American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

From the Director's Desk

Chronic Uncertainty and Expectations

Heidi Nelson, MD, FACSHeidi Nelson, MD, FACS
Medical Director, ACS Cancer Programs

An illness is generally considered a chronic condition when it has persisted over some period of time, and when the body puts in place biologic mechanisms and/or compensatory adaptations that preserve function. We acknowledged in the August Cancer Programs News newsletter that we had gradually transitioned from an acute to a chronic phase of the pandemic, and that we had adapted in ways that would keep us safe and functional such as working from home, holding virtual meetings, and so forth. All things considered, we are doing pretty well, at least in part because we have reached a stable adaptive state by accepting new ways of conducting our work and personal business.

As time goes on and we are coming into a new season, it may once again become apparent that we are facing many uncertainties, and just as a chronic illness can cause fatigue, so can the chronic uncertainties of a pandemic cause us to feel drained and/or unbalanced in our lives. Ironically, we may be doing less because there are fewer things we can do―such as travel, attend events, and generally socialize―and this fact alone may challenge our ability to identify reasonable expectations. The impact of chronic uncertainty can be subtle and insidious, and we may still be holding onto expectations that life will return to normal soon and/or we may expect more from ourselves than is reasonable given our circumstances. There is no doubt that the pandemic will end, but none of us knows when that will be and so it is important that we periodically reappraise our expectations and use our knowledge about well-being to make adjustments that will carry the day for us. Perhaps the hardest of all the adjustments we are making is the setting and resetting of expectations. The absence of old routines and schedules that used to help define our boundaries and our milestones can no longer be considered reliable. For now we might have to accept that we are not at the top of our game and we must have faith that we will return to personal and professional expectations that feel more like an old shoe than a departure from who we aspire to be.