December 2020/January 2021
Welcome to the December/January issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being.
*Please note that to access hyperlinks of articles, resources, and other tidbits referenced , please subscribe on the website.*
This month only, the hyperlink to the official newsletter may be found here (why April? no idea): https://mailchi.mp/781be024f030/wonderwell-april-9496693
Some things that had me wondering this month:
1. COVID and...vaccines.
November was a big month in terms of vaccine development, with vaccines from
Pfizer and Moderna/BioGen -- both are similar in terms of efficacy (not to be confused with effectiveness -- primer on the difference re: trials here, and with vaccines here), but one is more 'stable' than the other in terms of logistics. Logistics is HUGE when it comes to vaccines, as the global health world has shown us for decades. If an adequate cold chain is not maintained, the vaccine is effectively ineffective. It will be an interesting 'race' to watch which gets picked, for where and whom.
As well, vaccine distribution -- in both Canada and the U.S. -- is a tricky topic. This piece in NBC news is interesting as it does get to the idea of distributive justice...without going all the way. It's a topic I've been thinking a lot about.
2. A podcast to listen to:
This episode from the #AmWriting podcast is excellent, as it covers themes that every journalist (and health professional) must grapple with: boundaries. Here, journalist Lauren Sandler discusses her book, in which she is an 'immersion journalist' covering a young homeless woman during her pregnancy and after her delivery, as a window into the issues homeless women in general (and pregnant homeless women specifically) face in America. I'll admit, I cringed at parts, because I personally don't think I would be able to embed myself in that way, and I've embraced the movement away from what's known as "poverty porn-- that said, kudos to Lauren for openly speaking about the challenges, the ethical aspects, and how she is reconciling it (part of it includes setting up a way to donate to the cause on her website here). She also makes a key point that made me rethink my position -- how are we meant to advance change or become aware of some struggles without having stories that capture our hearts (and minds)?
3.On...being misunderstood...and asking if you're ok?
This is probably the best essay I've read in months, and it's a little like a Rorschach test (I sent it to a few friends and we each took something different away). To me, it's about being on the spectrum and having experienced sexual abuse, but not wanting to make those aspects overshadow her identity. But the *way* the piece was written, without using terms that we feel tend to be loaded, makes it particularly interesting and perceptive. I've been thinking a LOT about how some of us need more information in order to understand another, whereas often this 'other' just needs acceptance (and understanding might come later). I've noticed it with one person in my life in particular, and it's been a tricky thing to navigate but an immense opportunity to learn.
And this, by Duchess Meghan Markle, is well-worth the read in that it's timely and applicable to all of us especially as these dark days of Winter approach. She's an admirable woman who successfully extricated herself out of a toxic situation where she wasn't able (or allowed) to thrive, but the point here goes well beyond her devastating experience with a miscarriage. It gets to why simply asking "are you ok" can make all the difference.
4.Sound (and wise) reflections
~From the BrainPickings newsletter -- more on William Blake, whom I wrote about in September. Fascinating artist/poet who wasn't appreciated until years after he died.
~Great reporting by Canadian healthcare journalist, Wendy Glauser, on the psychosocial aspects of the pandemic.
5.Miscellany
~An expose into McKinsey -- but specifically because I can't stop thinking about their hiring process, which I, and many others have personally experienced. It's case-based, but heavily math-based (i.e. long-hand division) and timed. Imagine if consulting companies looked at other aspects, e.g. ethics and integrity, and ability to solve problems or think in unique ways. Could the outcome here have been different? Could this crisis be the beginning of something really great for McKinsey in terms of how they approach solving tough problems, now that they're coming to terms with a big one of their own?
~The untimely and tragic death of Zappos CEO, Tony Hsieh hits close. Part of his personal story is featured in my own book, and his book (Delivering Happiness) is a must read for anyone interested in workplace culture and organizational psychology. Hsieh certainly left an influence on the world, that goes beyond tech and entrepreneurship -- placing customers first and looking at how to make workers thrive -- could do wonders if we applied those principles to healthcare. Above, I've linked the audiobook because it's Tony reading it himself, and I loved hearing his energy and excitement, but most importantly his commitment to those he worked with. He was a true example of "servant leadership."
6.Best tweet of the month goes to...
Holland Stanton, a medical trainee -- only because I've been personally obsessed with the idea of compatibility as it relates to the Match.
Can you do a story on The Match? & Med School education in America?
