|NARRATIVE MEDICINE SYMPOSIUM ON COVID-19: INDIVIDUAL CONTRIBUTIONS
|Year : 2020 | Volume
| Issue : 2 | Page : 145-147
Acquiescence: Stoicism in medicine during COVID-19
Department of Family Medicine St. Luke's University Health Network, Family Medicine Residency, Anderson Campus, Easton, Pennsylvania, USA
|Date of Submission||04-May-2020|
|Date of Acceptance||21-May-2020|
|Date of Web Publication||29-Jun-2020|
Dr. Andrew Goodbred
352 Northampton St. Easton, PA 18042
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goodbred A. Acquiescence: Stoicism in medicine during COVID-19. Int J Acad Med 2020;6:145-7
”Mr. S called – he started with fevers up to 102 degrees this morning, and is starting to cough,” Kara said. That's how Thursday begins.
Mr. S? You mean the Mr. S that was perfectly fine yesterday when I saw him for a check-up? The Mr. S that asked if his recent travel to California and frequent visits to New Jersey put him at a high risk for Coronavirus? The Mr. S whose hand I shook – cavalierly – and whose air I shared for the better part of 45 min the day before? That Mr. S?
This is when my mind begins to race.
Great, just great. So now he has COVID-19, and he's exposed his family, our office staff, and me. What am I going to do if I get it? How can I reasonably keep everyone calm in the office and residency if I get COVID-19? God, what if I take it home to Marcey (spouse) and my boys?....
Instead of allowing panic to rule in this moment, I chose to breathe deeply and consider the wisdom of ancient Roman leaders and philosophers. My next steps, and the path to sanity in this situation, can be traced back over the course of the past year, when I began to study the writings of the Stoics, a school of thinkers and doers whose arc of influence began in the time of the Roman Empire and has inspired countless men and women since then, including some obscure individuals like George Washington, Theodore Roosevelt, and Bill Gates.
In this moment, one of the most famous Stoic tenets sprang to mind, somewhat grudgingly. To paraphrase the great Roman slave-turned-philosopher Epictetus, “the most important thing in life is figuring out what we can control and what we can't, and then focusing all of our energy on that which we have the ability to change.”
As the COVID-19 pandemic of 2020 has unfolded, all of us, medical professionals and otherwise, have found ourselves face to face with circumstances well outside of our control. Without much thought, a veritable laundry list of these items comes to mind, for example, a global pandemic striking the United States from across the ocean or the toilet paper supply at the grocery store.
As humans, we have gotten exceedingly good at dwelling on these things. More than ever, as physicians, we must try to acknowledge and accept the things outside of our control, and then move on. Our energy is finite, and it is imperative that we direct that energy where real work may be done. Ryan Holiday, a prolific writer who brought Stoic philosophy back into the mainstream, explains in his book “The Obstacle is the Way” that the Stoics called this approach, “The Art of Acquiescence.” In other words, accepting the things that escape our control for what they are. It's important, however, to distinguish this idea from fatalism or a feeling of powerlessness. In fact, recognizing where you're unable to induce change allows you to rightly focus your strength and power on action rather than anxiety.
So, after a deep breath and an internal “shake” that would have made any wet Labrador retriever proud, I began to consider the things that I could control.
- My perception and framing of the moment – would this be a tragedy that has happened to me or something in which I can find good and opportunity?
- My reaction – my response to this moment would create a script for all those around me: staff members, residents, and fellow faculty physicians
- My next actions – would panic drive me into a state of catatonia, unable to do my job?
At first, my inner monologue was, let's say, petulant. I can't believe this. Why would this patient come into the office, knowing that he'd been to two endemic COVID areas in the past two weeks? I can't believe I was so stupid shaking his hand and disregarding the risk. Now I'm going to have to worry for the next two weeks. See? Petulant. It occurred to me that in the first ten minutes after I learned of the patient's symptoms, every single one of my thoughts and emotions was about me. Any thoughts about the patient who now likely has a life-threatening virus? Nope. Just me. This insight reminds me that the amygdala, the driver of the fear and anxiety centers of our brains, is more ego centric than a fighter pilot. When allowed to rule, it will make us think only of ourselves and the (usually tragic) effect that a situation will have on us. Not a great mindset for anyone, particularly a physician. Come on Goodbred, you can do better than this.
