Since March, Mimi Ferraro has experienced losses big and small.
She lost her mother, Joan Polin, who died of COVID-19, alone in a hospital. As a chaplain for Abramson Senior Care, she lost access to her older Jewish patients. As a rabbi to Congregation Tiferes B’Nai Israel, she lost in-person contact with her congregants during the High Holidays. For a time, she lost the comfort of selecting her own produce at the grocery store.
But as a chemotherapy patient at Fox Chase Cancer Center, where she recently passed the two-year mark of chemotherapy sessions for her stage 4 colon cancer, the quality of care, thankfully, has stayed the same. Even there, though, Ferraro can’t have her husband or daughter with her to ask questions and take notes from the doctor. She can’t see her doctors’ faces behind their masks; she’s not sure that she would recognize them on the street.
She’d just like things to feel normal again.
“But even when we go back to whatever normal is, I still feel like I’m extra vulnerable,” Ferraro said.
Cancer care is already a tricky proposition for patients, their families, doctors and hospital workers. The intermingled processes of treatment have been complicated even further by the pandemic. And beyond the world of doctors, nurses and patients actively fighting cancer, offshoots like screening services and chaplaincy have been affected as well.
Dr. Jeffrey Farma, a surgical oncologist at Fox Chase Cancer Center, is thankful that he and his patients have been able to see one another in person as much as they have, even if the process of an in-person visit now involves tests, masks and other PPE. And to be able to see patients via telehealth, different as it may be for both parties, is better than nothing.
But it’s still a notable divergence from the way he learned how to care for people.
“Part of what I love about what I do is the relationships I’ve built over the years with my patients and their families, and seeing them and getting hugs, and frequently kisses, and shaking hands and the physical contact,” he said. “A lot of my patients have become family, and it goes both ways. And so that becomes very difficult.” Respectfully declining a hug from a older Jewish patient, one who reminds him of his own grandmother, was just one of these hard moments. Farma’s patients can’t even have visitors.
Dr. Richard Bleicher, also of Fox Chase, explained that the Temple Health system quickly recognized the risk that COVID would pose to immunocompromised patients, which includes those with cancer. Fox Chase was declared a COVID-free zone, and patients who developed coronavirus were transferred elsewhere in the system for treatment.
“It was just a Herculean effort on their part,” Bleicher said. Of course, even though the hospital is “COVID-free,” it exists in the reality shaped by the disease. Consequently, Bleicher has found himself treating his patients’ fears about the pandemic alongside the cancers that they’re already afflicted with.
In addition to the changes made in visitor policy, Fox Chase turned attention toward its order of care procedures, creating new schedules of therapies and surgeries that minimized risk for patients. Telehealth, which can keep vulnerable patients at home for visits that don’t necessarily need to be in person, is one example.
Dr. Mark Morginstin, an attending physician in oncology and hematology in the Einstein Healthcare Network, believes that those telehealth visits are here to stay. There are obvious positives, he believes, but he knows that it’s a new experience, for doctors and patients alike; toward the beginning of the pandemic, patient satisfaction scores were down as a result of the perceived impersonality of a video chat, in his view. Those scores have since recovered, but Morginstin misses the in-person visits.
“I’ve been doing this for many years, and I like to have people in front of me,” he said. “You get to see their expressions of their face, you get to see if there’s something really going on. You don’t get that over the phone; even on a video, you may not get that. So I really think it’s not the best way to do medicine. This is not how things are meant to be.”
Elaine Grobman, CEO of Susan G. Komen Philadelphia, is concerned that certain short-term effects of the pandemic could become lasting. Grobman is troubled by stories she hears about more and more women delaying their mammograms, increasing the risk that they won’t be able catch signs of breast cancer at an early stage.
“I’ve spent 30 years educating women about the importance of early detection and treatment,” Grobman said. “Delaying getting your mammogram puts you in a difficult spot if there’s something going on.”
She hopes that women who feel comfortable doing so will soon return to such risk-mitigating practices.
Doctors and patients aren’t the only ones with reservations about telehealth.
Rabbi Tsurah August, a chaplain with Jewish Family and Children’s Service of Greater Philadelphia for 12 years, is still trying to figure out how best to be emotionally and spiritually present for patients requesting her services at a time when she can’t be physically present. It’s no idle question for her; so many connections have been forged in her line of work, she said, through a hand laid on an arm. Like Morginstin, August said that she strives to make patients she interacts with become much more than someone to whom she is providing a service.
August has found that the phone skills she gained as a management consultant a few careers ago have served her well. Still, she’s looking forward to being in person again.
“One of the feedback loops in doing this work that wasn’t true in management consulting is there is this reciprocity,” she said. “Not the thank-you’s, but that when I would look into someone’s eyes, they’d look into mine.”
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