COVID-19 has given us many things, some of which we expected. Scarce resources, anxiety about keeping ourselves and our families safe, a sense of unparalleled vulnerability, and a solid helping of helplessness, knowing ultimately we may not be able to function as the doctors we strive to be when it matters most. Personally, COVID-19 has given me an unexpected gift—one I really hadn’t seen coming. Psychologists call it the “dissociative state,” a coping mechanism used by victims of trauma, where they develop an internal duality—a chasm between what they feel and what they do. It allows people to function in times of unbearable emotional discomfort, offering the ability to subjugate moral injury and still do the tasks expected of daily living. This chasm that COVID has created had unearthed some incompatibilities in my life I had managed to ignore, much of which surfaced once I found myself on restricted shifts at the hospital. The doctor role of expert “hero” contrasts wildly with the inadequacies I experience at home, balancing the demands of mothering, schooling, and partnering. If ever I’d felt any hints of the imposter syndrome at work, it’s nothing compared to what I experience at home right now—pulled in many directions, with kids videobombing conference calls, and me distractedly half-ignoring family to respond to the near suffocating influx of urgent emails, messages, and updates. Let’s call it here: I’m only half present with either of my key stakeholders (work and home), which presumes that the runner up of self is such a distant also ran that it’s not even in the race. With more time away from the hospital, I realize how much I’ve allowed the role of physician to overtake my identity. Quite ironically, in this Great Slowing Down Of America, my usual laser-focused pace at work is now a tangled mess of distraction, half-presence, and disrupted effectiveness in all domains. Replacing my usual compensatory over-organization, it’s now a triumph to even remember to put something on my to-do list. The decades I spent conditioning my extended family to presume I am not available to them for holidays or even a phone call has become painfully apparent. The number of meaningful friendships I had managed to cultivate through the “busy-ness” of doctoring is small. And even though you’d think having a degree in education would prepare me for homeschooling, the half-attention I give this task has landed both me and my kids in frustration. Some of the gospel I had accepted as a physician seem almost surreal and meaningless at the moment. Not long ago, compliance meant discarding surgical masks every time we exited an OR, and I could easily burn through dozens of masks a day. Now we cling to the reuse of these items until they are nearly unrecognizable. There’s been a surge in virtual interfaces to bridge the divide between live patient care and physical isolation at home. I’ve come to cherish my online meetings with others for work and social reasons. But in some fundamental truth, this is also a glossy surreal surrogate for real connection, and the disconnect between “virtual” and “reality” widens the dissociation. I joked that in a recent formal online interview that we could all be wearing pajama bottoms and bunny slippers. This half-seen, show-only-what-you-choose virtual reality is the rickety bridge we have for now to connect us. So with an identity all tied up in doctoring, COVID has offered me a new set of forced insights. I’ve had to learn how to genuinely engage with my children on their agenda rather than mine. I’ve learned how possible it is to connect with my retired parents in the middle of the day, even for only five minutes. I’ve learned a little self-compassion when I dust off some old piano repertoire, and that there’s no greater joy than seeing my pajama-clad preschool daughter whirl around the living room with reckless abandon as I fumble my way through some shaky Chopin. I’ve finally seen the cherry tree that blooms every year at this time in the daylight, rather than in dusk and dawn as I pull in and out of my driveway to and from the hospital. I’ve even learned to be a morning runner. I’ve learned that only I control my own mind, and that I can decide how much anxiety to let in. And most importantly, I’ve learned to forgive myself for looking past all the daily wonders that have always been available to me, had I chosen to look up from doctoring for even just a moment. A fundamental tenet of physicianship is integrity, defined in terms of honesty and moral principles. But integrity also translates to “the state of being whole and undivided.” Until now, I had let being a doctor create a divide between my professional identity and that which I have outside of the workplace. Even my name is at odds: Dr. Black at work and Mrs. Ries in the neighborhood. I would strive to “leave it at work,” with micro-meditation and deep breathing in the driveway before I exit my car when I get home. By giving doctoring the singular focus I was convinced it would require in order to be expert at the job, I have often overlooked the serendipity of mundane surroundings, unwittingly cutting myself off from sources of bliss. Don’t get me wrong—I love my job, and the work of doctoring gives me great joy. And so do pale pink cherry blossom petals wafting through the air. The thing about the dissociative state is that eventually, all the things we bury and work around will surface and will need dealing with. Over the past few weeks, I knew I would learn a lot about virology, epidemiology, virtual communication, and social media influence, but didn’t realize I would learn so much about myself. Thanks, COVID, for forcing me into a new uncomfortable space. I’m hoping to come out on the other side of this with a greater sense of integrity, having repaired something I hadn’t even realized was broken. Stephanie Black is a pediatric anesthesiologist. Source
