The International Journal of Whole Person Care

Messier, Alexandre

	
VOLUME	8	●	NUMBER	1	●	2021	●	47-50	
©	2021	Alexandre	Messier.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	
CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
URGENT	MATTERS	IN	THE	
EMERGENCY	ROOM	WHEN	FACING	
COVID-19		
Alexandre	Messier	
Emergency	Physician,	Hôpital	du	Sacré-Cœur	de	Montréal,	Montreal,	Quebec,	Canada		
messier.alex@gmail.com	
	
ith 18 years working as an emergency doctor behind me, I am a witness of some failures in 
our health care system. Do you think I am exaggerating? Well, the statistics tell the truth when 
our data (in Quebec, Canada) are compared to similar countries in The Organisation for 
Economic Co-operation and Development. For example, after endless hours of waiting, one patient in ten 
leaves the ER without having been seen by a doctor. Let us not be fooled, some of them return later in 
worse condition. 
When the pandemic arrived in Montreal, I thought our system was bound to collapse. Overcrowding in the 
ER kills, and the situation made me fear for the worst. Once my first reaction (panic) passed, a vibrant 
anger took its place. I had just completed four years as an advisor to the Minister of Health. During that 
time, I realized that health systems are very complex and there are many influential actors: politicians, 
provincial managers, hospital staff (from top to bottom), federations, labour unions (still strong in Quebec), 
etc. Some of these groups have too much, or not enough, power, while others are unable to produce 
meaningful change. Ultimately, all of this is detrimental to the care of the population and I realized that our 
system was hanging by a very thin thread.  
After years of feeling a sense of urgency and attempting to communicate it, I wanted, at the risk of sounding 
pretentious, to shout: “I told you that we had to act!’’ That inner cry illustrates how I felt at the time but, of 
course, this is not constructive and fails to recognize those who do the right thing, despite challenging 
W 
Urgent	matters	in	the	emergency	room	when	facing	COVID-19	
Alexandre	Messier	
	
48	International	Journal	of	Whole	Person	Care	
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issues. COVID-19 had the potential to sink the system and I was angry with myself and just about everything 
else.  
Luckily, this fury was channeled into an unprecedented administrative sprint, including emergency services. 
During the weeks that followed, reorganization of services took place at the same time as we tried to 
understand a disease caused by a mysterious virus. Information rushed through cyberspace overloading 
email inboxes. Taking action can counter the impact of stressors of this nature; I felt a sense of excitement 
during this blitz. My last memories of being so obsessed by a unique problem were when I took my final 
exams in medical school. Decades ago. 
Hope emerged; perhaps this situation would be a catalyst for new ideas and transformation. Already 
collective efforts were getting in gear, prioritizing efficient actions needed now and afterwards. Could the 
pandemic precipitate changes that would propel our ERs into the 21st century? While I still feel hope 
resonating within me, other things have caused me consternation. For instance, Dr. Johanne Liu, a 
Canadian pediatric ER doctor, recognized by the WHO for her expertise in infectious diseases and a 
pioneer former President of Doctors without Borders, was not consulted by our Minister of Health. This 
resistance to “outsider” input by certain administrators triggers all kinds of negative emotions in me.  
Well, I must make a statement. I am aware of being very hard regarding our health system, but when I 
analyze all my observations from my time at the Ministry of Health, I feel a huge disappointment. I have met 
dedicated and extremely knowledgeable staff and decision makers. Nonetheless, widespread resistance to 
change is rooted in the medical culture. It seems that I am in a period of my career whereby, some days, I 
no longer have faith in the situation as it stands now. One glimmer of hope is that we will learn from what 
is going on and eventually achieve a better health system. 
Let us return to the ER. While committees were deliberating, little by little, people with COVID-19 arrived in 
our service at the Sacred Heart Hospital, where I work in Montreal. While we were ready, a palpable 
apprehension was present. Will we lack personal protective equipment (PPE)? I recall a meeting that 
bordered on the surreal when the question arose, “Should we intubate a patient if we do not have a mask?” 
When a person is in respiratory distress they breathe quickly and emit enormous amounts of virus in the 
air. In other words, the doctors and staff would be put elevated at-risk under these conditions. Would it be 
wise to do this? If we accept this, trying to ignore the rational fear of catching the disease, this could 
inevitably lead to understaffing or exposure of other patients to the virus. Yet, without attending to patients’ 
needs they could die!  
Subsequently, other issues arose, such as age. At a young age for a given patient, do we intubate without 
protection? My mind was turning in circles. Fortunately, I had learned to meditate years earlier and I was 
able to deal with these troubling thoughts and feelings in a way that allowed me to face them better. Against 
the odds, calm prevailed. In fact, we did not lack PPE, or testing kits (another worry and source of 
Urgent	matters	in	the	emergency	room	when	facing	COVID-19	
Alexandre	Messier	
	
49	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
confusion), and surprisingly the ER was not busy! None of us with upwards of 30 years of experience had 
ever seen such a thing. OK, there was a general order to stay at home for the entire population and that 
could explain less trauma victims, and perhaps coronary events, but not other serious conditions such as 
digestive bleeds or vascular cerebral accidents. We experienced a 50% decrease for weeks, no kidding! 
Frankly, this decrease was worrisome. 
A novel situation not taught in medical school or addressed previously in our experience arose. Are the 
investigations and the reasons for hospitalizations the same when symptoms have been present for a long 
time? Previously, I had never seen a patient with heart attack wait so long before coming to the hospital. It 
was destabilizing to confront these new scenarios. Our thought patterns were being undermined and 
uncertainty was gaining ground. Even though ER doctors are accustomed to constant shifting from known 
to unknown, the situations caused by the first wave of COVID19 was very disturbing. 
Little by little, hospital beds filled with viral pneumonia cases, but the ER was not overwhelmed. Lives were 
certainly saved by the measures put in place. Unfortunately, one bright morning the province of Quebec 
woke up to the fact that the elderly living in nursing homes were caught in a deadly situation. It is terrible to 
write but it was fortunate that we, the ER staff, were oblivious of what was going on with a select group of 
seniors during the crazy weeks that followed (70% of fatal cases we learned afterwards). Several months 
later a feeling of guilt crept into my psyche. Why did the personnel there lack PPE while we were equipped? 
Could we have assisted them better, sooner? Should we have kept patients in the ER longer rather than 
transferring them back to their living environments? There went my mind again, like a hamster running 
round and round, getting nowhere. I nicknamed it ‘Donald’, as it represented something to dispose of. 
In the everyday ER work I found it hard, at times, not to feel discouraged when confronted by human nature. 
Situations arose where egoistic and unconscientious behaviours prevailed. For example, patients who 
avoided confinement or others who tested positive but failed to quarantine themselves until test results 
were known. So much time was required to call and locate these patients. One professor refused to be 
tested until after he had finished an important meeting the following day. Some family members left their 
vulnerable parents alone to fend for themselves. My challenge was not to judge these people and remain 
professional. This was not always easy to do. 
Personally, I hope not to be infected with COVID-19 but, in hindsight, I can see that I never really feared 
grave consequences for myself. In the ER we play with statistics. As an example, we cannot test everyone, 
that would be poor medical practice, therefore we select those at high risk. Patient X has 1% chance to 
have a pulmonary embolism, so we stop investigating. So, at my age, I calculated that I have one chance 
in 250 to die, if contaminated. Thus, I can stop my ‘Donald mind’ from running amok. Yet, my head is not 
buried in the sand; if COVID-19 were dangerous for children I would have trouble quieting my mind given I 
have a son and daughter at home.  
Urgent	matters	in	the	emergency	room	when	facing	COVID-19	
Alexandre	Messier	
	
50	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
 
In conclusion, as a new chapter in modern medicine is being written, we are all learning so much. In the 
midst of conflicting emotions, I believe this situation offers a unique opportunity to better understand myself. 
There is fear, anger, disappointment, and guilt, but also hope. Clearly, we have internal resources that will 
help us get through. Despite the uncertainties and the difficulties, I am convinced of one thing: we will be 
better after the pandemic, individually and collectively.	
 


English

Urgent matters in the emergency room when facing COVID-19

Gonsalves, Carol

	
VOLUME	8	●	NUMBER	1	●	2021	●	33-35	
©	2021	Carol	Gonsalves.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
A	LOVE	LETTER	TO	MY	PATIENTS	
Carol	Gonsalves	
Physician,	The	Ottawa	Hospital,	Division	of	Haematology,	Ottawa,	Ontario,	Canada	
cgonsalves@toh.ca	
 
 
Dear You,  
 
 want to start out by telling you how much you have meant to me these last twenty odd years. You have 
seen me in my early days at my most insecure, barely competent self to what I hope has been the best 
of me and of most service to you at your most vulnerable of times. I have seen you through your worst, 
and been there for the victories, small and large. All of it has been a privilege for me.  
 
