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Showing My Patients I Care When Hugs Are Not Allowed

A make-shift sign posted outside Massachusetts General Hospital expresses thanks to MGH, Friday, April 3, 2020, in Boston. (Michael Dwyer/AP)
A make-shift sign posted outside Massachusetts General Hospital expresses thanks to MGH, Friday, April 3, 2020, in Boston. (Michael Dwyer/AP)

I am a doctor on the front lines of the coronavirus pandemic.

On medical rounds, my colleagues and I analyze patients’ fever curves and scroll through pages of laboratory values.

In daily Zoom town hall meetings, we steel ourselves as we hear that case numbers are doubling and that the surge has yet to arrive.

We sink with disappointment upon learning that our nasal swabs achieve a paltry 65% rate of detection -- often leading to repeat testing to ensure a true negative result.

At home, we anxiously count the hours until our own test results return. Before bed, we pray that the number of newly lost lives is zero.

Numbers are nothing new to medicine; they are our lifeblood. Written registers of heart rates date back to 300 BC, in the fragmentary records of the ancient Greek doctor, Herophilus. Today, we have command over more sophisticated diagnostic testing — CT scans, ultrasounds, labs — and both doctors and patients crave “objective data.”

Yet, in this omnipresence of numbers, providing care on the front lines reminds physicians of the primacy and constancy of words.

“I can’t imagine how hard this must be for you,” I say, as I try to console a grieving mother who cannot visit her son who is lying alone in a medically induced coma after a gunshot wound. (It doesn’t help her to be reminded of the data supporting COVID-imposed limitations on hospital visitors.)

“We’re here for you no matter what,” I hear promised by my own relative’s doctors, who have indefinitely postponed his open-heart surgery. I say the same thing to my patient who cannot get the definitive procedure needed for her painful swallowing problem.

An ambulance crew transports a patient at the Massachusetts General Hospital emergency entrance, Friday, April 3, 2020, in Boston. (Michael Dwyer/AP)
An ambulance crew transports a patient at the Massachusetts General Hospital emergency entrance, Friday, April 3, 2020, in Boston. (Michael Dwyer/AP)

It does not inspire hope to share the striking statistics showing that they are not alone in waiting for COVID-19 to pass to get the care they need. In Massachusetts, we are seeing a 25%  decrease in patients seeking treatment for illnesses like heart disease and appendicitis. Our hospital was only running at 60% capacity at the end of March as opposed to its usual 99%.

“That must be bad luck,” I whisper to myself as I walk by the room of a 31-year-old with no medical history who is intubated in the ICU with the virus. It doesn't help to recite the statistics demonstrating that the young and healthy seldom fall critically ill. Sometimes, numbers leave us with more hollowness and uncertainty.

I read the word "Thanks!" scrawled across a homemade sign on my way into the hospital — it's a single word that inspires me and gets me through the day.

It’s the stories about our patients and loved ones who are at war with COVID-19, not data, that overwhelm our emotions.

This is what medicine looks like on the front lines: juggling numbers, while drawing on the power of words. COVID-19 provides an opportunity to renew our values and redefine the role physicians have played over millennia. Medicine is not all miracles. It is melding science and humanism to focus on the patient in front of us.

Medicine is not all miracles. It is melding science and humanism to focus on the patient in front of us.

We pore over the explosion of medical literature that the pandemic has triggered, but individually as physicians, our ability to control or change the data is minimal. Sometimes all a patient needs to hear is a heartfelt “That must be hard for you” or a candid “We don’t know.”

We even have data suggesting the therapeutic power of clinicians’ words to their patients. One study from Stanford researchers suggests that a few reassuring words from a health care provider, can help patients overcome a noxious stimulus much more quickly. According to another study, cold symptoms disappeared faster and were less severe for patients under the care of empathetic doctors, than while receiving routine care.

How we verbally and emotionally frame a medical intervention, like administration of pain medications after surgery can improve the drug’s efficacy. We have innumerable studies about the importance of having end-of-life care conversations before it is too late.

The numbers tell us that there is no definitive cure for COVID-19, there is no vaccine, that cases are on the rise, and that the supply of ventilators is limited.

But numbers shouldn’t dictate how we treat each other. Data must not stop us from providing comfort and relief to our patients, and to those in the community who support us. While we cannot shake hands or embrace in a hug, we can still lift each other up with our words.

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Related:

Raaj Mehta, MD Twitter Cognoscenti contributor
Raaj Mehta, MD is an internal medicine physician and gastroenterology fellow at the Massachusetts General Hospital and Harvard Medical School.

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