But I also REALLY loved this, as Charles is a new friend and his success is incredible to watch (and inspiring) -- his book Interior Chinatown will make you laugh (and cry) and is so deserving of a National Book Award. More info on his book here, and our interview here. And, related to this -- another from Jacob Weisberg, only because Penguin Random House is *my* publisher (so I very much am interested to know if the imprint might be, indeed, Simon's Random Penguin 🙂 ).
Ok, and I REALLY loved this -- I had to mention something about the election, right!
In My Own Words...
This month, I'll share one last image -- that of my book manuscript, which, thankfully I'll be submitting on deadline. All 300 pages (100,000 words) of Draft 1 are here...in print. Keep in mind this is the first draft of what will likely be around 10 at the minimum. The marathon begins (or continues?). Can't wait for you to read it once it's ready.
This past month was also interesting for another reason, in terms of a cool opportunity that cropped up to not report on a problem I've been noticing, but actually be part of the solution. And it deals with tech and healthcare. Stay tuned next month for more details...at least what I might be able to share, but it's really exciting... 🙂
Can you believe we're at the end of the year that felt like a decade? 20/20 vision in optometry (and opthalmology) means "perfect" vision. For what it's worth, none of us had foresight that 2020 would be filled with a pandemic, massive social unrest (but for racial justice, which was a long time coming), and even more unusual political happenings (with a still 'contested' election in the U.S.). But we DO have the hindsight now -- of the many lessons this year has given us. With that in mind, we're entering 2021 with perhaps new priorities, restructured plans and goals, and perhaps a lot more hope.
Resilience, I've learned, is earned, not given.
Have a wondrous & well (and healthy, and safe!) Holiday season, in fact *make* it
especially so,
Amitha Kalaichandran, M.D., M.H.S.
November 2020
Welcome to the November issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being.
***Please note that to access hyperlinks please subscribe**
CREDIT: Olivia Van Dyke/Tofino British Columbia/ October 2020
Some things that had me wondering this month:
1. COVID and…hidden patterns
Some rapid-fire wonderings:
~Published in the BMJ: a new hypothesis on face masks might be associated in falls in the elderly (and note, it’s well known that a hip fracture in an older person is significantly associated with mortality risk during the following year). There’s no doubt face masks are crucial, but how do we avoid the externalities such as falls?
~From the NYT: how schools that are open to in-person instruction are shifting via allowing teaching to occur outdoors. Related to this: Richard Louv’s classic book “Last Child in the Woods,” is an excellent foray into the issue of ‘nature deprivation’ — outdoor teaching helps lower COVID transmission risk while also changing the setting for learning (it would be interesting to know if this helps with attention)
~A great, short discussion of Dr Akiko Iwasaki’s work and recent award, in Science. There are many unsung heroes, namely researchers and physician leaders, who are finally being recognized for their work this year, during COVID. There is also a Canadian/UofToronto connection here, as she did some of her training at the University of Toronto. That aside, especially as a woman of colour in research/medicine, it’s wonderful to see her gain influence.
~Few more choice pieces from the NYT: by the great Carl Zimmer on vaccine safety as it relates to research trials, Ashley Fetters (whose articles in the Atlantic were among the best in my view) on loneliness as it relates to working from home, and this great one on COVID long-haulers in pediatrics.
2. Two incredible podcast episodes to listen to:
Tim Ferris with Seth Godin: a long-time listener to Tim’s podcast, in 2020 his empathy and curiosity with his interview subjects is even more clear. He asks the questions most interviewers don’t, and really gets into the nuts and bolts of “process” and “habits”. This interview with Godin is excellent because 90% of the time they cover the writing process and what Godin advises. Godin’s thoughts on writers block alone are golden.
The GOOP podcast with Rebecca Traister: a somewhat divisive journalist, Traister isn’t afraid to ask tough questions and here she really interrogates traditional ideas of feminism, and specifically the role that white women have taken in oppressing women of colour as well as men of colour. We all intersect with various identities and it is sometimes the case where learning into power “over” an oppressed group is confused with self-empowerment. On my wish-list for 2021 is for Traister to have her own podcast: I’d really just love to hear more of her takes on provocative issues, and she seems like she’d be a thoughtful but brave interviewer.
3.Tiny piece on friendship and connection
Maria Popova’s hugely popular newsletter is hands down my favourite weekly email. This one is from last year, but it rings true during this time as well.
4.Sound (and wise) reflections
~From Knowable magazine — what lies ahead for “Black Lives Matter” from a political scientist and sociologist.
~Water on the moon!! But even better — a millennial discovered it, from the New Yorker
“‘For the first nine hours and forty minutes,Casey Honniball, a 27 yr old planetary scientist, didn’t have much to do. She took a nap, ate a PBJ sandwich, & used her laptop to work on research proposals.”