The past six months have been a rough ride. Unexpected, to say the least. Even terrifying at times. We 
hoped for the best but planned for the worst. We both consumed voraciously all the information we could 
to protect ourselves, our families, and each other. I learned how to not touch my face and taught you the 
same. I arrived early to work to review daily updated procedures and to change into scrubs – something I 
have not done since residency days. I learned how to don and doff the appropriate PPE. You learned how 
to express yourself through a mask. I limited my interactions with colleagues to video conferences and, like 
a new breed of superheroes, they guided us expertly and tirelessly through waves of ambiguity and worry. 
I took your increasing number of unscheduled anxious calls to soothe and advise you. I reviewed your 
upcoming visits to see which could be done virtually and which needed to be done in person. I cleaned the 
clinic room after you left. I wiped down every surface of my office at the end of each day and changed 
meticulously out of my uniform. I arrived home depleted. I soothed my raw and cracked hands.  
 
When we could not meet in person it was tough for you – for me too. The lack of being right next to you, 
unable to evaluate through a shift in your eyes or a slight change in your posture your ease or dis-ease, 
was mutually challenging. When I did see you in-person, we both felt the COVID-19 tension between us.   
No more hand-holding through bad news or comforting hugs. And when you were admitted to that isolated 
I 
A	love	letter	to	my	patients		
Carol	Gonsalves	
	
34	International	Journal	of	Whole	Person	Care	
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hospital room your fright in the midst of your delirium was palpable. You watched me in what must have 
seemed like an alien spacesuit without the comfort or familiarity of your family. I tried to be your family as 
best I could.  When you thanked me for my service, tears welled up in appreciation.  
 
Suffering, stress, and grief have felt surreal during COVID-19. Uncharted territory. There were times I felt 
impatient and rushed, falling short of my expectations for myself and probably yours as well. There were 
moments when I felt overwhelmed. But there was also desire and motivation to contribute, to the best of 
my abilities, in this unprecedented time. Then those initial weeks of adrenaline-fuelled activity and 
preparations stretched into months of chronic levels of anxiety and irritation as we both started to feel a 
little numb and frankly weary of it all. So insidious, these feelings were barely perceptible to me until I started 
to notice a change in my attitudes toward you. I started to notice your own impatience and abruptness, 
things I would normally have forgiven effortlessly. I was furious with you when you went to that gathering I 
told you explicitly to avoid. I thought you were demanding and self-centred that you did not seem to care 
enough to even do this small thing. I started to wonder why I was doing this job that required 110% from 
me as I was pulled away from my own family and friends. I was not sure I wanted our relationship anymore. 
To be honest, this isn’t the first time I have had these thoughts about this demanding job. But I have always 
managed to stick things through. The magnitude of COVID-19 pushed these boundaries. 
  
So, please forgive me for any time you felt less than completely cared for. I know you were facing your own 
burdens. I know you were doing the best you could as well. I know we were both getting worn down by it 
all, not by each other.  
 
The following is not an excuse but an explanation. You see, I’ve been dealing with a great deal outside of 
our relationship too. While I have been able to manage the expected and unexpected turns we all 
experience in life relatively well over all these years, this pandemic shifted everything. There was a lot of 
uncertainty in advice and policies and procedures in those early days that forced me to navigate by myself.   
I was worried about you, but also about my own family. I was grieving not being able to see my own parents 
for fear of transmitting the virus to them. I was afraid that I wasn’t helping my kids cope with the upside-
down turn in their lives. My mom and father-in-law were dealing with new diagnoses of cancer through this 
whole mess. That day I was abrupt on the phone in April – maybe you didn’t even notice but I did – my 
mom was undergoing surgery. The critical illness of a close friend happened just before lockdown began.   
The death of another dear friend’s father happened in the midst of it. I have been forced to care and comfort 
the people I love from six feet away or, worse, just over a phone. I would leave the hospital after focusing 
on caring and comforting you, drained and depleted, to return home to try and reassure my own family.     
 
I want you to know I tried to do all the things that worked in the past to keep me the fresh, expert, and 
compassionate physician you have come to rely on. I strived to sleep and eat well, to exercise and meditate 
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Carol	Gonsalves	
	
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regularly. It wasn’t enough. So, I needed some distance from you for a little while. Just enough to recharge 
my battery. Just enough to stop worrying for a little while – about multiple daily changes of clothes and 
sanitizing my car and what I was bringing home to my husband and kids. Just enough to remember why I 
went into medicine in the first place. Just enough to miss you again. Just enough to realize again that this 
was never a job. It is a calling. It has always been.  
 
While away, I got to focus on just being a mother, wife, and daughter. I was able to reconnect with friends, 
albeit at a distance. I stopped watching the public health and news reports daily. I could breathe a little 
easier again. And in the last few days my mind has started to wander back to you. How you’ve been doing. 
What you’ve been up to. How you are coping.   
 
It is said that distance makes the heart grow fonder. I am looking forward to seeing and listening to you 
again. Of helping you navigate through your decisions and lighten your burdens. Of hearing how your kids 
and grandkids are and if they will go to school – mine will. It will be nerve-racking but we will get through 
this together like we always have. In truth, we have had some success and good times during these six 
months and I was able to reflect on this. We have found new and effective ways to communicate with each 
other. We have lifted each other up. We talked perhaps a bit more about our lives, about our grocery outings 
and gardens. Small talk between friends.  
 
We will get through this together although it will not be at the same point we entered. But I can’t do this 
without you. As tiring as these six months have been, please know your role is as important as mine in this 
relationship. Please don’t let your guard down with this virus just yet.   
 
We are forever changed but there is opportunity for growth and learning. I will bring back my individuality 
to you somehow so you know without a doubt it is me behind the mask. We will share our stories with my 
colleagues.   
 
Meanwhile, my wish is that you may enjoy every day – every moment – as best possible. That we find rest 
in every day. Follow the public health recommendations. Eat well, sleep, exercise, and take a break when 
you need to. I’ll do the same. We have a lot more to weather in this storm, but I want you to know that I’m 
in it for the long haul. For better or for worse. I’m betting on the better.  
 
Yours in sickness and health,  
 
Carol  


A love letter to my patients

Rule, Amy RL

	
VOLUME	8	●	NUMBER	1	●	2021	●	36-39	
©	2021	Amy	RL	Rule.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
AFTERMATH	AND	MIDST	OF	A	
NIGHTMARE:	A	PEDIATRICIAN’S	
COVID-19	LAMENT		
Amy	RL	Rule		
Physician,	Assistant	Professor	of	Pediatrics,	Perinatal	Institute	and	Division	of	Hospital	Medicine,	Cincinnati	
Children's	Hospital	Medical	Center	and	University	of	Cincinnati	College	of	Medicine,	Cincinnati,	Ohio,	USA	
amy.rule@cchmc.org	
 
