The stuffing of things into organs for a desired effect, in this case, fattening a goose, is first recorded in Ancient Egypt and has since been used in multiple culinary traditions. It is now best known for French cuisine. What gastronomes desire animal welfare people abhor. The preferred method is to put more things (food) into an organ (stomach) to cause a secondary change (liver). I am sure the geese are not happy, but the patrons of the delicacy surely are. Who would think hepatic steatosis would be a good thing? Yet, I think this analogy is pertinent in our current COVID pandemic. The marriage of newly technologically enabled online meetings and learning opportunities with the COVID pandemic was fortuitous. It connected us with patients, our colleagues, and current minute to minute updates on the science and treatments in the shifting sands and whiplash of information about COVID. It also offered us a smorgasbord of extracurricular topics from which to amuse ourselves during lockdown. We needed up to date information provided through the internet to be informed physicians and to have an online presence for our patients. Separated families could share birthdays, religious observances, and reunions. Adding the word “novel” to the virus’s name made us not feel so dumb. “Novel” means we have no previous body of knowledge from which to draw and offer reassurance to our patients, adding to the overall angst that physicians feel. On a personal note, this is eerily reminiscent of working on the front lines in the early days of HIV. Once the Zoom genie was released from its confinement, scheduling a meeting became almost too easy. The usual excuses not to attend were no longer valid, and there was tremendous peer pressure to have your video presence or name in one of the boxes on the Zoom screen. Slinking out of a meeting no longer meant tiptoeing out of the back door but announcing to all that you “left” the meeting. Early on, we all fumbled with mastering the Zoom meeting, and “hit share screen” or “mute your microphone” shouted in the background by those technically savvy became the prequel to most meetings. The national meetings went online, became free, and they threw in CMEs for good measure. In addition, my bucket list of interests all appeared out of thin air, beckoning me to learn how to cook Indian food, study Impressionist art, do online exercises from my closed gym, ad nauseum. And since we, as physicians, are self-selected for curiosity, I became a worse information junkie than I already was. I hesitate to use the word “knowledge junkie” because that means “retention” of all the information I stuff in my head which, sadly, did not occur. In the early days, this all seemed an intellectual Nirvana. Slowly as the pandemic continued, the Zoom fatigue set in. “Zoom fatigue” is similar to the definition of pornography by Justice Potter Stewart in 1964: “I shall not today attempt further to define the kinds of material I understand to be embraced… ut I know it when I see it …” This phenomenon’s cognitive causes include a synchronous disconnect where the screen delay, even by a millisecond, can cause an uneasy cognitive dissonance. The brain then tries to compensate by further taxing our circuitry even more. We lack the necessary signaling of the nonverbal cues when only looking at one’s face. The presenter’s large face only a few inches from our screen may evoke our primordial threat response with its resulting cascading transmitters. The angulation of computer and phone cameras causes facial distortions. Unless one aligns oneself to be at the same level as the camera, the camera angulation may cause one to feel either looked down upon or looked up to, but rarely on the same playing field. Our neurons are living and breathing cells, and they need to eat and rest. The brain is responsible for filtering through vast quantities of homeostatic signaling from the rest of our bodies, which may affect the limitation of information that we can process. Our neural circuitry limits our information processing capacity. Just ask why can’t we pay attention to two ongoing conversations at one time? Electrical circuits have breakers for overload. We just have coffee. Should the pandemic stretch out for any great length of time, an augmented or virtual reality platform will be available to those privileged few with the proper equipment and bandwidth, which would mitigate many of the above issues. Of course, in live meetings, the presenter would not be interrupted every 20 seconds with a question, but now everybody can “chat” comments, questions, a hello from … all of which distracts both the presenter and listening audience, adding to the Zoom fatigue. Now that the monster has been created, how is it vanquished? I think to accept the limitations of the number of things we can stuff into the goose is the first. The calendar on my computer usually has five events every day at 7 p.m. when I thought nothing of registering for events that sounded interesting at the time. Just because we can increase our computers’ ability to store information by buying a larger drive does not mean our brains are capable of a similar feat. If you miss the lecture on gravity and black holes, you may not sound so smart at a dinner party but by the time dinner parties again arise from the ashes like a Phoenix, you would have forgotten it anyway. We can go a far way by projecting common decency digitally. You would not scream something while someone is lecturing, so turn the chat function off. Position your camera in the same plane as your eyes, avoiding angulation, and keep a distance from the screen. We should not unleash the Four Horsemen of internet conferences that can be accessed from “the comforts of one’s home,” and we should police ourselves to attend conferences only where the chance of learning something new and relevant is high and avoid conferences that just rearrange the dust. CME’s be dammed. We are required to be stewards of the environment and antibiotics; perhaps it is time to be stewards of our brains. Perhaps someday science will find a new disease, Zoom cerebral toxicosis, from stuffing our heads with cheap noncaloric information causing permanent infiltration of a substance which gums up our neural circuity. Lester Gottesman is a colorectal surgeon. Source
