Perseverance during COVID19: The Good, The Bad, and The Ugly

flag of USA on grass field

I asked one of my patients what he does for a living recently and he casually revealed he was a retired Navy SEAL. It’s not every day you meet a Navy SEAL with over 20 years of experience, and I certainly did not expect to be talking to one during a worldwide viral pandemic, when our resolve is being tested as a nation, as a community, and as individuals. I was curious what lessons I might learn from someone who had not only completed the training that many consider the most intense in the US military, but then continued to serve our country for more than two decades. 

Lessons from a Navy SEAL

As we spoke to each other behind our face masks, I learned about the incredible mental and physical challenges that all Navy SEALs must endure to earn their Trident. I thought my orthopedic residency training was tough with my 40+ hours on-call shifts, but compared to their “Hell Week” when they only slept 4 hours for the entire week my perspective changed.  I had heard of some of these incredible feats before, but listening to them first hand was remarkable. We spoke about his training in arctic warfare, HALO (high-altitude low opening) jumping, and of course underwater training.

He shared several lessons he learned throughout it all, but one principle was pervasive: the key to successfully completing seemingly impossible physical challenges was understanding that 80% of your success relied purely on your mental state, while the remaining 20% was a test of actual physical ability.

I had heard of this strategy from marathoners, elite weightlifters, and endurance athletes of many kinds — highlighting how mental preparation is just as important, if not more, than physical preparation.

person swimming on body of water at nighttime

Perspective is Everything

The profound effect of the mind and our own mental state is also seen in medicine. It likely explains the placebo effect, which has been confirmed across multiple scientific studies. In fact, the “mind over matter” effect has a real biological basis. Studies have shown it is linked to increased emission of neurotransmitters, like endorphins and dopamine, and greater activity in certain brain regions central to moods, emotional reactions, and self-awareness. But the power of perspective is not just an academic phenomenon. We also encounter it in our everyday medical practices when we counsel our patients about pain after surgery. Simply discussing opioid usage after surgery can decrease opioid consumption after an operation — the power of a patient’s expectations can literally affect their level of pain and need for pain medication. 

Unfortunately, as we battle the coronavirus, we are constantly reminded that some challenges can not be overcome simply by mental hardening. By definition, the virus attacks the body, on a subcellular level, creating powerful immune-mediated responses that can result in multi-organ dysfunction and sometimes failure. How can mental preparation help in this scenario?

Perhaps, the Navy SEAL mentality for never quitting may not be directly applicable for those fighting the COVID-19 as patients, but the value of perseverance can certainly be applauded in those healthcare workers on the frontline.  In the face of death, quite literally, frontline workers have returned day in and day out to help care for those in need. The dedication of these women and men, including hospital security guards, custodial staff, social workers, nurses, medical students, residents and attending physicians cannot be understated. 

Grit: What it Means and Why it Matters

Some call the ability to persist in the face of difficulty, grit. It’s been long valued across time, culture, and disciplines. Author and pyschologist, Angela Duckworth has written and spoken extensively about it in her book Grit: The Power of Passion and Perseverance. She defines grit as passion and sustained persistence applied toward achievement, combining resilience, ambition, and self-control in the pursuit of long-term goals. On the basis of her central tenet, the book provides balance to the idea that success relies merely on talent, but instead emphasizes the importance of effort.

Her formulation demonstrates the two-fold importance of effort: Talent + Effort = Skill. Skill + Effort = Achievement.

Recently, Angela Duckworth has even commented on grit’s importance during COVID-19 in a televised interview.

Without a doubt, in the face of a worldwide pandemic, we will require grit and perseverance to successfully fight the coronavirus. It has mandated a nation to combat our very own nature to be social, called for the closure of institutions and businesses that will forever alter the social and economic fabric of our society. To successfully navigate these dark times, it will take significant effort on the part of everyone. The importance of developing “organizational grit” has been widely discussed, and perhaps is more applicable now than ever before when thinking about how the US healthcare system can be reshaped to match our needs during times of crisis. Hint: it requires not just gritty individuals, but gritty teams, behind a shared common goal, perhaps fueled by a crisis. 

Perseverance alone is Not Enough

There are limits to grit. Angela Duckworth’s seminal work has been repeatedly criticized for its lack of consideration of context. For example, the influence of race, gender, and socioeconomic factors may limit the ability to develop grit, or severely hinder one’s effort. While Duckworth heralds grit’s importance for achievement, she does not discuss other virtues that may matter just as much (or more) such as integrity, honesty, civic mindedness, or altruism. 

These criticisms are especially relevant during the pandemic. In the epicenter of the United States, data has clearly indicated how poorer neighborhoods have been disproportionately affected by the coronavirus. Evidence is also emerging that demonstrates how COVID-19 has accentuated pre-existing healthcare disparities due to race.

In fact, as studies have emerged comparing countries that have successfully “flattened the curve” versus those that are still struggling, they have found that success has truly relied upon limiting the spread of the coronavirus to others, through altruistic actions and behaviors.  For example, we know now that the use of face masks is not for protecting us from being infected by others, but the reverse, it protects others from becoming infected by us.  We have also seen how limiting the individual desire for close social interaction can result in a common good for the community at large. 

When Persevering gets Ugly

Sometimes continuing on a course without a sense of purpose or satisfaction can get ugly. For example, physicians are no stranger to persevering in the face of challenges. We naturally had to build these skills as we trained throughout medical school and residency. Even after graduating and finishing our decade-plus training, we continue to work despite the onslaught of non-medical tasks that we are mandated to complete (e.g. interfacing with EMRs, the never-ending mouse clicks, endless documentation, etc.).

Pre-COVID pandemic, these relentless tasks contributed to physician burnout at such high rates that it was declared a healthcare crisis

man sitting on grey sofa

Physician suicide rates were staggeringly high, nearly double the average rate, demonstrating how bleak the outlook remained for many physicians for the foreseeable future.

During the COVID pandemic, physicians on the frontlines continue to be vulnerable. The story of one emergency room doctor in New York City exemplifies the importance of recognizing burnout and the terrible effect that repeated tragedies can have on healthcare workers.

No one knows what a post-COVID pandemic will look like. Many physicians around the world who worked tireless through this time will hopefully have regained a sense of satisfaction as they helped their patients, but rather than persevering through all the challenges our current healthcare system presents, perhaps it is time to change the paradigm entirely.

Summary Points

  • Overcoming your own mental limitations can help you conquer seemingly insurmountable challenges
  • Learning to see things from a different perspective can truly alter your reality
  • Being gritty may help you achieve your individual goals, but other virtues like integrity, altruism and civic mindedness should not be forgotten
  • Knowing when to persevere may be just as important as knowing when to stop, reflect, and consider whether its time for change instead
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