During my fourth year of medical school, I took improv and comedy writing classes at the Second City (when social distancing ends, I highly recommend this). My writing teacher introduced us to an idea called Face Your Fear Friday (known henceforth as FYFF). He encouraged his students to do something that terrified us once per week. Through this challenge he’d convinced past students to take risks such as doing stand-up comedy for the first time.
In the past few years, I’ve intermittently revisited FYFF, thinking about what scared me and attempting to face it straight on. This typically led to some degree of embarrassment, for example the time I drove a carful of friends up one of the steepest hills in Seattle in heavy traffic. New to driving manual transmission, I figured facing this fear in a high stakes environment was the best way to learn. This exercise ended in deeply concerned friends and a police officer asking the several cars behind me to back up, as I’d rolled dangerously close to them while stalling out multiple times (of note, I can now drive up any hill without stalling, so maybe this worked after all!!).
In the past few weeks, when faced with a virus I cannot see rather than a hill I can conquer, I’ve thought about fear differently. Not as something to face straight on, but something to reckon with. To cope, I’ve thought about the following things: What scares me the most, what allays these fears, and what actions can I take to address them that won’t hurt other people?
Of course, like everyone, I worry about many things (for example, the mental health of society right now, whether I’ll be ostracized for blowing my nose one time after biking to work in the cold). But here are two things that scare me most:
1. The sickness and death of my loved ones. I think this is on everyone’s list of greatest fears. I worry about many, including my dad, one of my heroes, a doctor who could get exposed at work, and who is in a higher risk group because of his age (although anyone who knows him would agree that he’s young at heart). It’s unbearable to think about him getting sick and being unable to visit him.
To deal with possibilities that make my stomach turn, I quickly focus on reassuring things and those that I can act upon. My dad will do everything recommended to prevent the spread of illness, staying at home when possible and using the right equipment at work. I can teach him what I’ve learned about COVID-19, which might help him. I can continue to draw strength from his calm demeanor, analytical mind, his lightness and humor.
2. Practicing “crisis standards of care.” Crisis standards of care means we are forced, by a pandemic or natural disaster, to change how we would usually practice medicine. If we didn’t adopt these less ideal care standards, it would likely result in more illness and death.
For example, the usual standards of care are to dispose of gloves after each use. However, in a disaster, there might be a shortage of gloves, and the crisis standards of care might be to wash gloves and use them again. While washing gloves is far from ideal, once the last pair of gloves is used, providers would be forced to wear no gloves, or to not touch their patients or the equipment in the room such as IVs. This would lead to more harm to patients and providers. In a crisis, perfect is the enemy of good.
This concept is a nightmare for providers. I appreciate the necessity of these measures when there is no other choice. However, physicians, nurses, and other health care providers are not trained to do “ok.” The thought of providing suboptimal care, even if compelled to do so to avoid further illness and death, is morally distressing.
But, “hope is the only thing stronger than fear,” said my boss, the director of our residency program, in an email a few days ago. He’s not quite sure where this quote came from, but I like it so I’m sticking with it.
And there’s a lot of hope that allays my fear. I’m encouraged by people bearing social distancing to slow viral spread and decrease the surge of sick patients that we’re expecting in Seattle in the next few weeks. At a meeting yesterday, our program leadership laid out a plan for upstaffing our hospital in a way that took provider rest and recovery into account. We’re conserving materials in a way that maintains protection of providers and prevents spread of illness.
The enemy here is invisible, and there are many things we cannot control. There is a lot to worry about these days. But there are things we can change, too, so I try to spend my energy on these things, and trust that others are doing the same. With this collective action, being conscious that viruses don’t discriminate and we’re all in this together, I’m able to move forward with my day and not be crippled by fear.