Berks County Medical Society Medical Record Summer 2020 - 36

Coronavirus Chronicles: Berks Responds

Anxiety, Moral Distress, and Healing
IN A WORLD WITH COVID-19
by Deborah Bevvino, PhD, CRNP,
Associate Faculty for Behavioral Medicine
Family Medicine Residency Program Reading Hospital/Tower Health

T

he first thought I had when the novel coronavirus became
a global crisis was that Mother Nature had hit the pause
button, graciously allowing us to query who we are as
individuals, as a nation, and as a species. For a global community,
these are essential questions, which in the past, were left to the
great scholars and philosophers to ponder. We no longer have that
luxury, but our responses to these questions may well transform our
lives moving forward.
In the day-to-day lives of every American, COVID-19 has
created universal anxieties of generalized fear, fear of death, present
and anticipatory distress, subtle and large losses, and foreboding
uncertainty. I hear these anxieties every day in my practice as a
psychologist. Depending on internal (psychological) and external
(physical) resources, coping outcomes vary. Some have found
greater awareness in the slower pace of life, the peaceful quiet
of nature, time for exploring new skills, time for self-reflection,
greater self- care, enjoying more family time, etc., while others
suffer devastating isolation, crippling depression, chronic anxiety,
helplessness and hopelessness. We hear the full range of the human
condition in a time like this.
However, in my work with health care providers, I hear
narratives of a different kind. Stories of physicians and other health
care providers triaging-with limited resources-complex patients,
observing accentuated health disparities, physician exhaustion
and burnout, managing ambiguous advanced directives, helping
patients and families to allay unimaginable uncertainty and
sorrow, and shepherding those dying alone. In the quotidian of
their everyday work, these providers are immersed in an ongoing
Greek tragedy of human suffering, only to methodically dethrone
themselves and return to loved ones at the end of a shift while
writing the next scene in their head. Support is the available and
welcomed tonic.
For their efforts, devotion, and courage, healthcare providers
have been called heroes, and rightfully so. But it may come at a
cost. Physicians are wrought with anxiety about lawsuits, insurance
reimbursements, inadequate safety supplies, concern about too
little or too many patients, distress about adequate patient care, and
witnessing of chronic suffering. This characterizes a kind of Moral
Distress, which has been described as the act of being expected
to engage in actions contrary to one's moral values. In a global
health pandemic, this moral distress can rise precipitously. The
corporatization of medicine can challenge the integrity of medical
practice. The inability to practice medicine according to deeply held
moral values and expectation is, at a minimum, disconcerting. On
one hand, the ugly underbelly of the American healthcare system

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is becoming visible. On the other hand, we witness a soaring of the
human spirit and an opportunity to radically reevaluate who we
are as stewards of health-how we deliver heath and wellness to all
people including our healthcare providers.
Perhaps this exaggerated moment in healthcare history will
allow us to reflect on how fragile life really is-for our patients
and ourselves-and gives us pause to change our personal and
professional course. Honoring our micro and macro losses during
this time, evaluating personal and professional priorities, and
finding deeper meaning in our daily lives as we forge ahead will
take courage, albeit full of enormous possibility. There is no going
back to the "old order" and a "new order" does not address the
needed transformation. Twenty years ago I studied a concept called
Post Traumatic Growth. What I learned is that after crisis some
people transfigure their lives and begin to thrive for the very first
time. Often they paint life from a larger and more diverse palette
and create a new sense of purpose. Others never recover from crisis
and still others carry on as before as if nothing happened. Perhaps
given this organic "time out" we can begin to paint with greater
intention, treat ourselves and others with deeper respect, garner the
courage to question and redefine long held ideas, do what we love,
practice vulnerability, and to listen more intently to ourselves, to
others, and to beautiful music.
And then there are the unintended consequences of finding
our way through crisis, which in the case of COVID-19 may be
a greater connection to the natural order. In the weeks of Shelter
in Place, we saw the ozone layer heal and smog lift over some of
the busiest cities in our country. Being more attuned to nature
may provide ongoing access to our inner worlds and our senses,
bypassing our intellect and the mind where fear resides. We may
actually hear the nuances of varied bird calls, witness the lifecycle
of spring flowers as they bloom forth in splendor and then die,
giving rise to nature's next transformation. It is in the recognition
of beauty, fragility, and vulnerability that our true collective spirit
thrives. Although the day-to-day experience of the coronavirus
pandemic varies, the experience of living through this struggle is
common to all of us. The recognition of this may be the only thing
that heals ourselves, others and our healthcare system in this time
of great uncertainty.

Live as you would die tomorrow.
Learn as if you would live forever.
- Ganghi
Berks County Medical Society Medical Record Summer 2020

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