We read so much into facial expressions. Often described as the windows to the soul, the eyes are all we have left in a world of mask wearing. Now a days one may put on a smile but if it doesn't reach the eyes, no one will ever know that we even tried. Eyes easily convey emotions of fear, stress, exhaustion, hope and joy. Through our eyes we show personal connection, focusing on the person before us, letting them know that what they are saying is important. As grateful as I am to have video conferencing technology, it is hard to look someone square in the eye on Zoom.
The eyes tell me how sick someone is. Glassed over, easily distracted, drifting eyes tell me that someone is struggling. Wide eyes, showing more of the white, with quick, distracted darting movements tell me someone is anxious and fearful. Often, when following up with a patient, I'll walk in a room and immediately sense that they are doing better. Their body language shows comfort, positive energy but mostly I see it in their eyes. I thought it might be interesting to share some of the windows into my experience with COVID through the eyes that I have seen.
His are tired eyes. I can easily tell his energy is low. His chest xray shows viral pneumonia and his oxygen levels are borderline low. He is not sick enough to go to the hospital but he is not far from it. He needs to stay home and rest. When I tell him how long he needs to stay self isolated, the eyes change. The muscles at the edges contract quickly in annoyance, glaring just a bit, followed by a resigned sigh and a hint of rolling. I get it, he doesn't get paid if he doesn't work. He has gone to work not feeling well many times before. I ask him to stay home not for just his own benefit but for all those with whom he could come in contact. This infection is different.
These eyes showed some irritation and anger. I had just asked her to be tested for COVID due to the persistent cough she has had for over a week. She has been doing everything right. She has not expanded her social bubble, has worked from home, and has been wearing an N95 mask on the rare occasions when she has left the house. She has even helped design the protocols to keep the children safe at her children's school where there has not been a single case reported. How could I ask her to get tested? And yet her children had coughed a bit and she didn't want it to turn into pneumonia. Of course, I wanted her to get tested. Twenty to forty percent of all those who spread the disease have no idea that they are carrying the virus. Most become symptomatic a few days later but by then it is too late. Still, she refused to get tested.
Looking into these eyes I find love and acceptance tinged with the regret of just one bad decision. Her and her husband don't declare their faith, they live it. Now in their retirement, they moved far away to be near family but on Tuesdays they are found giving food to the poor. Being elderly, they know they are vulnerable so they have been careful and cautious. The only social gathering they have been to was the funeral of a family member. "I knew I shouldn't have agreed, but we drove to the cemetery from the church with two cousins." It was a twenty minute drive and though they had on their masks, the cousins did not and were "coughing all over the place." Later, the cousins were hospitalized and one is still on oxygen. My patients thankfully recovered nicely after feeling horrible for a few days.
As I activated the Zoom call, I couldn't see her eyes at all. She was asleep at the table in front of me. I waved to the screen to no avail so I picked up the phone and called her at home. She wasn't at home. She was at work where she cares for children. She gets this every year, she says. It is just a cold, though she agreed that this one was pretty bad. Could she get a rapid test? You see the fall festival feast was the next day and it was important that she make it. Besides that, she had received an email this last week from her boss telling everyone to not call in sick as there were no backup workers available. I explained that it was important for her to stay home to not only recover but to also protect the children and their families. In her condition, there would not be a test that could rule out COVID. The chance of a false negative result was too high. Her eyes showed understanding but were oh so tired. We agreed to touch base again in a week and she would go get tested the next day.
I am used to seeing fear in the eyes of those I see in the respiratory clinic. Compounding the fear they bring to their visit, I walk in the room looking like someone out of a horror film. On top of my scrubs, I don the cafeteria worker's hair net, booties over my shoes and a full length protective gown tied in the back. I have gloves that seal the gown at my wrists. Up top, my reading glasses are perched, librarian style on my nose so I can tip my head to look through them to see up close or peer over them to look at the patient. The N-95 has been fit tightly over my face. I test it by exhaling sharply and making sure there are no leaks. It will stay on my face the entire shift. I place a surgical mask over the first, that keeps me from touching the N-95. The face shield straps over all of this and extends past my chin. The stethoscope slides under the shield. It is cleansed after each use and is a dedicated, augmented scope used only in that clinic. The amplified sounds from it are helpful as there are loud blowers in the rooms that suck air out, making sure that there are no air currents that come out to the rest of the clinic. As such, when I come into the room, I am quite the spectacle.
