CSA Online First

CSA Online First is a weekly blog featuring insights from CSA members themselves.

Edited by Rita Agarwal, MD, FAAP, with contributions from CSA’s Committee on Professional and Public Communications, Online First is a place where knowledge and opinion from any one of our 3200 plus physician-anesthesiologist members can be shared, discussed and deliberated to advance the specialty of anesthesiology, the practice of medicine and society in general.

"Better solutions to difficult problems are usually made when all sides are heard."

Steven Goldfien, MD

 

Wellness in a Time of Fear and Uncertainty

by
  • Hammer, Greg, MD
| May 26, 2020

gregory-b-hammerWe are amidst the third month of the coronavirus pandemic, heading for month four. Our sheltering in place efforts have helped flatten the curve in California, and we were fortunate not to have been overrun with the surge of new cases we anticipated only a few weeks ago. Although some elective surgeries are now being performed, a great deal of uncertainty remains, and important questions will be answered only with the passage of time. When will we see the decline of the spread of this deadly virus even as our beaches, parks, and economy begin to re-open? When might we be back at work full-time? Will the patients continue to come for elective surgery as the existing backlog gradually diminishes? Can we keep our families safe? When can we safely spend time with our family and friends without doffing our clothes and showering upon entering our homes? Will there be another wave of disease spread once this one is under control? What about the economy – will it recover swiftly in the coming months, or will we experience a lasting depression? There is so much suffering around us – even though we may continue to get a paycheck and may have avoided infection, we cannot help but be adversely affected by the pandemic.

Uncertainty brings stress. While acute stress may be adaptive in selected cases, such as running away from a predator or rescuing a child from the swimming pool, chronic stress is essentially always maladaptive. Stress causes elevations in catecholamines, serum cortisol, and glucagon, resulting in increases in heart rate, cardiac energy consumption, and blood sugar. Decreases in estrogen, progesterone, and testosterone cause fatigue, mood swings, headaches, and weight gain. Our sleep is compromised. Our energy is sapped, and we may be unable or unmotivated to exercise. Our nutrition suffers as we reach for fatty “comfort foods” or refined foods high in sugar for relief. We experience anxiety, a nagging ache in our chest that intensifies when we see the rapidly rising number of Covid-deaths in the US. We see evidence of human suffering around the globe and feel powerless to help alleviate it.

For all of us who are experiencing these ideations and symptoms, these are normal responses to chronic stress. You are not alone

Might there be a silver lining to this pandemic? There are hopeful signs. Many of us are connecting with family and friends with whom we may not have spoken for some time. We appreciate the magic of the internet, thanks to which we can virtually join with others around the world. We may be physically isolated but do not have to be socially and emotionally alone. We feel compassion for others who are severely affected here in the US and around the globe, irrespective of ethnicity, nationality, or political beliefs. The virus knows no geographic borders, and neither does our compassion. We may find ourselves being unusually “present” with our loved ones, working together to try to make the best of a difficult situation. For many of us these experiences bring a sense of well-being in the midst of tragic circumstances.

What are the lessons we may learn during this crisis? 

One is the importance of gratitude – we are appreciative of the company of those with us at home and, for at least some of us, at work. We embrace connecting via the internet and telephone. We recognize how much worse things could be. It is worth remembering the influenza pandemic of 1918. Information, food, and clean water were scarce. People were isolated - there was no internet and so no Facetime or Skype, and the health care system was completely overwhelmed. The most basic supplies were not available, including medicine, material for masks, and even coffins.  Global suffering was unimaginable. Fifty million people died around the world. We have it so much better now, 100 years later. There is much for which to be grateful. 

Second, it is clear that beyond isolating ourselves and wearing protective gear at work there is little most of us can do to change our circumstances. Many of us find ourselves (mostly) accepting the conditions we face. We understand that we did not cause this pandemic and we cannot cure it. We do what we can to stay as safe and well informed a possible, but we are otherwise forced to adapt and allow what happens to unfold. 

Third, we may discover that we do have some control over our thoughts – panicking and catastrophizing accomplish little, so let’s be as positive as possible. I am pleasantly surprised to observe how many of my friends and colleagues are taking the opportunity to practice intention – purposefully guiding their thought processes in a pragmatic and optimistic direction. Hunkering down and having the pace of life slow down can facilitate this.

Fourth, we can and should let go of the usual judgment of others and even ourselves. We are all doing the best we can during this stressful time. We are all in this together. It seems trivial and even ridiculous to judge the way in which others are coping. Let’s treat ourselves the same way we treat our dearest friends and loved ones – with understanding and nonjudgment.

In other words, the silver lining may be that we find ourselves practicing Gratitude, Acceptance, Intention, and Nonjudgment. These are the essential components of resilience and indeed happiness. They define the acronym, GAIN, which is the thesis of my book. One day the pandemic will be behind us. I am hopeful that we do not forget these positive ways of being once this comes to pass.

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