others had to do this work without the benefit of adequate PPE, so their worries were more than valid. In addition to the physical concerns was the emotional toll that SARS- CoV-2 exacted on health professionals. Witnessing so much suffering and death—much of it evitable—and being unable to forestall it would be hard for anyone to take, especially when combined with gruelingly long hours, lack of sufficient sleep, and constantly being on one’s feet and on high alert, conditions endured by many. Although I could not be with them personally as they worked in the hospital (which was difficult and frustrating in its own way), I heard the exhaustion in the voices of our faculty members when I spoke to them on the phone and saw the fatigue etched on their faces when I saw them on Zoom. I vividly remember speaking late one evening on the phone to a faculty member who suddenly broke down in tears when I asked how she was doing because a COVID-19 patient of hers—a relatively young man who had recently indicated signs of improvement in his condition—had unexpectedly crashed and died that day. A seasoned professional, she was embarrassed by her tears, but personally, I saw in them only the evidence of her humanity. I never heard any of our faculty complain, and all comported themselves with the utmost professionalism—sometimes even heroism— in spite of the burnout (or higher than usual propensity thereto) that they may have been feeling. Of course, depending on the specialty or subspecialty of a given healthcare professional, he or she may have had more direct responsibility for COVID-19 patients and thus more acute experiences of depression, anxiety, and burnout. In the large, 14-section LSU Department of Medicine, there are four sections that were severely impacted: the Sections of Emergency Medicine, Hospital Medicine, Infectious Diseases, and Pulmonary/Critical Care Medicine. The chief of our Section of Pulmonary/Critical Care Medicine, Carol Mason, M.D., described her section’s experience during this time thusly:
in the ER, seemingly in an endless loop. The morgues were overwhelmed in several hospitals and funeral homes. And, even now, the COVID-19 surges are not over, with no apparent end on the horizon. Our teams (fellows and residents) were outstanding in their efforts in this fight for the patients, though so many of the patients did not respond but worsened.
I feel certain that this firsthand account speaks to the experiences of so many of the most essential healthcare workers.
COMMUNICATION ISSUES
Like people across the globe, the faculty and staff in the LSU Department of Medicine quickly came to learn during the pandemic that zoom is more than just a verb meaning “to move rapidly.” Face-to-face meetings have been replaced with Zoom conferences, and events such as Medicine Grand Rounds, Medicine Research Day, awards ceremonies, and graduation had to be held on that platform. While this technology has been indispensable in allowing much of the business of our department to continue while maximizing safety, it is also fraught with its own challenges, such as so-called “Zoom fatigue,” which has been widely reported, as well as issues such as transmission delays (which make communication difficult even when they are minor) and a decrease in the ability toperceivenonverbal communication cues. And of course, sometimes the technology itself has simply failed to work. This has been a problem for our faculty and learners as well, as our preclinical courses also had to transition to Zoom for a time. While the youngest (i.e., preschool and elementary school) learners are certainly the most affected by this disruption to their customary education, even adult students are not immune from the difficulties of learning from behind a screen rather than in person. The importance of authentic human interaction cannot, it seems, be overstated. LESSONS LEARNED Fifteen years ago, in the first article I authored about the impact of Hurricane Katrina on the LSU Department of Medicine, I wrote, “I am … aware that in every hardship, there is an opportunity for growth,” 3 and I enumerated a list of ten lessons that I believed to be the most important takeaways from the crisis. As noted above, I feel that the same lessons apply to the challenges posed by COVID-19.
As the first surge developed, the numbers of [COVID-19] patients began to climb significantly, and we found that most of the hospitalized patients were elderly and that they did not recover quickly. As the waves of pandemic surges continued, we at least learned about a few treatments that had some benefits, but, those treatments were not enough. We still experienced far too many patients who did very poorly with COVID-19. In high numbers, the elderly patients succumbed to COVID-19 despite all of the teams’ efforts. Provider exhaustion was common, and many a tear was shed in the ICUs, by both family members and the ICU staff. Unfortunately, those who died were rapidly replaced with another COVID-19 patient waiting
1. Difficult problems must be handled as quickly and directly as possible while still maintaining sensitivity. The COVID-19 pandemic, without a doubt, is one of the most difficult problems I have had to navigate in my 32-year tenure as chair of the 46
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