Harvard Macy Community Blog

Fostering the ongoing connectedness of health professions educators committed to transforming health care delivery and education.

“Unmasking” in the Era of COVID-19

This joint narrative reflection weaves through the experiences of three female physicians, practicing internationally during the COVID-19 pandemic. It uses the metaphor of the ubiquitous masks we now all wear to explore the boundaries between caregivers and patients and the unanticipated “unmasking” that has taken place across technological platforms, in hallways and patient spaces. The focus is on the commonality of experience of clinical caregivers in these extraordinary times, despite the diversity of social and cultural settings. Most importantly we describe what has been uncovered and what other health care providers might take away from this once-in-a-life-time experience.

The message on the screen reads “patient is ready,” but instead of walking into an examination room, we are now welcomed into living rooms, dining areas, and foyers. Sometimes we sit together in gardens in the dead of night, where we compliment green thumbs and stare at strings of outdoor lights hanging precariously on potted plants. “You are early” the patient remarks. The appointment was for 9:30 pm but it is only 9:20 when my face appears on the screen. It is Ramadan, patients have broken their fast, completed their sunset prayers, and the night comes alive. Here we are, their doctors, instantaneously accessible, unmasked and ready to connect.

Before the SARS-CoV-2 pandemic, we were expatriate physicians working in tertiary academic medical centers in the Middle East; female clinicians delivering care to patients and educating young trainees in a foreign environment. Speaking in Arabic at various levels of fluency, with each awkward roll of the tongue, we inched closer to our patients. Then came COVID-19. The early days were marked by longer, more deliberate hand washing at sinks and screening questionnaires at reception desks across the nation. Then the frenzy: the nightly curfews, the floor stickers, the temperature probes, and finally the masks. The small, blue, rectangular wall of the mask was erected, furthering cultural and language chasms, challenging expressions of empathy, care, and compassion. 

So here we are in patients’ gardens, marveling at the weather and the night sky while paying attention to breathing patterns. Listening to the crunch of grass beneath their feet while remarking on pedal edema. Making note of shoulder range of motion as they showcase mantles and mementos. These sessions seem to be working for both of us. The gravity of the pandemic fades into the backdrop of the majestic majalis of our Bedouin patients. Formal clinic attire, a traditional head covering and an impeccable white kandurah, is replaced by a Yankee cap and a colored t-shirt. Dark tresses usually concealed by hijab during clinic visits, now showcased on screen; a privilege afforded by our shared gender. We are introduced to grandchildren, serving as technical assistants while filling in the color of our clinical impressions. We assess the pandemic panorama together, discussing practices to mitigate risk of transmission, navigating through newly imposed diagnostic and therapeutic protocols and re-prioritizing management plans. The reality of the global crisis still in view, but now in the background of our respective living spaces, at least momentarily.

Back in the hospitals and clinics, we shuffle by, wearily greeting beardless and make-up free colleagues. . We discuss patient cases and peer into eyes just a little longer, all from a distance now deemed “safe.” Distances subconsciously varying by specialty and exposure risk, as instincts of self-preservation get the best of us. Then all it takes is a fissure, a small, almost unnoticeable crack in the voice or an oddly hurried glance caught in a hallway. And sometimes it’s an earth-splitting crevasse formed by an unspeakable moment of clinical calamity. That mask, self-assuredly lodged between the bridge of the nose and the curve of the chin, suddenly trivial in its tensile resolve and its layered filters. Formidable in fending off aerosolized virus while feeble in obstructing the transmission of shared experience; inhaled through skin and memory.

At face value, we do appear further apart. There is no denying the separation brought on by social distancing measures and the unnerving ease with which we have slipped into leading our daily lives in isolation. As physicians, our encasement in personal protective equipment (PPE) and the physical separation from our patients and peers, seem to be slowly forcing us to disengage. This is not the case if we are more attuned to what’s been uncovered. After all, the familiarity of household sounds, wallpaper and windowsills, not your own, were borne from this pandemic. The question becomes, once we venture out of PPE, shut off our screens and resume our new normal, how much of this do we take with us? That will be determined by future hallway and elevator check-ins with colleagues. Will we acknowledge the new facets revealed about each other?? It will be decided in future conversations with patients. Above of all, will we be willing to keep the masks off - even if they are on for some time to come?

 

Did you know that the Harvard Macy Institute Community Blog has had more than 250 posts? Previous blog posts have explored topics including personal protective equipment and empathy, three things and five communities even more relevant during COVID-19, and being together, when apart.

 

Author BIO's

Sawsan Abdel-Razig, MD, MEHP (Leaders, ’20) is a medical educator and hospitalist. Sawsan currently serves as Chair of Medical Education at Cleveland Clinic Abu Dhabi. Her areas of professional interest include international medical education, healthcare system reform, and equity, inclusion, and diversity. Sawsan can be followed can be followed on Twitter and LinkedIn.

 

Pascale Anglade, MD, MBA is an executive leader and gastroenterologist. Pascale currently holds a position as director of physician experience and staff physician at the Cleveland Clinic Abu Dhabi. Pascale’s areas of professional interest include gender equity and international clinical operations. Pascale can be followed on Twitter

Halah Ibrahim, MD, MEHP is medical educator and hospitalist. Halah currently holds a position of senior internal medicine consultant at Sheikh Khalifa Medical City. Halah’s professional areas of interests include gender in academic medicine and international medical education. Halah can be followed on Twitter.

 

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Sunday, 28 November 2021