What's Important: Facing Fear in the Time of COVID-19.

This article is unlike others we have written, but these are extraordinary times. For one thing, we feel like we are living in “dog years,” where things are changing so quickly around us that every day feels like a week. The days fill themselves up with virtual meetings and planning for this never-before-experienced, pandemic crisis, and yet, at the end of the day, there is very little to show for our effort. Last week, when our state government issued a stay-at-home advisory and ordered the closure of nonessential businesses, we thought we’d have abundant time to become proficient in our new “virtual” practice and lifestyle. There were few patients in the clinic (only those requiring acute management or evaluation) and even fewer surgeries; only the most urgent cases involving trauma, infection, or impending neurological compromise remain on our OR schedule. The American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting was cancelled, and suddenly, the calendar looked relatively bare. However, we instead now find every day completely filled with Zoom gatherings and telephone calls as well as work we are trying to accomplish remotely. A few of us in our department have already tested positive for COVID-19, a number that will undoubtedly grow. Others have experienced flu-like illnesses and have been (self-)quarantined, the ultimate social distancing. With our partners and families, we are making real and sobering preparations for what’s coming next. Those of us with children, who are now housebound with schools closed, are starting to see strain from their boredom and anxiety.

Fear appears to be the new ingredient. Some of us are worried about being in the hospital and seeing emergency room patients with COVID symptoms, while others have financial fears superimposed on our personal and family health concerns. As our local health-care systems become overwhelmed, we know that we’ll soon be asked to branch out from orthopaedics to take care of these sick medical patients. Perhaps this will place us at greater risk for infection, but maybe not. Regardless, it will place us in clinical settings with which we are definitely less familiar. We’re all starting to “feel the heat,” and we’ve been thinking about what that means.

It quickly became apparent that only a few of us have ever been asked to do a job that entails serious personal risk of injury or death. Although we all know intellectually that, as physicians, we’ve taken an oath to place our patients’ well-being above our own, the current reality feels quite different. This is where heroes are distinguished from volunteers, with both being critical to solving this crisis. Heroes are individuals who “fight” for a cause knowing there is personal risk. Not everyone wants to be a hero, nor needs to be, but in these trying times, some of us must accept the risks and step forward.

So, faced with this unique set of circumstances, and clear feelings of anxiety and vulnerability, we sought advice. In all of our local communities, there are some who have faced more actual danger than others. There is a group of military veterans affiliated with our medical school—current students, faculty, and graduates—so we asked them to reflect on their backgrounds and provide some insights. Similarly, we contacted several orthopaedic surgeon friends who are currently serving in the military. We also contacted some of our patients who are police officers and firefighters to ask for their thoughts about doing dangerous, heroic work. There was real wisdom in what they told us, including the following:

Remind yourself why you became a doctor. This is the health event of our generation, and it’s our privilege to be able to help, even though it’s not quite our specialty.

Take care of yourselves and take care of each other so you can “remain in the fight.”

Buddy up. Stay close to your teammates and rely even more closely on each other than usual. Keep open lines of communication; in times of stress, unfettered communication is essential to all parties.

There will be good days and bad days, so stay flexible and optimistic.

You are capable and resilient. You will excel in this as you have in nearly everything you’ve ever done.

Don’t force yourself to do “heroic” things; find your comfort zone and volunteer to support and assist in any way you feel comfortable.

We hope you find this useful. If you find yourself struggling, ask for help. This is the time to stick together and help each other.