Checklists and Connections

Juggling my third-grader’s virtual school with work in the first months of the pandemic, I coped with my anxiety by being hyper-organized with daily checklists and color coded calendars. The only way I could manage my primary care patients’ concerns alongside my young child’s schooling was to delineate clear boundaries. I checked the electronic health record inbox at specific times throughout the day. If any task took longer than 15 minutes, I would delegate it or schedule a visit for the patient. I built walls. No lines would be blurred on my watch. If I could switch robotically from one set of responsibilities to the next, I would stay sane. I would keep the messy, sinister creep of pandemic life at arm’s length.

Of course, this strategy didn’t work. Bleary-eyed, I filled in countless checkboxes by the designated deadlines and felt hollow all the time. Each patient concern weighed on me. A trio of irate emails regarding a bill soured my mood for weeks. My dread of going into work grew to outsized proportions. I experienced frequent, throbbing headaches for the first time in my life. My stomach roiled with acid as I shuffled into my medical office. At the end of a lovely afternoon in the clinic, I remembered only the heaviness that I carried into the building that morning. Whether a given day turned out  good or bad was irrelevant—my mood had predetermined that it would be a disappointment. And so it was.

A COVID force field

In medicine, we’re trained to alleviate, solve, and fix. We sit with our patients in pain and validate their experiences of suffering. Regardless of cure, we can always offer our care. Sometimes, this is enough. In the days of the pandemic, it feels like it doesn’t even come close.

COVID-19 has introduced new challenges to the practice of medicine and robbed clinical care of many joys. One of my favorite parts of being a primary care physician is sitting in a room with a patient I’ve known for years, face-to-face, smiling, listening to stories about their lives. Now, we’re tense and masked. We measure six feet from my rolling stool to their exam table. Some patients seem worried in my presence, as though they sense a halo of invisible coronavirus particles all around me. They ask if I can examine them without touching them. Others adopt the opposite approach and remove their masks, telling me not to be so scared. They tell me there’s no pandemic.

Outside the clinic walls, other patients call me with pressing concerns. They’ve lost their jobs and can no longer afford their medications. Their anxiety and depression are so severe they can’t function at work or at home. Six months after having COVID-19, they’re still so short of breath when they walk their dog that they worry they’ll faint. Before their illness, they ran marathons.

Leaning into love

Early one cool, clear morning in September, I met Mrs. B, my son’s new virtual orchestra teacher. We spoke about many things that morning, standing six feet apart in the autumn air—my son’s violin, the emptiness of the school hallways, the new administrative burdens on teachers in this remote world. And then she added, “But when I see my students’ faces on that computer screen, everything is better. They’re my therapy, my mental health boost. All I need is to see them, and then—I’m good.” As she said these words, she radiated pure joy, a light and love no mask could obscure. She shared stories of her students through the years, her voice animated, her eyes crinkling with delight.

As I drove home, Mrs. B’s affection for her students warmed me. I marveled at how her sense of purpose could elevate her spirits so profoundly. Her message was clear—there’s a weight to our lives amidst COVID-19, but her love for her work is even more powerful. Love can tip the scales to overcome despair.

The sheer energy of Mrs. B’s love for her students allowed me to acknowledge my regimented approach to work during the pandemic. I needed to reignite my passion for giving care. I pictured the faces of my patients I care for deeply. I nudged my thoughts toward the patient relationships that bring joy and laughter. This new thought process felt expansive. Memories of meaning and purpose began to multiply.

New (old) connections

To continue to cultivate this reminder of love, I decided to call one beloved patient each week just to say hello. A five-minute conversation only to ask how they were doing. No medical agenda. No reminders about colonoscopies or mammograms. Two human beings forming a deeper connection as they make their way through a pandemic. If a week is prohibitively busy, I allow myself to hold a patient in my heart instead, to meditate on them and wish them well.

This helped tremendously. I spoke with a retired football coach worried about infection, a woman my age newly diagnosed with breast cancer, a grandmother who missed her family desperately. Each conversation is brief, nourishing, and full of warmth. It brightens my mood and reminds me why I went into medicine. Now I once again associate my work with the faces and voices of these people I love. When someone complains to me about parking or directs their anger over their new COVID-19 diagnosis toward me, I no longer absorb their words as  wounding insults. I feel less brittle and more fluid. The weekly phone calls allow me to take daily frustrations in stride. They restore a sense of purpose and replenish something I’d lost.

Point of light

Now the pandemic surges once more. School remains virtual. My headaches linger, to-do lists grow, and I remain inadequate and small in the face of my patients’ suffering. There are many evenings when I shuffle home, weighed down by the pain of some patients and the maskless disregard of others. And there are many mornings when I still seek solace in my checklists, rife with perfectly square boxes begging to be colored in and marked complete. Sometimes I still try in vain to impose order on the chaos the pandemic has wreaked on daily life. And then I hear my son find the notes for “Mary Had a Little Lamb” on his violin, and I remember Mrs. B’s radiant self-permission to love her students and let this love enrich her life. I plan which patient I’ll call this week to say hello. Cultivating love for my patients offers a moment of respite, something to look forward to, a point of light. When I gently place aside my color coded calendar and allow myself to revel in connections with people who bring joy and meaning, it keeps me whole.

4 things I’ve learned from this experience:

1. In times of prolonged stress, our normal coping mechanisms (checklists, color-coded calendars, rigid boundaries) may become maladaptive. Especially if they ignore the root of the crisis.

2. People outside of medicine, like Mrs. B, can provide us with a fresh lens through which we may see ourselves clearly.

3. We can always offer our patients our care. And we can have faith that sometimes, this is enough.

4. Taking five minutes to connect with a patient who fills your cup can help mitigate emotional exhaustion and restore a sense of purpose.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.