The week of March 13,, MD, PhD, SFHM, professor of medicine at the University of California, San Francisco, got word that schools were closing because of COVID-19.
“My first thought was, ‘You’re kidding, right?’ ” she said. That was the start of a series of reactions that included denial and bargaining and, finally, some semblance of acceptance.
In a session at HM20 Virtual, hosted by the Society of Hospital Medicine, she and, MD, MPH, associate professor of medicine at New York University Langone, described the complicated logistics and emotional and psychological strain that has come from working during a time of such great health care need while balancing home responsibilities and parenting.
At the time schools closed, Dr. Alfandre said, he was busy with clinical work while his wife’s work as an academic psychiatrist, including research activities, stopped for a time, allowing her to manage many of the family duties. Ever since her work picked back up, though, it’s been a juggling act.
“Our roles were dynamic and changing, sometimes week to week,” he said. “It was quite a shock to the system.”
Well before the pandemic struck, Dr. Nye and Dr. Alfandre had been scheduled to talk during the annual conference about work-parenting challenges. The pandemic has further underscored those challenges, they said.although they did make suggestions in that vein.
Child care and odd hours always have been a challenge for hospitalists, they said, and for those in academia, any “wiggle room” in the schedule is often taken up by education, administration, and research projects.
“And then, of course, there are those ever-important baseball games and ballet recitals and any number of school-related activities to help support your kids,” Dr. Nye said.
COVID-19 has brought a new degree of strain, she said. There is the concern that hospitalists’ very work brings a higher infection risk to their children. Extra work responsibilities have brought on guilt about perhaps not doing a well enough job helping their children with schoolwork “without having any definition of what ‘well enough’ actually looks like.” At the same time, she said, she’s felt “incredibly grateful to have a stable job.
“There is this spectrum of guilt and gratitude that is constant – it’s an undulating, never-stopping pendulum,” she said.
Dr. Alfandre noted that it was a “tremendously proud moment” to have people cheering for his colleagues and him at shift change in New York. Still, after several days off, he “felt guilty that I wasn’t in the hospital.”
Dr. Nye observed that, while working from home on nonclinical work, “recognizing how little I got done was a big surprise,” and she had to “grow comfortable with that” and learn to live with the uncertainty about when that was going to change.
Both physicians described the emotional toll of worrying about their children if they have to continue distance learning.
At work, her center seems to be in a constant state of instability – they’re either dealing with a surge or a reopening.
“It just goes on and on and on and on,” she said. “I find it overwhelming.”
Dr. Alfandre said that a shared Google calendar for his wife and him – with appointments, work obligations, children’s doctor’s appointments, recitals – has been helpful, removing the strain of having to remind each other.
“It’s really about cooperation with your partner,” he said. “I really think this is the most important aspect.”
He said that there are skills used at work that hospitalists can use at home – such as not getting upset with a child for crying about a spilled drink – in the same way that a physician wouldn’t get upset with a patient concerned about a test.
“We empathize with our patients, and we empathize with our kids and what their experience is,” he said. Similarly, seeing family members crowd around a smartphone video call to check in with a COVID-19 patient can be a helpful reminder to appreciate going home to family at the end of the day.
When her children get upset that she has to go in to work, Dr. Nye said, it has been helpful to explain that her many patients are suffering and scared and need her help.
“I feel like sharing that part of our job to our kids helps them understand that there are very, very big problems out there – that they don’t have to know too much about and be frightened about – but [that knowledge] just gives them a little perspective.”
Dr. Nye and Dr. Alfandre said they had no financial conflicts of interest.