Volume 7 no 2

OPINION: The “gift” of COVID-19: a golden opportunity to slow down and refocus

Peter Brindley, MD

Back to Index

OPINION: The “gift” of COVID-19: a golden opportunity to slow down and refocus

Peter Brindley, MD

 

https//doi.org/10.37964/cr24732

 

With far fewer distractions, we finally have what we claim we always needed: time to think, reflect, and make sense of the nonsense. The problem is we have equal amounts of time to fall into despair. I tend to experience both optimism and despair, in equal amounts, often on the same day.

 

CITATION: Brindley P. The “gift” of COVID-19: a golden opportunity to slow down and refocus (opinion). Can J Physician Leadersh 2020;7(2):77–80.

 

It is so common for people to become emotional on long journeys, especially plane rides, that travel agents have a name for it: “the mile cry club.”1 Theories include relative hypoxemia (i.e., lower brain oxygen), a feeling of vulnerability (you are perilously high up and straddling flammable fuel), and the otherworldliness of travel (we didn’t evolve to race across the planet). This six-foot-tall, 220-pound doctor has long tried to play the “ICU tough guy,” but it’s time to come clean. Before COVID-19 grounded me (quite literally), my academic job turned me into a frequent flier, and travel made me a not-infrequent crier. I suspect some of you can relate despite your exalted leadership titles and high-brow portfolios. Regardless of when and how your emotions leak out, it is worth acknowledging how COVID-19 has taken us all on quite a ride. Top

 

Months of living “la vida lockdown” has resulted in many disruptions to our previously manicured lives. One of the biggest is how, where, and whether we get to travel. Plane journeys used to offer the gift of down time. Now, in the age of COVID-19, this is as likely to come from a long car ride: something that Canada “specializes” in. With far fewer distractions, we finally have what we claim we always needed: time to think, reflect, and make sense of the nonsense. The problem is we have equal amounts of time to fall into despair. I tend to experience both optimism and despair, in equal amounts, often on the same day. Top

 

Regardless, I frequently use long trips to unwind. This starts with reflecting on all of the patients with overdoses, gunshot wounds, car crashes, and medical futility that I have stickhandled through the ICU. However, these early thoughts can be brushed aside by reassuring myself that at least I tried my best and by assuming that, because I am exhausted, it must have been important work. It gets tougher two hours into the journey and deeper into my headspace. This is when I think about broader concerns with my profession’s (and my society’s) obsession with biomedicine and technology, rather than community and connection. It is usually at the three-to-four-hour mark that I admit to nobody but myself that we do a great job of “processing” patients, but are less reliable at truly “caring” for them. The five-hour mark is when I question why I can’t, literally and figuratively, slow down.

 

If you will allow me to persist with this fairly unoriginal analogy, namely that medicine is like a cross-Canada journey, our hectic distracted life styles seem akin to driving on, despite a warning light on the dashboard. During a long career — just as with a lengthy road trip — you may have to pull over to the side and look under a smoking hood. You might not like what you find. In short, the COVID-19 journey means time to think awkward but important thoughts. The extra time spent inside my own head has left me convinced that emotional connection matters more than electronic connection, pills, or devices ever could. These are especially inconvenient truths for anyone working in biotechnical medicine. Top

 

Last year — 1 BC or the year before COVID — I boarded a plane after backpacking in Alaska and northern British Columbia with my elder son. The scenery and the challenge were “just what the doctors ordered”: humbling, inspiring, and distracting (the Canadian holy trinity, you might say). My son and I had reconnected during challenging days and nights. We had been entirely sans Internet and fully avec each other, and if it wasn’t on our backs then we didn’t need it. We got to the airport gloriously tired and beaming with “we showed them” pride.

 

The problem was that before even taking off we both slipped into old ways and reached impatiently for the latest news. I often feel a sense of duty that I should keep up with current events, even though they reliably leave me cold. Regardless, as I read page after page of despair and anger, I questioned whether I was returning to “civilization” or leaving it. If nature had been my antidote, then, hyperbole aside, urban life might be some sort of poison. Top

 

Nature deficiency disorder (NDD) was described in Richard Louv’s 2005 book, Last Child in the Woods.2 The point is that, just like friendship and family, nature is a form of “life support.” We shouldn’t starve ourselves or our patients, even if NDD has yet to be medically sanctioned by the World Health Organization (WHO) with an ICD-code. NDD is also not in the psychiatrist’s bible, the Diagnostic and Statistical Manual of Mental Disorder (DSM).3 But let’s talk about the hallowed DSM. It has ballooned to 900 pages, 350 disorders, and includes things that seem more personality than pathology. For example, the new DSM includes apathy syndrome (i.e., you can’t be bothered) and oppositional defiance disorder (namely, you may be a teenager).

