Connection

Humans are profoundly social animals, and our relational connections shape our inner neural connections. Much of the time, we need more than reasoning to maintain social distancing even if an infectious disease outbreak mandates it.

And that's no small thing. Social distancing is never easy. And it's even more difficult for kids. Dr. Ainsworth's groundbreaking "Infant Strange Situation" study discovered attachment science, and changed how we understand the importance of secure attachment or intimate human relationships for kids.

Here it is in a nutshell: Ainsworth assessed mother-infant interactions throughout the first year of a child’s life. At the end of the year, each mother-infant pair was brought into a room for an experiment that lasted about twenty minutes, followed by separation of baby from the mother. Securely attached babies show clear signs of missing their mom when she leaves the room, actively greets her when she returns, then quickly settle down and return to their toys and activities once the mother is back in the room.

Ainsworth, in short, showed that sensitive mothers are more likely to have securely attached children. That’s an important concept. Although there’s no formula that’ll fix every problem our child faces, there’s one thing we can always do: just show up. Showing up means what it sounds like. It means being there. We all need to. Remember, we all are born with a drive for connection. To give you an example, the wisdom of showing up helped me to break the cycle of insecure attachment - and break the regulation of my hospital, too. Two nights ago, a mother was sent to my infectious disease ward when she developed fever under quarantine order; her husband had been diagnosed with the nasty novel coronavirus infection ten days ago. Then, guess who else was sent to the children's ward? That's right, another close household contact: her twenty-month-old daughter.

I kept waiting for the mother to appear. Wait, wait, and wait.

She wasn't escorted up because her daughter was in a body-shaking crying mode. A nervous breakdown. It's hard enough to send an infant to hospital, but it's even harder to separate her from the mother who's supposed to be locked up in another double-door isolation ward. Plus, it's impossible for the daddy to come because he was too sick in another hospital. As we struggled with putting on emotional brakes, the child continued crying. The mother cuddled the infant when our colleagues kept saying, in the most polite tone, "Just can't wait. Go."

I tried not to show how impatient I found myself to be. I've seen the need to hide our bad feeling time and again over the years in my work with patients. We doctors simply had to be patient with patients (pun intended). It makes sense, doesn't it? I sized up the situation and then remembered Ainsworth's story. And instead of putting two patients in two different isolation wards, we ended up with a new option: admit the child to an airborne infection isolation ward, and her mother into the same room. Paediatric team looked after the child, and I took care of the mother. Under the same roof.

Perfect.

Percuss

Recently, weighed down by the ever-present concern about epidemic of coronavirus infection, doctors are often separated from patients by double doors. Even when doctors muster the energy to go through the doors, the patients should still be examined with gloved hands.

That's what I have been - and supposed to be - doing in the medical wards catered for patients returning from Wuhan province or Korea.

Eager to get an accurate diagnosis, we are instead relying on advanced imaging techniques or laboratory tests like real-time polymerase-chain-reaction assay. Too often, we skip the step of touching the patients.

I'll preface this by saying that I lament the loss of basic physical examination. Skipping physical examination of patients is not my thing. Not remotely. The way I see it, once you've decided to make good use of stethoscope, and if you can bring a proper one instead of improvising the primitive-as-a-toy stethoscope at bedside, there's little reason why you should have a cursory examination. You either listen properly or do not listen. Don't pretend to listen.

The same goes for percussion, another time-honoured bedside skill we have been teaching medical students. Imagine cocking your right wrist and let the right fingertips fall like piano hammers on the left fingers placed on a surface. Then pay attention to finger tapping on patient's body parts - the pitch and tactile sensation - to get the feel. The sound will be resonant on percussing a hyperexpanded chest, but appear stony dull if there is fluid pushing the lungs away.

Over the years, I have learned to appreciate the musical notes crafted by finger-tapping. It works, especially when you don't have easy access to handheld ultrasound machine wherever you go. But then, having worn latex gloves in most hospital designated areas, I am stuck. The typical features of resonant or dull percussion note simply blurred. Try as I might, I could no longer tell the difference between a hollow structure and a fluid-filled body part.

What's the quick fix? My tip: remove the gloves (and make sure the infection control officer isn't behind your back, of course).

Or so I thought.

Decompression

The problem with long working hours in hospital is not that we get overloaded. The problem is that we have had almost no idea how to call it a day.

We've decided that there should not be long shift for doctors looking after quarantined or suspected coronavirus patients in our hospital. If safety and protection are what we sought in such high-risk areas, we should limit the hours of physical and mental stress from putting on and off the full personal protective equipment, as well as mindful hand washing.

I settled in and handled the shift work with reasonably aplomb. I never complained. But while I managed to adjust, I knew there was something amiss. The eureka moment came when I viewed the TED talk by the psychologist Guy Winch. To steal a remark from Guy Winch, we need clear guardrails. We have to define when we switch off every night, when we stop working.

Here's my way of rebooting: I start running home after work, a habit I had recently forgotten.

The very simple and yet empowering action of changing shoes to running footwear defines a boundary from working mode.

A signal for an upcoming break.

There's nothing I like better than a physical springboard to decompress. It works like the step of decompression before surfacing of a scuba diver who has been breathing compressed air (somewhat like a suffocating N95 mask) in deep water.

It's hard to say exactly how important that decompression is, until you find out what it's like without it.

Just before yesterday, at the end of my shift, my mind was so clouded that it allowed dumping my fountain pen with working clothes into the collection bin. In case you skipped over the last sentence, I'll repeat it. I threw away my favorite fountain pen. Seldom have I been so wrong.

Little did I know my faux pas until I was experiencing flow on the running route back home. My body and mind was wide awake by then, and in a matter of nanoseconds, I registered the plan to go to the collection bin first thing the next morning.

It sounds like a magic moment, and it is. I didn't lose my fountain pen. And neither my marbles.