger than ever.

According to the Mayo Clinic, reconnecting with others Increases your sense of belonging and purpose, boosts happiness, improves self-confidence and self-worth, encourages physical well-being, and helps us cope with trauma.

To all health care workers, this is our moment to lead, and to define how our generation responds to crisis – we need to use the opportunity to facilitate a safe emotional congregation during periods of physical isolation.

Let me know if anyone wants to swing by for dinner on Saturday.

Mara L. Schenker is an orthopedic surgeon.

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