So what was that about millennials being lazy and entitled again? 🙂
~And an obituary from a very interesting psychologist– one who questioned the status quo, and the elements of psychiatry & psychology that have become, rightly or wrongly, dogma. The squeaky wheels in medicine/psychology are the ones that often make these fields better.
5.Miscellany (politics edition)
~AOC in Vanity Fair: her journey, and earnestness, has been incredible to watch
~Racial politics and Kamala Harris, in the New Yorker: how does a possible future Vice President navigate the harmful stereotypes on anger?
~Why this year really does feel different, from Politico.
6.Best tweet of the month goes to…
ANOTHER TIE between
Posthumous Richard Feynman:
One of the signs of intelligence is to be able to accept the facts without being offended.
and editor Jenee Desmond-Harris, mostly because I couldn’t agree more:
The beach really fixes everything. Except home pandemic haircuts.
In My Own Words…
This month, I’ll share an archival piece about Halloween (one of the first pieces I ever published) and trends related to allergy — the Toronto Sun is Toronto’s answer to the NYPost (!); I’m just glad they liked it enough to publish it. And another archival one on election stress, and how it can affect voter turnout, published in Ozy, also from 2016. The month was busy writing wise but because I was invited to contribute a textbook chapter, for a textbook on physician well-being, to be released in late 2021. I’m fortunate to work on it with two mentors I greatly respect and enjoy working with, and the chapter focuses on physician mental health. Academic writing is much much different compared to say magazine or news or op-ed writing (obviously) but it was still fun. I’ve excerpted the last paragraph of our [draft] introduction here [for subscribers only]
This is a BIG week ahead for my American readers (but really, who are we kidding — it matters for all of us). If you can vote, please do. I know I’ll be feeling a bit anxious for the results.
Have a wondrous & well (and healthy, and safe!) month,
Amitha Kalaichandran, M.D., M.H.S.
August 2020
Welcome to the August issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being.
So…it’s been awhile! I took a few months off to focus on the first deadline for my book…yes book! Details at the end. Oh, and I broke my wrist (ironic, given the title of my book). Let’s say that the experience was eye-opening, as I had a first-hand glimpse into the American healthcare system! I also left beautiful New York City, a place that I got to know well, & fell deeply in love with, in sickness and in health. As mentioned in my last newsletter, we are living in very strange times currently, so the newsletter has pivoted slightly to include the same themes, but with a COVID19 lens.
Some things that had me wondering this month:
1. Can pandemic boredom be…Good?
Perhaps. At least according to a piece in the New Yorker and another in the New York Times Opinion Section. Perhaps some of our anxieties involve having to sit in deep contemplation — whether we like it or not. But what possibilities might this afford us? I loved this quote from the NYT Op-ed:
“This suggests that self-reflection can be intrinsically aversive…Sure, boredom is a signal that we’re underaroused, but if we sit long enough with our uncomfortable thoughts and feelings, boredom could provide us with an opportunity to rethink whether we are spending our lives in a way that is rewarding and meaningful to us. What things might we change to make life — and ourselves — more interesting?”
2.Election things and Current events
A big month in the U.S., as Kamala Harris was chosen as the Vice Presidential candidate, marking the first time a South Asian American and Black American was chosen for the role. This is a great article on what it means for many women who identify with parts of her heritage — myself included!
We also marked the passing of actor Chadwick Boseman from colon cancer, at the age of 43. This is a form of cancer that has seen an uptick among young (20s-50) people, and it’s a disturbing trend that serves as a reminder to take the signs and symptoms seriously, and to get screened. It’s also a reminder that we never really know what strangers, and sometimes even our loved ones, are facing privately — so kindness is key. There were lots of tributes over the weekend: this one from the New Yorker is especially good, as is this essay by Marvel director Ryan Coogler. What’s clear is that Boseman was motivated to use his platform and his work to advance social change, particularly as it applies to racial justice. His work speaks for itself, and he left a legacy — both in his work and all of those he impacted (the consistent theme is his humility, grace, and kindness) — which may inspire us all. This quote below, from the New Yorker article, sticks out as it reflects how often the industries we find ourselves in reward the conformists over the trailblazer. Personally, I’d much rather blaze a trail.
It is, perhaps, this very sense of history, of responsibility, of implicit but intensely personal political commitment, that also inhibited the acclaim, while Boseman lived and worked, from his timid and stumbling Hollywood milieu.
3.Are Doctors People?
