December 2020 Health & Wellness

Playing the Long Game

by Edward Walker, MD, MHA
Symposia Medicus faculty member Dr. Edward Walker provides perspective on the importance and impact of self-care during the ongoing pandemic.

Today is the nine-month anniversary of the little index card sign I placed over the latch of my front door. Its crumpled, askew message says, “WASH HANDS.” It was a reminder that there were now two worlds—the safe interior of our home and the unpredictable, threatening external world which could kill us in one careless moment. We needed to stay focused—our hands were raw from scrubbing, our groceries smelling of Clorox. Those were the days of fear and anxiety.

Today I’m not afraid anymore, but still a bit anxious. Fear is easy—you are afraid of something, and you can focus on it and avoid it. It makes you pay attention. But anxiety is a more sinister enemy. It is a diffuse, unfocused uncertainty, a dis-ease that does not have a firm target. Something just does not feel right. It’s not a neurotic, abnormal reaction to a normal life, where a well-adjusted person in the same place would feel just fine; it’s an appropriate, normal response to an abnormal situation, where the familiar, the comforting, and the routine are just not there anymore.

Our patients, and we as their caregivers, are now in the marathon phase of the pandemic. The “we can do this” energy of the early months has been replaced by the fatigue and numbness of the long game we must play. We watch in agony as our leaders politicize the determinants of our health. Impossible decisions about school, caring for aging parents, even brief car trips with others give us pause. We can yield to numbness, sadness, anxiety, and resentment, or we can change. It’s time to choose.

Why not adjust and shift gears to the marathon? Routine is now your friend, yet variety still your ally. Time to find the beauty in daily solitary walks in the quiet of autumn mornings or sunsets. Zoom happy hours can yield to connecting with people individually at a deeper level, not just through a dozen two-inch windows. There is still joy to be found in the satisfying completion of avoided projects—the things you’ve really wanted to get done—as well as the guilt-free consumption of secret pleasures. Feeling okay about sharing pain, not forced optimism, and allowing the others in your life to give back that hope you crave. All the while staying focused on a future where things will slowly, but inevitably, return to something like what we used to know. It will not be the same, just welcome and familiar. We will have changed; what we need and want will not be exactly the same.

The hard place where we feel so numb and tired is the entrance to a new awakening for our patients and ourselves. So much to discover between now and then.

  • Take care of yourself first (remember the oxygen mask advice during the pre-flight briefing?). Do what rejuvenates you. Your family and patients will benefit if you are centered and well.
  • Follow the lifestyle advice you normally give to your patients on diet, exercise, sleep, hobbies, family time, and pleasurable event scheduling. The stronger you are, the better your clinical care will be.
  • Follow some routines that foster your health and centeredness… you know what they are for you. Keep moving forward—your life energy comes from momentum and discovery.
  • Listen to your patients—more than ever before. Yes, give them advice on the same things you’re following for your own health, but be sure to listen to the barriers they experience as they try to implement your wisdom. They need to find their own path, but just telling their stories to you may illuminate and clarify their way forward.
  • Your medically and psychologically vulnerable patients will have new challenges with social support, resource management, and maintaining their new routine for the long haul. Celebrate their victories, console their losses, and keep their vision focused on the near future. Help them build a framework of one-at-a-time successful days with realistic expectations and a mix of normal emotions—chocolate still tastes wonderful, a nice walk in the winter air is still invigorating, and not seeing your grandchildren as often as you’d like still feels crummy. Life goes on.

Above all, remember the big picture—that each generation bears its own unique challenges to make things better for those we love and those we are asked to care for. Be thankful for what you have been given, acknowledge the loss of what you have been unable to achieve, and allow hope and peacefulness to dwell within you, within your family, and within those you serve—your patients.

Dr. Edward Walker is a Professor of Psychiatry and Behavioral Sciences at the University of Washington. He lives in Seattle, Washington.