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Why Do We Mask Our Vulnerabilities?

"Behind the Same Mask"

graphite and aquarelle pencil on drawing paper

By Stephanie Garbern, MD, MPH, DTM&H

In processing the past couple of months, what has struck me most has been the inequality in how COVID19 disproportionately affects people of color, immigrants, and the poor. Of the patients I’ve intubated with COVID19 in the past couple of months, all but one was a person of color, many of whom did not speak English as a primary language.

However, we appear more similar to our patients now than ever. We wear the same mask and have the same fears, despite our differences in language, culture, eye and nose shape, and educational opportunities. Behind our masks it is more difficult to register those who are “not like me.”

In my piece “Behind the Same Mask”, the elderly patient on the left is an anonymized representation of two non-English speaking patients with severe illness from COVID19 that I had to place on a ventilator in the emergency department. Long after my shift ended, their faces kept me awake at night, rechecking their medical records, analyzing the critical care team’s clinical notes, wondering if I’d done the right thing, given the right medications, and questioning the reasons why they had such poor outcomes compared to others. A portrait of me, after one of my shifts, is shown on the right. My mask, more precious to me in those moments, serves more to hide my expression of terror and vulnerability than as protection from the virus.

My fears and doubts of my own sufficiency as an academic emergency medicine doctor, serving as both clinician and educator for training doctors and students, have weighed constantly on my mind. In sharing my vulnerability with others, especially trainees, I wonder if these lessons are more important than the extensive technical skills acquired in our work. I have reached a point now where the number of years I spent “in training” have surpassed the number of years “since training.” The greatest gains I have made as a doctor have been in learning that the extra minutes spent with a patient are far more important than the number of patients seen per hour, and that the best teachers are not the ones who never seem to be afraid.

The piece was drawn using pointillism—a technique that relies on the ability of the eye and mind of the viewer to blend a set of colored dots into a fuller range of tones. It is therefore impossible to see the whole of a person without stepping back and looking away from individual marks made by the pencil. The process itself, of taking pencil repeatedly to paper, was for me a kind of meditation, allowing me to see more clearly the fine lines, iris pigments and facial expressions that are shared between two people. We are not defined by our skin color, gender, age, legal status, occupation, medical problems, or the mistakes we have made, anymore than we are a single dot on a page.

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