Reflections at the Time of Covid-19: The Doctor Becomes the Patient.

As a family physician, we are trained to practice a biopsychosocial-spiritual approach for a holistic patient care. But a doctor gains deeper appreciation for the importance of addressing a patient's spirituality once he becomes a patient himself. My spirituality played a role in my recovery as a patient. This experience led me to appreciate the unique role a patient's spirituality can play in one's recovery. It has given me a different experience with God.

“The Lord is my portion,” says my soul. “Therefore, I have hope in Him.” (Lamentations 3:24)

Introduction

As a family physician, I have always practiced the holistic approach to my patient care. I have wholeheartedly practiced a biopsychosocial-spiritual approach to patient management. I understood the importance of spirituality in people to “express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred (Puchalski, 2009).” As a clergy, I know how important spirituality is to religious people especially Christians. I also recognize the role of chaplains in addressing the spirituality of patients in the hospital. However, I have never fully understood the patient's spirituality until I was at the other end of the hospital bed. I have never truly understood how important it is to include the patient's spirituality in patient care until I became the patient.

The patient's spiritual domain is one of the important domains advocated by family physician for holistic patient care (Saguil, 2012). Throughout the years, experts and advocates have lobbied for the inclusion of spirituality in patient care. Health care workers have started to recognize the importance of spirituality and started integrating it to patient care. Different tools life FICA, HOPE, or RCOPE have been used to integrate the role of spirituality in managing the patient.

However, very few doctors were able to share their spirituality when they became patients. There have been more than 13,000 documented cases of health workers including physicians becoming infected with Covid-19 (Sabillo, 2020). Several doctors have shared their experience as Covid-19 patients and shared their reflections (Ramachandran, 2020). However, only few have been able to share their experience much more their spirituality as a patient.

My reflections hope to focus on the spiritual aspects of my experiences, reflecting on moments when I needed critical care, appreciating the way my fears and doubts were managed by the healthcare team, examining the role of my spirituality as a coping mechanism and the importance of addressing my spiritual crisis in my recovery. This paper advocates for doctors to intentionally include spirituality in patient management as my experience led me to appreciate deeper the significance of integrating spirituality in patient care.

Discussion

The Context of my Experience

Every person's context can affect the experience as patient. I am often away from my family for several weeks to lessen their risk of getting infected. I spend most of my time in the hospital as a frontliner. Being away from my loved ones is already a struggle. I was also mourning the death of my uncle who died just a few days ago. It is difficult because we could not go home or gather together to mourn his death because of the pandemic. As a family physician, I am part of the Hospital Task Force overseeing our Covid-19 response. It was a stressful job because we need to solve the problems and concerns in the operations and management of Covid-19 patients. One Wednesday morning, I was not feeling well and had a very bad headache. Although headache was a symptom of Coivd-19, I was hoping it was something else (CDC, 2021). I made sure I did not have other illness so I had my Dengue blot taken and Typhoid test. I went home early because I thought it was just a migraine. I was in denial. The next day, I quarantined myself when I learned that I had close contact to someone positive with Covid-19 two day ago. I also had a swab test later that day. I monitored my body temperature and it was persistently going high up to 37. 5. Later that night, I was feeling feverish. Indeed, my body temperature was already at 38 degrees so I immediately went to the hospital. I was admitted on Thursday night.

I was anxious of what would happen in the next few days. While in the hospital for the first couple of days, I was feeling okay with only the fever as my persistent symptom. I was taking paracetamol every 4 hours. The fever would go down after taking the medicine but it comes back before the 4th hour. It was like that for several days. I was also closely monitoring how the other affected colleagues are doing. I was worried for myself because I was thinking the possibilities after knowing that some of the doctors had pneumonia. I was exercising, eating well and doing everything in my capacity to make sure my body can cope. I was telling myself I have to get over the first 10 days without any respiratory symptoms. The worst Covid-19 symptoms usually appear during the first 11.5 days (CDC, 2021). However, on the 8th day the fever was persistent and I was starting to have shallow breathing and catching my breath with my short walk to the rest room. My CXR and CT scan showed pneumonia and it was severe.

I appreciated that the doctors and the nurses caring for me included me in the decision-making process of their management. I was asked if I needed oxygen. I refused at first thinking that I can train my lungs to naturally manage the situation. But the next day, my oxygen saturation was going at 80s already which is below the acceptable level. I was having short shallow breaths. When I tried putting the oxygen via nasal canula, I was breathing better. I am thankful for the doctors for asking my consent on the choice of medicines they would give me including the trial drug remdisivir. I am grateful for the doctors for respecting my choice and finding an alternative course to manage my illness. At that time, different thoughts started to fill my mind at that point. I was still within the 10-day period where most of the morbid cases of Covid-19 usually takes place. Different scenarios were playing on my mind. I was stressed. I did not sleep well. I would wake up every 3 hours even at the middle of the night and early evening. I literally just lay flat on bed as I cannot move well with the IV fluid on my hand. In those moments, I can only stare at the window. I could not believe it, in an instant the doctor is now the patient.