 

Tongue in cheek criticisms aside, my bigger point is that after a quarter century of doctoring, I don’t need the DSM or WHO to tell me something matters. I worry that people forget the importance of nature for the same reason that they fail to go after a better version of themselves. It is usually some combination of fear, finance, access, or perceived lack of time. Inadequate time spent in nature doesn’t need to medicalized, but sometimes we do need to be reminded that tweets actually originate from birds and facetime once occurred without a screen. Not everything that matters warrants a pill, requires a life coach, or benefits from the modern medical industrial complex. Top

 

Alongside NDD is the “biophilia hypothesis,”4 popularized by Edward Wilson in 1984, of all years. His argument is that humans have an innate need to connect with nature. The same is true of the widespread desire to connect with animals. This is why emotional-support animals mean so much to so many. It is also why so many of us have grown up with pets, and why more will do so, courtesy of “pandemic puppies.” This inbuilt love of nature is why we adore babies, children, and any animal with floppy ears. Notably, these three things were among the first to be banned from hospitals during the COVID lockdown. In an increasingly urbanized, impersonal, and now locked-down world, it will take efforts to rebuild empathy and connection. Fortunately, there is hope.

 

Pet therapy is increasingly popular in hospitals.5 Sadly, where I work, the ICU, these furry love bombs were verboten well before COVID-19. I suspect that, within my career, we will discover that human and canine microbiomes can coexist and that doggy-power is as strong as some of our lacklustre pills. In addition, more hospitals are building patios,6 so that staff, and especially long-stay patients, can get some restorative fresh air. Spaces in hospitals where patients (even those, perhaps especially those, on ventilators) can get some sunshine are not an unnecessary luxury, nor are they an impossibility in the Canadian climate. With over three-quarters of Canadians now dying in hospitals and approximately one-quarter dying in an ICU,7 death has become institutionalized, so let’s get it right. Given that death rates are still 100%, and holding steady,8 let’s put effort into saving deaths not just saving lives.9  Top

 

In some countries, family doctors now write outdoor exercise prescriptions for their patients. The concerning part is that this took so long, and it has still not taken off in a country as naturally blessed as ours. We all know that going for a run, a walk, or a cycle clears our head, so why not prescribe “two bike rides and call me in the morning.”10 Another “treatment” that could save both lives and cash is not a drug, nor surgery, nor even that Monty Python medical machine that goes “bing.”11 Instead, it is “community,” and “social connection.” Data from a Somerset village (the Compassionate Frome Project12) suggest that when isolated people are supported by community groups, then emergency admissions fall and erstwhile patients — why can’t we just call them people — feel better. The investigators came to understand what our grannies always knew: much of what truly matters is not inside a modern hospital, even if that hospital is a technological marvel. This must-read-about Frome project also encourages us to throw away our doctor-only words (i.e., dyspnea) and use words that patients use (i.e., “give me enough breath so I can see my friends”). “Patient-focused” means delivering what patients crave (the ability to get out of the house), not what is most convenient for us (i.e., puffers and steroids).  Top

 

We are increasingly electronically connected but socially disconnected. It’s too easy to wholly blame the Internet, and so I won’t. In fact, the Internet is likely the symptom as much as the disease. After all, I needed that remarkable technology to write and reference this article and for you to read it. However, the Internet should be a tool, and the point with tools is that we can put them down. Instead, our phones and tablets are increasingly hijacking our attention, and, hyperbole aside, manipulating our thoughts.13 They become the first thing we look at in the morning and the last thing at night. The Internet does this by offering the illusion of community while creating people who are alone in their bedrooms and unfulfilled at their desks.