I dug deep into the archive for this one, reflecting on burnout and the struggles many doctors are facing during his pandemic. Roger I Lee was an incredibly accomplished physician leader who also served in WWI. He also had a little mischief and sarcastic streak, which makes him even more interesting. This short essay is worth the read. His books are hard to find as they’re out of print — this one is next on my list, and sitting patiently on my nightstand.
4.Our memories and our attachments and….a contrariwise state
The theme of “attachments” has preoccupied me since January, for many reasons. I just gave a talk framing this idea within the context of the Biblical Book of Job, and William Blake’s rendering of it. This season finale episode of Malcolm Gladwell’s podcast, Revisionist History, builds on this theme in a slightly different way, and it will move you to tears. It’s well worth a listen, especially as we mourn many loved ones this year. After you listen, read this, from the Globe and Mail — a beautiful reflection on how we might mourn our old [pre-COVID] lives.
Sometimes the biggest attachments we have are to our opinions — so the challenge then becomes understanding how these opinions form (the best understanding I have is that it’s a confluence of information and our values), and what it might take to change our minds. I’m in the process of changing my mind about something quite significant (I’d share but am still cocooning it), and so this essay, on Medium, which touches on Heraclitus and Jung and the idea of “contrariwise” — that eventually we gravitate towards our opposite mind-state, is fascinating.
5.A book I’ve been enjoying
On my pandemic wish-list, since around March, was that someone, somewhere, might write an anthology — short stories and essays and images — about this ‘time of COVID.’ A written and visual “time capsule” of this moment, in other words. Well, Bill Hayes has done just that with “How We Live Now,” just released this month. Hayes is an amazing writer, whose subjects generally focus on medical nonfiction (everything from an exploration into the man behind “Gray’s Anatomy” i.e. the textbook not the show! And his own struggle with insomnia). He is also the partner of the late, great, Oliver Sacks (and this lovely piece describes their love story). I’ve been enjoying his latest book as a way to integrate my own reflections of this time, some of which will make their way into the last chapter of my own book. It’s worth the read.
6.Best tweet of the month goes to...
Adam Grant — with his tweet on which opinions we decide to share. It might especially be relevant for forums like Twitter.
“Not every opinion needs to be voiced. Not every emotion needs to be expressed. A key question: does what you’re about to share align with your values? It’s good to be true to your thoughts and feelings in the moment. It’s better to be true to your guiding principles in life.”
In My Own Words…
This month I gave a talk to the National Partnership for Hospice Innovation, on grief and attachments during COVID. I’ll link to the video next month. I also moderated an important discussion for Ellevate, on mental health, with a focus on this challenging period. Last, I’m pleased to share my formal book announcement — it’s slated for publication in 2022. Thank you for joining me on this journey!
Have a wondrous & well (and healthy, and safe!) month,
Amitha Kalaichandran, M.D., M.H.S.
A physician’s suicide reminds us that the plague of COVID-19 creates deep emotional wounds in health care workers
One of the oldest tales in the history of medicine is the story of the archetypal “wounded healer,” Chiron. As legend goes, Chiron, an immortal centaur, who both taught medicine and served as a physician, attended a gathering hosted by another centaur named Pholus. After a series of events involving other centaurs fighting over wine, Heracles (aka Hercules), in his attempt to intervene, accidentally unleashed a poisoned arrow that hit Chiron’s knee. Chiron, being immortal, was forced to endure unbearable pain.
Despite his ability to heal others, Chiron was unable to heal himself. Filled with shame, he retreated back to his cave, still committed to teaching his disciples. Eventually, after nine days, his pain became unbearable and Chiron requested that Zeus remove his immortality so he could die. Though a myth, it serves as the first documented story of a physician suicide, albeit assisted, and suggests that the challenge of healing our healers stretches back centuries.
The recent suicide of Lorna Breen, an accomplished and compassionate physician, researcher, colleague, friend, sister and daughter, after she served on the front lines of a busy New York City emergency department, reminds us that the plague of COVID-19 also creates deep emotional wounds in health care workers. As her father Philip Breen described her, she“was like the fireman who runs into the burning building to save another life and doesn’t regard anything about herself.” Her death was not due to COVID-19; it was due to a system and culture of hospital medicine that failed to value her as a human beyond her profession.
Right now, COVID-19 is a stress test, exposing the vulnerabilities in our financial, social welfare and health care systems. But it’s also a catalyst, giving rise to novel solutions such as providing a guaranteed basic income, expanding blood donation eligibility, reducing bureaucracy in hospitals and encouraging partnerships between tech companies. As such, it must also be a catalyst for improving medical culture so that one day no physician is forced to choose suicide as a result of an inability to cope or seek healing for themselves.
