“I just want to go home, Dr. Hill,” Priscilla told me with tears in her eyes. “I know I may not quite be ready yet, but I am anxious to get past this and move on with my life.”
She had been in the hospital for more than two weeks and it was emotionally wearing her down. I was on duty the night she first came into the ER. A few hours after her arrival, Priscilla looked at me sincerely and asked if she was going to be OK. She had many COVID-19 symptoms despite receiving a negative test result earlier that same day from a drive-through screening center. I told her we were in this together. In a matter of 36 hours, she went from stable, breathing well on her own to the ICU on a ventilator.
Priscilla teetered on survival in the days that followed. At first, her lungs worsened. Despite the ventilator’s support, day by agonizing day she deteriorated. Then, suddenly, she rallied. A few days after her remarkable turnaround, she was able to come off the ventilator. She began regaining her strength and earlier optimism. Then, unexpectedly, she had a setback and her weakened lungs needed the ventilator’s support once again.
During the next three days on the ventilator, her lungs once again made steady, measurable progress ,and soon she no longer needed the ventilator. Everyone involved became cautiously optimistic that she had turned the corner for good. All the hospital staff celebrated with her, walked a little lighter, smiled more to each other, shared in her success. It was Pricilla’s victory, but it was ours as well.
Outside the hospital, people are tentatively recovering from the long night of the coronavirus nightmare: getting back to work, heading to the beach or mountains on the weekend, talking to neighbors rather than avoiding them. We all want the same thing Pricilla wants: to go back to the way things were, to return to normal, to move on with life. But there may be a “new normal” for the foreseeable future, a cautiousness at churches, in sports arenas, at schools, and on airplanes regardless of how loudly protestors clamor to eliminate restrictions or how quickly government officials drop them.
Priscilla and her family for a while may observe stay at home directives, follow social distance suggestions, wash their hands regularly regardless of government requirements. They’ve seen COVID-19 too directly, too personally to ignore it’s haughty power. Her neighbors, friends, and attending healthcare workers may not be as loud as the protestors because their battle may not be over with the disease. Given the long incubation period of the coronavirus, none of them know if they will be next in the ICU, hooked up to a ventilator, fighting for their lives.
This global pandemic with its ever changing rules threatens every frontline healthcare worker to a point where some of us may never fully recover. A couple of weeks ago, an experienced New York City ER doctor committed suicide after toiling for weeks to save as many lives as possible. Scarce supplies and protective equipment, a harsh medical climate, and something called “moral injury” likely all played a part in Dr. Lorna Breen’s decision to give up the fight.
Hundreds of thousands of healthcare providers can relate to Dr. Breen. She was not burned out. She was morally wounded. She was asked one time too many to ration resources for dying patients while continually putting herself, her family, and her co-workers in harm's way.
Moral injury is a wound to the soul that affects healthcare workers' consciences and relationships with friends, family, and society. I first read about it in an article written by two physicians, Simon Talbot and Wendy Dean. It was a mental game changer for me. I recognized its effects on my own psyche, on co-workers, and on friends I care about. It gave a name to our disquiet.
Moral injury is not confined to physicians. Nurses, paramedics, respiratory therapists, LPNs, pharmacists, advance care providers, and non-clinical staff can suffer in a climate of high stress, uncertain or rapidly changing protocols and isolation from their families amplified during times such as this current COVID-19 pandemic.
“As ER nurses we are built to be tough and critically think through anything. The biggest difference for me right now at home and at work is questioning if I did everything right. Did I do everything I was supposed to do to protect myself, my patients, my work family, and my kids at home? I’m confident in my skills. I’ve been doing this for 13 years. I’ve never questioned my skills before, and now it’s the simple act of gowning up and off with each risk of exposure that I falter,” said Jessica Waycaster, a local RN.
Some of those most at-risk providers in a hospital during the current pandemic are respiratory therapists. Treating patients in a COVID-specific ICU today is like stepping onto another planet. There are no families present, IV pumps are placed in hallways to allow adjustment without entry to the room, and RTs enter each room knowing the patient has a highly contagious, serious disease. Getting assigned to a COVID ICU can feel like being asked to sweep for mines in a field with a blindfold: you’re not quite sure if there is a mine or not and you must feel your way more by instinct than by sight.
“Before the COVID pandemic, my job was more routine. I simply helped people who had difficulty breathing. Now, every time I put on my scrubs, I carry so much responsibility for my co-workers and my patients that my shoulders feel weighted with bricks. I don’t like wondering if this will be the day I inadvertently make a wrong decision and carry this virus to another coworker, patient, or my family,” said Angela Hayes, a local respiratory therapist.
Some frontline workers face increased isolation even as they struggle with decreased hours and compensation, all while fighting an ever present invisible threat. Again, this type of uncertainty isn’t new, but magnified during a pandemic where they now have to face the fear of a second wave of infections.
“A lot of the time we don’t know if a patient has a contagious infection like meningitis, or is an overdose victim with used needles in their clothes, or a gunshot victim that could bring more violence into the hospital. We worry about the growing pandemic and constant daily exposure that eventually adds up. But constant exposure to unidentified risks — knowingly or not — are always there,” Graycen Clark, another local RN, said.
Facing the future with courage and fortitude in the face of uncertainty is what defines us. But like any injury, it takes time and the right medicine to heal. Priscilla’s personal recovery offers so much hope. Many aspects of national recovery seem well within reach. But only if we are willing to continue to put the general interest above our own personal interests.
The first day that I drove in early to have some extra time to see Priscilia, dozens of community members lined the street near the hospital with homemade signs thanking healthcare workers. The nationwide effort to thank healthcare workers had spread to East Tennessee.
In the coming days, more supporters with more homemade signs thanking healthcare workers showed up on the street near the hospital. Their homemade signs and encouragement helped me think that maybe we can replace vitriol and anger with support and inspiration. Even as we fight the pandemic with everything we’ve got, maybe it can help heal us. Maybe things don’t have to go back to the way they were. Maybe they can be better.
These weeks of isolation in our country have amplified fears and threatened too many lives.
Without the right support, isolation can make normal tasks difficult and any adversity seem intolerable. But together, at home or as government restrictions ease, we can recognize we are all essential and all bound together: adept healers, anxious sufferers, and appreciative supporters.