t is 2 am and I am awoken from a pandemic on-call, anxious, broken sleep not by my pager, not by the 
code alarm but by a soft cry on the other side of the wall of my bedroom. My husband stirs, finds my 
hand and gives it a squeeze. I shake my head a few times to try to focus my sleepy brain as my feet 
find the cool floor. I tiptoe into the next room. 
I find my four-year old son scrunched in the corner of his bed in a wet mess of tears and tangled blankets, 
clutching his beloved, worn green stuffed dragon. “Mommy, I had a dream, the sickness got so bad.” I climb 
into the small, soft bed, folding my body into the curve of his spine. “I am so sorry buddy for the dream, you 
are safe and well and so are Mommy, Daddy and your sister.” I try to comfort him and maybe myself using 
the most soothing tone my exhausted self can muster. He quiets, the crying lessens, I feel his body relax 
and stretch. “Mommy, I want to tell you something.” He says in a softer voice still on the break of tears.  
“Mommy, the sickness is lasting forever, it is changing everything.” 
I am a pediatrician. My high volume, high acuity workplace prepared for the novel coronavirus (COVID-19) 
arrival at our doors by shutting down elective services, stockpiling PPE, skeletonizing in-person work and 
lining up ventilators in anticipation of the storm. On the home front, our dual-health professional household 
formulated protocols for protecting our family. Upon arrival home each day: (1) undress in the garage, (2) 
stuff scrubs in a garbage bag, (3) dash to the bathroom while holding my breath outrunning my toddler and 
preschooler along the way, saying, “Hi, how was your day? No, no, Mommy is dirty, dirty, you can’t touch 
I 
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Mommy yet.” Before securing the door, I locked eyes with our essential, nanny Ms. P one of my son’s most 
beloved, pandemically-unemployed preschool teachers who thankfully herds my little ones toward the 
playroom until decontamination is complete. Post shower, having dumped the bag of scrubs into the 
washer, I snatch a single minute on my bed, breathe deeply, and mouth a silent prayer, “Please don’t let 
today be the day it snares us.” 
It did not come for my family, my hospital, or my patients. Although there are examples of tragic exceptions, 
children have been relatively spared by COVID-19 infections. My children in lock-down live for our evening 
walks. They told us how they pined for their friends, looked longingly at the ghostly playgrounds, sometimes 
with tears, mourning their own genuine losses more and more each day. As I comforted and helped them 
process these emotions, my fears for my most vulnerable patients grew with every passing hour.  How were 
the single parents doing? How were the Black and brown kids managing in neighborhoods with the highest 
COVID-19 rates? How many had lost their parents, their grandparents? How many kids were hungry? How 
many were losing their homes?  These vulnerable people haunted my dreams and dominated endless 
Zoom meetings where my colleagues and I fretted despite having few infected patients. Our worries were 
limitless.  
Weeks morphed into months and as the weather warmed, our low COVID-19 prevalence state officials 
began a cautious discussion of slow reopening. Each afternoon on my non-clinical days, as the children 
slept, Ms. P and I would gather to listen to the governor’s briefing on TV. The unveiling of a plan ensued 
over the course of several days. Day 1: they discussed expanding elective health care services. I was glad 
my chronically ill and medically complex patients would soon receive needed care and surgeries. Day 2: 
essential public services like vehicle registration and business licensing were covered. Day 3: restaurants, 
bars, and retail stores were considered. Day 4: featured recreational spaces and other businesses. With 
each passing day, Ms. P and I exchanged glances with increasing exasperation and confusion. What about 
children? A week in, it hit us, no grand plan was coming for them.  
Furious, I ranted to Ms. P, my husband, filled the social media void, and inundated professional 
organizations with emails. What about the hungry kids? What about the kids whose families are close to 
losing their home, their food sources, their income and now must choose between their kids’ safety and 
feeding them? What about the kids whose parents are told to return to work but have no care or safe place 
for them other than fragile, vulnerable grandparents or elderly neighbors? What about the kids who have 
learning disorders or disabilities who have not received services in 3-5 months? No, they are not essential 
workers. No, they are not as impacted infection-wise although we do not understand exactly what that 
means. How did we rank opening bars and gyms over caring for our children and families? I took some 
solace in the fact that other states were worse.  
Finally, two weeks into the plan reveal, as an afterthought it seemed, a childcare reopening plan was 
released. However, school districts were left to their own devices about what to do next in the fall, a few 
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short months away. Within twenty minutes of the announcement, a tempest of a different kind engulfed me 
and my colleagues via a myriad of texts, voicemails, and emails. Suddenly everyone, from my sister three 
states away, to the local TV station wanted my opinion on everything from hydroxychloroquine prophylaxis 
for teachers (NO!) to the risk of lunch boxes as transmission vectors (low to none). Everyone craved 
numbers, risk quantification albeit numbers that fit their personal paradigms. What a medical, socio-political, 
treacherous minefield of endless decisions and unending questions this presented.   
If you advocated for kids to get services and socioemotional interaction you were potentially sacrificing a 
portion of them and their teachers to morbidity or even mortality from COVID-19, no matter how much you 
mitigated the risks you could not promise no transission. If you advocated to keep kids at home, you were 
sacrificing the most vulnerable children to abysmal fates, potentially increasing abuse, suicide, creating 
impossible situations for single parents (a disproportionate number of whom are working mothers), 
sacrificing vulnerable grandparents, and worsening inequities in ways that are impossible to fully quantify 
and address. There was no winning. 
Subsequently personal decision making as health care professionals cropped up. Suddenly we were back 
at work full-time, our pandemic-nannies returned to their childcare jobs. They no longer qualified for 
unemployment and we could not provide full benefits to keep them working for us. As essential workers 
with more than enough resources, we had viable, relatively safe full-time childcare options. Our privileged 
children would get social interaction with masks and distancing while so many others would not because 
centers were shuttering their doors due to a lack of resources. Lessening restrictions could cause spread, 
or at least we thought that was likely. Data to inform decisions were nonexistent. Nothing was certain, 
nothing was risk-free but everyone expected us to have the unknowable answers anyway. 
The sunshine and openings persisted. Daily afternoon briefings were filled with mounting cases, surges 
traced back not to kids on the playground or in daycare but to adults eating out, gathering en masse, 
attending gyms and work, often not masking, or respecting physical distance. We pediatricians experienced 
this as a tightening cord, tying our hands, as we shouted for our patients’ needs against the rising tide of 
adult chaos. The storm we avoided in the spring, rolled in with a vengeance during the summer and fall 
imperiling the reopening schools and the lives of children who depended on them. 
As much as I endeavored to protect my patients and my own children from adult worries, failures, and 
burdens they creeped in, silently spreading like an eclipse in the night. The winds of that storm howled 
through my son’s dreams and in his wakening cries. “Mommy, the sickness is lasting forever and it is 
changing everything.”  I was grateful for the darkness in his room so that he could not see the tears flowing 
down my cheeks as I replied, “You are absolutely right, buddy.” 
Aftermath	and	midst	of	a	nightmare:	A	pediatrician’s	COVID-19	lament	
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COVID-19 did not stalk the children, but the pandemic did, and it continues to lurk and threaten them. I fear 
the eye of the storm has not passed. It will be years before we fully understand the impact and extent of 
neglect our children experienced as adults failed to include them in their deliberations.  
Yet, undeniably, while data, words, and leaders failed them, children lead us forward. Their artwork 
decorates windows and sidewalks around my city. I pass kids in my neighborhood sitting in driveways 
discovering ways to play with their friends across the road, filling the silent streets with laughter. I am in 
awe of children showing off with pride their colorful masks with Paw Patrol, sharks, unicorns, and flames 
as they return for their appointments while a few blocks away adults argue bitterly about masks. My own 
masked son (bright airplanes) confidently tells me, as he returns with Ms. P to preschool, “Mommy masks 
help people and I am a helper. I am going to stop the sickness.”   
Even at 2 am in the aftermath and midst of a nightmare, they blaze a trail for us.  After a long, oddly peaceful 
silence, my son turns and nestles against my chest “Mommy, I love you. We are together, it will be over 
some day and we can go everywhere again.” He pauses and sighs, “I can’t wait.” 
“I can’t wait either, buddy.” 
 
 
 
 


Aftermath and midst of a nightmare: A pediatrician’s COVID-19 lament

Lemos, Vivienne

	
VOLUME	8	●	NUMBER	1	●	2021	●	11-15	
©	2021	Vivienne	Lemos.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
ONE	SMALL	VICTORY	
Vivienne	Lemos	
Physician,	Family	Medicine,	Toronto,	Ontario,	Canada		
vivienne.lemos@gmail.com	
	
	
	
	
OVID-19 POSITIVE. 
Red. Bold. CAPITALS. 
The result had been sitting in my inbox like a Trojan horse all weekend – a completely mundane, uneventful 
weekend as all weekends have been since the start of this pandemic. 
My tea steamed at my elbow as my hands paused on the keyboard. 
I was not in clinic that Monday morning, but results and in-boxes wait for no woman and it was with a 
resigned sigh that I had sat down at my computer to deal with the inevitable Monday deluge. 
I just had not expected this to top my list. 
I had to call her.   
With the result came a note from her retirement home – she was case zero and had been quarantined to 
her room, a fact about which she was not terribly pleased. Her husband – also my patient – refused to leave 
her, even though his test was negative. They had weathered decades together and they were not about to 
be separated now, risk of contagion, aside.  
In the early spring of 2020, COVID-19 was still very much a vast unknown that was cutting a swathe through 
the world’s population.   
C 
One	small	victory	
Vivienne	Lemos		
	
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I could not think of a worse person to get this virus.  Name a comorbidity – she had it.   
In the past, I had, by turns, admired, respected, and been frustrated by her fierce independence, a self-
reliance which she acknowledged sometimes bordered on sheer stubbornness. She was a woman who 
knew her own mind and spoke it freely. And while her body seemed to be failing her in recent years, she 
still retained the sharp wit along with a keen mind that had served her well during her journalistic career.   
I picked up the phone and made the call. 
“Hello?” 
“Hi, it’s Dr. Lemos. I just called to check in. I got your COVID test result this morning.” 
“I had a feeling I’d be hearing from you. Ugh. I feel fine. A little tired but FINE. I don’t see what all the fuss 
is about. It’s just a bit of a sniffle and everyone around here is losing their minds.” 
I could picture her, rolling her eyes behind her round, wire-rimmed glasses and shaking her head, one hand 
curled around the cane that was her constant (reluctant) companion.   
“I don’t understand why I can’t leave my room. It’s completely ridiculous.” 
I had learned over the years that there was nothing she hated more than being told what to do. And that if 
she truly did not want to do something, then she simply was not going to do it. Unfortunately, she had little 
choice in the matter this time – and she knew it. She just needed a place to park her frustration and it 
happened to land on my ears.   
I could not blame her.   
Because underneath the bluster, I heard the fear. 
I felt for her. Being in her 80’s with multiple comorbidities, the odds were against her. There was little we 
could do beyond supportive care and watch and wait for the disease to run its course, one way or the other.  
But even that warranted tight communication with the nursing team at the retirement home who were 
bearing the brunt of her care. 
She was lucky to have them.   
One special nurse: diligent, careful, attentive. Experienced enough to know when to call for help and calm 
enough to ride the storm of our shared charge’s moods, of which there were many. 
Over the coming weeks, we would come to know each other well.   
One	small	victory	
Vivienne	Lemos		
	