Awareness of the suicide epidemic plaguing the profession has gained ground over the last five years. Doctors have the highest suicide rate of any profession: about 300 doctors die each year in the United States (the size of a typical medical school student body). Effectively, suicide has now become an occupational hazard of the profession. But it’s also the canary in a coal mine serving as a warning for an overwhelmed and unhealthy system, one that doesn’t care for its doctors.
One thing is painfully clear: physician suicide isn’t about resilience. Doctors by definition are resilient; we must be to jump through many hoops to gain admission, serve on long overnight calls often without food, water or sleep, and work unreasonable work hours, often with an inadequate support system. Sadly the overemphasis on individual resilience at the expense of ensuring the work environment is healthy has placed the onus on doctors themselves—which is nothing more than victim-blaming.
While substance use and mental illness may be factors, many doctors do not have a diagnosed mental health disorder like depression and anxiety. This may, in part, be due to stigma around seeking a formal diagnosis, but we also know that symptoms of depression are wildly dependent on the environment; the influence of our situation on our reactions has been understood by sociologists for decades.
While things like mindfulness help to a degree, it’s a lot like expecting a soldier to meditate while bombs are being dropped all around her. The priority must instead be to get that soldier into a safe space with a battalion she can rely on, with the appropriate protective gear. Putting an otherwise healthy person, someone who is driven, intelligent, empathetic, in an environment that is not conducive to her well-being will place additional pressures on her with little room to thrive, or possibly even survive. The consequences can be disastrous, but are not surprising.
The problem of physician suicide is so deep, and the role of culture so paramount, that pontificating on solutions often feels futile, especially as the issue isn’t so much what the solutions are, but how to actualize them.
Culture must change from the top down, and this takes sound policies and commitment. Policies must include limits on work hours, time for self-care, and zero tolerance for bullying and harassment. We must also increase psychological safety (defined by Harvard scholar Amy Edmondson as “a climate in which people are comfortable expressing and being themselves”), a matter that is a pressing issue during the pandemic, as with the firing of doctors in Mississippi who have voiced concerns.
We should also ensure that all physician health programs are free of conflict of interest, completely divorced from licensing bodies, and accessible both geographically and financially. During a crisis especially, as we know from humanitarian aid workers, reentry trauma is common, and so access to these programs now is paramount in order to offset the risk of suffering alone. Isolation is an unsafe breeding ground for trauma, anxiety, and unprocessed grief.
Beyond telling the story of Chiron’s death, the ancient Greeks came to see suicide as primarily due to malfunctional “humors”—the end result of the build-up of black bile (melancholia) or yellow bile (mania). The beauty of medical knowledge is that it evolves; so too must our understanding. We must take lessons from as far back as Chiron, and as recently as Lorna Breen, to understand that environmental factors matter much more than the individual. Breen’s passing during this pandemic offers us a moment to reflect on how best to use our outrage and mourning, as patients and physicians, to finally move out of the clouds of ignorance, willful blindness and institutional inertia to prevent the same tragedy for repeating itself.
Once Chiron died, he left two legacies. The first was in those he taught: like the father of medicine, Asclepius, who in turn was said to have taught Hippocrates. Thousands of medical students take the Hippocratic oath each year. The second legacy, according to the poet Ovid, was through a gift from Zeus, who wanted to ensure Chiron’s spirit lived on in the night sky, so he created the constellation Centaurus—what may now be viewed a literal interpretation of the saying per aspera ad astra (“through hardship, to the stars”).
It shines brightest during the month of May. This year it might remind us of the thousands of physicians who took their own lives while healing others—some during this pandemic—doctors who might inspire us to finally change direction. And for Breen, as one of those bright stars, may we also vow to honor you as the hero you were, illuminating our path forward.
If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingOfSuicide.com/resources for a list of additional resources. Here’s what you can do when a loved one is severely depressed. For physicians on the front lines expressing mental distress or suicidal thoughts, or who just wish to talk, call the Physician Support Line 1-888-409-0141, which is open 8am to 3am ET, seven days a week, and provides free and confidential support with a volunteer psychiatrist.
**Originally published in Scientific American**
The coronavirus pandemic will leave lasting emotional scars.
According to my mother, there are two unique forms of grief that everyone touched by war understands. There’s the grief associated with the loss of human life—through bombings and brutal combat, and through the disease that runs rampant when health care and all other social services are halted. Then there’s the grief associated with the loss of a life as we once knew it: loss of country, loss of employment, loss of identity as a “prewar person,” and the subsequent need to start over. The two run along together like two dark snakes intertwined.
