Dr. Lara Kunschner Ronan is an Associate Professor of Neurology and Medicine at Geisel School of Medicine Dartmouth. She also serves as Vice-Chair for Education Neurology Department Dartmouth-Hitchcock Medical Center.
Submitted July 19, 2020
My experience during the past five months of the COVID-19 pandemic has been as a Neurologist consulting with, but not acting as the primary physician for COVID-19 patients at Dartmouth-Hitchcock Medical Center in New Hampshire. Reporting from my home in Vermont where I have learned to do telehealth appointments to the soundtrack of barking dogs, we are slightly less deluged with cases compared to other places in the US, at a time when the United States has shown itself to be the global leader of infections and deaths from the virus.
I suspect that my great frustration and despair that the simple and accessible measures to slow down this pandemic such as mask-wearing and social distancing have been politicized and rejected by so many in the US echoes many in health care these days. The shock and anxiety that initially stunned our health care community during the spring has been ground into a grim realization that without a public health response that meets this crisis our “world-class” medical care has been rendered useless for more than 135,000 people. Front line providers cannot yet imagine the light at the end of the tunnel and mostly just want to reinforce how much we want everyone to please wear a mask.
As I reflect on the intervening five months, I see that I, with the resident physicians I train and the medical students I teach at Geisel School of Medicine at Dartmouth College, have already passed through several unique phases of the pandemic. My books have buoyed me through these strange stages described by Albert Camus in “The Plague,” Thomas Mann in “The Magic Mountain,” and Jose Saramago in “Blindness,” and have made this journey less lonely, but I remain in that unsettled place of wishing I could skip ahead to read the happy ending.
At DHMDC we believed at first that maybe we would not be affected in our unique rural environment away from the crowding of cities, but then a member of our community returned from Italy and tested positive prompting many trainee colleagues to be placed on quarantine in March. Our hospital suddenly went on lockdown with a staffing crisis. We saw the wave affect Seattle and realized that the virus could quickly take down the limited number of individuals that we all depend on for health care. We implemented crisis schedules that only exposed a fraction of providers at a time. This was unsustainable though, and by the end of May new medical pressures emerged to return us all to the clinic and hospitals. Patients were afraid to come to the ED even with strokes, seizures, and brain tumors and those who arrived were sicker and in more dire straits than pre-COVID.
Life and illness unrelated to COVID-19 continues, of course. As the initial wave of infections gradually peaked and then passed in the northeast, anxiety lessened a bit and we tried to resume seeing patients and attending to all the myriad “routine” medical issues facing our population. Shortly thereafter we saw that things would not so easily be normal. Everything had to change to protect each other. This phase of disorientingly rapid change continues to evolve. The daily emails stating new policies, obviating yesterday’s policies were slowly starting to taper down, then the current resurgence of infections took off.
The resilience of doctors, nurses, emergency providers, health care workers of all types is legendary, but American health care had a serious problem with provider/physician burnout prior to the onslaught of COVID-19. The collective resilience of our field has not seen a challenge like this before, and the stories of doctors hitting their breaking points are unsettlingly and increasingly common. Even those in the hospitals who are physically well are struggling with relentless fear and anxiety.
The masks, PPE, hand sanitizers and virtual delivery of medicine cannot cancel the great psychological shift that has been caused by the realization that every clinical encounter may cause your death. New humility in the face of a true and nefarious nemesis has fundamentally affected health care, and I wonder where and how this precarious moment can possibly spark a real reckoning in our society about how we choose to or choose not to care for everyone in our country.
My hope is that somehow our leaders will pull together to channel the immense pain that the pandemic is causing into a real improvement for American health care. But I don’t personally know any single person in health care who can see that outcome yet. In the meantime, I will be seeing patients from behind my sweaty face shield, shouting to be heard through a face mask, and bathing in Purell for the foreseeable future.
As we all struggle to find equanimity, my solace is painting and drawing the nature around me in Vermont where my family is isolating. The gardening that we once found a chore is now our salvation. “Like other artistic endeavors, garden making can be a response to loss”. (Sue Stuart-Smith in “The Well-Gardened Mind: The Restorative Power of Nature,” 2020)
I remain and have been throughout my career as a physician so grateful that I attended Vassar where the arts were an ever present part of life. So many stresses and experiences inherent in a career in medicine and health care can be disorienting and demoralizing, but having the arts in my daily toolkit has informed and sustained my career over and over again.