13	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
In some ways, it reminded me of my time working in Northern Ontario, relying on the skills and competence 
of a nurse in a remote, fly-in community to be my eyes and ears on the ground in order to care for a person 
I had never met. There is an understanding that builds between providers in a crisis, particularly when your 
only connection is a phone line.   
You must trust each other more deeply than if you are in the same room.  
Clear communication is essential.   
Verbal orders reinforced by faxed order sheets.   
Phone calls well outside of regular office hours.   
Putting out fires and backing each other up.   
Whatever needed to be done.   
My patient would often unload her frustrations onto her nurse but, then would share with me how much she 
appreciated the care that same nurse provided.   
I recognized through these conversations that she was seeking to control what little part of the universe 
she could while everything else went spinning madly around her. And sometimes that meant striking a 
balance between her safety and her need to be in charge of her own destiny.   
“I don’t need the oxygen. Why do they keep putting it on me?” 
“Because you were having some trouble breathing and your oxygen dropped to 92%. How are you feeling 
now?” 
“A little bit better. Just tired. But I hate that they come in here and poke at me all the time.” 
“She’s just following my instructions and looking out for you. Everybody wants you to be around for a good, 
long time.” 
“I know...but I don’t have to like it.” She grumbled, and then barked out a laugh. 
And I was grateful that, despite it all, she had sufficient breath to laugh and complain in the same sentence. 
4 weeks. 
By some act of grace, her husband’s tests (four of them!) all came back negative. 
And finally, hers did too. 
One	small	victory	
Vivienne	Lemos		
	
14	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
She, who had endured it all while caring for her frail husband through the course of her own illness, had 
quashed her virulent enemy. 
I am convinced that the independent spirit of hers that I admire so much had a large part to play in that. 
“Did you see it?!” I called the nursing station to speak to the nurse who had been my constant virtual 
companion over the last few weeks. 
“I know! I can hardly believe it!” She laughed and I could hear the cheers in the background. 
And suddenly we both found ourselves whisking away tears on both ends of the line, unexpectedly 
emotional at this one, small victory over a virus that had killed so many. 
“Thank you.” I said. “I simply could not have done it without you.” 
A cake arrived at the nursing station: 
“Dear Nursing Team, 
Thank you for risking your lives to care for my patients and doing such an excellent job.   
Stay safe and stay well. 
Dr. Vivienne Lemos” 
* 
This pandemic has brought to the fore how connected and yet, so isolated, we all are. I returned to Canada 
on one of the last flights out of Mumbai before India closed its airspace in mid-March 2020, uncertain of 
what my practice was going to look like when I got back and deeply worried about the family I was leaving 
behind.   
Fear coloured everything.   
The uncertainty weighed heavily on me.   
My friends and family members are all frontline workers and none of us had the luxury of just staying home.  
I remember the first day I stepped into my office after the lockdown was declared, wearing the scrubs that 
I had previously relegated to the back of my closet, rubber clogs, hair wound under a scrub cab, mask taped 
to my face, goggles and face shield compressing my skull and the whole mess covered by the tent of a 
level-2 isolation gown.   
None of my patients recognized me.   
One	small	victory	
Vivienne	Lemos		
	
15	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
I did not recognize myself.   
We have sacrificed so much for our patients. I have been deeply angered and frustrated with the anti-mask 
protests, the conspiracy theories that COVID-19 is a hoax and the unwillingness of some individuals to 
follow public health recommendations. It is an insult to all of us who are risking our lives for those of in our 
care and for the families who have lost loved ones to this virus. 
I, like many others, have not seen my family in nearly a year, and likely will not be seeing them any time 
soon. It is that social disconnection, the absence of touch, that I find hardest to bear.   
And yet, I am one of the lucky ones.   
I have a family.   
So many of my elderly patients do not.   
It is their isolation that I feel most keenly, unspoken between the pauses in conversation.   
Reason for medical visit: social isolation.   
There are some whom I call periodically to check in for that reason alone: there is simply no one else.   
In these difficult times, it is my hope that we rebuild our communities, redefine what it means to be family 
and reach out to those on the edges of our circles.   
That we begin to think of the collective, not just the individual.   
Life is too short not to be shared and too long to be lived alone. 
 


One small victory

Lucena, Ricardo

	
VOLUME	8	●	NUMBER	1	●	2021	●	43-46	
©	2021	Ricardo	J.	M.	Lucena.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License		
CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
MENTAL	HEALTH	PPE	IN	TIMES	OF	
COVID-19	
Ricardo	J.	M.	Lucena	
Psychiatrist,	João	Pessoa,	Paraíba,	Brazil	
lucenar@uol.com.br	
	
n Brazil, dealing with COVID-19 became extremely challenging because of the political crisis that 
accompanied the pandemic. Disagreement between the Brazil president and state governors unfolded. 
The former could not lead the latter and unite the country; consequently, no national evidence-based 
guidelines were defined to combat the spread of the virus. The president did not wear a face mask in most 
public events, nor did he recommend home confinement. Moreover, he strongly expressed his belief in the 
antiviral effectiveness of hydroxychloroquine which caused conflict with his own health ministers. Two 
physicians who were health ministers left government in less than a month. The president appointed an 
army general to take over the Ministry of Health to ensure that his personal beliefs prevailed without regard 
to evidence-based information. The vulnerable, two-tiered health care system very soon became saturated 
with an inordinate number of confirmed cases and deaths followed in rapid succession.  
 
In my Brazilian hometown (João Pessoa, Paraíba), similar to cities in other countries, stores were shuttered, 
buses stopped circulating (except those to serve health care professionals), beaches were closed, home 
confinement and face masks were recommended (and subsequently became mandatory). Sanitizing rituals 
began in many households: handwashing, cleaning groceries, doorknobs, carrying 70% alcohol gel, and 
disinfecting carpets. I observed apprehension, fear, and sometimes panic invading people’s lives. I, too, 
was frightened and personally used the skills I present herein. 
 
Using telemedicine, I continued to assist my psychiatric patients. To help them cope adaptively with the 
sudden changes brought by the pandemic, I prepared a brief protocol of intervention and named it Mental 
Health PPE. It is based on Dialectical Behavior Therapy (DBT) Skills Training.  
I 
Mental	health	PPE	in	times	of	COVID-19	
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44	International	Journal	of	Whole	Person	Care	
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Standard DBT is delivered as a one-year outpatient treatment modality with four modes: individual therapy; 
group skills training; therapist consultation team; and telephone coaching - as needed. I chose specific skills 
from the DBT to help patients cope with the fear associated with the pandemic and its consequences. DBT 
Skills Training mode is composed of four modules (each one with its own set of skills): Mindfulness; Distress 
Tolerance; Emotion Regulation; and Interpersonal Effectiveness (which were included in the Mental Health 
PPE, except Interpersonal Effectiveness, as described below).  As an example of this intervention I present 
a clinical vignette related to the case of a patient with generalized anxiety disorder and alcohol dependence 
whom I named Fátima.   
 
Fátima is a 38-year-old General Practitioner (GP) working in an outpatient clinic of a hospital. During the 
pandemic, Fátima stopped going to work. She refused to leave her home. The hospital was not offering 
PPE (e.g. face protection, disposable apron, and hat) to protect doctors. She feared being infected by the 
new coronavirus and becoming a patient as well as dying and losing her elderly parents to the virus. She 
made an appointment with me concerning these issues and let me know that she was having trouble 
sleeping. She had relapsed into using alcohol to sleep. Finally, she needed a doctor’s note to allow her to 
remain absent from work during the pandemic.  
 
MENTAL	HEALTH	PPE		
The intervention lasts on average three months (around twelve psychotherapy sessions). Mindfulness and 
Distress Tolerance Skills (Table 1 and Table 2, respectively) were the first skills to be taught. In the 
sequence, Emotion Regulation Skills (Table 3) were taught as well. They helped Fátima to regulate her 
emotions (especially her anxiety), solve the problems at work, be in the present moment, and accept the 
difficult reality of the pandemic involving all of us. 
 
Initially, Fátima was terrified of being infected by new coronavirus. She worried about her parents, especially 
her mother who has diabetes and hypertension. She was anxious and restless. To help her keep the focus 
of attention in the moment, I suggested that we begin the session with a mindfulness exercise: meditation 
with focus on the breath or mindful walk (when she was too anxious). Then, I explained how to observe and 
describe her current emotion based on a model to describe emotions, which includes the antecedents 
(precipitating events, vulnerability factors, interpretations), the emotional expression in the body and mind 
(body sensations and thoughts), and consequences (the after effects of the emotion as well as secondary 
emotions) of the emotion felt. Then, she was able to name them. It did not take her long to realize that 
emotions within the spectrum of fear were the ones to change. 
 
 
 
Mental	health	PPE	in	times	of	COVID-19	
Ricardo	J.	M.	Lucena		
	
45	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
Table 1 Mindfulness Skills and Practices 
MINDFULNESS 
Mindfulness Skills Mindfulness Formal Practices 
Observe and Describe Emotions 
Focus on the Present Moment 
Meditation with Focus on the Breath 
Mindful Walk 
 
When she was unable to change her emotions, she used Crisis Survival Skills to make them less intense 
and calm Fátima down (paced breathing, cold ice pack on her forehead, and a cold shower after session). 
She also self-soothed with body lotions, incense and eating homemade bread. She distracted herself by 
watching Netflix series, calling her parents, observing Mass on TV, and saying prayers. We prepared a 
Distress Tolerance list of activities she would do when she was very anxious. 
 