When my mother and father moved to the United Kingdom from Sri Lanka, amid a civil war that would drag on for 26 years, they didn’t readily display their grief. My siblings were born into the only reality we would ever know: visiting ducks at the local park, swinging on our neighbors’ swing set, and blowing out candles at birthday parties that were evidence of both assimilation and normalcy. Yet my parents’ grief would peek through at moments. The first time I ever saw my mother sob was the day she received a phone call with news that my uncle back home had lost his foot in a land-mine explosion. Years after we had moved to Canada, she learned that a famous library holding thousands of historical texts in her native Jaffna had been burned to the ground by the army. Her silent tears and the way she stared off into space, I realized then, were two more dialects of grief.
That kind of sorrow is unfamiliar to many people who live in peaceful places. Yet COVID-19 will leave behind a complicated form of grief that will linger—potentially for many years after the immediate crisis has abated. Thousands of bodies have piled up in Italy, during a period when doctors wrestled with horrific ethical quandaries around rationing care. Now, in parts of the United States, refrigerated trucks have been deployed for use as makeshift morgues. In New York, a mass grave is being built, and cremations are happening all day long. Patients are dying alone, and much like during the Ebola crisis in West Africa, fears of contagion have interfered with families’ ability to mourn.
As of yesterday afternoon, more than 20,000 Americans had died of the new coronavirus. The growth in the number of cases, fortunately, appears to be slowing. Still, even relatively optimistic projections indicate that many more people will succumb in coming weeks; even some who recover will still be at risk of long-term health complications.
All of this damage is occurring while people are still dying from other causes, too—and when grieving people are being discouraged from even going outside, much less seeking solace from their loved ones. Making matters worse, the current crisis has put enormous stress on the healing professions that, in normal times, help families deal with loss and bereavement. Our society is ill-prepared for the kind of grief the coronavirus is visiting upon so many people during so short a span.
Research on grief after large-scale casualties is scant, but the literature suggests that suffering personal losses can be particularly harmful when experienced in times of broader social stress. A 2015 study found that children who lost a loved one during a mass-trauma event such as a natural disaster, a terrorist attack, or a war are likely to suffer long-term psychological trouble. Studies of service members and veterans who served during 9/11 found a high prevalence of what is sometimes called complicated grief—a type of bereavement that is unusually severe and long-lasting. These service members and veterans showed worse symptoms of post-traumatic stress disorder and had a higher number of lifetime suicide attempts.
A study of survivors of the Rwandan genocide found that what the researcher called “unprocessed mourning”—in part the result of the halting of traditional mourning rituals during the war—contributed to lingering mental-health woes. Two years after the 2004 Indian Ocean tsunami, chronic grief was found in almost half the survivors, and was strongly associated with losing a spouse or being female. And a systematic review of Ebola survivors found high levels of psychological distress, including prolonged grief, which was compounded by the stigma placed both on survivors and their families as they attempted to return to work.
The coronavirus pandemic differs from those catastrophes in various ways. But it brings stressors of its own. Especially for those worried about vulnerable elders, it brings a level of anticipatory grief, the form that appears when the death of a loved one appears inevitable. It also comes amid a sudden economic crisis and skyrocketing unemployment; the disconnection of people from their families, friends, and their usual routines; and the recognition that some of those routines will be permanently disrupted.
In her 1939 short story Pale Horse, Pale Rider, the writer Katherine Anne Porter describes the protagonist, Miranda, as she falls in love with a soldier named Adam while also falling ill with the 1918 influenza. Amid their fear of the disease, the pair also grieve their old way of life. “All the theatres and nearly all the shops and restaurants are closed,” Adam laments, “and the streets have been full of funerals all day and ambulances all night.” Only when Miranda recovers herself can she fully appreciate the world she and her lover have lost. And when she learns, by letter, that her lover has died from the disease, she descends into the darker depths of prolonged grief.
“At once he was there beside her, invisible but urgently present, a ghost more alive than she was, the last intolerable cheat of her heart; for knowing it was false she still clung to the lie, the unpardonable lie of her bitter desire.”
The Diagnostic and Statistical Manual of Mental Disorders defines prolonged grief disorder as grief symptoms persisting for six months or longer after a loss, along with separation distress, impaired social or occupational functioning, and the presence of symptoms such as confusion, shock, bitterness, and difficulty moving forward with life. As the public sits in anxiety and in isolation, policy makers seeking to cope with the current crisis must also begin to plan for the demands on mental-health services, specifically for grief and bereavement, in the near term and beyond.
