Before COVID-19, I could only ponder the importance of human connection in medicine, of narrowing the physical and emotional space between physician and patient. I wondered where we had wandered as a profession, one struggling to reconnect with the humanistic principles upon which it was founded. Though the incredible value of modern medical advancement is undeniable, progress in the field has been mirrored by a regression in engaged presence. The interpersonal element of care is now often buried beneath the weight of mounting financial pressures and time restraints, emphasis on the electronic medical record, and focus on optimizing numbers and statistics. Prior to the pandemic, I wondered at what destination we would arrive if we continued down this path. How would all of these forces detracting from human connection transform our quality of care and ability to practice the patient-centered principles echoed in each recital of the Hippocratic Oath? When COVID-19 arrived, I no longer needed to wonder. The pandemic ripped away the veil of uncertainty to reveal a view of what medicine becomes with the loss of human connection. It provided what could be a tragic lens into the future if we are not intentional about altering our course. We are suddenly faced with an intimate glimpse of a form of medical practice defined by limited physical contact, minimal bedside practice, and restricted family involvement. We despair in knowing nothing of what constitutes the human inside the isolation room, and face the inability to truly treat patients as people in the way they deserve. As the space between patient and physician grows, so too does the longing for touch and presence to fill the hollowness created by their absence. The deprivation of humanity in care creates a void that cannot be healed with medication. Patients are suffering, families are suffering, and healthcare workers are suffering. And they are often suffering alone. Months before I heard the first utterance of “COVID-19,” I followed a patient with newly diagnosed metastatic lung cancer on my Internal Medicine clerkship. He was one of those patients who reminds you of a new sweater – a little prickly at first, but transformed to a comforting favorite as you grow to fit each other in time. Our morning encounters became a welcome routine, me testing his strength and listening to the breath rustle through his lungs, he recounting stories of a life now fading into the distance. Something about him set his case apart from my other patients that month, but it was not the intricacies of his diagnosis or treatment plan. It was the way he was dying – alone. Disowned by relatives for his sexual orientation and since widowed, he received no family visitors or calls. I was haunted each night by chilling visions of radiation sessions endured alone, transition to life in a rehabilitation facility alone, and end-of-life discussions shouldered alone. In the face of tragedy, I turned to the only treatment I knew how to impart: empathy and companionship. I couldn’t cure his cancer or fill the cavernous emptiness in his social history, but what I could do was be with him. I could rest a hand on his in a moment of exposed vulnerability. I could share a smile and a little of my time. I like to think this brought a small touch of comfort to an otherwise Earth-shattering and lonely experience. The same sadness I felt leaving his room revisits me now. Thousands of patients are dying from COVID-19 alone. They are trapped in isolated, unfamiliar rooms, separated from their loved ones, and all that brings them comfort. I worry about what is missing from their care: presence, connection, touch. Once taken for granted, these are now avoided by necessity. When the pandemic eventually fades into the past, will its memory continue to drive the wedge of physical separation further between us and our patients? I cling to the hope that it will instead spark the embrace of personal contact even more fiercely than before. I hope for reflection on our experience in this difficult time to reveal what was true all along but is apparent now more than ever: we need humanism in medicine. Crises uproot the things we have buried and overturn what we have come to blindly accept, illuminating what is broken and revealing what is missing. They stretch the fabric of society, laying bare the very threads that stitch it together. But with destruction comes opportunity, a chance to rebuild and improve. While there is much to despair and regret about this time, I find encouragement in the potential it provides us to redirect our focus in medicine. The distance mandated by COVID-19 allows us to clearly examine the power of physical and emotional connection through the lens of its absence. We recall moments of comfort, trust, and fulfillment in relationships with our patients when embracing this connection in the past. Without it, we feel a hollowness and lament the burden our patients bear by enduring their darkest hours in solitude. The pandemic not only points to the need for humanism, it exposes it. In a way, the pandemic has fostered isolation and loneliness. But in another sense, catastrophe has brought the world together, demonstrating the courage and resilience that can be achieved when we unite as one. It has inspired a sense of solidarity and connection to our shared humanity, fertile grounds for replanting the seeds of humanistic care in medicine. The reverberations of COVID-19 will echo into the future – some that we wish to suppress, but others that I hope will linger like slowly-burning embers to fuel change for years to come. Let us allow these embers to re-ignite our passion for personal connection and bedside presence. Let us strive to reinvigorate the way we practice when the dust of COVID-19 settles, and the wall between patient and physician is leveled. Let us remember what it feels like to prioritize the humanized patient experience, and endeavor to narrow the space between us. Dominique Gelmann is a medical student. Source