Table 2 Distress Tolerance Skills  
DISTRESS TOLERANCE 
Crisis Survival Skills Reality Acceptance Skills 
Paced breathing 
Temperature (cold ice pack) 
Distract with Wise Mind ACCEPTS 
Self-Soothe with the Five Senses 
Improve the Moment 
Radical Acceptance 
Turning the Mind 
Willingness 
 
 
We acknowledged that the pandemic is a disturbing, unexpected, terrifying event that remains out of our 
control. We are stuck in a reality that we did not seek; it moved in like an inconvenient guest who has not 
announced how long the visit will last. Then, I presented to her the Reality Acceptance Skills. I explained 
that Radical Acceptance would help her to overcome resentment associated with the pandemic and its 
associated consequences.  
 
In the discussion about accepting the reality we cannot change, we also faced an aversive topic to Fátima 
i.e. the possible death of her parents, another situation that sooner or later we all might face. Meanwhile, 
we needed to turn our minds toward acceptance of this unsettling reality and keep the focus on what we 
must do to survive in this moment. Stemming from accepting reality as it is, I explained the attitude of 
Willingness to do what is essential each day – to take care of herself, her parents, and keep her job. Then, 
we moved to the aspect of the intervention where change needed to take place that is, to regulate her fear, 
return to work, achieve restful sleep, stop alcohol abuse. We tackled Emotion Regulation Skills. 
 
 
Mental	health	PPE	in	times	of	COVID-19	
Ricardo	J.	M.	Lucena		
	
46	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
Table 3 Emotion Regulation Skills 
EMOTION REGULATION 
Changing Emotional Response Skills Reducing Vulnerability to Intense Emotion Skills 
Check the Facts 
Opposite Action 
Problem Solving 
Accumulate Positive Emotions 
PLEASE Skills 
 
Once Fátima had identified those emotions within the spectrum of fear needing change, we advanced in 
the process of emotion regulation. We discussed the Emotion Regulation Skill of Check the Facts, which 
helps us to understand whether an emotion felt fits the facts of a situation. We assessed Fátima’s emotion 
of fear through two general questions:  
1. Does the emotion make sense in its context?  
2. Is it effective to act based on the emotion?  
 
The answer to the first question is YES. The answer to second question is NO. We cannot avoid work and 
other errands outside the home because of the virus. Therefore, the emotion fear, in this context, alerted 
Fátima of a threat (the virus), but it cannot paralyze her. The intensity of the emotion needed to decrease. 
Then I presented to her the Opposite Action Skill which helps to decrease the intensity of emotion or even 
extinguish it. I explained that she had to show up at work even when feeling the urge to avoid it. Fátima 
needed to do the opposite of what her fear dictates (do not avoid; expose yourself carefully in this context). 
I explained that we were going to problem-solve together so that she could protect herself as much as 
possible. Thus, she would not need a doctor’s note to keep her from work. We designed a plan of action 
for her to go back to work, including to buy the PPE she needed, which the hospital did not provide. 
 
Then we discussed the PLEASE Skills: PL (treat Physical illness), E (balance Eating), A (Avoid mood-
altering substances), S (balance Sleep) and E (get Exercise). They helped Fátima to take care of her 
intense fear and anxiety by taking care of her body. I adjusted her medication and reviewed the protocol of 
sleep hygiene. Her sobriety plan included replacing alcohol with anti-anxiety medication.  
 
COVID-19 remains a threat to us all. It created an unwanted reality that we have not yet been able to 
modify. Continuous adaptation is required to live in an altered, more challenging world. Mental Health PPE 
may contribute to keeping us safer and healthier until the day when the current pandemic exists mainly in 
history books. 
	
 


Mental health PPE in times of COVID-19

Wright, Scott

	
VOLUME	8	●	NUMBER	2	●	2021	●	21-22	
*This	article	has	been	originally	published	on	CLOSLER,	3	Jan.	2020.	
©	2021	Scott	Wright.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	2	(2021)																																																																																																																																																																													
	 	
MALCOLM	GLADWELL’S	“TALKING	TO	
STRANGERS”	APPLIED	TO	PATIENT	
CARE*
Scott	Wright	
Department	of	Medicine,	Johns	Hopkins	University	School	of	Medicine,	Baltimore,	MD,	USA	
swright@jhmi.edu	
 
est-selling author Malcolm Gladwell’s latest book, “Talking to Strangers: What we Should Know 
About the People we Don’t Know”, highlights how there are frequent misunderstandings in our 
communications with others. He explains that confusions are more common the less-well we know 
who we are speaking with—and particularly when we are “talking to strangers.” 
Select examples from the book include: 
1. Prime Minister Chamberlain’s misinterpretations of Hitler’s intentions related to the invasion of 
neighboring countries. 
2. Bernie Madoff winning the trust of savvy investors. 
3. The circumstances surrounding Sandra Bland’s wrongful arrest that culminated in her suicide. 
Gladwell explores the false assumptions and mistakes we make when dealing with people we don’t know. 
In reading it, I could not stop thinking about conversations between patients and healthcare professionals. 
I am fortunate to have practiced at the same institution for many years and to have relationships with some 
of my patients for 25 years; with many of these patients there is familiarity, comfort, and mutual 
understanding. However, when I am working on the inpatient units, caring for patients newly assigned to 
me or those who usually see my colleagues, I am in fact, “talking to strangers.” 
  
B 
Malcolm	Gladwell’s	“Talking	to	strangers”	applied	to	patient	care	
Scott	Wright	
	
22	International	Journal	of	Whole	Person	Care	
Vol	8,	No	2	(2021)	
	
Here are five tips that I took away from the book that may help healthcare professionals when talking 
to patients that they do not know well: 
1. Consciously reflect upon the idea that we often misread those we don’t know well. 
 2. When patients are uncomfortable or stressed, their communications may be less clear or accurate as 
compared to when they are at their best. This will naturally influence our ability to learn their true story or 
understand their authentic perspectives. 
 3. We are often missing vital pieces of our patients’ back stories that could help us understand their beliefs 
and behaviors. Asking about such particulars can help to establish rapport, shows genuine interest, and 
can convert stranger to friend. 
 4. Keep in mind psychologist Dr. Timothy Levine’s “Truth Default Theory.” This model explains that most 
people tend to believe anything that they hear, even if there is opposing evidence. Some patients may 
consciously elect NOT to be truthful or candid with their physician for various reasons. 
 5. Know that we all have a predisposition to doubt “out-of-the-ordinary occurrences.” As such, IF you 
witness something bad (like bullying of anyone [e.g. a trainee or a nurse], or a colleague acting 
inappropriately or unprofessionally), know that you are wired to convince yourself that things are not as 
they seem and that you are incorrect in your assessment. To counter this, look carefully at the facts and 
reflect thoughtfully on the details. If you notice that something is amiss, speak up. 
 


Malcolm Gladwell's "Talking to Strangers" applied to patient care

Dobkin, Patricia Lynn

	
VOLUME	8	●	NUMBER	2	●	2021	●	1–2	
	
©	2021	Patricia	Lynn	Dobkin.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	
CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	2	(2021)	
EDITORIAL	 	
THE	WEIGHT	OF	WORDS	IN	WHOLE	
PERSON	CARE	
Patricia	Lynn	Dobkin,	Editor-in-Chief	
Programs	 in	Whole	Person	Care,	Department	 of	Medicine,	 Faculty	 of	Medicine	 and	Health	 Sciences,	McGill	
University,	Montreal,	Quebec,	Canada	
patricia.dobkin@mcgill.ca	
	
	
 
uman beings use language to exchange ideas with one another. How this is done in clinical 
settings is crucial to whole person care. When the person-clinician talks with a person-patient 
and/or family member, this can be helpful or harmful given the weight of words.[1] How we 
communicate includes tone of voice, cadence, diction, body language, time allotted, as well as spaces 
between words enabling integration of information. We may have inclinations such as: premature closure, 
interrupting, formulating mental answers rather than listening, holding biases, using frightening metaphors 
(e.g., a time bomb in the chest). These learned ways of communicating may or may not be conscious.  
Dr. Wright and Mr. Kaleka, a seasoned physician and medical student, respectively, highlight that the way 
we talk with strangers (who happen to be patients) can be pivotal. Dr. Wright notes, “We are often missing 
vital pieces of our patients’ back stories that could help us understand their beliefs and behaviors. Asking 
about such particulars can help to establish rapport, shows genuine interest, and can convert stranger to 
friend.” Mr. Kaleka, a trainee, inherently understands, “We assume that what we perceive to be important 
is what the patient would or should like addressed, a form of paternalism. Yet, if we step back and view 
ourselves as human beings interacting with other humans, our considerations may change. We begin to 
see the patient’s perspective; this, in turn enables us to better understand and help them. Such is the power 
of humanism…” 
Dr. Berkani and her colleagues describe a program offered to seniors who were isolated during the COVID-
19 pandemic that transformed cold calls into warm encounters with strangers. They trained more than 300 
volunteers to provide friendly phone support to more than 600 older adults offering social support along 
H 
Editorial	
Patricia	Lynn	Dobkin	
	
