• Rosalind Kaplan, M.D.

What Do You Want the Next 'Normal' to look like?

I haven't been sleeping very well the past few nights. I know that's true of a lot of people. Some of my friends tell me they haven't really slept since before shelter-in-place, or even before lockdown, or before we ever heard of 'social distancing.' My insomnia has likely been worse than usual over the last week because of the tragic worsening of the coronavirus crisis in New York, which seems to be the stuff of nightmares, or like something out of a frightening science fiction movie, but worse because it is reality. To make matters worse, an in-law family member was hospitalized with covid and intubated a few days ago, which brought things closer to home (he is doing better now.)

When I am asleep, many of my dreams have been about chaos, death and destruction, so I guess I'm focused right in there, even when I try to distract myself before bedtime with books or music or other neutral content. One night I dreamt that I was flying a plane and people were parachuting out into other countries, looking for someplace safe. I knew in the dream that there was no safe place. What I didn't know in the dream was how to fly a plane (no, I don't know how to fly a plan in real life, either), but I was doing it in the traditional medical model of 'see one,' 'do one,' 'teach one.'

Last night, I lay awake for a long time before I fell into a light, frequently interrupted doze. I couldn't stop thinking about something I'd seen earlier in the day on Medscape: In Memorium- a list of all the healthcare workers who have died worldwide since the beginning of this siege. I counted 242 on the list, and I am certain the list is not complete. Nurses, doctors, X-ray techs, an EKG tech, all losing their lives in the line of duty. I also kept thinking about the total number of people dead from this pandemic, and the fact that it is likely that the true number is several times that currently reported.

These people died without their families or friends by their sides. And those patients hospitalized, without visitors, frightened, some of them seeing their loved ones on line for the last time right before being intubated.

Sure, all this sounds like the casualties of 'war', but it's not a war, it's a humanitarian crisis and tragedy. It might help some people to look at it as a war with an invisible enemy, and if it helps, that's okay. I'm not on the true 'front line', and anyone who is need to view it in whatever way gets them through. I guess the covid crisis has become something of a war because it is so politicized, and because the chaos has created situations that feel like war zones. But wars divide the world. Humanitarian relief efforts should bring it together.

As the hospitals in New York started to act like a unit, sharing responsibility and equipment and staff, it has made a positive difference. As other states offered to help, kicking in more ventilators where they were needed, it has made a positive difference. Open sharing of information between scientists, healthcare workers, hospitals, states and countries makes a positive difference. People and companies who have generously given money and time and goods that they can do fine without to help those who are in need, whether the need is for food or money or PPE or medication or even just a kind word makes a positive difference. Sharing of resources works. It gives everyone the tools to do the best work they can do, which means more patients getting better, more healthcare workers staying well, and faster recovery of the economy, our society and our mental health.

The things that have thwarted the efforts to control the pandemic and decrease suffering are all about acting alone, separating oneself, caring only about one's own person, or family or entity or town or state or country. Like our president caring about the stock market and his re-election rather than looking at the big picture for well-being in this country. Like people who are not respecting social distancing and sheltering-in-place because it is inconvenient or unpleasant for them or their families. . Like the hospital administrators who are muzzling the healthcare workers (the same healthcare workers who are putting their lives on the line) to protect their hospital corporations' bottom line and their own bonuses. Like everyone who was so dead set on the piecemeal private insurance system we have in this country because universal coverage might hurt their own pocketbooks. Like people who still believe that someone else's poverty is not their problem (wake up!- poverty makes it harder to control the spread of Covid, and Covid has crippled our entire society!)

Everyone I talk to says that this crisis brings out the best in some people and the worst in others. The best in some systems and the worst in others. I agree completely. I see the people who, because of fear or anger or desperation, are behaving in terrible and outrageous ways (think people purposely coughing on someone they're angry at. Think Trump accusing healthcare workers of being 'complainers' for asking for protective equipment.) But more, I see the people who are going out of their way to be kind to each other, and volunteer their time, and donate what they have to give. I see the incredible coordination of medical teams to go the extra mile for every sick patient, working doggedly to provide the very best care and to calm and reassure patients and families. I see the work of systems and groups to set up testing and triage and extra hospital space when it seems like an insurmountable task, and I see all the gratitude poured out to the 'front lines' every day.

Call me naive, but I truly believe there is more good in most people than bad. But we have to learn something from this. We can't go back to living our lives in our own separate little corners and only worrying about ourselves (and I mean that on every level, from the personal to the global). If this doesn't teach us, nothing will. 'It takes a village'- and by that I mean a family, a community, a state, a country, a world, a universe... to take care of all of us. Okay, call me a socialist, or call me whatever else you want. But we can't go back to not caring about 'other people's problems,' whether those problems include food insecurity or lack of health insurance or mental health challenges or overwhelming educational debt. The interconnections have become undeniable.

I read every day about how things will never go back to how they were before Covid. Maybe they shouldn't. Maybe this can be the wakeup call. We shouldn't need a pandemic and the deaths of millions and the collapse of the economy to bring out the better part of humanity.

#covid #coronavirus #physician #isolation #compassion #physicianwellness #doctor #nurse #patientoutcomes #teambasedcare #medicalpracticemodels #universalhealthcoverage #socialjustice

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© 2017 Rosalind Kaplan