The New Normal: Practicing Medicine Quasi-Masked and Semi-Remote

by Melissa C. Janse

It’s 7:30 am. My husband glances over at me and queries, “Are you seriously in a med school faculty meeting right now?” I look down at my striped pajamas and pull the comforter further over my shoulders with as much dignity as I can muster and without toppling my laptop, which is open to a virtual meeting. I am propped up in bed with two pillows, sipping a ceramic mug of coffee with a picture of our 3 boys glazed on it, and petting my dog’s head, which is deeply snuggled into the crook of my leg.

“It’s not like the camera’s on,” I reply defensively. “Or the microphone. I’m paying attention. It’s…well, it’s how we do things now.” My husband glances over skeptically, finishes knotting his tie, and grabs his cell phone.

“Well, I’m heading to work. To actually see people. In person. Enjoy your meeting.”

Several hours later, prepping for my Emergency Department shift, I put on hospital monogrammed scrubs, tug up my pink striped compression socks (it’s going to be a busy one), hurriedly twist my hair in a facsimile of a bun, and take a quick minute for some minimal makeup.  I skip the lip color, as the lower part of my face will be hidden behind a mask anyway.  I also leave in my nose stud; no one’s going to see it. This mask is the final part of my uniform, which I passive aggressively delay until just before walking through the doors of the Emergency Department. With a practiced hand, I guide the elastic loops around my sore ears and pinch the light blue covering over my mouth and nose, which immediately fogs up my glasses. I emit an audible sigh which only worsens the fogging. Every. Time.

My first patient is a bright-eyed, pleasant octogenarian with dementia who was sent by her nursing home for some changes in baseline behavior. I introduce myself. She has absolutely no idea where she is or why she is here. She furrows her brow at me when I approach her stretcher. “I can’t see your face.”

“Pardon?”

“I can’t see your face,” she staunchly re-announces.

“Oh.” Sheepishly, I pull the mask down and give her my best winning smile. “We have to wear these now. Because of Covid.” She looks unconvinced. I see a flaccid, unused mask in her lap and opt not to tell her that patients are supposed to wear them, too. Later, I pull my mask down again to review her EKG, as my glasses are still intermittently fogging and instead of improving my vision, they are obscuring it. 

When I call the hospitalist to admit the patient, he initially asks me to repeat several sentences as my voice is muffled.  In frustration, I jerk the mask off so that my words can connect to him clearly, without barrier. I leave it off another few minutes to gulp down a quick cup of tepid coffee as the waiting room census mounts. 

Mid-shift, a fourth-year medical student passes through the ED and sweetly takes the time to enthusiastically greet me. I taught her during her first year of medical school. I enthusiastically greet her back although I must surreptitiously read her name badge to figure out who she is since it has been a while, and the mask is hiding the lower half of her face. I am having a hard time recognizing her without all the puzzle pieces to put together- it’s harder with just eyes and hair. I want the nose and mouth, too.

It has been over two years since the onset of the Covid pandemic. We keep waiting for things to get back to normal. But they’re not going to, are they? Ever positive, we call it the “new normal.” There have been incremental shifts in the way that we practice and teach medicine, and some of those changes seem that they are here to stay. 

One of the positive effects is the convenience of virtual meetings. I don’t have to shower, dress professionally, fix my hair or put on makeup, or even leave the comfort of my own home. I can effectively conduct business in sweatpants, sitting on my sofa, with my dog contentedly sighing in my lap. Or even while I’m on vacation in a different state. Thankfully, I’m an introvert. I’ve been preparing for this scenario my whole life. 

But these scenarios admittedly blur the lines between home and work life. Instead of being a calming respite from work, your home inexorably slides into an extension of work. Yet we know that in any healthy relationship, there need to be boundaries; we need a differentiation of self. Our getaway vacation is no longer a retreat for wellness if we spend every morning virtually dealing with work and work stressors, meeting via screen with students or giving lectures. We no longer have the uninterrupted, dedicated time to ourselves and loved ones to restore our spirit and replenish our physical and emotional needs if we are always reachable, always accessible, even if we aren’t physically in the hospital or our office…or the state. It’s on us to create healthy, personal boundaries and keep our job from becoming that needy, jealous partner who consumes all.

And there’s something else missing, too. I think it’s that human-to-human connection and communication. Even if we are seeing a patient or colleague, resident, or student, in person and not through a screen, the physical barrier of the mask on our face is inhibiting. You miss subtle facial expressions and non-verbal messages playing around the nose and mouth:  irritable nasal flaring; a corner of a lip raised in irony or sardonic amusement; the mouth twisted in contemplation; a broad, unguarded smile of joy; or pinched lips of pain and distress.

The post-pandemic changes, with their requisite benefits and detriments, are continuing to evolve, and we are continuing to adapt. But in the interim, patient care must come first (always) and continue. So, I keep working my shifts. But now when I go into patients’ rooms to introduce myself, I quickly lift my mask to give them a glimpse of my face in its entirety as well as a warm smile of greeting before pinching it back onto my nose. And fogging up my glasses. Again.

Melissa C. Janse, MD is an Emergency Medicine physician at Prisma Health-Upstate. She is also a clinical associate professor who teaches first-year medical students and serves as a career counselor at the University of South Carolina School of Medicine Greenville.

One thought on “The New Normal: Practicing Medicine Quasi-Masked and Semi-Remote

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s