Scrubs, shoe covers, surgical cap, then mask and an eye shield. Wash at the sink, then it’s backwards through the swinging door, into the cold calm of the operating room, for the final layers of gown and gloves.
This ritual is one that we surgeons perform every day. At different times, it has felt like donning a costume, or armor, or like a comfortable sweater that calms us in times of stress. When we first scrubbed in as medical students, or from time to time during our surgical internships, we hoped to hide behind the mask, trusting it to render us invisible — and therefore unable to be singled out by surgeons who would occasionally hurl anatomy questions at us. We felt unseen, unknown, unknowable.
Over time, however, we have learned that it is the masks that become invisible, not the humans behind them.
In the operating room, we have learned to take one another’s emotional temperature with minimal cues from facial expressions. It requires paying attention, taking a beat and being an interested observer, and it can have profound resonance.
For a surgical resident negotiating a tough mentor, a supportive wink from a sympathetic scrub tech can mean the difference between a devastating day and a tolerable one. An observant attending surgeon reads confidence or terror in a trainee’s eyes and offers guidance accordingly. A resident senses boredom in a medical student’s glazed expression and pauses to engage. A nurse tears up during intubation; we provide support and learn that her father passed away from the same disease as the patient on the table. We have been a part of all of these stories. We have learned that the mask, on its own, demands neither anonymity nor aloofness.
Surgeons are accustomed to the odd reality of building rapport while our faces are hidden. We have seen colleagues in the cafeteria — after spending hours scrubbed in side by side — and not immediately recognized them. “So that’s what you look like,” we've said at those moments, “It’s nice to actually see you!” We have learned that it is possible to build close and trusting relationships with people whose full faces we rarely see.
In the last month, our masked world expanded: every employee working in our hospital must now wear a mask at all times, to protect against COVID-19.
We pass through the hospital doors into an environment that changes by the day. We present, per a new policy, our “day pass” — a signed attestation that we are symptom-free. Greeters in personal protective equipment dispense a serving of sanitizer on our hands and hand us a mask to wear for our whole shift or until it becomes “visibly soiled.” The ritual has changed, and new rituals are taking hold. The CDC now recommends that every American don a mask before leaving the house; schoolchildren are fashioning cloth versions at home.
We are negotiating the rules of this new world, which bears little resemblance to the way things were before. How do we protect ourselves, our families and our colleagues from this virus? Is everyone getting the protection they need? How many of us will die? Will we die?
We have learned that it is possible to build close and trusting relationships with people whose full faces we rarely see.
We have heard stories about how dehumanizing it feels to have life-altering conversations from behind a mask and goggles. In ordinary times, when we have to deliver news, we remove our masks and make intentional eye contact, as we hold space for our patients’ reactions. Now, all news is delivered from behind a mask, and we understand that it can feel as though we are putting up a barricade: an uneasy reality for health care providers who treasure intimate relationships with our patients. Though it has become a necessary part of our uniform, the mask shouldn’t impede our ability to communicate, connect or care.
As we brace for what is to come, we need to write a new playbook: how to convey concern during a goals-of-care conversation; how to assuage a child’s fears with only our eyes and the tone of our voice; how to console a family member while breaking the news about the death of a loved one.
We would do well to take the time to pause, to check in with one another, to make purposeful eye contact with our colleagues and neighbors, the way we have learned to do in the operating room. Not to hide behind the masks, but to accept the challenge they pose, and to care for our patients and support our colleagues and neighbors with renewed and specific attention.
Even with our faces covered, we can see people for who they really are, and we take comfort in knowing that they can see us, too. We can recognize kindness, hope and courage. We can sense our shared desire to do the right thing. We can see connection, pride, and togetherness as we fight this new and insidious enemy. The mask cannot hide any of this.
We are masked; we are not hidden.