John J. Ryan: Ordinary resilience in extraordinary times

It is hard to handle the COVID-19 crisis when we don’t know when it will end.

(AP Photo/Rick Bowmer) Salt Lake County Health Department public health nurses look on during coronavirus testing outside the Salt Lake County Health Department Thursday, Nov. 12, 2020, in Salt Lake City.

Throughout this past year there has been considerable emphasis on promoting resilience among health care workers. Most famously, this was expressed in cities where communities would applaud frontline staff as they returned from their shifts caring for patients with COVID-19.

But resilience is not always about overcoming a major obstacle or extraordinary circumstance, such as the pandemic. Resilience is largely about overcoming serial small tests and going from goal to goal with newly acquired skills. In health care, as in life, resilience requires a capacity to recover quickly from challenges and using that experience to prepare for the next one.

With COVID-19, as with any challenge, it was easy to be enthusiastic at the beginning. For example, at the first training session of a season for a sports team, large numbers turn out, and people generally turn up on time, as there is considerable enthusiasm for what lies ahead. Similarly, on the week of a championship game, it is easy to remain motivated and engaged.

What is far harder to be energized about is a middle of the season training session, which could very easily be skipped, and no one would notice. It is in this time, the so-called middle hour, when no one is watching, that the bulk of resilience is formed, as small victories are won, and the skills are developed that are required for long term success.

The challenge for health care workers, and indeed for all of us this past year has been that during the pandemic, we do not know when the middle hour is, because we do not know when this circumstance ends. It is a challenge being resilient when there is no known finish line.

It is in this setting that the relationship between purpose and resilience becomes of the utmost importance. Finding purpose is hard. Perhaps surprisingly, even within health care, finding purpose during the pandemic has had its challenges. For those in the emergency departments and in the intensive care units, their clinical roles have largely been well defined, appropriately celebrated, but exhausting. The demands on these providers have been considerate, and in some cases too much. For others, such as those performing elective surgery, for a time their role was to do nothing. Finding purpose in either of these circumstances can be difficult.

As the pandemic has gone on, the skills required to develop and retain resilience have evolved. Just like everyone else, health care workers have had to cultivate an attitude of survivorship, recognizing that we are not the same people that we were when this all started. The prior experiences, the lockdowns, the shifting patient interactions to always require personal protective equipment clinics have changed us and changed our skill sets. We have evolved and are more empowered to face the adversity with which we are confronted, but it has required a major shift in how we provide care. There is a need for all of us to talk about what we are going through and stay connected. With home and work life being experienced online, and minimizing interactions, it can be challenging to get personal time with friends and co-workers to have a joke or air grievances together. The sharing of laughter and sorrow is therapeutic and finding healthy ways to do this together, will be a priority for health care workers and beyond this coming year.

We also need to promote and practice self-compassion. For some, this is done through meditation and exercise. For others it is found in watching “The Queen’s Gambit.” As long as it is healthy, the manner in which we recuperate should not be prescribed. All that matters is that we do it. The key to resilience is recovery and the key to recovery is time. People need to feel empowered and have ownership over how they spend their time recovering and preparing for another day of serial small tests.

According to German philosopher Immanuel Kant there are three things that people need to happiness: something to do, someone to love, something to hope for. The vaccines against COVID-19 have given us something to hope for.

There will hurdles to overcome as they are introduced on a wide scale. But the challenges we have experienced throughout this past year, hopefully will have provided us with the ordinary resilience necessary to find purpose and happiness in these extraordinary times.

John J. Ryan, M.D.

John J. Ryan, M.D., is an associate professor in the Department of Medicine, and director of the Pulmonary Hypertension Comprehensive Care Center, at the University of Utah.