She was rather calm during her visit. It was the first time we’d met, and she was establishing primary care with our office and me. We were both delighted to learn she was from a small Georgia town not too far from where I previously practiced, and we quickly reminisced about the slow pace, lack of certain resources, and genuinely good, devout people that often stem from and still reside in such places. Our initial conversation was bursting with derivations of chuckle, earnestness, and smile. She was a new patient to me. She was rather calm during the visit. I saw her in the year 2020.
Her chief complaint was anxiety. She, in colloquial terms, “wore it well.” That’s an assertion often made when a man or woman has some conspicuous or inconspicuous ailment known to the person making the assertion, but they don’t let it throttle their progression and happiness. They don’t let it keep them down. They don’t let it steal their joy. I can hear the echoes of yesteryear in the annals of my mind from keenly observant elders in my family refer to it being “putting your best on the outside to not allow people to know just what you are going through.” Ergo, she did.
Anxiety often manifests in peculiar ways. Some patients are visibly shaken. Others are not. Some have palpitations. Others do not. Some have random and even triggered spurts of attack. Others do not. She was so calm during my interview that I almost didn’t believe her, and it made me question her more. It made me delve deeper into an understanding of her plight, and therefore gave me pause for a very brief moment to think to myself that this is what the practice of medicine is all about. This, in and of itself, is germane to its necessary employ. This is what we are cautiously trained to do—to listen to the patient, to take our time, and to not rush or be rushed, essentially evading the rules that come with business sense to stick to the fifteen minutes that almost never seem to be obeyed in the interest of interest in one’s patient. I didn’t want to miss a drop of knowledge of her that she was willing to share. The willingness to share one’s mental workings with a complete stranger and even a friend is never easy in the African-American community. It is often stigmatized, and what we were doing was the very exercise needed to tear the kingdom of stigma and disdain down. We were talking openly and honestly about it.
She lost six family members to the pandemic. One by one, slowly and seemingly without fail, they faded slowly away into the cooling grip of death. From uncles to aunts to younger and older cousins, she dared share with me with remarkable detail their plight and her plight due to losing people she grew up with, around, and loved. Their deaths were so close and successive that she didn’t have enough time to grieve for one before being faced with the knowledge that yet another one was gone. Bereavement is often much kinder, but this type of bereavement is utterly cruel. She affirmed what I already knew. Her family would never be the same, but she was calm. She was thorough in her explanation, and I allowed it. Her calmness suggested peace, but she never once voiced that it was this novel coronavirus and the way it has changed her family, her world, our world, and her memory forever as the trigger for her mental state that seemed to lie deep within her so much that she didn’t allow it fully to show, even within the quiet sanctity of the doctor’s examination room.
The consequences of this coronavirus pandemic are perpetual. It is eternal. The year 2020 will be a year etched forever in our minds of loss and lease of our lives and livelihoods to this remarkably shifting and unrelenting virus. I contend from it there will be no everlasting reprieve, as it has and will continue to alter life as we know it. With it, come changes in our families that can never be undone. With it, come changes in our economy that will forever be in place. With it, come changes to our social constructs that it, singlehandedly, has reconfigured. With it, comes a willing partner of a mental health pandemic that affects our minds and hearts. The way we live, breathe, work, learn, and socially engage will never be the same. Its effects are always and forever, and it, like those we as a global community lost to it, will never be forgotten.
Earl Stewart, Jr. is an internal medicine physician in Atlanta, Georgia, a 2023 Doximity Digital Health Fellow, and a 2023 Climate and Health Equity Fellow (CHEF) with the Medical Society Consortium on Climate and Health. He can be reached on E.S.J., M.D., LinkedIn, Twitter @EarlStewartJr, and Doximity.
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