Baylor College of Medicine

Resilience

Master
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Feb. 24, 2021

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Dear Members of the Baylor College of Medicine Community,

What a week. I considered starting this message with a “plagues of Egypt” quip. A little humor often helps in difficult situations. However, in reflecting on the events of the past week, humor seems out of place.

We just passed a grim milestone of 500,000 dead from COVID-19 in the United States. More people have died from this virus than in any U.S. war (save the Civil War). In addition, we all lived through an unusual weather event where major catastrophic failures of public utilities turned what should have been a pleasant “snow day” into nearly a week-long ordeal of discomfort, anxiety, property damage and still more death. It seems appropriate at this point to at least pause for a moment and reflect – we have just lived through an unusually bad week, capping off an unusually bad year.

Thankfully, there is much good news. All our disease metrics are dropping rapidly. Over 75 million vaccine doses have been administered in the U.S., and about 13% of the population has received at least one dose. We are vaccinating about 1.6 million people every day. Many of those vaccinated are people with risk factors known to promote more severe disease, so even partial vaccination of the population will probably help decrease future demands on our hospitals.

Locally, FEMA is starting a six-week effort to vaccinate an additional 142,000 people. Vaccine supply is increasing and diversifying. True, we are engaged in a “Vaccine versus the Variants” race, but I am relatively optimistic we will win that race and return to some semblance of normal life by the Fall. Normality could even come by the summer if our vaccination rate continues to accelerate, which I believe it will.

In my opinion, we have a long way to go, and we need to maintain our focus on vaccinations and good viral control practices, but the worst is probably behind us. Increasingly, it will be important to start contemplating what is to come. What will life be like after the pandemic has faded? How has this experience changed us?

Think of the stressors many in our community have endured – economic insecurity of people at or near the poverty line; families ravaged and upended unexpected health challenges; small business owners watching personal savings dwindle and incurring debt as they fight to keep their life’s work afloat; front-line health care workers slammed by a tidal wave of disease, struggling to get to their feet only to be inundated by an even bigger wave, and then a bigger wave still.

We are learning a lot about ourselves through this ongoing crisis. We often grow in adversity. You know the platitudes: “The finest steel has to go through the hottest fire.” “What doesn’t kill us makes us stronger.” Unfortunately, what doesn’t kill us sometime leaves us broken and discouraged. Will we emerge stronger or impaired? The pandemic has been a test of our resiliency.

The role of resiliency has been a long-standing interest of the U.S. military. A colleague of mine recently brought to my attention a Rand Corporation report from 2011, “Promoting Psychological Resilience in the U.S. Military.” Per the report, “resilience is the capacity to adapt successfully in the presence of risk and adversity.” Risk and adversity seem to be apt adjectives to describe our past year. I do not mean to draw equivalency between our shared COVID-19 experience and that of our men and women in uniform – repeated military deployments for extended periods of time separated from family while living under the constant and unpredictable threat of violence – but I do think some of the findings from the report are applicable.

One useful construct in the Rand report is that of a “resilience continuum” to assess mission readiness. As I concluded this message, pause for a moment. Where you are on this continuum? Where are the people you care about?

Optimal. Clearly, this is where we all want and hope to be, truly mission ready: Functioning at peak performance; positive outlook; sense of purpose; embracing challenges.

Reacting. This may be where many of us are – still highly functional in a chronically stressful environment but beginning to fray at our psychological edges: Irritable; feeling overwhelmed; difficulty sleeping; inability to relax; problems concentrating.

Injured. Hopefully, very few of us reach the point where stress begins to take its toll, degrading our ability to function and impacting our quality of life: Feelings of guilt; decreased energy; anxiety; loss of interest; social isolation.

Ill. This is the point we want to prevent anyone from reaching, where you are unable to function effectively, and are truly in need of help: Depression; anxiety; anger; aggression; danger to self or others.

As in many things in life, prevention is preferable to cure. In a future message, I will attempt to summarize some specific strategies, but in the meantime, prevention starts with recognizing where you fall on this continuum. We are now almost a year into an event that fundamentally changed many lives. On the resilience continuum, where were you a year ago? Where are you today? Importantly, when you look at the people around you about whom you care the most, where do they fall on the continuum?

This pandemic has already extracted a steep price – 500,000 dead. It has stolen livelihoods and loved ones. It has derailed dreams. The price we have paid is high enough. As we look back at this time, when COVID-19 is an unpleasant memory, I want us all to be able to say that we bent but did not break.

If you need help, please seek help. Your primary care physician is a good place to start.

Stay well (and resilient).

James T. McDeavitt, M.D.
Senior Vice President and Dean of Clinical Affairs

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