January 2021 • DALLAS MEDICAL JOURNAL 13
and grief can coexist. Our circles got
smaller by necessity, and we became intentional
about our connections, out of which
came bonus time with family and pets
(and plants). Without our usual external
outlets and distractions, we turned inward
and made time for introspection. We came
upon unexpected opportunities for nourishment
- we took up new (and old) hobbies,
games, books, podcasts, and yoga. We
made a commitment to support struggling
local and small businesses. Even if the
presidential election of 2020 delivered a
powerful referendum on how divided we
stand, we found ways to unite over popular
fads and shows. We developed new coping
skills, and when these were not sufficient,
we leaned on our colleagues, families, and
friends for support. Meanwhile, our scientific
community also embraced the challenge
of 2020 with a promise of a vaccine,
which has been developed in record time.
Priorities - There’s nothing quite like a
pandemic to make us reevaluate our priorities.
As physicians, we (finally) learned to
say no, as self-care became more critical
than ever. We watched a third of the country
burn in wildfires and came to appreciate
the profound impact of our choices on
our environment. A discussion about Turning
2021 would be entirely remiss without
acknowledging the pandemic of racial oppression
thrust into the forefront in 2020.
The intersectionality of COVID-19 pandemic
and social determinants of health has
been underscored by the disproportionate
and devastating impact of the pandemic
on black, Latinx, and indigenous people of
our nation. So we committed ourselves to
the task of self-examination and intentional
antiracism. Out of activism came a
commitment to change for the better with
more progress on equity and justice.
If 2020 was the ultimate exercise in
improv, we gave a performance worthy of
cheers and ovation. Even so, 2020 was
especially stressful for doctors, as we
were stretched beyond our capacities in
all spheres of our lives, all at once, and
for far too long. Published research on
the impact of the pandemic on healthcare
workers in the U.S. is limited at this point,
but the data from China, Italy, France, and
other countries impacted by COVID-19
earlier on in 2020 is telling. As a volunteer
psychiatrist for the Physician Support
Line, a free and confidential peer phone
support helpline for struggling physicians
and medical students, I have heard countless
stories of physicians who endured a
risky, exhausting, and demoralizing milieu
for much longer than the human body
and mind were meant to tolerate - all the
elements of not just burnout or burnover
but of anxiety, depression, post-traumatic
stress disorder (PTSD), substance use,
and much more.
In his seminal book on trauma and its
effects, “The Body Keeps the Score: Brain,
Mind, and Body in the Treatment of Trauma,”
Dr. Bessel van der Kolk discusses
how trauma and chronic stress rearrange
the brain’s wiring - specifically areas dedicated
to pleasure, engagement, control,
and trust - in a process known as neuroplasticity.
The human response to psychological
stress is one of the most important
public health problems, and doctors are
especially susceptible to it because of the
nature of our work and the long hours, only
compounded by the pandemic. Many of us
are Turning 2021 psychologically wounded,
physically exhausted, and mentally exhausted.