2	
	
International	Journal	of	Whole	Person	Care	
Vol	8.	No	2	(2021)	
	
with ways to access community resources. The experience was described as “heartwarming and facilitating 
enriching life experiences for seniors, volunteers, and clinicians alike.”  
Dr. Dobkin reminds us that like music, the space between the words (like notes) can reveal as much as 
spoken words, if we are attentive. Campion’s poem, while less straightforward, employs words to evoke 
emotions related to both the patient and caregiver’s hospital experiences. Strikingly, in Ms. Lewis’ essay 
no mention was made about what the various doctors she encountered in the emergency rooms said to 
her. Were their words lost in the commotion or simply buried in her memory?  
How can we be mindful of speech? It is often automatic, conditioned, and culture dependent (e.g., in 
medicine, battle-field comparisons). There is a Buddhist saying, “When meditating, watch your mind. When 
in the world, watch your words.” Buddhist psychology recommends that we ask ourselves these questions 
before we speak: 
 “Is it true? Is it kind? Is it useful? Is it timely? Is it conducive to harmony?” 
Mindful congruence[2] involves being aware of the self, the other, and the context such that we pause 
before speaking, consider our intentions, examine our habits of mind before responding to a situation. 
Moreover, we need to consider the patient’s state of being (e.g., agitated, lonely) and the setting (e.g., 
emergency room or private clinic). While it may seem idealistic given the hustle-bustle of clinical work, it 
can be learned[3]. Perhaps this volume will inspire you to reflect on the power of words recognizing that 
have the potential to weigh heavily on others. 
REFERENCES	
1.   Bedell SE, Graboys TB, Bedell E, Lown B. Words that harm, words that heal. Arch Intern Med. 
2004;164:1365-7. 
2.     Hutchinson T, Dobkin PL. Discover mindful congruence. Le Specialist. 2015;17(1); 31-32. 
3.   Hutchinson TA, Liben S. Mindful medical practice: An innovative core course to prepare medical 
students for clerkship. Perspect Med Educ. 2020;9(4):256-259. doi:10.1007/s40037-020-00591-3. 
 
 


The weight of words in whole person care

The piece is an essay or reflection on the importance of humanism in medicine. The author encourages clinicians, first and foremost, to consider their relationship with patients from the vantage point of a shared humanity. This view allows for a better understanding of patients' needs and ensures patient-centered care.&nbsp

Kaleka, Kultaj

	
VOLUME	8	●	NUMBER	2	●	2021	●	3–6		
©	2021	Kultaj	Kaleka.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	2	(2021)	
	
HUMANISM	IN	MEDICINE	
Kultaj	Kaleka	
Medical	Resident	Internal	Medicine-Psychiatry,	University	of	Kentucky,	Lexington,	Kentucky,	USA	
kultaj.kaleka@uky.edu	
	
	
	
ABSTRACT 
 
The	piece	is	an	essay	or	reflection	on	the	importance	of	humanism	in	medicine.	The	author	encourages	clinicians,	
first	and	foremost,	to	consider	their	relationship	with	patients	from	the	vantage	point	of	a	shared	humanity.	This	
view	allows	for	a	better	understanding	of	patients'	needs	and	ensures	patient-centered	care.		
	
KEYWORDS:	Humanism, Medicine, Patients 
 
 have, for some time, harbored a wariness of words, concepts, and practices that end with “-ism.” 
Superficially, “-ism”, is a simple word-forming element. It comes from the Greek “-ismos” and serves an 
important function in the English language, signifying the practice or teaching of phenomenon. However, 
in our contemporary context with a drive to intellectualize and codify everything, “-ism” creates a certain 
mystique and complexity around simple concepts. It makes what is easy and simple in practice, esoteric. 
Being human or placing the interests and values of humans above all, does not need to be an “-ism.” 
Humanism is nowhere near as complex of a construct as capitalism, communism, socialism, colloquialism, 
etc. For the practice of humanism, no heavy leather-bound texts need be consulted or revered; nor is there 
a need for a revolution or purchase of stock. All being human requires is comprehension of, and reflection 
on, the truth that the other individuals are almost your mirror image. Just as you feel hunger, pain, cold, 
I 
Humanism	in	medicine	
Kultaj	Kaleka	
	
4	
	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	2	(2021)	
	
warmth, love, sadness, anger, confusion, and illness, so do others. Similarly, they too try their best to 
alleviate pain and cherish moments of compassion and happiness. As human(s), comprehending this truth, 
it behooves us to act in the best interest of other humans. In my strong opinion, humanism is the worthiest 
and most profound of all the “isms”. Here, in support of this opinion, I relate a recent experience where my 
attending physician and I acted as human(s) and intervened to engage compassionately and respectfully 
with a vulnerable patient.  
Through my chart review and prior conversation with my attending, I knew that Mr. P was an elderly patient 
with lung cancer. He had a poor prognosis, refused palliative care, and wanted to die at home. The only 
reason for his visit was a renewal of his COPD medication. Proudly independent, he lived by himself in an 
isolated rural area. While being his own decision maker, he was supported by a loving and caring family 
that regularly checked on him. His son, a busy firefighter and primary support, helped Mr. P with most 
instrumental and some daily activities of living.  
Before meeting patients, I always struggle with a thought kaleidoscope. In addition to considering their 
reasons for the visit and related considerations (medications, differential diagnosis, etc.), I try to imagine 
how my patients live their day-to-day life: the kind of work they do, the people that are important to them, 
the struggles and barriers they experience. As someone with prior experience caring for the geriatric 
population, I wondered about Mr. P’s ambulation, his diet, his gait, his cognitive status, the structure of his 
day, and his emotions in relation to his cancer. My short rumination spent trying to picture Mr. P in his own 
context and considering questions that would help me understand the same, ended as I spotted an elderly 
man with a cane and his presumed (similar in appearance) son sitting adjacent to one another in the lobby.  
At first glance, Mr. P had a somewhat bionic appearance. His hand loosely grasped a metallic cane, an 
artificial but steady limb to compensate for the inevitable infirmity brought by time. A small oxygen machine 
was slung over his shoulder. His oxygen tubing had been reinforced, taped to his body, at multiple sites: at 
his neck, just before it bifurcated, with loops taped behind both ears. One look revealed that the tape had 
been recycled. It had had been detached and reapplied to Mr. P’s body many times. Despite the ardor and 
care in application, the tubing seemed to have had a mind of its own. Yet, ironically, the nasal prongs were 
still in place. The apparatus, patched and clumsy though it was, was sustaining the very organ that had 
allowed him to cherish life but would soon take him to the final resting stop in his life’s journey.  
Mr. P lit up and smiled warmly as I introduced myself as a medical student. I joked that his firm handshake 
indicated he couldn’t be older than forty-five. I deemed it too soon to talk about, and clearly inappropriate 
to comment on, his long fingernails and the stains on his shirt. His son’s face told a tale of fatigue, I noticed 
bags under his eyes and a worn face as I acknowledged him. I explained my purpose and role to them. 
They both agreed to allow me to assess him. As I ushered them into the clinic and towards the examination 
room, I mentally thanked them and all patients for their compassion for, and trust in, students.  
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Mr. P shuffled into the examining room, taking small, slow steps towards a seat. I asked after how he was 
doing. Did he have any health concerns, or any needs? His responses, summarized, implied that he did 
not have any concerns or problems that he was worried about or needed to be addressed. He ate cereal 
and toast with coffee most days, watching TV as he did so. His son visited him once every two days, 
bringing dinner with him. He resolutely, as I had been previously told by the attending, did not want to talk 
about his cancer or palliative care. To my additional directed questions, he responded by relating a previous 
or current health problem, and how it had already been addressed perfectly by the attending. He often 
ended answering questions with some variation of how he no longer had any problems. As an example, 
while answering my question about any instances of shortness of breath he replied, “No, I got no shortness 
of breath now. This machine, the doc got it set up for me. The medical supply guy gets the oxygen to me. I 
got no trouble with it now.” Talking to him, I sensed that he did not want to be a bother. Like others who 
cherish and pride their independence and self-reliance, he did not want to appear needy or dependent on 
anyone.  
Proceeding to the physical, I conducted a comprehensive but unnecessarily exhaustive examination of Mr. 
P. With the innocence, eagerness, excitement and vigor, that can only be possessed by a novice, I 
subjected Mr. P to tests like a circus ringmaster. Full neurological, cardiovascular, respiratory, and 
gastrointestinal examination were undertaken. Not surprisingly, I saw only what I would have expected from 
a review of his chart: disease progression There were audible wheezing and a cough, consolidation to the 
right lower lung base as well as reduced grip strength and general muscle atrophy. Mr. P wanted nothing 
to be done about any of these findings. Frustrated, not being able to add anything of value to Mr. P’s care, 
I calmed myself. This wasn’t about me. Mr. P was here for a refill of his medications. Mr. P, the patient 
around whom care and this interaction was centered, did not expect anything more from this encounter.  
Considering his point of view, I changed my approach. I tried again to imagine Mr. P in his own context. I 
wanted him to feel comfortable, not a burden, but an active partner in his own care. I wanted him, his 
perspective, his own identified needs to be seen and addressed. As I took off his shoes and socks to palpate 
his pulses, I noticed long toenails with dirt underneath them. I did not comment on them in the moment but 
waited until I had fully examined himself using my new lens. Finally, I sat back and addressed both Mr. P 
and his son. I stated, “Mr. P, I noticed you shuffling when you came in the room. You were using your cane, 
but still shuffling. If I am not wrong, if you are shuffling here, you were likely also shuffling at home. I think 
your toenails might be bothering you, can you reach your toes?”  
Mr. P looked at me, then his son, and then back at me and replied, “They do hurt, I can’t reach them. I 
asked him to cut them the other day, he don’t got the time. I haven’t showered in about two weeks either, 
or had my laundry done.” The son, embarrassed, immediately apologized to Mr. P and explained how his 
busy schedule in the past month had been taxing, tiring, and the reason why he didn’t have time to attend 
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more diligently to Mr. P. I sat silently, an outsider to their family context, listening and respectfully waiting 
until the conversation was done. There was something that did bother Mr. P, and I had gained just enough 
trust for him to state it. His active medical issues were under control, he had understood and made his 
peace with his diagnosis. Nonetheless, his quality of life was affected, and his independence was 
compromised. Just like the cane that supported his gait and the oxygen machine that helped him breathe, 
something had to be done to continue to help him live his life the way he wanted to. Having gleaned as 
much as I could, I informed them that if there was nothing else they would like to share, I would go report 
to the attending and return with a plan. 
I presented Mr. P to my attending, highlighting the issues as I saw them. His nails needed to be cut, 
caregiver burnout and support needed to be discussed. With my attending’s full support, we went back into 
the room with clippers and sterile scissors. With Mr. P’s grateful consent, we clipped his nails. Additionally, 
we spoke to Mr. P and his son, trying to negotiate a plan where he could get help with a shower and laundry 
in a more regular fashion. Without blaming his son, and with his support, we identified Mr. P’s daughter and 
grandson as additional caregivers who could support Mr. P. A plan was made to involve them in Mr. P’s 
care. As my attending signed the order for Mr. P’s medication refill, Mr. P thanked us profusely, specifically 
remarking on how he’d never before had a doctor trim his toenails.  
I reflect on this interaction often, especially Mr. P’s remarks regarding his toenails being trimmed. As 
physicians and medical students, our medical knowledge and lens dominates our interactions with patients. 
Although important, this approach leads to an inherent bias. We sometimes overlook what patients really 
want or fail to identify their concerns. We assume that what we perceive to be important is what the patient 
would or should like addressed, a form of paternalism. Yet, if we step back and view ourselves as human 
beings interacting with other humans, our considerations may change. We begin to see the patient’s 
perspective; this, in turn enables us to better understand and help them. Such is the power of humanism, 
shedding away preconceived notions, viewing and accepting patients for who they are, through 
compassion.■
 
