Invictus
– William Ernest Henley
These are difficult and challenging times. The current situation with the pandemic is unprecedented. The impact it has imposed in terms of economic cost, human suffering, and strain on our healthcare teams around the globe is unbelievable. Furthermore, while there is a glimmer of hope on the horizon, the road ahead will be difficult and fraught with yet unrealized challenges.
Although different in nature and likely smaller in scale, many of us have endured difficulty in the past; we have worked in areas of conflict, non-permissive environments, and other settings where we have endured tremendous personal hardship and self-sacrifice. In some instances these efforts have placed our safety in jeopardy. Outside medicine, others have sustained themselves through remarkable suffering as well: imprisonment during times of war, political violence, or life-threatening illness. Despite many significant differences, there are some similarities between these past experiences and our current situation. In fact, I would submit that the psychological skills and coping modalities learned from other episodes of human hardship are informative and valuable in light of the current situation.
How we approach these situations can really make a big difference in how we think, what we feel, and how we act. Our mindset has a profound effect on attention and performance. Therefore, the appropriate psychological state is important as we struggle to take care of the very sickest patients that continue to flood our emergency departments and stretch the capacity of our critical care services. I would further emphasize that, unlike many things that occur outside our sphere of influence, what we think and how we approach the current situation are well within our control.
What follows is a conglomeration of advice based on my personal experience, the experience of those that have endured more remarkable hardship, and evidence from the psychology literature.
1. Focus on the mission and what is at stake
Our patients’ (friends, family, and community members) lives are at stake. So is our personal safety and that of our colleagues. To that end, the safe and expedient provision of medical care is important. That was what we did before COVID, it’s what we are doing during COVID, and it’s what we will be doing long after the COVID pandemic has ebbed. So, while having a healthy respect for the danger and numerous challenges we face is reasonable, allowing it to consume our thoughts and steal valuable cognitive resources is counterproductive. Focus instead on the critical tasks and key steps necessary to provide care today.
2. Invest energy where it counts: training, preparation, research, and development
Dwelling on mistakes, lamenting how administration may have handled things poorly, pointing fingers, placing blame, or wallowing in how you believe you’ve been mistreated or undercompensated are generally not helpful. There is certainly a time for justice and standing up for ones safety is certainly warranted. However, the emphasis should be placed on learning from our mistakes, insuring safety moving forward, and finding solutions to novel problems.
Around the world there have been many great examples of ingenuity and creative techniques to designed protect providers and patients alike. While these tools and techniques should still be subject to rigorous academic investigation to establish their safety and efficacy, they represent reasonable allocation of individual effort. Likewise, numerous ongoing academic endeavors to answer important questions on clinical, epidemiological, and basic science fronts illustrate admirable action. Redoubled training and education efforts on relevant topics such as airway management or mechanical ventilation are phenomenal investments of time and resources. Finally, work outside the clinical environment to support the community is certainly helpful.
3. Develop a positive attitude: be realistic, but optimistic and hopeful
This situation sucks. It’s exhausting, it’s frustrating, it’s hard, and it doesn’t look like it will be over for a while. It presents significant personal risk to those on the front lines in healthcare. It brings sadness and heartache to those who have lost friends, colleagues, or loved ones. It also carries tremendous economic hardship. All true.
However, we have weathered storms before. We’ve made unbelievable advancements as our individual medical specialties have matured. This international crisis, like others before it, will result in important lessons learned on many fronts. We can hope that what is learned in the coming months will improve emergency and critical care across the board as well as prepare us to deal with future pandemics.
We will emerge from this stronger, smarter, and better prepared. This, too, will pass.
4. Have faith in your team and draw strength from our medical community around the world
Social distancing, isolation from families, and spending the entire work day in personal protective equipment don’t exactly facilitate strengthening of social bonds. However, our healthcare teams in the ED, ICU, and prehospital environment are bound together in a common effort to save lives and ameliorate suffering. Despite differences in personality, politics, or coping ability, we are team with a common purpose. We must have faith in this shared mission and that our teammates will support us to this end.
The FOAM community around the globe is strong. In a post from a few years ago, titled The Ties that Bind, I discussed the power of social capital, social networks and the amazing international FOAM community. At times like this, the incredible ability of our community to share information, inspire each other, and provide support cannot be underestimated. Use it to access reliable resources for clinical information, updates, and ideas. Stay in touch and reach out to each other for emotional and psychological support.
5. Know yourself and your limits
Take stock of your abilities. Identify deficits in clinical knowledge and skills necessary to meet the demands of the current situation. Work to shore up strengths and develop weaknesses.
Knowing your limits also means understanding how you respond to acute stress (e.g. during resuscitation) and cultivating methods to help manage it. Furthermore, this appears to be a marathon and not sprint. The pandemic will likely continue impact us for months to come. As a result trying, as best as possible, to develop reasonable wellness habits that support physical, mental, and emotional resilience are important.
No one is immune to the effects of this pandemic. In healthcare we are surrounded by death and suffering on a daily basis. If you need to talk, reach out to friends or colleagues and always feel free to access the professional resources available at your institution.
Conclusion
In the end, we will get through this. In the interim, it will be rough. Really rough. Know that we are all in this together and that adopting the proper mindset can make a world of difference.
For those of you that have been in difficult situations in the past, whether it be a deployment to a combat zone, a deployment to an epidemic hot zone, or any other crisis…please share your thoughts. How did you get through? What worked for you?
References
- Southwick SM, Charney DS. Resilience: The Science of Mastering Life's Greatest Challenges. Cambridge, UK: Cambridge University Press; 2012.
- Fretwell P, Kiland TB. Lessons from the Hanoi Hilton: Six Characteristics of High-Performance Teams. Annapolis, MD: Naval Institute Press; 2013.
- Divine M. Unbeatable Mind: Forging Mental Toughness. Middletown, DE: Mark Divine; 2015.
- Sheridan S. The Fighter's Mind. New York, NY: Grove Press; 2010.
- Afremow J. The Champion's Mind: How Great Athletes Think, Train, and Thrive. New York, NY: Rodale Inc; 2013.
- Dweck CS. Mindset: The New Psychology of Success. New York, NY: Ballantine Books; 2006.
- Psychology of Survival. In: Field Manuel 3-05.70 Survival. Washington, DC: Headquarters, Dept of the Army; 2002.
University of New Mexico Health Sciences Center
Former US Air Force Pararescue and Critical Care/Flight Paramedic
- COMM CHECK: More On Resuscitation Communication - July 16, 2020
- Invictus: Survival, Sustainment, and Service in the Era of COVID-19 - April 25, 2020
- COMM CHECK: On Checklists - January 3, 2019
interesting to include Bill Henley and Invictus in a post about service. Invictus is an ode to self sufficiency with nary a hint of service.
Hello,
It feels really good that i came across this article.
And learned alot from this. Thank you!!