1. Borger, Angela L.

Article Content

I sit here and write this in isolation. By now, there is not one of you reading this who has not been affected by the COVID-19 pandemic that has taken hold not only of the United States but also the world. Although this is published in July, I write this on a brisk April morning, as cases of the coronavirus continue to escalate. Daily, sometimes hourly, conversations occur about this epidemic and how it is to be handled. My hope is that, by the time you read this in July, this infection will be lessening and that "flattening of the curve" occurred before too much devastation has occurred. But I do not know. I have tried to remain well-informed but not obsessively guided. After several weeks of being, ahem, what I will call "heavily invested," I now try to limit my information gathering to a daily noon check of the Pennsylvania Department of Health website to see how my county is doing and listening to a little bit of news each night. Regardless, between my daily noon teleconferences at my work and text-message updates from well-meaning family and friends, I am still getting quite a bit of information daily about this epidemic. I am sure you can relate.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

This constant need to keep up-to-date was a bit overwhelming. There was an almost requirement of keeping current, only because the nature of this coronavirus pandemic moved at speeds that made staying apace difficult. Decisions that were made in real-time were often outdated in only a few hours or days. Decisions that may have been difficult to make at the time are now seen as reasonable and obvious. For example, I missed seeing many of you at our Dermatology Nurses' Association Convention in Denver, CO, in March. That this was rescheduled now seems blatantly clear, but if we can remember back to early March, I am sure the decision to postpone the conference was not as clear-cut. Thank you to Dermatology Nurses' Association for making these difficult decisions. The Convention was rescheduled for this month, July 2020, in Denver, and I am hopeful we get to see each other again soon. I guess time will tell, right?


All this uncertainty can be difficult. The changes associated with COVID-19 have been difficult on ourselves, on our family, on our practices, on our communities, and on our nation. We are grieving the loss of our former naivete. We know now what can happen and how bad it can get. However, I have seen extreme resiliency as a result of these changes. Families have developed a new routine, our practices have adapted as necessary, and our nation continues the best we can. People are both surviving and, in some cases, thriving. Has anyone reading this taken up a new hobby or dusted off old skills as a result of this situation? Has anyone reached out to family and friends more, with the intention of reconnecting and keeping in touch? I think many of us are using online teleconferencing platforms for work and office-based meetings. Well, I had the opportunity last night to have a "teleconference" with my three best friends from high school. These are three women I usually see in person a few times year, but given the current circumstances, we decided to have a happy hour of sorts online. Each with our drink of choice, we shared, caught up, and laughed for over 2 hours. Joining together in this way, we were able to connect and laugh; sometimes, we do not always have to actually be there in person to feel the love and support of long-standing friendships. Are any of you texting, calling, or writing more often to those you love and care about?


Connections are important during this time in that they can often ground us and remind of what is important. You, my dermatology friends and colleagues, are often who grounds and connects me. I have heard from many of you over the last few weeks, often with only a quick hello or inquiry to how I or my family are doing. From the bottom of my heart, thank you. Your inquiries have meant a great deal to me. I am thrilled to be with you, my dermatology companions, who are educated, passionate, and driven. Your commitment to providing care, even in this unique circumstance, is inspirational, and I am impressed with your flexibility and innovation when required. Like many of you, my office has turned to telehealth as a way to modify and adapt to the pandemic. We are doing office visits by both phone and video, and our patients have been receptive. I am glad to know we are able to offer visits in this manner because I know it helps to keep people safely in their homes, which hopefully in turn will help reduce the number of coronavirus cases.


Words like "redeployment" and "reassignment" are being discussed in my office, as I am sure they are in yours as well. If you get a chance, let me know how your nursing skills are being used differently during the response to the current coronavirus. I am interested to hear how our dermatology nurses have been supporting healthcare during this time.


Regardless of our connections, uncertainty can be overwhelming for some. The necessary tools of isolation, which are now required, can be uncomfortable for some. I reached out to a number of nursing friends to unofficially "poll" their first impressions of the current pandemic concerns. You can see their responses in the word cloud of Figure 1. You will, of course, notice the words you would associate with the coronavirus pandemic-COVID-19, masks, fear, nurses, ventilators, and PPE. But if you look more closely, you may also see words you did not necessarily think of at first-kindness, caring, hope, calm, creativity, faith, togetherness, and neighbor. It may be that, out of this horrible situation, one that has been relentless and characterized by death and loss, people are still able to see the positive and are reminded of the joy of living. We all need this reminder occasionally. The requisite stretching of ourselves, our skills, our resources, and our food can be challenging. It is my hope that you are all finding resiliency during this time. If you, like others, find that you falter, I hope you have someone to reach out to and connect with, but if anyone needs me, I invite you to connect with me, too. I would be more than happy to hear from any of you and would welcome an opportunity to talk to dermatology nurses during this time. Having a family, whether it is a biologic family, a work family, or a chosen family, is important. I am thrilled to have you all as my chosen dermatology family.

Figure 1 - Click to enlarge in new windowFIGURE 1. COVID-19 word cloud.

In 1910, Theodore Roosevelt gave a speech entitled "Citizenship in a Republic" (Theodore Roosevelt Center at Dickinson State University, n.d.). A small part of this speech has become known as "The Man in Arena." The passage states:


It is not the critic who counts; not the man who points out how the strong man stumbles or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows the great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.


Since then, when referring to someone who is actively participating in a situation that requires courage and skill, that person is referred to as "the man in the arena." My dermatology friends and colleagues, I know that you are all, in some small way, for this purpose considered "the man in the arena," and for that, I thank you and wish you all only the best. Wishing each of you safety during this difficult time.


As always, I am looking forward to hearing from you,


Angela L. Borger






Theodore Roosevelt Center at Dickinson State University. (n.d.). The man in the arena.[Context Link]