Resilience Lessons from the Front Lines.

Watercolor Portrait of Medical worker in PPE during COVID-19 Pandemic by artist Jayashree Krishnan
Watercolor Portrait by Jayashree Krishnan

Antiseptic.  Sterile.  That’s the way it had to be…scrubbed of virus…scrubbed of all human contact, except for essential workers.  That’s what Mark was, an essential worker.  As an Internal Medicine physician, he was the proverbial firefighter rushing into a burning building, while many of us were rushing out as fast as we could.  During his month on the COVID ward during the greatest surge of the pandemic, he moved toward patients who were fighting an illness that could easily take their lives as well as the lives of their care-givers.  Even with PPE, any time spent in a room with a COVID-sick patient increased the risk of patient-to-physician transmission.  Indeed, Mark knew of physicians, who moved toward COVID patients to heal, and lost their lives in the process.  A good friend and colleague from a previous practice spent forty days on a ventilator fighting for his life.  Now it was Mark’s turn to answer the call to service.

Research has shown that, by and large, resilience is not an inherited trait so much as a muscle that grows through practice.  And Mark had plenty of practice.  As the oldest child of immigrant parents, his childhood was colored by the experience of helping his parents navigate a new culture with a new language.  Mark agreed to sit for an in-depth interview so that I could surface what helped him maintain his equilibrium and buoyancy, throughout the COVID crisis.  I hope to combine his interview with those of other frontline workers as part of a study to uncover what resilience lessons can be learned from this unique moment in history.   

Our meeting commenced as so many meetings have this year, over an online Zoom call.  From my home office, I joined up with Mark at a lake cabin, surrounded by his wife and three school-aged children, as well as a mom and dad he hadn’t seen in more than a year.  The casual intimacy of that backdrop provided a sharp contrast to the subject matter at hand.  Mark very generously invited me into a space that was obviously a sanctuary.  What I hadn’t counted on was the way that my questions would pull him out of that sanctuary, and place him back in time to one of the most excruciating experiences of his life.

The COVID Ward during “The Surge”

Imagine death as a daily occurrence at work.  Now imagine that it is your job to inform people that they are going to die.  What’s more, you are the only contact between this dying person, and their family, and that contact can only occur over a sterile phone call.  In absence of all visitors, you are the messenger given the task to, “Tell mom we love her.”  The background music to the ICU was the constant beeping of ventilators.  High volumes of oxygen were pumped into the airways of wide-eyed Step-Down patients who prayed with all their might to avoid the ICU.  Even the general COVID ward patients knew that their prognosis could rapidly decline and they could die “within a week or a day.” The ward pulsed with an anxiety made all the worse for the Isolation.  This was the internal and external landscape for patients as well as their healthcare professionals on the COVID ward during the surge.  This was the backdrop for one of the most excruciating experiences of Mark’s life.      

At one point toward the end of the interview, I asked Mark, “what was the hardest moment of the pandemic for you?”  He suddenly became quiet.  Looking down, he picked up his phone, and walked away from his family.  A full minute of quiet walking later, he sat down at a distance.  With his head in his hands, he wept quietly.  It was during this month on service, while quarantining from his family that Mark’s wife was diagnosed with breast cancer. 

Growing Resilience in a Sterile Environment

When I asked Mark what resilience was for him, he said that “Resilience is not a matter of someone being stronger than another.”  “Resilience” for Mark is found in the  “ability to recognize the challenge, to set a goal,” and figure out how “to best get to that goal.”  During the anticipatory phase of the build-up toward his service, Mark was well aware that “there was no insurance policy that I wouldn’t get sick or die.”  Mark recognized that his greatest fear was having “to leave my family” due to death. What did Mark do with his fear?  “[He] began looking at what circumstances [he had] control over.”  He asked himself, “What can I do about that?” He began meticulously practicing the proper procedures for putting on, and taking off protective medical equipment (PPE).  Simultaneously, he prepared for the worst.  He put his affairs in order.  He made sure that his wife had access to passwords, and all other administrative information she would need to carry on with the boys in the event that COVID took his life.  Rather than focusing upon those things over which he had no control, Mark found his resilience setting his attention on those things over which he could make a difference.  “Focusing on what I could do, allayed my fear.”

In his seminal, Man’s Search for Meaning (1946), Viktor Frankl described how a sense of meaning was the psychological bedrock to thriving in unimaginable circumstances.  This was the second resilience strategy that emerged during his month sequestered from friends and family:  “the call to service.”  COVID  was “all consuming” during this time.  “To actually be able to do something about this pandemic” provided the sense of purpose, and motivation to continue this important work.  A second, more practical “call to service” became necessary in the midst of this month.  Having to leave his seriously ill wife, and their children to go to work on a COVID unit just seemed wrong to Mark.  To counter this obstacle, he consciously called to mind that it was this job, with its salary and benefits that would allow his wife to get necessary treatments, and would provide resources for his beleaguered family.  Once at work, it was the all-consuming nature of the work that kept his mind off of ruminating over worst case scenarios for his wife. 

Months later, I am happy to report that Mark’s wife has responded well to her treatments.  Her prognosis is quite good.  At the time of diagnosis, Mark and his wife faced all the excruciating challenges of confronting serious illness.  Like so many other things, COVID complicated things, raising existential questions.  “Would COVID allow us to get treatment for her in a timely way?”  “If treatment devastated her immune system, and I brought COVID home, would my job kill her?”  “If she gets sick with COVID and survives, will that put off necessary treatment?”  Before the “dust settled,” and those questions got answered, it was difficult to employ Mark’s usual COVID strategy of setting a goal and focusing on what is within one’s control.  What did he do?

The answer can be found in a fundamental choice made years ago, by Mark and his wife, Raechel.  That choice was affirmed hundreds of times by subsequent daily choices.  Despite his demanding career, this son of immigrants told me that, “family comes first.”  Over the years, when distance or conflict threatened marital equilibrium, he and Raechel focused on removing the barriers to their friendship, up to and including marriage counseling when necessary.  When the dual challenges of cancer and COVID arrived, there was a sturdy foundation in place to weather these storms.  From a physical distance, they spent hours talking and working out their fears. 

I have yet to meet a frontline worker who craves the title, “Hero.”  In Mark and Raechel’s case, heroism is a quiet thing constructed outside the limelight.  It is built brick-by-brick in little choices to move toward one another, rather than away.  For Mark, it is a focus on what he can change, rather than on what he can’t that accounts for a staying power in the dignity of his call to serve.  Rather than offering empty praise, perhaps the best thanks to workers like Mark and his wife would be to learn from their example, and employ homegrown resilience recipes for our own Hero’s and Heroine’s Journeys.     

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