Pandemic 2.0: Cancer Care, Workplace Stress, and Finding Strength

Pandemic 2.0: Cancer Care, Workplace Stress, and Finding Strength

Don S. Dizon, MD, FACP, FASCO

Mar 21, 2022

Dr. Elizabeth Comen headshotBy Don S. Dizon, MD, FACP, FASCO (@drdonsdizon), and Elizabeth Comen, MD (@Elizabeth_Comen)

I finally got to see my mom and sisters. It had been 3 years since our last family reunion, delayed due to COVID-19. Yet even before I left, the numbers of people getting infected with COVID had started to rise, due to the Delta variant for sure, but also due to the Omicron variant, initially identified in the U.S. on December 1. To be honest, I wasn’t worried at the time. Everyone in my extended family who was eligible had been vaccinated, even boosted, and when I left in mid-December, things were still okay in Providence; we had not experienced any surge.

By the time I returned, things had turned upside down. We went from a rolling 7-day average of 1,090 people infected when I left on December 15 to 3,716 on January 5. It was as if no progress had been made in 2 years. We immediately had to figure out how the outpatient cancer clinics would function because so many staff were infected with COVID, and system-wide, it was compounded by an overwhelming volume of people requiring care. Surgeries were cancelled, visitors restricted. In our infusion units, people had treatments alone and if you weren’t on treatment, we discouraged you from seeing your doctors in person. What a way to practice!

In my own clinic, half of the patients scheduled to see me in person had their appointments converted to telehealth visits, including some who had disease progression. Definitely an issue. This time we also felt the implications of supply chain slowdowns as chemotherapy shortages were reported. Some of those days, I found it hard—hard to feel like you're unable to provide best practice.

This came up in a conversation on social media with a colleague, Dr. Elizabeth Comen. We have never met in person, but like so many I’ve come to know and admire, she is a twiend (Twitter-friend—albeit, borne out of Instagram). Dr. Comen is a breast medical oncologist at Memorial Sloan Kettering Cancer Center with a research interest in immunotherapy as well as the relationship of clonal hematopoiesis to solid tumors (disclosure). The through-line in all her work is connection and communication—with patients, with students, and with television audiences and social media as a featured expert on breast cancer. I shared my above thoughts with her and they sparked a thoughtful conversation about adaptation and resilience.

DD: What struck you as different this time around, as compared to last year’s surge?

EC: At the start of the pandemic, while many of us were already burned out from existing challenges in medicine, I still had more reserve. I was bolstered by invigorating memories of dinners, theater, and other social events when New York City felt alive with opportunity and energy. Our lack of knowledge about the virus at the start of the pandemic certainly resulted in tremendous medical uncertainty, including concerns that health care professionals would not have access to enough PPE. But, as residents of every neighborhood throughout New York City rallied every night at 7 PM to clap, scream, and bang pots and pans from their windows, the heart of our city buttressed my and other health care workers’ spirits.

But this latest COVID variant and surge feels strikingly different. It has threatened far more than access to PPE—it seemingly threatens the soul of our health care teams. Alongside the rising number of infected health workers, staff, and patients, our health care system feels even more constrained, and public support for it seems to have waned. Health care workers are exhausted; patients even more so. And in many instances, the distance between general public awareness of what’s happening in hospitals and clinics versus the understandable urge to “return to normal” is ever more divided. The present surge is accompanied by a cultural war between those who are vaccinated and those who are not. That divide is excruciatingly impactful at cancer centers, where our immunocompromised patients are disproportionately affected by COVID, which only further challenges our already undervalued and drained health care workers. The entire dynamic also throws into high relief the magnitude of the health care inequities in society, as well as the contagious damage of rampant scientific misinformation spread online and through other media outlets.

DD: Of course, this time we are experiencing the surge when vaccines are readily available. I am sure that most (if not all) of your colleagues are vaccinated, as is the case for me. Despite this, they are getting infected. Has it personally affected you? We are both working within systems too that are trying to meet many goals simultaneously, and I certainly see the efforts being made. Have you found anything particularly frustrating, though? And on the flip side, anything that has instilled more hope (or resilience) in you?

EC: Undoubtedly, the Omicron surge caught many of us by surprise, especially in the setting of vaccination. Everybody assumed that vaccination would be a panacea, and a return to normalcy. It hasn’t been. And none of us were fully prepared for the sudden absence of sick colleagues and the scramble to keep our service up and running. As a mother of three children under age 11, I had just vaccinated my children before the present surge. We were finally celebrating with our children in the hope that we could engage in more social activities as a family. It was heartbreaking to answer their questions about why we again needed to be on high alert despite having just been vaccinated.

Personally, the surge has centered me on the fundamentals: 1) how can I best care for my patients given the present challenges; 2) how can I care for my family—particularly my children; and 3) how can I stay present, energized, and emotionally available for not only the “work of it all” but equally for the unexpected moments of joy. Staying laser focused on these priorities has helped me pare down my own personal expectations and give myself a little more grace and internal flexibility. I deeply miss the comradery that comes from more social interactions with colleagues. The seemingly stolen moments of laughter, levity, and at times somber connection that I previously took for granted reminds me of a light I now dearly miss.

