Life was so normal a few weeks ago. For me, and I imagine for many other health care workers, before the novel coronavirus etched its deadly path across the U.S., day broke to a remarkably similar routine. The alarm would go off at six-thirty; I would walk my dear-but-crazy mutt, Scrappy; swim a mile; grab a coffee; and then head into a clinic of waiting teenagers. I would greet my coworkers with hugs. And I would spend the day seeing the patients I love.
Now, mornings are stressful; I awake not knowing exactly what the day will look like. I make my own hand sanitizer; use an online calculator to see if I’ll run out of toilet paper; have daily calls with the leadership team; and my morning swim ritual has given way to grueling runs. My old routine seems like so little to have to give up, but, at the end of the day, on the front lines, it’s the memory of the little things that give me hope that normal life will return. That, and the telemedicine visits that allow me to still connect with my patients.
Since the pandemic, my clinical obligations have careened: inpatient care, primary care, urgent and sick visits, and, after a bit of training, telemedicine visits. At first, I was skeptical. I am someone who depends on the energy of interaction with other people. It gives me life. To say the least, seeing my patients only through a video portal on a laptop screen sounded unappealing to me.
But on day 1, I set up my “clinic” at the dining table; only a staircase would be visible behind me. I wore a loosely ironed button down and black sweatpants, obscured by the table. Scrappy lay at my slippered feet. I saw four patients that day. I loved it. It was so sweet to see them in their element, in their sweatpants, fuzzy blankets draped around their shoulders, and in their rooms. After asking the parents of my second patient to leave “the room” so that we could complete the confidential part of the visit, I noticed a piece of art hanging on the wall behind her. I asked her what it was, and she told me it was her art. I then asked her to show me around her room (if she wanted). And she did!
This was such an unexpected joy, only made possible by telemedicine. I asked every patient after to do the same, if they liked: Show me your room! Or simply something meaningful. In one week, I have met pets and siblings, seen pictures of cousins and puzzles completed virtually with friends, and I even requested a cello mini-performance (I was turned down).
That first day, my last patient was really struggling. Like many young people right now, he was scared. His head hung down on my screen. I asked him to look up, at me, and then to look around his room and show me something that makes him happy. His eyes darted around and then fixed on something lying on the floor. He smiled before taking his laptop over to show me a simple, white poster board friends and family had made for him with inspirational quotes and musings on it. “I go here when I’m feeling bad, and it helps,” he said. “I’ll keep doing that now.”
We finished the visit. I closed my laptop. And I cried. I was so moved. I was so honored to see these young people in their own spaces. I had imagined that telemedicine would remove the human aspect of medicine, but it was exactly the opposite—it enhanced it. The more I think about it, the more I realize that our interactions with our patients are always on our terms and in our environment. A clinic isn’t probably the place where patients are most comfortable. Through telemedicine video visits, we are able to see something more personal and really special. One of the scariest things about the pervasive sadness and pessimism of this moment is it can blind us to new kinds of connection.
I’ve been humbled to get a (different) glimpse into my patients’ lives. I get to see what they are proud of, the people and things they love, their art, their resilience, and also, yes, a pile or two of dirty laundry.
Zachary McClain, MD, (@DrZachMcClain) works in the division of Adolescent Medicine at The Children’s Hospital of Philadelphia and is an assistant professor of clinical pediatrics at the University of Pennsylvania.
McClain, Z. (2020). Silver Linings Pandemic. Journal of Adolescent Health, 67(1), 138. https://doi.org/10.1016/j.jadohealth.2020.04.001