Reframing and moving forward – next steps:
- Reframe my perception and shift the focus away from myself. This is going to be a scary time for Mr. S and his family, not to mention my office team. I also need to ensure that the residency crew is safe. Going a step further than just damage control, this experience will make us better. I will be better as a physician and we will improve as an office, having navigated this obstacle. This reframing takes a fear-inducing event that happened to me and transforms it into an opportunity
- Awareness of my external reaction. Like a first impression, I was only going to get one shot at setting the tone for how to respond to news like this. Fear and concern are normal at a time like this, but panic is contagious. “OK,” I began, controlling my expression as I spoke to Kara, “I bet he's worried that he may have coronavirus. Let me call him and we'll make a game plan. In the meantime, let's make sure we know the protocol for exposure, since you and I were exposed. Let's make sure we chat at the end of the day about how to keep our families safe.” Was “inside Andy” as calm as “outside Andy?” Not quite. However, by reframing my perception, and thinking outside of myself, I was able to react in a way that was right for the moment and the environment. I found that you sometimes have to act a certain way to feel a certain way, rather than the other way around
- Deciding on my next actions. Note: anxiously sweating and fanning myself would not count as “rightly-directed action” in this case. What would help Mr. S? What would protect and care for the office staff? How could I begin to act on the opportunities that had presented themselves?
The rest of the day was action-driven: speak with Mr. S, arrange his COVID-19 testing, plan the next steps in management for him and his family, connect with Employee Health in order to discuss monitoring myself and staff members as a result of our exposure, think about how cases like this could be avoided in the future through expanded questioning during the previsit screening process, and brainstorming how to make this a “teachable moment” for our residents. By acting, I used my fuel in a productive way, rather than spinning my proverbial wheels in worry.
Now, don't get me wrong. I drove my commute that evening still very concerned that I might be on the way to being sick myself and that I'd be bringing it home with me. Over the following days as Mr. S's COVID-19 testing came back positive, and I monitored myself for symptoms, I had to repeat the refrain of “focus on what you can control” mantra. Two weeks later, I was still symptom free, Mr. S was well on the mend, and the team around me had a clear and level-headed approach to COVID-19.
The study of Stoicism has changed the lens through which I perceive the world. Like polarized sunglasses, I'm able (on my best days) to filter the glare of things outside of my control, allowing my eyes to absorb the full spectrum of things within my control. It's hard to explain how important this has been for my personal wellness. For me, anxiety and burnout don't arise from the amount of work I do. Bring it on. Burnout, for me, is born from the feeling of being overwhelmed by a lack of control. By learning, through practice, to acquiesce, the crisp image of that which I can control may be seen through the haze. With that clarity comes peace.
Many more “Mr. S” moments will appear over the coming months and year of my career. By continuing to grow, learn, and gain experience, while continuing to implement the wisdom of the Stoics, I'll be prepared. When Kara says, “Mr. S just called,” both outside Andy and inside Andy will take a breath and say, ready for whatever may come next, “Great, what's up?”
I'd like to thank Dr. Nicole Defenbaugh for her review of my work, her comments, and her constant support of the Narrative Medicine movement.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Ethical conduct of research
No human research was conducted for this publication. The author of this manuscript declares that this scholarly work complies with reporting quality, formatting, and reproducibility guidelines set forth by the EQUATOR Network (http://www.equator-network.org). Within the broader context of narrative medicine, this article discusses individual stories and patient encounters as integral aspects of the lived experience of health and illness.
| References|| |
Epictetus. The Discourses of Epictetus: With the Encheiridion and Fragments. London: G. Bell and Sons; 1916.
Holiday R. The Obstacle is the Way: The Timeless Art of Turning Trials into Triumphs. New York: Portfolio/Penguin; 2014. p. 146.