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Doctoring from Behind the Mask

Headshot of Rachelle Keng, an obstetrician-gynecologist in Charlottesville, VA.
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My heart sank as I saw the black void on the screen. My patient had normal first-trimester symptoms and a positive pregnancy test, but on her ultrasound there was only emptiness. Miscarriage. Her third in three years. She was 40 years old, with "advanced maternal age," the dignified label given to aging eggs. I prepared myself for the encounter: I would hold this woman's hand and tell her how sorry I was for her loss. I would wipe her tears. I would give her a hug. Doctoring in these moments was a chance to shape this woman's grief.

But that was doctoring before COVID-19.

Now that we were in the middle of a pandemic, I could no longer grieve with this woman as I usually would. I was behind a mask, more worried about whether her tears would have a viral load. I needed to maintain a six-foot distance in case her emotions became a vehicle for transmission. My glasses were protecting my eyes, but also blocking the only tool I had to convey compassion.

Over a year ago, COVID-19 changed doctoring overnight. Fear had gripped the medical community. Personal protective equipment (PPE) kept everyone safe, yet also created a chasm in doctoring. Doctoring was now sterile, virtual, and devoid of human contact. I wanted to soften the bad news I had for this grieving woman, but my PPE was an insensitive barrier.

Doctoring in these painful moments is the hardest part of an obstetrician's job. Most people think an obstetrician's job is surrounded by all of the joyful moments in new birth, but the truth is that it's also defined by how we process with patients in their darkest moments. Patients will replay that bad news moment in their minds for many years. They will remember our tone of voice, the temperature of our facial expressions, and the distance at which their doctor sat from them. Good doctoring is a presence that requires less than six feet. When we sit by our patients, there is solidarity in the battle; but when we are sitting apart from our patients with a wall covering our faces, bad news is lonelier than ever.

How Do We Bridge the Six-foot Gap with Compassion?

We have an opportunity to understand our patients in a deeper way than we did before COVID-19. When the COVID-19 pandemic was in its early stages, physicians and patients were bonded by a fear of the unknown. We were in self-preservation mode, scampering for available PPE and trying to fight an unknown enemy together as we were confronted with the limits of medicine.

The helplessness we experienced during the COVID-19 pandemic was an important lesson for the medical community: it taught us compassion and to understand our patients' helplessness in the light of bad news. The ways in which we processed our fears with COVID-19 taught us how to deliver bad news to patients more compassionately. We may not feel as helpless now that we have safe, effective vaccines, but remembering the questions we asked at the beginning of the pandemic can break complacency and deepen empathy.

How Do We Cope with the Problems We Cannot Fix?

We must ask ourselves what our source of strength and joy is when the world is broken.

COVID-19 is giving us new lessons in doctoring as we ask the hardest questions in medicine and in humanity. Maybe it takes more effort to speak through a suffocating N95 so that we will listen better. Maybe we have more face-to-face time with telehealth visits without the usual distractions. Maybe we can learn how to hold a patient's heart without holding their hand. Maybe we can learn how to wipe tears from afar when we learn how to shed our own.

With the vaccine, many of us have resumed our busy clinic schedules. We have gone back to the illusion of control that gives us a semblance of peace. But perhaps when we see a patient with her third miscarriage, we will remember the fears we had during our early pandemic days and the helplessness we felt as a medical community. Perhaps with our next demanding patient, we will remember how we all coped with uncertainty. Perhaps the understanding we have and the compassion we give will be deeper, sweeter, and richer. We have an opportunity to bridge the gap before the masks are removed; and if we process our own humanity, we will know how to comfort the next time we deliver bad news.

One day, I hope to deliver this sweet woman's baby. But today, I sat down behind my PPE and listened to her heartbreak in that helpless moment. I did not have all the answers for her recurrent miscarriages, and I did not presume to understand her pain, but I did understand mine. This empathy can bridge any six-foot gap and knock down any masked wall, because empathy is deeper when we understand our own rawness. We cannot save patients from every bad experience, but we will have greater compassion for them if we have been shaped by ours.

Good physicians know how to lead patients to the mountaintop, but great physicians know how to navigate the valleys as well. Our experiences with COVID-19 can be a place of rebirth even in a bitter season of loss. We can close our eyes until the next mountaintop view, or we can choose to dig in this dark valley. I choose to dig—with a gloved hand, of course.


Dr. Rachelle Keng is an obstetrician-gynecologist at Martha Jefferson Hospital and Jefferson OBGYN in Charlottesville, VA.

Disclaimer: The thoughts and opinions in the Frontline Voices initiative reflect experiences of individual ACOG members and do not represent official organizational opinions of ACOG.

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