On What Happens Next
It seems that the pandemic is fading into history, with a whimper. Of course, this feels like the 5th time I have written an “End of The Pandemic” piece. The virus is not gone. Plenty of people are getting sick, and people continue to die. But, for now, most of us no longer keep a watchful eye on the 500-pound gorilla. COVID19 is no longer the central force directing our day-to-day existence. I see people experiencing joy in re-establishing old rituals, particularly rituals of gathering. It seems that what we have missed most has been each other. But I still do not sense jubilation or relief in the slow restoration of old ways. There is a lot of tension and uncertainty. People still seem to be figuring out how to move on.
One thing that I have found curious is that many people have seemed to be angry, or at least intolerant, even as things objectively improve. Quite a few people appear to be more reactive and less “patient.” Less aware of how they are presenting and the impact that their emotions are having on those around them. The technical term for this is self-regulation. I have a couple of thoughts about why this might be the case. One is that we have been under stress for so long that our responses to new stressors, even seemingly minor ones, can be less calibrated than usual. Emotional self-regulation takes energy, as anyone knows if they have ever come home from a long day at work to find that the dog has eaten several pairs of shoes. And we have been drained by the demands of the past two years. So emotional reactions to seemingly trivial frustrations can be, well, disproportionate. We are also out of practice. The pandemic disrupted social interaction and isolated us from one another, apart from the disembodied interactions between our avatars on Zoom. Perhaps self-regulation, containing one’s emotions within oneself rather than allowing them to spill into the environment, is a skill that requires more energy in person than online, at least in the context of work. The virtual professional environment serves as a sort of emotional buffer zone as a result of physical separation, the removal of subtle social cues (e.g. body language), and the enforced turn-taking that characterizes video conferences. It feels emotionally depleted, which may be part of why we dislike continuous Zoom meetings. But the same limitations of the virtual environment also constrain our emotional reactions, so long as we feel the need to act “professionally.” So we don’t have to work as hard at self-regulation. As we move back towards in-person interactions, the emotional barriers are removed and we have to relearn the old ways of working together, building back our self-regulatory muscles.
It is commonplace to say that the pandemic has changed everything, but I am not at all sure that’s true, at least at work. There seems to be a tremendous gravitational pull in healthcare back towards the pre-pandemic ways of operating, especially at the organizational level. Remote work and telehealth are definitely more a part of the landscape than they were, but the system has incorporated them, grafted them onto the pre-pandemic workflows, rather than transformed to center these new approaches to work. The productivity imperative seems as strong as ever, and the frustrations are deeply familiar.
So the post-pandemic world of medicine is very much like the pre-pandemic world. And yet, can it be true that the last two years were nothing more than a hiatus? Are there no ways in which we have grown in the face of all of the death, all of the fear, all of the rending disruption? It’s hard to see any such growth at the societal level, looking at the state of the world. Or at the level of the health care organization. But I believe that many individuals have grown, finding new things within themselves or resolving to feed things that were there but neglected. These discoveries are intensely personal and have many ramifications. At work, they often shine through as new ways that people want to approach work, reflecting a re-ordering of personal priorities and values. These changes may lead to people changing careers or roles or simply stepping back. These changes encourage people, even compel them, to resist passively sliding back to the status quo ante.
This presents a bit of a challenge for line leaders in this liminal phase between pre-COVID and post-COVID. Many of our people long for something different from their work, even if they may not be able to articulate exactly what it is that they want to change. On the other hand, as I suggested earlier, our parent organizations are inherently conservative and favor what worked before, with minor modifications, as the surest way to get the organization itself back on its feet. Leaders must navigate these cross-currents, supporting our people as they try to move forward and grow while simultaneously rebooting the group to support the organization. All the while integrating our own experiences and evolution. There isn’t a playbook for this. All we can do is maintain awareness of the tension and balance our roles as leaders and managers as best we can. That said, one can never go wrong by helping one’s people find their way, even if that way leads away from you.
We should acknowledge that it is hard to come back, to move on. Hard for our teams and hard for ourselves. I’ve had a lot of conversations with women who are finishing their adjuvant treatment for breast cancer. For quite a few such women, completion is a relief, but there is still some trepidation, even anxiety, about how to move into an uncertain future after the trauma they have just been through. How do they integrate this new experience, so all-consuming while taking place, into their new conception of themself and the world? I find myself in a similar frame of mind. How am I different from who I was in March of 2020? What have I learned? What do I want to bring with me? And what do I want to leave behind? Still working on finding the answers to those questions.
I wish that I was going to be around to read the history of our time. What will they say about how the world emerged from this experience? We will not be named in those books. But the course we choose for ourselves and what we do for each other will determine what is written.