 


Humanism in medicine

Sang, Laura

	
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©	2021	Laura	Sang.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
A	DAY	IN	THE	LIFE:	DOCTOR	TURNED	
PATIENT	OVERNIGHT		
Laura	Sang	
Family	Medicine	Resident,	Faculty	of	Medicine	and	Health	Sciences,	McGill	University,	Montreal,	Quebec,	
Canada	
laura.sang@mail.mcgill.ca	
	
here I lay, listening to the rhythmic hum of my IV. The hypnotic waves of my heart rate on the 
telemetry screen reassured me that in that moment I was okay. My eyes burned with fever and my 
body shivered with a mix of cold and fear of what was yet to come. Having worked on the wards 
and seen how this disease progresses, I knew I was either going to turn the corner and be safely transferred 
to the COVID-19 ward, or I was about to crash, require intubation, and an admission to the intensive care 
unit (ICU). I glanced at my phone—25% of my battery remained. I prayed for the former and that I would 
be well enough to update my worried family before my phone died altogether.  
Suddenly I jolted up in bed, my heart racing almost as fast as my thoughts. I was home in my own bed, 
completely safe. I settled back under the covers and breathed deeply. Just another nightmare about my 
time in hospital, I thought to myself. I shook it off like a wet dog drying itself, letting the droplets of fear and 
anxiety dissipate. Although the flashbacks and nightmares were growing less frequent, my mind refused to 
let me forget what happened. I can still feel that sinking feeling in the pit of my stomach that fateful Friday 
morning when I awoke with fever. To this day, I am still in awe of how quickly I deteriorated and that, as a 
young, previously healthy woman, I required a three-day hospitalization.  
When you are hospitalized in your place of work, the boundaries between being a doctor and patient blur 
completely. My colleagues became my caregivers; those once teaching me how to collect health 
information were now privy to mine. Attendings who once evaluated me sent me daily texts to see how I 
was feeling. Instead of seeing me at my best, they saw me at my most vulnerable: unkempt, unwell, and 
crying from the overwhelmingness of it all.  
T 
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To any physician who has been a patient, you know how challenging it is to accept the sick role. Being in 
the doctor role is comforting; you have the knowledge and some control over the situation. Being a patient 
is riddled with helplessness and uncertainty: you are a prisoner to your own ailment. I wanted to wear my 
doctor’s hat from my hospital bed; so much so that I once tried to intervene on a code white in the middle 
of the night. Naturally, the nursing staff sent me back to my room. Isolated from my family, I gave them 
news by phone. I tried to present these health updates like a doctor to hide the fear that I had as a patient.  
Despite my rapid return to my usual state of health within a few weeks, the experience had shaken me to 
my very core. The patient role was thankfully temporary; however, the boundary confusion persisted in a 
variety of ways. From regularly working with staff who cared for me to treating patients in the room that was 
once mine, I have constant reminders of my time in hospital. Albeit confusing, this experience has helped 
me to better connect with my patients and understand their illness experience. Who would have thought 
being a patient would make me a better doctor? 
As the morning sun rolled in, I swatted away the memories like bothersome mosquitos. Time to go to work. 
Now several months into the pandemic, my new daily routine has become second nature. Every morning 
before I leave for work, I pick up the pumpkin scented candle on my coffee table and give it a whiff just to 
be sure I have not lost my sense of smell. Every time the glorious scent of nutmeg and cinnamon tickles 
my nose, I breathe a sigh of relief. “Safe for now,” I think to myself. Although I know I likely have some 
immunity, I do not want to take any chances; being sick once was bad enough. On my way out of the house 
I check to make sure I have my hospital ID, wallet, keys, phone, and mask. During my walk to work, I often 
find myself debating whether it is safe to see my partner, my family, and my friends this week. This often 
requires an arduous mental calculation of risk based on who I may have been exposed to, how long ago 
that was, how many new cases there are in my area, etc. Although the risk of losing loved ones to COVID-
19 has somewhat blended into the many existing background risks, like wearing your seatbelt in the event 
of a car accident, I still try to do my part to mitigate any threats.  
Once arrived at the hospital, I bypass the queue of patients waiting to be allowed in. As I walk the halls of 
what feels like my second home, there is a foreign sense of familiarity. There is still the same enticing smell 
of breakfast as I pass the coffee shop; unchanged except for the floor markers in place to maintain social 
distancing. There is the usual hustling and bustling of various health care workers except everyone wears 
a mask now. Colleagues smile with their eyes as they pass each other in the corridor, but they keep a 
distance and do not hug the way they used to. Chairs in the waiting room and cafeteria are taped up or 
removed completely to enforce social distancing. The friendly volunteers you saw guiding people in the 
hallways have been replaced by hand sanitization stations. What is even more surreal is that another year 
has come and passed, and I have new resident colleagues with whom I have worked with for several 
months and have no idea what they look like.  
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Thankfully, medicine is still medicine—a constant in a sea of uncertainty. While the practice of it has 
changed, the mental puzzle of diagnosis remains at the forefront of patient care. Most of my family medicine 
clinics have been replaced by phone consultations which brings about a whole set of challenges. Asking 
patients to take their vital signs at home and guiding them to perform basic physical exam maneuvers on 
themselves has become commonplace. And for those few necessary in-person appointments, no amount 
of protective equipment can dissuade human connection. In the emergency room, I call a patient’s wife to 
give her an update on how he is doing as she is immunocompromised and cannot be there with him. On 
the wards, I hold the hand of a frail older woman as she sobs in a state of complete exasperation after not 
seeing her husband for several weeks. The firm grip of my gloved hand is the only solace I can offer. At the 
end of a long day after inhaling whatever leftovers I have in my fridge, I collapse into my couch and let it 
absorb me completely.  
Near the end of February 2020—the last time I ate at a restaurant indoors—I opened a fortune cookie that 
said: “A thrilling time is in your immediate future.” I have to say, what unfolded in March was not exactly 
what I had envisioned. Yet here we are, navigating one of the most challenging times in our collective lives. 
Working during the pandemic has revealed the wounds and weak points of our society i.e. whom we value 
versus not, and who we take care of versus who we ignore. The media paints a portrait of simultaneous 
cruel selfishness and collective kindness. From stories about hoarding toilet paper and violence against 
minorities, to feats demonstrating remarkable bravery, COVID-19 has exposed humanness in the rawest 
way I have ever experienced. Every night before I go to sleep, I feel a sense of gratitude for the little 
moments of happiness that carry me through the day. From singing in the car at the top of my lungs to my 
favourite song at a red light to watching my tomato plants finally begin to bloom. These tiny moments let 
me forget for a short while that this pandemic exists, offering a brief escape to normalcy. But what is 
normalcy anyway? It is hard to say. Tomorrow is just another day in the life of a frontline health care 
worker.■ 
 
