As a primary care physician, I hear dozens of deeply personal stories every day from my patients. The coronavirus crisis continues to take an ever higher emotional, physical, and financial toll on them, and their stories have become increasingly painful. They cry out for new, innovative approaches to care.
Recently, one of my patients, a young woman in the health care industry, shared what it has been like for her to look after her seven-month-old child and her toddler, all the while trying to hold an increasingly difficult job. The father of her children lost his job in the pandemic and their relationship frayed under the strain. With nowhere else to go, he is now sleeping in her car. Her mother — once the main caretaker of her children — is riddled with arthritic pain and afraid to seek medical care.
My patient walks around her apartment all day with her teething baby on her hip, trying to work remotely. Her employer wants her back in the office soon, but she has no place to turn for her children. While grateful that she still has her job and shelter, her life is teetering on the edge. We made a plan to connect her to a social worker for her rising anxiety and depression; time from work to care for her mother; a case manager to explore scant child-care options and work possibilities for her estranged partner; and frequent follow-up telehealth visits with me so she doesn’t feel so alone.
In practicing medicine through the pandemic, I can no longer place my hands on the shoulder of a patient or give them a hug for comfort. Often times, I receive their stories through a screen with poor Internet connection or by phone. But I can help guide their storytelling with some gentle questions, and I can listen. This telling and receiving of stories is a deeply therapeutic part of our relationships.
In relating their stories, my patients can start to make sense of what is happening in their lives and, with their telling, is born a kind of locus of control. However, outside of these small forums of time and space, there are few places where my patients and thousands like them have the opportunity to share their stories and have people receive them through truly listening.
Across the country, there is deep trauma and devastation that is quickly mounting. It is becoming increasingly clear that in order to heal and rebuild, we must begin to build innovative forums whereby the inequitable impact of the coronavirus pandemic on Black, Latinx, and immigrant communities must be accounted for and immediately addressed.
One such opportunity is to create time and space whereby individuals who have inordinately suffered and become victims during the pandemic can tell their stories. Stories can be guided by gentle prompts and shared in trusted community spaces, such as community centers and health centers. They can be catalogued and safely de-indentified for the victims of trauma as needed. In telling their stories, individuals can regain some of their agency and begin to heal their traumas. As receivers of these stories, we can further understand the human lives behind the never-ending COVID-19 statistics and how their multi-layered stories are wrapped in the deep health inequities and racial injustice that have plagued our country since its inception. Finally, by listening to these important stories, policy makers and leaders can further address what people need and how to meet these needs.
A possible inspiration for this work is a model in the legal field called “restorative justice.” The world witnessed its success in South Africa when Archbishop Desmond Tutu and others created the Truth and Reconciliation Commission as a path for the post-apartheid country to make reparations to its victims. Premised on the idea that the traditional criminal justice system leads not only to extreme incarceration rates but also the continued trauma of its victims, the restorative justice model sets up safe forums for victims to tell their stories. By asking questions such as: “What happened and how has it affected you?” and “What is needed to make things right?” victims have the opportunity to tell their stories of the trauma, regain some control of their narrative, and begin to heal.
While many take reassurance in Massachusetts’ diminishing deaths due to COVID-19, the coronavirus is not over and some of the most difficult work of healing is still ahead of us. We must face and understand the trauma and physical, emotional, and economic devastation that has ripped through our Black, Latinx, and immigrant communities during this pandemic.
Though this work will not be easy, it is critical. As James Baldwin wrote, “Not everything that is faced can be changed, but nothing can be changed until it is faced.”
Dr. Katherine Gergen Barnett is the vice chair of Primary Care Innovation and Transformation and residency director in the Department of Family Medicine at Boston Medical Center and Boston University Medical School.