Approximately two months after the World Health Organization declared COVID-19 was a pandemic, I was dropped off at the front of Tampa General Hospital for the resection of an L3 schwannoma. I would be staying in the hospital for at least two nights and because of social distancing measures, patients were not allowed to have visitors.
As a medical student nearing the end of my third year of school, I at least found solace in that I knew what to expect. I knew that I would be asked about the last time I ate. I expected that there would be IVs placed in pre-op. I also knew that I would be asked my full name and date of birth at least 10 times before surgery started. What I didn’t know was what it was like to be a patient during a global pandemic. I soon learned of the consequences of the measures taken to reduce the spread of COVID-19. In addition to limiting visitors at the hospital, staff and patients alike were expected to remain six feet apart and, of course, wear face masks.
A correctly fitted face mask must cover your nose and mouth and be tightly secured behind your ears or tied behind your head. The top of the mask should be positioned where there is the best seal around your nose and mouth.1 Simply put, a properly worn face mask covers the majority of the wearer’s face. I didn’t realize the emotional impact this face covering had on me until my experience in the hospital. When I was waiting in pre-op, the chief neurosurgery resident began the informed consent process, her eyes peeking above the sterile surgical blue of her mask. I already knew and understood the risks of the surgery: bleeding, infection, limb weakness, loss of sensation, CSF leak—the list goes on. Although I tried to focus on what she was saying, all I could think was that I just wanted to see her face. I wanted to see the face of the person who would be caring for me during the scariest and most vulnerable time of my life. As I signed my name, I made my last effort by glancing at the photo on her ID badge.
In medicine, we often talk about the physician-patient relationship and how sacred and privileged it is. In school, we learn tools for providing empathy and support for our patients in order to foster this bond. Could something as little as a surgical mask have compromised this relationship? As the rest of my surgical team trickled in one-by-one, I realized it could. It felt so bizarre not to see the faces of any of the people that would be providing my medical care. Especially during a time when I could not be with my family, I had hoped to rely on the reassurance and support of my medical care team. However, without the ability to see my providers’ facial expressions our encounters felt distant and impersonal. Throughout my hospital stay, I began to feel less like a person and more like an MRN number.
As a medical student, I thought I was prepared for the resection. I knew that the resident would be the one to close my incision at the end of the surgery, I knew what the role of the anesthesiologist was, and even that the CRNA would be monitoring me during the surgery. I knew the expert abilities of the medical professionals on my team and what the operating room was going to look like, because I had been in it before as a student; although I knew all of this, I still felt alone and scared. Even when there is not a pandemic, patients without a medical background are not afforded the comforts of such knowledge. Despite the best efforts of physicians to prepare their patients for what to expect, there is no way for patients to be aware of all of the nuances of surgery and a hospital stay in the same way that we as medical professionals are. The changes associated with the pandemic bring another set of challenges for patients. Without visitors, patients cannot as readily rely on their friends and family for support. Additionally, when every member of your healthcare team is wearing a face covering, it makes it more difficult to connect with them. As a result of this, patients may not feel as though they can look to their medical providers for emotional support. A hospital stay is often a stressful time for patients, and it is well established that social and emotional support are protective for health.2 This attests to the importance of a patient having a strong support team that can in part be made up of their healthcare providers. It is up to us as health workers to be aware of the effect of even the subtlest of changes caused by the pandemic, such as wearing face masks, and how to overcome these challenges to continue to care for our patients.
Based on my experience, the following are a few tips for providers caring for patients during the COVID-19 pandemic:
- Using Masks:
- Go out of your way to make patients feel comfortable: spend an extra minute in the room with them to ask how they are doing.
- Speak clearly and enunciate. It is hard to hear through a mask.
- Make your ID photo on your badge visible.
- Make sure to clearly explain who you are and what your role will be in their care.
- Be a Helping Hand:
- Remember, many patients, especially with COVID-19, may feel isolated or have visitor limitations in the hospital.
- Patients who are getting admitted to the hospital have to bring all of their belongings with them when they first arrive. Ask if there’s anything you can grab from their bags for them, such as: a computer charger, change of clothes, snacks they brought. This is especially important for patients who are post-op or have mobility issues for other reasons.
- Call the patient’s family and give them an update on the patient. There is no such thing as too many updates for a family member that can’t be in the hospital with their loved one.
Acknowledgements: Shanu Gupta, MD, provided support for the development of this manuscript and valuable technical editing and writing help.