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ER Goddess

ER Goddess

The Little Things during the COVID-19 Pandemic

Simons, Sandra Scott MD

doi: 10.1097/01.EEM.0000697696.05614.15
    COVID-19, mental health

    I've lost count of how many small disappointments and difficulties COVID-19 has rained down on our day-to-day lives. “Why am I feeling so depressed when nothing calamitous happened to me?” a friend wondered recently. She is not alone in underestimating the cumulative mental health effects of 2020's many everyday micro-stressors. I suspect many people need to hear this: You don't have to be working in a hotspot surrounded by intubated COVID-19 patients to feel down right now. Little letdowns and losses take their toll as well.

    Even ripples of change that at first glance seem harmless can swell into downstream problems. Consider our patients. Every time we go to work, we see how just a small tweak in one's routine can start a cascade of modifications that snowballs into an ED visit. The simple and understandable choice to go braless while staying home, for example, left some women with inframammary intertrigo.

    Shifts in sleeping patterns, as teenagers turned into vampires to play video games all night, resulted in miserable headaches. A 2020 graduation yard sign, tossed stakes up into a graduate's closet, left a finger laceration when she later went digging for clothes. The mere use of the Zoom app triggered acute paranoia in some schizophrenics, a population already mistrustful of screens and technology.

    Simply adjusting families' schedules so they spend more time together sadly spurred an uptick in domestic violence injuries. Cutting just one event from a daily schedule also created more time for substance abuse. I've never seen more cases of cannabinoid hyperemesis syndrome. It doesn't take major trauma or catastrophic pathology to affect your health—patients show us how one little tweak is enough.

    The Quarantine 15

    The same is true for EPs. Minor changes that we may think are not a big deal can snowball and threaten our physical and mental health. As I write this, I'm supposed to be on an Alaskan cruise. It's just a trip, but not taking that trip means no joy of anticipation, no joy of getting away, no joy of new experiences. The loss is real. Gym closures seem minor, but still managed to throw my workout routine completely off track. Now I have the quarantine 15 to lose.

    Likewise, the sight of 14- and 15-year-olds on their phones—normal teenage behavior—may not normally be stressful. Yet after school and sports were cancelled, seeing my sons stare at their screens all day long left me questioning my mothering capability. Being unable to bring home toilet paper for my kids didn't do much for my confidence either. If there were any doubt, having to spend 30 minutes combing knots from my son's hair after he didn't brush it for a week made it crystal clear to my conscience that I can do better. Such little details add up to mom guilt.

    COVID-inspired adjustments like takeout meals and cocktails felt like perks at first. Yet getting takeout rather than sitting down in a restaurant or a bar chips away at our social lives. Staying home in my pajamas with Zoom sounded like fun initially, but ultimately disconnected me from friends and family, even more than my baseline level of disconnection as a nocturnist who works opposite hours from everyone.

    When I did see people, the little changes made it bittersweet. I am so worried about what germs I might bring into my sister's house that I won't even use her bathroom. Constantly feeling like you might infect your loved ones weighs on a person. With the change from hugs to six-foot distance—maybe an elbow bump if you're lucky—we're all feeling a vacuum of physical touch.

    Little Losses

    None of these stresses taken singly is ruinous, but the cumulative snowball effect of multiple micro-stresses over the long run hurts us. Don't trivialize the little losses and expect yourself or others to trudge on unaffected. It's the minor changes that you may not even think are worth grieving that will ultimately affect physician mental health.

    I know some of you are thinking, “People are dying, and you're worried about workouts and socializing?” Yes, because without workouts and socializing, I have less capacity to deal with people dying. Life's joys are in the small moments—high-fiving my sons for acing a test, watching them make a tackle, hugging my mom, or bellying up to the bar with my fiancé for a flight of beer and a tray of raw oysters. Now as we find ourselves dealing with the immense stress of being on the pandemic's front line, many of the small delights we counted on to recharge between shifts are suddenly not there. Missing out on moments of joy depletes our ability to recover from the moral injury we experience as physicians.

    Like precarious Jenga towers, we can only lose so many building blocks of our work-life balance. The cumulative micro-losses are leaving each of us with a void that is not going to go away by taking a walk or making your bed in the morning, as many well-meaning articles have suggested. Coping strategies like sleep hygiene, unplugging, and getting out in nature have their place, but to me, implying that they will balance out the cumulative loss inflicted by the pandemic seems to disrespect the degree of strain we're all feeling. Stress and angst are manifesting themselves in angry social media posts, political unrest, and riots in the street.

    Instead of dismissing the countless tiny disappointments, we must take appropriate pauses to grieve our lost trips, cancelled plans, and scratched sources of joy. We will persevere, but we are not really superheroes; we are human, and each of us is experiencing letdown on some level. Trying to go on like nothing's changed when the reality is that everything has changed will cause the little things to grow into festering cancers and eat us from the inside out. Now more than ever, it's OK not to be OK.

    Be gentle with each other. What the world needs in 2020 is TLC, like the care packages lovingly sent to my mailbox and the wine lovingly left on my doorstep. (Thank you, kind souls.) Just as little disappointments can snowball into an avalanche that trips us up, unexpected ripples of kindness can swell via the butterfly effect into a current of positivity that will ultimately help us regain our stride.

    Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at

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