And I have found that light in places I never knew I could! In praise of screen time, I have connected with many other like-minded doctors on social media, particularly oncologists that I truly admire—like you! Oncology hasn’t historically engaged with media avenues as much as other fields in medicine, but the pandemic has highlighted what we have all known in our clinics. There is virulent misinformation online about medicine—whether it be COVID-19 or cancer treatments. And I’ve enjoyed participating in the novel ways oncologists are connecting online and working to educate the public. It re-affirms our shared dedication to the field and our willingness to think outside the box.

DD: We have a generation of clinicians training during COVID, with the required masks and face gear, video visits, and those done solely by phone. That lack of human interaction is so detrimental in medicine, and in my post that we connected on, I mentioned how worried I am about the future of health care. I think it’s changed me in subtle ways. For example, I am so used to telehealth that I find myself reflexively moving people from an in-person to a virtual visit, without so much as a thought to what they would want. I’ve caught myself when I think this way, and I am called out about it by others who have refused to see me virtually. I wonder, how has this entire experience changed you as a physician?

EC: In October 2020, my dearest friend and colleague, Dr. Tomas Lyons, died suddenly and unexpectedly at work—and in my arms. Tomas was one of the most extraordinary physicians and human beings I have ever known. He was the rare unicorn who was equally brilliant, kind, and funny beyond words. Everyone cherished him. I won the colleague jackpot in getting to share clinic space with him, not to mention relishing in our endless laughs, philosophical conversations, and his spot-on fashion tips.

In one of our last text exchanges, Tomas sent me an article titled “Do Your Career and Work Values Align?” This article underscores how essential it is for intrinsic values (what motivates/fulfills us), extrinsic values (tangible rewards), and lifestyle values to align in order to attain a sense of professional fulfillment—and the challenges that arise when they are not. I frequently think of the conversation I had with Tomas about this article. There have been many moments during the pandemic where I have felt overwhelmed, both drowning in the intensity of the work and wondering if I was there for my children enough. In those moments, I have grounded myself in my conversations with Tomas, recalling us playing the refrain from a popular song: “I’ve got soul but I’m not a soldier.” And I have worked hard to align my values for myself, personally and professionally—even at times (most times) when the path forward is not so clear or easy.

DD: We speak a lot about resilience. What has helped for you? What things need to be addressed?

EC: As oncologists, daily, sometimes even minute by minute, we trek in and out of the valley of death with our patients. These past few years have acutely highlighted for me our precious ephemeral time, and heightened my commitment to my patients, family, and community. While I’ve learned that I have more resilience than I knew (my Peloton leaderboard name is #DrResilientAF!), I’ve also learned that resilience doesn’t just entail endurance, but also the need to pause and recharge. I’ve come to appreciate that medical institutions (if not most large institutions) don’t always recognize the need for that recharge, so self-advocacy is critical. For me, pause can take different forms, whether it involves slowing down clinic to spend more time with one patient, or taking personal time to spend with my family and loved ones. Whatever the case may be, resilience and endurance require recovery. No one can run forever; the pandemic made me realize just how long I’ve been scrambling up a never-ending hill without enough moments of reflection.

In all of this self-reflection, I am grateful for the gift of my extraordinary husband, parents, children, and friends. Ironically, some of the most helpful professional advice has come from my tremendous wolfpack of working mothers outside of medicine. Spanning such fields as the beauty business, biotech, psychology, media, and finance, these formidable women have strengthened and galvanized my professional resolve, not to mention my negotiating skills!

But the thing that has helped me most is playtime! Finding time to play with my children, my friends, and my husband has rejuvenated my soul. Movement is medicine for me—be it running, spinning, yoga, or just impromptu dance parties with my kids. Prioritizing play makes me a more connected, grounded, and probably empathic doctor, not to mention mother, daughter, and friend.

Back to your question: what needs to be addressed? How much time do I have?!

In 1927, Dr. Francis Peabody famously said, “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” And while he’s famous for saying it, the irony is it’s no secret. Our deep caring for our patients is why we show up day in and day out despite so many obstacles professionally and personally. Before the pandemic, there was already an epidemic of burnout in medicine—I’m even burnt out just from that phrase! Some have more broadly labeled it a “moral injury” and “betrayal” within the health care system. Regardless of labels, it goes without saying that today, more so than ever, physicians struggle with ceaseless obstacles and demands that pull us away from the essence of care.

I deeply hope we come out of this pandemic righting the compass of medicine towards patient care, rebuilding trust in science and medicine with diverse populations, and recognizing that physicians (and all health care workers for that matter) do not have bottomless reserve. Personally, I am especially interested in how this is uniquely relevant for women, in light of the often unpaid labor women do both at home and at work, as well as the glaring gender disparities in promotion and pay.

The pandemic demonstrated just how nimble and flexible medicine can be, from quickly mobilizing telemedicine platforms, to international collaborations to develop COVID-19 treatments and vaccines. And if there is any silver lining in this pandemic, it’s my deep belief that we can creatively work to refocus away from administrative duties and quantitative metrics for success towards both the patient that shows up in our clinic as well as the public health at large.


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