Masks, Fear and Loss of Connection in the Era of COVID-19

By Leif Hass, MD |  April 22, 2020 | 

Over the din of the negative pressure machine, I shouted goodbye to my patient and zipped my way out of one of the little plastic enclosures in our ED and carefully shed my gloves, gown and face shield, leaving on my precious mask. I discarded the rest with disgust and a bit of fear. I thought, “This is a whole new world, and I hate it.”

I feel as if I am constantly battling the fear of dying from COVID-19 but am doing the best I can, given the circumstances at hand. I have the proper equipment and use it well. My work still brings meaning: I serve those in need without hesitation. The problem is that deep feeling of connection with patients, which is such an important part of this work, feels like fraying threads moving further apart due to the havoc this virus has wrought. A few weeks ago, the intricate fabric of what it is to be human connected me to patients through the basics: touch, facial expressions, a physical proximity and openhearted, honest dialogue. Much of that’s gone, and while I can carry on, I will surely burn out if I can’t figure out how to get at least some of that connection back.

Overwhelmed by the amount of information I need to process daily, I had not been thinking about the interpersonal side of the pandemic for the first weeks. I felt it leaving the ED that morning and later that day, and I felt it again with Ms. Z who was not even suspected of having COVID. She is a 62-year-old I interviewed with the help of a translator phone; she said at the end of our encounter, “But doctor, will you make my tumor go away?” From across the room, I said, “I will try.” I saw her eyes dampen as I made a hasty exit, following protocol to limit time in the room of all patients.

Typically, leaving a patient’s room, I would feel a fullness associated with a sense of meaning. How did I feel after that? In that moment, mostly ashamed at my lack of compassion during my time with Ms. Z. Then with further reflection, tense from all things COVID-19! Having an amped up sympathetic nervous system is understandable, but it’s not where we want to be for our compassion to flow.

We connect best when our parasympathetic nervous system is predominant. So much of the stimuli we need to activate that part of the nervous system is gone. There is a virtuous cycle, much of it unconscious, where something positive leads to more positivity, which is crucial to meaningful patient encounters. We read each other’s facial expressions, hear the tone of voice, and as we pick up subtle cues from our patient, our nervous system is further engaged and our hearts opened.

The specter of COVID-19 has us battling a negative spiral of stress and fear. For the most part, I try to keep that from consuming me, but it clearly saps my energy during encounters. In the same way we need to marshal our resources to battle both the stress and the disease itself, we need to actively engage pro-social elements of providing care to maintain our compassion. Clearly, I needed a more concerted effort to kick start this virtuous cycle of compassion.

My next patient was Ms. J., a 55-year-old with advanced COPD who came in the night before with shortness of breath. Her slight frame shook from coughing as I entered the room. I did not think she had COVID-19, but we were ruling it out.

We reviewed how she felt since admission, and I performed a hasty exam and stepped back across the room. She coughed again and said, “I feel so weak, and the world feels so crazy; tell it to me straight.” Then looking in my eyes, “I am going to make it, doc?”

I took my cue from her; I walked back to the bedside, placed a gloved hand on her shoulder and with the other, I took her hand. I bent forward just a little. Making eye contact and attempting a comforting tone of voice, I said, “Everyone is a little scared, including me. We need each other more than ever these days. We will do our best for you. That means thoughtful medical care and a whole lot of love! And, truly, I don’t think you are dying; this is just one of your COPD flares.”

“God bless you!” she said, squeezing my hand as a tear rolled down her cheek.

“Bless you, too. We all need blessing with this madness going on,” I replied. Despite the mask, I am sure she saw the smile in my eyes. “Thanks for being the beautiful person you are and opening up to me. That’s the way we will make it through this. I will see you tomorrow.” Backing away, hands together in prayer, I gave a little bow and left the room.

With Ms. J.’s help, I began to figure it out. To tackle the stress of COVID, we need to be very direct – almost to the point of exaggeration – to make sure our words and actions convey what we need to express. William James, the father of psychology, believed that if you force a smile, your emotions would follow. The neural pathways could work backwards in that way. He said, “If you want a quality, act as if you have it.” The modern translation would be, “Fake it ‘til you make it.” You may be feeling stressed, but with a deep breath and a moment’s reflection on the  suffering of that patient you are about to see, you can turn the tide on anxiety and give those under your care what they need.

These are unprecedented times; anxiety abounds. While we can aspire to positivity, there are times when we simply can’t muster showing it. Alternatively, as I experienced with Ms. J., honesty and vulnerability can open the door to meaningful connection. This can be quite powerful when we, as physicians, open up to our patients.

People are yearning for deep connection, and we should attempt to deliver it with:

  • Touch (as we can) to convey connection
  • Body language that adds emphasis to our message and our emotions that may go above and beyond what we are used to
  • Tone of voice that enhances our words
  • Talk that emphasizes the big stuff, such as love, fear, connection and community

With gloves, masks, distance and fear between and us and our patients, we need to actively engage our pro-social tools to turn the negative spiral of fear into the virtuous cycle of positive emotions that promotes healing of our patients and emotional engagement for those providing their care.

2 Comments

  1. Avatar
    Debi Wong April 27, 2020 at 1:52 pm - Reply

    The “social distancing” we need to do in the community does not help either. I have recommended in posts, that we refer to it as physical distancing. It seems that social distancing is just the next road to social isolation which at the end of the day will be the demise of us as a society.

  2. Avatar
    Wilma Brown May 5, 2020 at 6:32 pm - Reply

    Your patients are very blessed to have such a DOCTOR as yourself. I have a feeling we take your concern and heart felt care – for granted. Hopefully after this – our North American Governments will understand the need to help keep our Doctors , Nurses and other workers on the fontline safe and HEALTHY.

    We should be advocating for more items that provide comfort to patients – what about taped messages from Doctors – that can be played for patients ( casette players ) – MIND stimulation that in turn helps heal the body heal. Casette players – etc – we are truly embracing technology – and why can’t technology be used to comfort patients – when you have other tasks to attend to.

    The other thing I find – is that healthy diets and food are not provided for Doctors , Nurses and front line workers. If you are to help others – goodnes knows – you have to eat well – not junk. You are very busy and you should have ACCESS – ALL the TIME – to healthy food while at work. That is the job of Health Organizations to provide this for you.
    Please look after yourself as well – so that you are able to share your knowledge and expertise and LOVE with patients and co-workers.
    Keeping our immune systems balanced and healthy – is our job – and the best way to help you and our care givers.
    More focus has to be put on prevention – so you are not exposed to life threatening siturations – constantly.
    Mind, body and spirit – all come in to play here – building resilience.

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About the Author: Leif Hass, MD

Dr. Leif Hass was trained in family medicine at UCSF after attending McGill University for medical school. He works as a hospitalist with Sutter Health in Oakland California. He is an advisor on health and healthcare for the Greater Good Science Center at UC Berkeley and clinical faculty at UCSF School of Medicine.

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