As a physician who is also the child of two physicians, I worry in particular about the grief experienced by the health-care providers who are making good on their ethical duty to serve those suffering from the coronavirus. After the 2004 tsunami, prolonged grief disorder was found in one in 10 hospital workers surveyed. In the current crisis, medical providers—including my mother, an anesthesiologist who performs intubations—are at personal risk. Even those who survive COVID-19 or do not contract it in the first place may lose valued friends and colleagues, amid the deaths of other health-care workers who have had to work without adequate protective gear.
In the hospital, doctors and patients alike have reasons to grieve. Doctors grieve the loss of a patient who has died. Patients, once a disease is diagnosed, grieve the loss of their health. Medical trainees grieve their former idealistic self as they become inured to a system that, ironically, often places little value on their own well-being.
Before the coronavirus, the ethos of humanism—of listening closely to patients’ concerns and fears and tending to their needs—had never been stronger in the medical profession. The pandemic returns doctors to a time when compartmentalizing a patient’s suffering—and one’s own—is an emotional survival tool. “We’re asked to be as dispassionate as the disease itself,” Daniel Lakoff, an emergency-room doctor in New York City, recently told me. “We don’t touch the patient in many cases, we use telemedicine, we give oxygen, and we watch and wait. And we often feel powerless.”
Claire Bidwell Smith, a counselor in Charleston, South Carolina, who has written three books on grief, told me that these recent weeks have been the busiest of her decade-long career. (She offers her services online.) She raises the possibility that grief may play out differently during this pandemic from how most people typically experience it. Usually grief feels very personal, Smith says, because the rest of the world proceeds normally while the bereaved feels numb and alone. That dynamic may change because much of the world has now ground to a halt. Grief may be delayed, she said, but a shared catharsis may lie ahead. “I think there will be a massive collective mourning when we’ve emerged from this, for us as a culture,” Smith said. “While what’s happening is heartbreaking, and we haven’t been able to ritualize or memorialize. We will come back to this.”
When I was growing up, another way in which grief visited our home was when my parents’ friends and extended family from Sri Lanka would stop by and reminisce. They would briefly recall the war but also use it as a frame in which to tell more uplifting stories of laughter and overcoming. Grief, when these adults experienced it together, became a connecting agent, joining the broken pieces into a more harmonious common mosaic.
The scars always remain. At the end of Pale Horse, Pale Rider, months of hardship give way to a future that is both brighter and tinged with melancholy. “No more war, no more plague,” she writes, “only the dazed silence that follows the ceasing of the heavy guns; noiseless houses with the shades drawn, empty streets, the dead cold light of tomorrow. Now there would be time for everything.”
**Originally published in The Atlantic**
Us, Interrupted is a series that focuses on public figures as well as professionals on the front lines of the COVID-19 global pandemic. During this unprecedented crisis, we hope these stories of vulnerability and resilience will help us move forward, stronger together.
Sophia Bush is an American actress, activist, and entrepreneur. She is a member of the Directors Guild of America and has starred in various independent projects, shows, and movies such as John Tucker Must Die, Incredibles 2, One Tree Hill, Dick Wolf’s Chicago PD, and This is Us and has joined the cast of the upcoming show Love, Victor. Bush also co-founded and sits on the board for the public awareness campaign “I am a voter,” which promotes awareness of registration tools and encourages all to use their resources to participate in the voting process. Most recently, Bush launched a podcast, Work in Progress, which features frank conversations with people who inspire her about how they’ve gotten to where they are.
We spoke to Bush about how her normally busy life has been changed by the impact of COVID-19 and why she’s learning to not expect too much from herself while staying home.
1. What was your life like before we learned about COVID-19, in terms of your self-care and maintaining a sense of well-being?
I’ve always struggled with routine since on set there is no such thing. Some days I have a 4:15 a.m. call time, and some days I go to work at 6 p.m. and film until the next day at 8 a.m. So I think I’ve always been enamored with people’s routines and looked at them with total fascination. In recent years, I’ve really tried to examine how to create routine.
Read more at MindBodyGreen.
Us, Interrupted is a series that focuses on public figures as well as professionals on the front lines of the COVID-19 global pandemic. During this unprecedented crisis, we hope these stories of vulnerability and resilience will help us move forward, stronger together.
Rachel Pearson, M.D., Ph.D., is a hospital pediatrician and assistant professor of medical humanities in San Antonio, Texas. Through the Center for Medical Humanities and Ethics, she runs the website known as “Pan Pals,” which uses the humanities and allied disciplines to help preserve compassion, justice, and humanitarian values through and beyond the pandemic.
