AT WAR

Every day on my way to high school, I would drive past the local Catholic hospital near my home. I had been in a few times but didn’t often stop to think about what went on inside. I mean, it’s full of sick people, but that’s all a hospital is, right? Then when the pandemic struck, I no longer drove past the hospital every day but would pass by occasionally with a slightly new sense of dread, and curiosity, at thoughts of the COVID-stricken world that must be inside. Phrases from the news like “hospitals overflowing” and “running out of respirators” came to mind, but I really had no picture of what this truly meant.

 

At the Wave After Wave lecture, I finally got a deeper sense of what this meant for those experiencing the full blow of the pandemic’s effects, health care providers. Having heard previous accounts of the grueling and emotionally tolling work of frontline workers during the thick of the pandemic, I did not expect to hear anything especially new from the panelists of this lecture. I was wrong. What had been missing from the endless news stories and previous accounts of pandemic-stricken hospital work was the deeply personal and emotional account- the storytelling that was truly the only way to help those of us not on the frontlines to understand the hurt and pain and utter exhaustion of treating patients during a pandemic. In her account of working as a physician during the beginning of the pandemic, Dr. Nicole Rae Van Buren described it as a “war,” beginning from her first realization of its potential destruction to the exhaustion she felt and wounds she took while on the battlefield.

 

As a member of her hospital’s bioethics committee, Van Buren was tasked with collaborating to create a revised visitation policy for the hospital, a job that required weighing the factors of patient, visitor, and worker safety while acknowledging families’ wishes to be with their loved ones. In the beginning of the pandemic, Van Buren recalled that the visitation policy was harsh; a vaccine had not been created yet, and scientists were trying to get an idea of just how dangerous the SARS-CoV-2 virus was, leading to the prohibition of visitors from the hospital. As a result, Van Buren was inundated with phone calls from family members who could not visit their ill loved ones, begging for information. As the outcomes of COVID-19 patients worsened, day after exhaustive day went by, and Van Buren continued to receive constant calls, her response became almost robotic: “Your loved one is dying... They’re not going to make it through COVID... No, you can’t come see them.” After having this conversation twenty to thirty times a day for six weeks, Van Buren finally got a call that took her to her breaking point. While Van Buren was speaking to a mother of young children whose husband was in the hospital, the woman detected the monotony of Van Buren’s voice and became distraught with anger. She unleashed her emotions, forcefully expressing her anger at Van Buren and the hospital and making Van Buren feel extremely guilty for this woman’s pain. After this, Van Buren broke down and backed out from working in the ward unit that she had been in for the past six weeks.

 

Van Buren also worked on the hospital’s triage crisis committee which involved deciphering a method of allocating scarce resources to be used in the event of having more patients than medical equipment could supply. This program used an algorithm to determine the recipients of medical equipment based on factors contributing to their ability to have the most fruitful outcome if they were given the equipment. The task of reducing patients to numbers in a spreadsheet was impersonal, but was a necessary step to prioritize them and work to save the most lives possible. Van Buren described the feeling of designing this program as being “weird to work so hard on something you hope you never have to use.” Fortunately, they did not need to use it. The closest she recalled her hospital to being in a situation of resource scarcity was when they were down to four ventilators; she got the “sickest feeling” in her stomach knowing that they would have needed to deprive patients of ventilators and prioritize others should they have run out.

 

The emotional toll that Van Buren and other physicians experienced during the COVID-19 surges and still today is consistent with the issue of physician burnout. Dr. Dike Drummond, physician and psychological coach for healthcare providers, describes burnout as “the constellation of symptoms that occur when your energy account has a negative balance over time,” specifically, a low physical, spiritual, and emotional energy (Drummond, 2015). In the everyday patient care setting, small traumatic experiences pile up to a state of burnout, such as how Van Buren’s difficult phone conversations piled up to compel her to leave work (Milleson, 2021). In Drummond’s words, the first law of physician burnout is, “You can’t give what you ain’t got.” With physician burnout being a clear negative state that exhibits itself primarily through personal physical, social, and emotional exhaustion, institutions seemed eager to put the burden of burnout on physicians themselves. Yet, as bioethicist Alex Dubov noted in a recent presentation on physician burnout, it is not a “personal issue” but, rather, a systemic one (Dubov, 2021). Van Buren recalled that, in response to physician complaints, institutions gave “a lot of lip service” and offered resources like yoga and meditation classes. Yet, as Dr. Cohn, bioethicist and co-presenter on the lecture panel, noted, these barren attempts at aiding physicians required time and energy to complete, which did not alleviate burnout. Instead, as discussed by Van Buren and Dubov, institutions need to take concrete steps to alleviate physician stress, such as giving time off work, hiring more workers, offering financial assistance, and ensuring employee access to basic necessities, including food, PPE, and scrubs.

 

While the COVID-19 pandemic wracked all our worlds, it truly struck those on the frontlines of the war, the health care workers. Yet, like any battle, it revealed our weaknesses-our chinks in the armor-not only on the personal, but on the systemic level. Let us recognize these and make concrete steps to take care of our toughest warriors who fight daily behind hospital walls- they deserve it.