Take a Moment: Reflections on a Pandemic, Suffering, and Humanity

When reflecting on the COVID-19 pandemic, it is easy to be overwhelmed by the numbers: millions infected, hundreds of thousands losing their lives, and new cases climbing day after day. However, it was through a single patient that I grasped the impact of the pandemic.

On this day in clinic, I was seeing a patient with a branch retinal vein occlusion and resultant macular edema that I had been following for nearly a year in my resident clinic. I probably should not have favorite patients, but she is one of them. She was always funny and energetic during our visits, constantly joking with her husband who accompanied her to each appointment and me. In the midst of busy clinics, she would ask whether I had had time to eat lunch and about how my family was doing.

That day, however, she came alone. Stranger yet, she had missed her last 2 monthly appointments. Her vision had dropped to 20/200 with worsening macular edema in her affected eye after we had previously achieved 20/40 vision. She sat down in the examination chair, lacking her usual charm.

I sensed something was wrong. Glancing at my schedule, I saw the red glare of 6 “waiting for physician” markers. I knew, though, I could not just proceed with business as usual. I finally paused and asked, “What's wrong?”

Suddenly, her face disappeared into her hands as she began to sob. Through muffled cries, I made out that her husband had recently passed away from COVID-19. Truthfully, I didn't know what to say. He, with a spirit to match her own, had been in my clinic only a couple of months ago as enthusiastic as ever. Stunned by her revelation, I put my hand on her shoulder, an honest violation of social distancing. Then we sat together in a moment of silence as she unburdened herself of her grief.

In a practice environment that focuses on volume, it can sometimes be hard to pull away from habits of rapid and efficient patient turnover. The reasons behind the focus on volume are numerous and complex, ranging from the sheer extent of patient need to a compensation system that largely rewards volume.¹

The stresses of working in this environment can distract and distance us from the humanity of our patients. How often do we refer to patients by their disease? Do we become upset when a patient asks “too many” questions during a busy clinic day? I am certainly guilty of these offenses. Providers, particularly trainees, may also lose touch with their own humanity, sacrificing their well-being in the setting of impossible external demands.²

For me, the pandemic has served as a sobering reminder of the humbling responsibility that we as physicians have of bearing witness to the suffering of others. Our health care system must of course focus on health, but we also must not forget to care. The simple act of listening, though it may not be charted or billed, not only makes us better doctors but also more compassionate humanitarians.

In addition, as trainees, many of us practice in underserved communities with marginalized populations, many of color, who face unimaginable hardships in their daily lives—all of which have been disproportionately accentuated by the pandemic. We must not allow the callousness with which our society treats these particularly vulnerable patients to bleed into our practice.

I am not naïve to the challenges of carving out even just 5 minutes a visit to listen to patients in the midst of overbooked clinics. Although our personal behavior is of course important in shaping our relationship with patients, we are also constrained by external administrative pressures. It is our duty as physicians, therefore, to advocate for structural changes that will allow us to better serve our patients. We cannot sacrifice the doctor-patient relationship at the altar of clinical volume and stifling bureaucracy.

Since that encounter, my patient has returned every month. Her vision has improved once again, and a smile—punctuated by moments of grief—has returned to her face. Our preinjection ritual has since transformed from telling jokes to recounting memories of her husband. I know that these moments are as important to her as any medical treatment I can offer.

This pandemic has taught me to slow down. To be wholly present in the service of my patients.

To stop.

To take a moment.

Appendix. Supplementary materials

Supplemental Material available at AJO.com.