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From the Heart
July 8, 2020

Life and Death, Hope and Despair in the Era of Coronavirus Disease 2019

Author Affiliations
  • 1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
JAMA Cardiol. 2020;5(9):985. doi:10.1001/jamacardio.2020.2420

What is worse than death? Fear. As physicians, we are used to caring for the patients with the most critical illnesses in the hospital. Whether the patient is an elderly person with good functional capacity one day who suddenly had a stroke, or a young person with worsening pain who is newly diagnosed with pediatric cancer, health care professionals are trained to have difficult discussions with patients and their loved ones after devastating diagnoses. Despite the complexities of diagnosis and management in clinical medicine, one of the most difficult yet rewarding aspects of the field is allaying fear and uncertainty during a time of great change and adaptation for patients. For the most part, we are able to provide information to patients and families regarding what to expect before and after a devastating diagnosis.

Over the past several weeks, however, something significant has changed. A killer has spread across the world, one that knows no bounds with regards to sex, race/ethnicity, politics, socioeconomics, or age. Indeed, in the era of coronavirus disease 2019 (COVID-19), one can only gasp in incredulity as the case counts and mortality, mapped across the country and world, continue to spread, overwhelming clinics and hospitals and upending daily life for everyone. More importantly, there is a sense of fear and dread among both health care professionals and patients that is unprecedented. Patients feel alone, since hospitals have changed visitation policies. Clinic rooms sit idle, and whole sections of intensive care unit beds face the tsunami that inevitably follows an earthquake. Physicians, who are supposed to be bulwarks against fear and stewards of calm and reassurance, live in uncertainty and fear themselves. How do we comfort patients when we are scared ourselves? How do we provide accurate information when there is a continually changing environment, exponential growth in COVID-19 cases, and new medical knowledge everyday? How do we maintain our humanity?

I am young and fortunate enough to not have lived through a catastrophic war or famine. Having spoken with those who have, I have learned that the current epidemic is unlike anything before this. The pandemic affects everyone. In the US, we have been fortunate to be health care professionals in a system relatively rich with resources. Indeed, medicine is a field built on complex communication and collaboration among all team members to deliver the most advanced care to the patients with the most severe sicknesses. Yet all of these luxuries are extremely resource intensive. Until now, I have never imagined having to triage the life and death of patients because there is no blood available or having to choose who to save because there are no more supplies or equipment. Rationing is not in the popular lexicon of US medicine.

Yet fear and uncertainty present a time of great opportunity for health care professionals to make a difference. We should remember that medicine is as much about providing hope as saving lives. Heroes are not born but made. In a time when we are told to practice physical distancing, we should not be socially distant. Now is the time, more important than ever, to be not only a doctor but a physician, for whom the art is as important as the science. Despite fear and dread, I have also witnessed some of the most incredible acts of kindness over the past several weeks. For example, when hospitals changed policies to not allow any visitors, there were those who helped livestream a patient’s birthday celebration to family and friends. When personal protective equipment ran low, clinicians worked hard to conserve resources. When the blood bank was depleted, enthusiastic volunteers organized safe blood drives to donate to the cause.

Our duty as clinicians has not changed at all. Despite all that we know, we have never had all the answers in medicine, and we care for patients to the best of our ability based on what we think we know. Those on the frontlines, in direct contact with patients with COVID-19, attempt with all their might to battle with inadequate personal protective equipment. The rest of us are now tasked with comforting patients and their families, even though we are scared and uncertain ourselves. Health care professionals are not only pivotal in matters of life and death, but also between hope and despair. The warmth of a human hand, the voice of soothing calm, and the humanity in a time of social distancing are what defines us. That has not changed and never will.

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Article Information

Corresponding Author: Siu-Hin Wan, MD, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (wan.siuhin@mayo.edu).

Published Online: July 8, 2020. doi:10.1001/jamacardio.2020.2420

Conflict of Interest Disclosures: None reported.

Additional Contributions: The author acknowledges Katie Murphy, MB, BCh, BAO, Mayo Clinic Arizona, for her enthusiasm, dedication, and genuine desire to improve the lives of the patients she serves.