	


A  day in the life: doctor turned patient overnight

	
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©	2021	Patricia	Lynn	Dobkin.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License		
CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
NOT	FACING	COVID-19	ON	THE	
FRONTLINE	
Patricia	Lynn	Dobkin		
Clinical	Psychologist,	Programs	in	Whole	Person	Care,	Department	of	Medicine,	Faculty	of	Medicine	and	
Health	Sciences,	McGill	University,	Montreal,	Quebec,	Canada	
patricia.dobkin@mcgill.ca	
	
	
espite adding my name to three volunteer websites to ‘contribute to the cause’ I remain confined, 
at home, with my spouse. As a psychologist, I understand that even when people are fortunate 
enough to have a safe place to wait out the COVID-19 pandemic, struggles with unresolved inner 
conflicts or complicated relationships will arise. As a teacher of Mindful Medical Practice, I long to reach out 
to colleagues who are, in contrast, working directly with patients. When I offered my psychological services 
to our university-based hospital, no response was forthcoming. Most likely more immediate concerns such 
as securing personal protective equipment, creating red zones to quarantine positive cases, rotating staff, 
to name just a few, took precedence. 
 
Full disclosure: I did receive calls from my provincial psychological corporation – both requesting that I 
attend to homeless people who have been isolated in an old run-down hospital or at a downtown testing 
tent site. My first thought was, “Yes, I can go.” My subsequent thought was, “My spouse will not agree.” At 
age 65 he has lived with diabetes for 20 years – two risk factors. His reasons for objecting were predictable 
and logical, like him. Normally, he encourages me to be fully engaged in my work, so I did not perceive this 
reaction as controlling. I consulted with my brother, a retired cardiologist [see Common Decency in this 
volume] who has decided to serve despite his age (67) and pre-existing conditions. Next, I talked with a 
family physician/friend. Of course, neither answered the question, ‘Do I go or not?’ but I needed to run my 
thoughts by them just the same. I chose to respect my spouse’s wishes. What clinched my decision was 
when he said, ‘What a lonely death this illness has to offer; no visits allowed, masked and gowned strangers 
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taking care of patients.’ I could not imagine him there and me here, unable to say adieu. My dilemma is like 
others’ who must weigh out the risks and benefits of their choices.  
 
Dr. David Saint-Jacques, a Canadian astronaut, offers advice for coping well with confinement.  
Living for 204 days on the International Space Station underlie his views. See: 
https://www.rcinet.ca/en/2020/03/24/what-we-can-learn-from-astronauts-about-how-to-deal-with-isolation/. First, get 
informed, but do not overdose on media. Learn from and listen to the scientists, but do not focus exclusively 
on the negative information (e.g. number of deaths) – include positive facts as well (e.g. recovery rates). 
This helps to keep things in perspective. Use information to protect yourself and others (e.g. wear a mask, 
respect physical distancing).  
 
Second find meaning or purpose in your actions. I tell myself that I am contributing to flattening the curve, 
as Montreal has more cases than any other city in Canada. We are told to, ‘Stay home, save lives’ – so I 
am following those directives. 
 
Third, Dr. Sainte-Jacques suggests following a daily routine. This can alleviate uncertainty. Alas, there are 
many unknowns: How long will this last? When will a vaccine be available? How will we exit confinement? 
Will there be a second wave of infections? etc. I confess that I have not, thus far, heeded this point. In fact, 
I have relished not having to stick to a schedule. Before COVID-19, teaching, professional meetings, travel, 
reading, writing, attending yoga classes, swimming, and social activities were scheduled and carried out 
accordingly. Now what I do and when I do it varies from day to day. I feel freed from time constraints. I have 
relinquished rushing. Rather than defining myself by what I do, I am simply being with what is, moment by 
moment, day by day, week by week, month by month. That is, being: curious, restless at times, occasionally 
generous, dogged by back pain, attentive, restless, present, tired, grateful, i.e. fully human. Nonetheless, I 
have made a point to walk an hour each day (pools are now off-limits), practice yoga most mornings, and 
meditate almost religiously. Of course, others, such as children, need structure and it makes sense to guide 
them through each day with regular meals, home schooling, games, exercise, and fixed bedtimes.  
 
Dr. Saint-Jacques’ next recommendation is to “create a mental bubble.” He describes how he and his fellow 
astronauts gave each other mental space while working in outer space. “Immerse yourself in your daily 
activities,” he said. This reminds me of informal mindfulness practice, when you carry out daily activities 
(e.g. shower, walk your dog, cook) with heightened awareness of sights, sounds, smells, and touch. 
Wandering in our neighborhood I notice tiny green buds on branches, birdsongs, children dashing by on 
bicycles (without helmets!), wind in my hair, and the warmth of the noon sun. I lose myself in books and 
enjoy participating in virtual narrative medicine groups. This inspires me to write.  
 
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The last piece of advice, I think, is the most important, “Try to shift your mental focus to helping people 
around you. And, you know, you can kind of set the trend and then others will think of you and help you. 
And I think that is a very positive way to go about hard times when you focus on what you can do for others 
around you.”  
 
I have had to be creative to enact this while in confinement. First, I created a 40-minute video entitled, 
‘Maintaining Resilience: Working Through COVID-19,’ and made it widely available to healthcare 
professionals (see: https://youtu.be/18NlkqaHJI4).  
 
Second, this special gathering of stories came to mind as another way to contribute. By providing a platform 
for others to share experiences they and their readers may benefit. I edited a book of this nature in 2015 
(see Mindful Medical Practice: Clinical Narratives and Therapeutic Insights, Springer Press) that showed 
how mindfulness can be applied in the real world of medicine.  
 
Another way I can help others (while respecting physical distancing) is by facilitating online sessions. I have 
learned new skills via webinars, to be able to do this. Currently, I run two such groups and it is remarkable 
to me that we connect virtually without feeling too distant. One of the two groups have been meeting for 
nine years, once a month for two hours, 10 months per/year. We have history, trust, and continuity to enable 
us to support each other. The second group was the result of our having to postpone the Mindful Medical 
Practice course we offer each spring. I woke up one morning with an idea: rather than charge a fee for a 
weekly session, participants who wished to meet virtually could donate to a local COVID-19 charity. A win-
win-win proposition. This group is more challenging for me to lead as the doctors and other health care 
professionals have differing levels of experience with applying mindfulness to their work in medicine. 
Nonetheless, open, curious minds have arrived, and we end each session with a sense of surprise and 
satisfaction. I will offer my first online Mindfulness-Based Medical Practice course this coming fall. 
 
Recently, I gave Grand Rounds for the Department of Medicine at one of our local hospitals entitled, “When 
the Adrenaline Wears Out.” It was attended by 74 doctors and residents – who will reach many more 
patients than I can ever meet. (see: https://youtu.be/99tLBuRpnFc). And as the pandemic spreads across 
the globe, I offered a Webinar for specialists entitled, “COVID-Related Mental Health: The Second Wave?” 
My intention was to help them help their patients cope with the chronic stress of living with uncertainty, loss, 
fear, and constant change. In December, I will give a day-long workshop to pediatric social workers entitled, 
“Mindfully Surfing the Waves of COVID-19”, as they find the frontline work exhausting and telemedicine 
challenging. 
 
“It’s all about our ability to adjust,” Saint-Jacques says. “The human soul has this incredible capacity for 
adaptation.” Collectively, we will pull through this. I am proud of how Canadians have reacted to this crisis. 
Not	facing	COVID-19	on	the	frontline	
Patricia	Lynn	Dobkin		
	
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Our motto is: ‘Stronger Together.’ Of course, some refuse to wear a mask and others gather at parties – 
ignoring risks; but overall, we value communitarianism. Our universal healthcare system is holding up even 
though we were caught off guard, like other nations, with a penury of personal protective equipment. But 
we have adapted to this as well, with new hospital protocols in place, testing centres up and running, etc. 
 
I confess that I maintain a nagging feeling that I am not doing enough. I contribute to food banks and local 
charities but wonder, ‘What else?’. Perhaps other opportunities to assist will arise. I am ready and able to 
respond. For example, I put my name into a pool of potential participants in a vaccination trial at my 
university. I believe there will be a ‘before COVID-19 and after COVID-19’ etched into our collective 
psyches. My optimistic nature believes that this crisis could convince us how interconnected we truly are.  
I hope we will comprehend Inter-being (as described by Thich Nhat Hanh, see: 
https://www.youtube.com/watch?v=kgU8sLTZduQ) once we have integrated this experience.  
 


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