COMMENTARY: COVID-19 Diary Week 3: I've Never Been More Emotionally Exhausted

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MAY 06, 2020 -- In the oncology division, we have been taking turns as the inpatient consult attending, with duties that include seeing people with cancer who are also COVID-19 positive. This past week was my week, and as it came to an end, I don't think I'd ever been more emotionally exhausted.

Our oncology floor has been vacated to make room for patients with COVID-19 or those under investigation for it. Called a "warm zone," the doors are closed and a PPE station at which to gown, glove, and place your face mask greets you right off the elevator. There is a strict protocol on how to don PPE; the first day it literally took me 15 minutes to do it.

Entering the ward was a surreal experience. Because of all the PPE, I could only see people's eyes. Normally I'd smile at others, greet them with a "good morning," or engage in small talk. Now I couldn't tell if anyone was smiling at all or even greeting me as I entered.

We were all trying to act as if this is the new normal, but the dominant sense I perceived was low-level anxiety. Perhaps I was projecting onto everyone else, but clearly this isn't normal.

The environment itself was also different; the lights seemed less bright and everyone was quieter. Then it struck me: The floor was different because of the emptiness. There was no chatter—even between healthcare workers—and there were no visitors. Every room I crossed had someone in a bed or a chair and everyone was alone. Witnessing this filled me with such sadness. We all need support to get through life, and yet in the hospital, people had to make do without.

Beyond the COVID-19 wards, the sense of loneliness seemed pervasive. On our dedicated cancer floor, patients were alone too, not because they had the virus, but because the blunt hammer of physical distancing meant no visitors anywhere.

The sense of loneliness became even more apparent with one particular patient, a young man with terminal disease. He knew he was dying and his one wish was to be with his kids. He was slated for transfer to hospice, but we couldn't tell him when the transfer would happen. All the while, I worried that he would die while waiting.

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I inquired about getting an exemption so that his kids could visit. Despite hearing me out, and the fact that he was dying, the response was no—they could not visit.

You might think it was some detached bureaucrat who made this decision, but it was not. The call informing us that our request had been denied mirrored the conversation I personally had with this patient when I told him he was dying. It was full of angst, frustration, sadness, and many, many tears.

As each day passed last week, the mental challenge of seeing patients in our "warm zones," of seeing those grappling with a new cancer diagnosis, and even those being treated for complications unrelated to cancer, became harder and harder.

Part of it arose from doing it all alone. I never realized how much of my motivation came from having a fellow with me. Another part of it was the typical seriousness of any situation that warrants a person with cancer coming to the hospital. A final part was having to don PPE day in and day out.

But as I look back, the real challenge for me was the lack of human interaction. Speaking to nurses and colleagues through surgical masks, or to patients alone in their rooms, and walking down formerly busy hallways that were now uncharacteristically empty—it's been pretty lonely. For that singular reason, I can't wait for this to be over.

Don S. Dizon, MD, is an oncologist who specializes in women's cancers. He is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital.

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