My Spiritual Struggles

My situation as a patient was not only physically draining but more emotionally, mentally, and spiritually stressful. I was not just a patient trying to recover physically. Even if I am a doctor, I could not cure myself. There were also other concerns that were affecting me mentally. I was imagining how the other doctors and health workers affected with Covid-19 may have felt knowing they were at a critical condition and could die. I was thinking of my friend, who was a doctor, who died because of Covid-19. Thinking about death, there is no fear but more of sadness in my mind. I was lamenting too. I was also thinking how my Uncle, the elder brother of my dad, may have felt during his own hospitalization. He knew he had Covid-19 and he was having difficulty breathing. No one was with him while he was in the hospital. What were his thoughts? We may be worried of the same things. He knows he was in critical condition. Indeed, later my uncle died the next day after he was confined. Not one family member was with him when he died and when he was buried. It was emotionally stressful for me. Our family could not even grieve properly for his death. I can also hear the other Covid-19 patient in the next room. I can hear the beep of his ventilator. For several days I wake up at night to the sound of that beep. But one afternoon, the nurse called code on him. My next room neighbor did not make it. He was another death case from Covid-19. I can imagine the grief of the family. It seemed an eternity of mental and emotional stress for me. Even if I am a clergy, I was in a spiritual crisis. What more, I was alone in my room and clinically getting worse. I felt alone. If I do not make it, I would have many unaccomplished goals. I would be leaving my wife and kids with nothing. I would not fulfill my promise to my family. I would let my friends and colleagues down. I would waste the gift of life given to me. So, I turned to God.

My lamentations turned into questions. How could I overcome my situation? When I turned to God, I realized what was wrong. I asked myself, how long have I been trying to protect myself from Covid-19? How hard am I trying to heal myself from Covid-19? How many people have messaged and told me with good intentions to keep myself healthy? That I can do it. But where was God in all of those efforts? Have not I trusted too much on my own strength? Have I forgotten to put everything on God alone? Is not God the God of everything? Then why am I trying to make things happen? Where is my faith really? Whenever I wake up, I cry reflecting and thinking about these questions. For the longest time, I was trying to make myself physically able to fight the virus. This concept was fed by messages of “kaya mo yan” (you can do it), “palakas ka”(make yourself better), “ganito gawin mo, ganyan” (do this and that). These messages feed in me the thought that I can fight the virus with my own effort, I just need to do some things for my body to resist it, including taking medicines and supplements. But I realized that God was left out in the equation. In my own effort, God was not part of the healing. It should not be. God is the one who should heal me, not me. God will desire to happen what God wants to happen, not me. God will use the cells in my body, even the medicine and technology if God so desires, not me. I realized, I should surrender all to God and let God. No effort from me to heal me but the only effort to surrender what God wants me to do. But it will be all God at work, all the time.

I was more hopeful as days went by. On the 10th hospital day, I told myself to take it one day at a time. I will be improving only by God's work. I am not yet out of the woods but there is hope. I will get pass the critical period. The pulmonologist visited me and told me that my laboratories were improving but I needed to shift to new antibiotics. Although my X-rays did not improve I was improving clinically. That was great news for me. It made my spirits high. It boosted my morale. Only by God's miraculous work can this happen. I never lost hope in God. Even when I was thinking the worst that could happen to me, that is when my hope in God was greater. I understood that hope is when everything is impossible, you still believe something good can happen. Hope is the only thing left. Hope is the only thing that keeps a person alive in the worst situation. I recognized how a patient like me can hold onto my faith as a resource for coping on my current situation. I found hope with the resources available to me around the room. Every morning, my hope gets high when I see the break of dawn. I would open my phone and play the hymns in YouTube like “When you don't understand, when you don't see His plan, when you can't trace His hand, trust His heart” to remind me to hope in God. I cherished the encouraging words that helped me gather strength not to despair. I appreciated how constant communication through social media eased my isolation and loneliness. I would read prayers of healing from family, friends, and church communities. People who overcame this illness inspired me and strengthened my hope. It is difficult to get by everyday with all the worries and anxieties and the negative “what ifs” without having hope. I said to myself, never lose hope or you will never survive. When I was having difficulty of breathing, I prayed to God who is my hope. I cannot do it. But I have hope in God that God can do it for me. I have hope in God that in God's perfect time I will be healed. I held on to that hope. When I can just easily give up, hope is the only thing left to keep you focused on recovering and getting better. I have high hopes because I have a great God. I never doubted so my faith in Him never wavered. My hope of recovery was never lost because I know God can do it. I was able to sustain and fight because God is my hope.

Conclusion

My spirituality played a great role in my quick recovery as a patient. This experience has led me to appreciate more the unique role a patient's spirituality can play in one's recovery. Doctors must therefore always address the patient's spirituality in their management for a truly holistic care. My situation has also given me a different experience with God. It led me to a deeper understanding of Him that cannot be described but can only be experienced—how we experience God working in our lives, how God protects us, and how God's plan at work may be different from ours. This pandemic can only make us better persons—Christians. However big this pandemic is, God is always bigger than the pandemic. As a Christian, this pandemic has led me to a richer experience of hoping in God.

We must always look into patient's spirituality as a resource for their quick recovery. It can be a positive coping mechanism. It helped me when I reflected that God will keep us safe and I must keep praising God for He is good even in times of trouble. God is in control, even if we do not understand. That God is faithful, even when we doubt. God is gracious so we must learn to trust in Him. I pray that our desperation makes us hope in God, our fear leads us to trust more in God, our weakness makes us rely on God's strength, our doubt makes our faith in God stronger, and our loneliness pull us together as one body of Christ. May we never lose hope for hope will keep us going. May we always be a blessing and that through our lives, even if we get sick with Covid-19, may we magnify God's goodness and that God be glorified. We will overcome this pandemic and every challenge in life. We will always be victorious because our hope is in God.