When we spoke to Pearson, she explained the way that her life as a doctor, a medical ethicist, and a newly expectant mother has been affected by the COVID-19 outbreak:
1. What was your life like before we learned about COVID-19, in terms of your self-care and maintaining a sense of well-being in and out of the hospital?
I was settling into a new job in a new city, and I had just found out that I was pregnant for the first time. I had made some friends, and one of my most important ways of caring for myself was going for walks in the evenings with a girlfriend. I would meet my friend Christy halfway between our houses, and we’d walk around the neighborhood with her two dogs.
In the hospital, one of the big joys of my new job was finding that I had lots of time to spend with my patients and their families, as well as with my residents. I could go from room to room in the afternoons and just sit down and check in with worried parents and sick kids. The human connection that comes from that time, as well as the knowledge that I was getting to practice medicine in a way I believe in, gave me a lot of peace and brought a lot of meaning into my life. I also knew that, with my own kid on the way, I would soon have a reason to want to leave the hospital as soon as possible—so, I was really relishing that deep time with my patients and families.
Read more on MindBodyGreen.
Us, Interrupted is a series that focuses on public figures as well as professionals on the front lines of the COVID-19 global pandemic. During this unprecedented crisis, we hope these stories of vulnerability and resilience will help us move forward, stronger together.
Blake Mycoskie is an entrepreneur, author, and philanthropist and the founder and chief shoe giver of TOMS. Since beginning with shoes, the brand has expanded to eyewear and a coffee roasting company that partners with other organizations that provide safe water in seven counties. His most recent project, Madefor, launched recently and aims to improve our brains and bodies with neuroscience, psychology, and physiology.
Here, mindbodygreen spoke to Mycoskie about transitioning to life during COVID-19 as an individual and as a business leader, and how he’s taking control of his experience and finding the good that he can:
1. What was your life like before we learned about COVID-19, in terms of your self-care and maintaining a sense of well-being?
How I start my day plays a big role in how I experience life. My morning routine begins around 5:30 a.m. and consists of a mix of contemplation, prayer, basic body movements, and a tea ceremony. There isn’t anything magical about my 30-minute routine, but I find there is magic in an intentional start to the day. It helps me be more present and leads to better decisions. Each day, I try to find the right mix of quality time with my children and friends, outdoor physical activities like surfing or climbing, and meaningful work. I’m at my best if I invest in these three areas on a daily basis.
Read more on MindBodyGreen.
Us, Interrupted is a series that focuses on public figures as well as professionals on the front lines of the COVID-19 global pandemic. During this unprecedented crisis, we hope these stories of vulnerability and resilience will help us move forward, stronger together.
Tommy Didario is a television host and on-air lifestyle expert who has appeared on The Rachael Ray Show, The Today Show, and Entertainment Tonight. He covers everything from celebrity interviews to human interest stories to lifestyle topics in the fashion, trends, grooming, travel, health, fitness, and wellness worlds.
We spoke to Didario about how his formerly regimented lifestyle has been changed by the COVID-19 outbreak and how he’s doing his part to slow its spread.
1. What was your life like before we learned about COVID-19, in terms of your self-care and maintaining a sense of well-being?
I was very regimented. I get up at 5:30 a.m. every day, and I do a 20-minute yoga session. Then I’d head to the gym for a workout and come back to have breakfast before getting to work. With my work, which is in the entertainment/lifestyle business, I never know what the day is going to look like, so getting my core “me” time in early on is key. And living in New York City, I crave my outdoor time, so I’d make a point to walk to any meetings that might be a 20-minute or less walk. I also enjoyed writing for fun or work—it was a creative outlet for me—and reading. Eating healthfully with a balanced diet was also important.
Read more in MindBodyGreen.
Us, Interrupted is a series that focuses on public figures as well as professionals on the front lines of the COVID-19 global pandemic. During this unprecedented crisis, we hope these stories of vulnerability and resilience will help us move forward, stronger together.
Mark Shapiro, M.D., is an internist and the associate medical director for hospital services with St. Joseph Health Medical Group in Sonoma County, California. He is also the creator and host of the Explore the Space podcast, which considers the relationship between health care and society.
We spoke with Shapiro about working in the medical field during the COVID-19 outbreak and how it’s affected his work and personal life.
1. What was your life like before we learned about COVID-19, in terms of your self-care and maintaining a sense of well-being in and out of the hospital?
I was in a pretty good place balancing family life, my clinical and leadership work, Explore the Space podcast, and my own self-care. Keeping an exercise routine, good nutrition, reasonable sleep, and having fun were things I was feeling more and more comfortable with.
Read more in MindBodyGreen.