As a high school volunteer in my local hospital’s oncology unit, I remember the sinking feeling in my stomach every time I saw the bright “Contact Precautions” sign on the door. I would begrudgingly don a flimsy plastic gown, fix a tight surgical mask around my ears, snap on a pair of gloves and proceed into the patient’s room. On one occasion, a sweet three-year-old looked up curiously and burst into tears as this alien figure tried to hand her a Dr. Seuss book. While I fully recognize and appreciate the necessity of hospital infection protocols (thank you, Atul Gawande), I always detested making a child — a pediatric patient with cancer, no less — feel like the “other.”
At least the COVID-19 pandemic didn’t single any one individual out; instead, it has made all of us feel like the “other” as we attempt to navigate this new world bristling with social distancing and travel mandates. Prior to my first day in the hospital, I had not fully appreciated the impact of the pandemic on the health care setting. After all, I had just emerged from months of studying for my USMLE Step 1 examination, and while I had pored over incoming COVID-19 news with the same tenacity as Pathoma, I was still an outsider.
My first day on service, the obvious effects of the pandemic — the lack of personal protective equipment, staggering death rates and naysayers denying the existence of the virus — were overwhelming. Physician-patient relationships, the true heartbeat of medicine, were more subtly affected as well. I quickly realized this new challenge while trying to communicate with any of my psychiatric patients. Psychiatry, especially, heavily relies on an immense amount of body language, and it was a little shocking to not be able to provide even just a kind smile to my patients.
Fast forward to my adult hepatology rotation (and year two of the COVID-19 pandemic), and new variants swarmed the hospital. I was working with patients considered to be some of the sickest in the hospital, and every potential interaction had to be carefully thought through. “Is it absolutely necessary that I go and confirm the patient’s pharmacy with them, or will I be able to do enough chart review to find my answer?”
“Should I check with the patient to see if they were able to tolerate the advanced diet, or is asking their nurse sufficient?” As someone who is a strong advocate for health care providers always going back to the bedside, these were difficult questions to ask myself. However, motivating each of these questions was the concern that every time an individual walked into a patient room, the patient could be exposed to the SARS-CoV-2 virus and severely affected.
As I finish up medical school, and the pandemic shows no signs of slowing down, I am constantly reminded of our new normal. It is doubtful whether our hospitals will ever exist without masks again, for both the protection of our patients and healthcare providers. There are certainly benefits to this — it is already unbelievable to think that mere years ago, unmasked emergency medical providers would peek inside the mouths of patients fraught with airborne respiratory viruses. However, we cannot deny that masks establish a barrier between the physician and patient and that the fear of COVID-19 has likely shortened many inpatient bedside visits.
Physicians will have to work to overcome this extra barrier and put in the necessary effort to go back to the bedside, safely. This may mean mandated antigen testing, questioning the necessity of certain social gatherings and extra considerations made when traveling. We’ve asked our health care workers for so much of themselves during this pandemic, and these are certainly additional requests. Despite this, the opportunity to care for our patients at their most vulnerable time — during society’s most vulnerable time — is an immense privilege.