Looking Inward

By Heather Mitzel Levy, DO
Clinical Assistant Professor
The University of Kansas Medical Center

Dr. Levy

Dr. Levy

COVID-19 has been in my house. I have felt her wrap her ugly tentacles around my left eye eliciting a sharp pain which I can only imagine equates to the pain of an aneurysm ready to rupture. I have experienced her squatting on the left upper lobe of my lung, yielding a sharp pain with each breath, calmly reminding me of her presence for six weeks from the day I found out she had arrived. She tied 200-pound weights around my ankles and put a backpack filled with bricks on my back and said, “go get ‘em girl.”

I have always believed in, and in fact started this column to discuss, the power of the mind in medicine. The power we each have to control our relationships and success by the way we think about and prioritize our lives. At times in the last 10 years of my journey post-residency graduation, I have felt “mind over everything.” And why not, we physicians as a group get so used to pushing ourselves past our comfort zones physically, mentally, and spiritually every day. But when COVID came to visit, the fatigue that ran through my body literally felt like someone had drained all my blood from my body and replaced it with sludge. I could not imagine ever even walking between operating rooms or being able to regain the physical stamina to walk down stairs to staff our MRI suite. Although dramatic, the five to seven days I had the most severe fatigue, I actually had the thought “what if this doesn’t lift-I would literally have to go on disability.” When I would shower, the 10 minutes I would be standing would wipe me out for the day!

I started researching and found that I was not alone. Ten percent of COVID patients have been described as being “long-haulers” with symptoms lasting weeks to months after the person is considered recovered. The strange thing they are finding as well, is that the correlation between being a long hauler and the severity of initial illness, is not proportional. This means that even if you have mild symptoms when you are first experiencing COVID, and never require hospitalization, you are just as likely to experience these long-term symptoms. The two most common complaints people experience as long haulers, according to early studies, are fatigue and brain fog.

I was lucky in that my symptoms of the brain fog lifted a couple weeks post diagnosis before returning to work, however the fatigue has been a beast to carry around. Not only did it affect my physical wellness and being able to get around work, but my relationships at work, as well. The last article I wrote was about finding one to two people to have deeper relationships with at work; however, the last several months I have been so empty I simply cannot put socialization up at the top of my survival list.

One may wonder why I am sharing these details of my experience with COVID in a mental wellness article. The reason ties back to my original intent of covering multiple ideas to keep ourselves well and keeping mindful and aware of what is happening in each of our bodies and minds. Last month I introduced a conference I had been to, which covered a multitude of wellness ideas. One of the most cumulative was the idea presented by Dr. Laurel Fick.

During Dr. Fick’s presentation, she distributed a handout focused on performing your own history and physical. The twist, however, was that it was a “personal well-being” history and physical. As I describe the handout, I would encourage you to think of your own answers and how you can intentionally choose to improve areas of your life you see to have the most power over your well-being.

The chief complaint. We all have done a zillion of these through our lives, but when you look at your own life, what is the chief complaint you have holding you back from contentment? Rather than history of present illness (HPI), what is your history of present state? For example, how did you get here? For many disillusioned people in medicine, that answer may be multi-factorial and we will get into many reasons in future articles. Just think of some of the main reasons you feel off balance right now. Is it that you are not sleeping enough? That you don’t call your old friends anymore? You stopped playing the violin because who has time for hobbies? You stopped running? Each of us has to look within ourselves for this answer of what has given me peace and happiness in the past, and find what is missing now.

The personal well-being ROS. Dr. Fick amazingly broke down the review of systems into components and asked us to look at what our needs were in each area, what our goals were in each area, and what makes us feel like we are thriving and happy in each. The components she mentioned were; social, occupational, spiritual, physical, intellectual, emotional, environmental, financial, mental, and medical. We then did the examination of each of these components, as well as an assessment and a plan to improve each of these areas for more optimal and contented living. Finally, we wrote ourselves a prescription to follow to get ourselves on the happier path in life.

When I was stricken with COVID this year, I realized that as strong as my mind was, there was no amount of outthinking or mental negotiations I could participate in to get me out of my fatigue. It was real. My experience made me respect each one of my patient’s personal physical journeys and empathize with their pain, or their weakness. Furthermore, since COVID became part of my story, my path this year is to really physically respect my own health and rebuild my physical strength to pre-infection level. It also re-illustrated the fragility of our bodies and how we must keep up the maintenance on these vehicles or we will run out of gas, no matter how sharp the operating system. I laugh as I write this analogy, that we are “like machines,” but in medicine it can seem like that because we work through anything. We have to turn things “off and on” and it is just part of the job.

This quarter, I encourage you to take a look at your own life, and write out your review of systems to see where you would like to intentionally make forward progress! Remember the goal is progress and not perfection. Maybe you wish you could run every day but you can only do three days a week. Be proud of yourself and keep doing it.

Perhaps your family and friends are scattered around the country and you wish you could make it to each big event. Pick one and put it on the calendar. Have coffee over Facetime on your couches; use technology to your advantage. A better you leads to a better doctor, husband, wife, mother, father, friend, etc. Pick the things most important to you and give those things your time! No matter where 2021 leads, make sure it leads to a better and more intentional life for YOU!

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