 

Social reconnection is difficult, but, then again, so is any health intervention that truly matters. Too often, I have reached for my phone, read something dispiriting, cursed the state of the world, did nothing about it, and then repeated the whole ridiculous process. It mirrors what I tend to do after each micro-dose of tragedy at the hospital. In contrast, with nothing to do but drive and hike and think, we all have a golden opportunity to slow down and refocus. I would call it a “reboot,” but it’s time to give up anything that smacks of computer-worship. COVID-19 offers us time and space to become a slightly better version of ourselves, and for that reason it is both blessing and curse. It is tough to know where to start, but, why not take a hike.  Top

 

 

 

References

1.Fenwick Elliott A. Mile cry club: the science behind why people cry more easily on planes. Telegraph 2019;26 Jan. Available: https://tinyurl.com/ydz3qqoj

2.Louv R. Last child in the woods: saving our children from nature-deficit disorder. Chapel Hill, N.C.: Algonquin Books; 2005.

3.Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Association; 2013.

4.Biophilia hypothesis. Wikipedia; 2020. Available: https://tinyurl.com/ybbtkda9

5.Herzog H. Do therapy dogs belong in hospital emergency rooms. Psychology Today blog; 16 May 2019. Available: https://tinyurl.com/y263nvqd

6.Dobson J. Hospital gardens are making a comeback. BMJ 2017;359. https://doi.org/10.1136/bmj.j5627

7.Cook D, Rocker G, Heyland D. Enhancing the quality of end-of-life care in Canada CMAJ 2013;185(16):1383-4. https://doi.org/10.1503/cmaj.130716

8.World death rates holding steady at 100 percent. Onion 1997;22 Jan. Available:https://tinyurl.com/y8pgnlwz

9.Mannix K. With the end in mind: how to live and die well. New York: William Collins; 2019.

10.Karasz P. Take two bike rides and call me in the morning: cycling as doctor’s orders. New York Times 2019;10 May. Available: https://tinyurl.com/yxqlep3o

11.The machine that goes ping. Monty Python: The Meaning of Life; 2016. Available: https://www.youtube.com/watch?v=tKodtNFpzBA

12.Monbiot G. The town that’s found a potent cure for illness – community. Guardian 2018;21 Feb. Available: https://tinyurl.com/ycoud73u

13.The social dilemma (documentary). Los Gatos, Calif.: Netflix; 2020.

 

Author

Peter Brindley, MD, is professor of critical care medicine, medical ethics, and anesthesiology at the University of Alberta and a scholar at the Peter Wall Institute for Advanced Studies. He is on Twitter @docpgb. Dr. Brindley writes regular opinion pieces for BMJ (see https://tinyurl.com/yxhcge3a).

 

Correspondence to:

Peter.Brindley@albertahealthservices.ca

 

Top

It is so common for people to become emotional on long journeys, especially plane rides, that travel agents have a name for it: “the mile cry club.”1 Theories include relative hypoxemia (i.e., lower brain oxygen), a feeling of vulnerability (you are perilously high up and straddling flammable fuel), and the otherworldliness of travel (we didn’t evolve to race across the planet). This six-foot-tall, 220-pound doctor has long tried to play the “ICU tough guy,” but it’s time to come clean. Before COVID-19 grounded me (quite literally), my academic job turned me into a frequent flier, and travel made me a not-infrequent crier. I suspect some of you can relate despite your exalted leadership titles and high-brow portfolios. Regardless of when and how your emotions leak out, it is worth acknowledging how COVID-19 has taken us all on quite a ride. Top

Pet therapy is increasingly popular in hospitals.5 Sadly, where I work, the ICU, these furry love bombs were verboten well before COVID-19. I suspect that, within my career, we will discover that human and canine microbiomes can coexist and that doggy-power is as strong as some of our lacklustre pills. In addition, more hospitals are building patios,6 so that staff, and especially long-stay patients, can get some restorative fresh air. Spaces in hospitals where patients (even those, perhaps especially those, on ventilators) can get some sunshine are not an unnecessary luxury, nor are they an impossibility in the Canadian climate. With over three-quarters of Canadians now dying in hospitals and approximately one-quarter dying in an ICU,7 death has become institutionalized, so let’s get it right. Given that death rates are still 100%, and holding steady,8 let’s put effort into saving deaths not just saving lives.9  Top