by Lisa Weaver, MD
As we come to the end of this infamous year, I can’t help but reflect on how different this year turned out to be than I expected. When 2020 began, I imagined that the most challenging part of the year would be a long recovery from a skiing accident I had in January. As we near the final days of December, I now find myself in a world looking desperately towards a vaccine that will hopefully allow people to go to restaurants, travel to see loved ones, and cease mourning the loss of hundreds of thousands of lives from a tiny virus.
There are so many things I could choose to reflect on in this post regarding how COVID has affected my life and my patient’s lives: getting COVID and experiencing quarantine, working in an ICU filled with dying COVID patients, learning how to deliver effective primary care in the outpatient setting during a pandemic. But what I may have spent the most time thinking about is how COVID has profoundly affected the mental health of my patients.
It may not come as a shock that depression and anxiety might increase in a global pandemic if one thinks about how much humans crave connection and the implication of what social distancing means. I first noticed increasing mental health needs in my continuity clinic. Although primary care is already inundated with anxiety and depression as chief complaints, I started to see an influx of these concerns as my patients lost their jobs, got divorces, and struggled to learn and work virtually. Patients that were already on therapy for depression and anxiety wanted to increase their doses of medication or see their therapist more frequently. As the weeks stretched into months, people became more hopeless as they realized they needed to adjust to this new reality.
I was especially surprised by the influx of teenagers I started seeing suffering from crippling depression and anxiety. When I admitted a 12 year old to the inpatient pediatric service, I asked him if anything happened that caused this first depressive episode and he responded with “2020.” I saw another acutely suicidal 14 year old patient in my clinic who had recently started doing virtual school and was feeling incredibly isolated. Yet another teenager at a well-child check with horribly cracked skin admitted that he was compulsively washing his hands in fear of contracting COVID. I already worry about the impact of social media and screens on children, and they are now forced to rely almost exclusively on screens for learning and most of their human connection. As adults, we are often not appreciative of how perceptive young people can be, and I think we as a society have underestimated how social distancing and virtual learning would impact our youth.
Another area in mental health that I saw impacted significantly by COVID was substance use. I saw a patient in my clinic who had not used any alcohol for four years prior to 2020. He relied on AA meetings, and when these were no longer in session he ended up getting admitted for alcohol withdrawal. I saw another patient in clinic who started using heroin again after getting evicted from her house. And I have noticed that many of the screening questions for substance use during our physicals have opened up conversations about significant increases in substance use this year.
Although it has been a challenging year in so many unanticipated ways, I am also in awe of the lengths people will go to help each other out and I am inspired by their resiliency when they are thrown into incredibly difficult situations. I have seen a woman care for her newborn niece when her sister was unexpectedly hospitalized in the MICU with COVID, family members and friends welcome each other into their homes when they lost jobs, and colleagues work 30 hour shifts for each other without complaint. Amidst a year full of so much darkness, I am also grateful to have observed and experienced a beautiful side of humanity. This gives me hope as I prepare myself for a long dark winter working with COVID patients through the holidays. As I anticipate getting my COVID vaccine in just a few short days, I know that these experiences and observations will give me a new appreciation for my patients and loved ones as I look forward to life after COVID.
Dr. Weaver is from Ephrata, PA. Her medical interests include women’s health, obstetrics, pediatrics, mental health, and LGBTQ medicine. She chose the University of Utah because of the unique mix and community and academic learning opportunities and the wonderful faculty and residents that she met during her interview. During her free time, she enjoys running, camping, weight training, playing violin, reading, and baking bread.