Abstract
People say our eyes are the windows to our soul. Experts estimate that most of our communication as human beings is nonverbal. Thus, our facial expressions are the most important nonverbal channels for communication. However, anything below our eyes gets lost behind our masks that hide many of our expressions and what is said cannot be placed into the right context leading to uneasiness and uncertainty.
We woke up in spring of 2020 and the whole world was seen behind masks. I thought staying safe was going to be a challenge; however, I would most certainly be able to provide care efficiently and excellently behind masks and goggles. However, I was not prepared for the “goals of care” discussions.
Thursday afternoon at the hospital, I planned to initiate a conversation with my patient's partner. As soon as I walked into the room, I noticed that she was hunched over while sitting on a chair. She seemed demoralized. Her posture reminded me of a willow, weeping over her husband's withering body. I could not tell if she was crying. Of course, she was crying and wearing a mask. “This is going to be hard” I thought to myself. We talked for a while, she talked about her husband's life before his disease. I tried to exaggerate my smile so she could notice my eyes crinkling and radiating warmth and joy as we were celebrating her husband's full life. And then we spoke about what is ahead, the immediate dark future and her husband's grave prognosis. I think my eyebrows came closer, I paused a lot, I let her notice my eyes as they were gradually tearing up.
By the end of our conversation, she continued to sit up and keep herself together. I could not picture her facial expression especially since I never saw her whole face before. Certainly, I could feel her! I could feel her crumbling in front of me. Then she looked up at me. Her eyes were screaming sorrow and begging for a human embrace. I thought she was going to fall into my arms. Instead, she remained physically distanced “as she should” these days … and alone. I looked at her and tried to let her know that I was going to be there for her. Few words followed. I left the room sad, disappointed, with an overwhelming feeling of guilt about a job hardly well done. This was an inhumane experience, just like everything about this pandemic, when people grieve alone and people die alone.
Goals of care meetings need pauses as they unfold. It is the time when patients and families need to accept a grave prognosis, process the information, and ask questions. These pauses can be uncomfortable. In the medical field we train how to allow for pauses and manage them the best way possible. But these days, between physically distancing, breathing behind layers of gear, gowns, masks, and goggles, these pauses have become even more uncomfortable. There is one last but powerful resource and that is the power of connecting with our eyes.
At the hospital we often wonder if our older patients can read our eyes, or if they can tell we are smiling. As a geriatrician, my patients often have limited vision or are cognitively impaired. How much of me can they see under all this gear? So, I made a promise to myself, during these difficult times to smile harder until sparks come out of my eyes, until my eyes crinkle. I am realizing my eyes are all I have for a deeper connection in these crazy times and I pledge to use them to channel love and compassion, care, and support. I realize that my eyes are all I have to make a deeper connection in these chaotic times.
We should all recognize the power of communication through our eyes since they are the only part of our face left visible. Eye contact is more important than ever and we owe it to each other to look deeply and carefully at when we meet. Although prolonged eye contact, looking hard and with intention, could be interpreted otherwise during “normal” times, for now it is the only path to channel empathy and compassion to those in our care.