Turning Life's Lemons Into Sweet Lemonade: A Positive Reflection on the Impact of COVID-19

• COVID-19
• Distance Education
• Health Education
• Homelessness
• Pandemics
• Patient-Centered Care
• Primary Health Care
• Telemedicine

Change is difficult, but change is essential. These past few months have been full of change on a global level, and these unprecedented times have brought many forced shifts toward our new normal. All we need to do is turn on the news or scroll through our social media outlets and we’ll have a long compilation of what is wrong with the world since this pandemic. A mentor of mine early on in this COVID business said, “We’re making lemonade.” After some processing, I remembered the old saying about life giving us lemons.

Shifting my practice to be online has been cumbersome, but it has been safer for our patients. During these months, I’ve done more “home visits” than ever before. I get to meet the entire family, including those who walk on 4 legs and are covered in fur. Many of these visits have been so intimate, where patients proudly pace around their homes, excitedly proclaiming to the rest of the family, “It is my doctor!” I can see for myself if the bed is too high for my elderly deconditioned patient or if there are fall risks around the living room. The continuity continues. The relationships I have with my patients are bolstered. Taking care of a wonderful 95-year-old patient who I’ve been seeing for 4 years has been a wonderful experience. Earlier this year, I had a telehealth visit with him because he’s been remaining home in almost complete isolation for his elevated risk. The largest issue he’s struggled with during the COVID pandemic: loneliness. I learned these visits mean more than just medication refills; they are an opportunity for helping those who are struggling during this time. I recently saw him again, and he was able to update me that he has found the courage to establish new friendships to keep him company at his assisted-living facility. These visits unveiled a new hope for telemedicine.

In my experience, patients have been appreciative of the flexibility of telehealth visits. For starters, they do not need to leave the comfort of their home and come into our building, which has turned its first floor into a COVID testing center. Those patients that are working are able to see me on their break and do not lose a whole day from their paycheck like they do when coming in person.

I’ve always asked patients about their medication list during a reconciliation, but I have often struggled finding out exactly which meds they are taking! Now, they just go grab their pill containers and read them out loud. One patient of mine could not find her reading glasses, so she just held the bottle up to the camera, I was able to read it myself, and we got a good laugh out of the scenario! Lemons can be sour, tart fruits, but when used appropriately, can be refreshing.

On the academic front, medical students were asked by the American Association of Medical Colleges to be removed from physical contact with patients. Although there could be much complaining about the delays in their education, many students have been on the front line of innovation amid the current conditions. We have flipped courses to be fully online for them to continue learning. Clinical teaching has shifted to allow us to be in different locations but connect on cases and continue to make patient-centered plans with us all “in the same room.” Students have also stepped up in our COVID Continuity Clinic, following up with our patients who have been discharged from the hospital with check-ins to make sure they are doing well in their isolation. Other medical students have volunteered to baby/dog-sit for providers who are on the front line while they are working. Their creativity is inspiring, particularly when I work with them in our clinic for the underserved. Students in our student-run free clinic have set up a switch to telehealth so these patients had continued access to care. They have been able to use the technology to assist in the most difficult of times. Like a cold glass of freshly squeezed, sweet lemonade.

In my world as an academic family medicine physician, there are plenty of lemons to go around. But, with some gratefulness, I am constantly squeezing the juice out of these situations to make them palatable. Although sickness and death will always be a difficult part of it, I have to remind myself of the joy and vitality that are also involved. I try to remain positive. I can bring hope and try to show my patients that there can be wonderful outcomes when sweet and sour are mixed together. The pain many are enduring is not ignored, but I believe being on the “front line” in primary care, we must continue to charge forward, with an outlook that encourages and brings the balanced sweetness of lemonade to our long, tough days.

• Received for publication May 6, 2020.
• Revision received October 9, 2020.
• Accepted for publication October 12, 2020.