Because I used to be a doctor and because many of my friends, colleagues, and clients are doctors and therapists, I have my finger on the pulse of what it’s been like to be a front-line Covid doctor or front-line mental health worker during a global pandemic. Those who are dealing with the physical and mental health consequences on the front lines are burned out, exhausted, demoralized, and now many of them are out sick with Covid, leaving the front lines largely untended.
On top of all of this, many front-line workers have been treated like pariahs, as if they were walking hosts of contagion because of their frequent exposures. Not only were their friends and families often scared of them, leaving them emotionally isolated or even shunned, they were also treated with the most egregious kind of disrespect and lack of empathy from the nearly half of the country who went the path of conspiracy theories, Covid denialism, anti-science, and fear or even hatred of conventional medicine and everyone involved in it. Every New Age spiritual bypasser, yoga teacher, alternative medicine practitioner, and agenda-driven doctor who claimed that doctors and nurses on the actual front lines were exaggerating, that Covid is just the flu, that case numbers are inflated, that the virus isn’t real, that those who care for their immune system can’t die- stuck a knife in the backs of these brave front line workers who risked everything because they took an oath that promised they would.
Like Vietnam vets who returned from the front lines and were met not with a hero’s victory parade for the risks they took and the courage it required to stay in the line of fire but with angry hippies who spit on them, our front line hospital workers are not getting adequately supported. Like shellshocked war veterans greeted by those who saw them as the enemy in their own country, front-line Covid workers have been celebrated by some Americans but treated mercilessly and without empathy for the traumas they endured by others. Hostile anti-vaxxers and anti-maskers now do the same thing to those who have been fighting the Covid pandemic, falsely accusing them of getting big payouts from Big Pharma, selling out to “The Man,” and trying to oppress people with their pro-vaccine messaging, all while they burn the candle at both ends trying to save lives.
Doctors, nurses, and mental health workers share something else in common with those demoralized Vietnam vets- “moral injury.”
What Is Moral Injury?
The term “moral injury” was first coined with regard to war veterans to describe the integrity breach and painful emotions that come from following orders and complying with a job that required you to violate your own ethics, as when you’re ordered to drop a bomb that you know will kill civilians.
Those who research burnout in health care workers have now adopted that term. Moral Injury is described by researchers as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”
My American friends on the front lines report a sense of helplessness and powerlessness. They know they could be doing a better job of serving the needs of patients and clients, only they feel hamstrung by a corrupt system that gives lip service to patient wellbeing but is ultimately in service to the financial bottom line, a health care system that is ripping apart at the seams. They know that a for-profit health care system is not capable of offering the healing patients and clients need, yet they have no idea how to offer their healing work differently in a way that offers health equity. Some feel tempted to leave the system altogether, hang out a shingle, and charge cash so they can get free of the for-profit insurance system, but that too feels unjust. Nobody I know wants their healing work to be a luxury good only affordable to the elites.
Harvard physicians Simon Talbot and Wendy Dean explain that “failing to consistently meet patients’ needs has a profound impact on physician well-being—this is the crux of consequent moral injury.”
Talbot and Dean write:
“Continually being caught between the Hippocratic oath, a decade of training, and the realities of making a profit from people at their sickest and most vulnerable is an untenable and unreasonable demand. Routinely experiencing the suffering, anguish, and loss of being unable to deliver the care that patients need is deeply painful. These routine, incessant betrayals of patient care and trust are examples of “death by a thousand cuts.” Any one of them, delivered alone, might heal. But repeated on a daily basis, they coalesce into the moral injury of health care.
Physicians are smart, tough, durable, resourceful people. If there was a way to MacGyver themselves out of this situation by working harder, smarter, or differently, they would have done it already. Many physicians contemplate leaving heath care altogether, but most do not for a variety of reasons: little cross-training for alternative careers, debt, and a commitment to their calling. And so they stay—wounded, disengaged, and increasingly hopeless.”
Those who are safe at home can lose touch with what’s happening in ICUs, ERs, and mental health hospitals. When Covid is surging, the decisions doctors must make are the stuff of nightmares. Who will get an ICU bed? Who will not? Who will get the limited medical attention available from a maxed-out staff? Who will wait in line at the door and die waiting? Who will get life-saving oxygen? Who will suffer when we run out? Who will get ousted from a bed because their future is deemed hopeless? Who will replace them in that bed? Who would have survived if only they’d been able to get treatment for non-Covid related conditions? Who matters more than someone else? Who should come to work wearing an N95 even if they are Covid positive- because if they don’t come to work, people will die. So many Sophie’s Choices, so much trauma, so many regrets.
The Mental Health Impact
It’s not just the doctors and nurses on the front lines of Covid who have been impacted. Psychiatrists and therapists are experiencing mental health crises themselves, as the impact of public health measures impacts the mental health of isolated elders, schoolchildren, and pretty much everyone who has been mostly at home for the past two years. My friends who are teachers (and my 16-year-old daughter) say kids aren’t doing so great. We lost one of the children in my daughter’s high school this week. The threat of substance abuse-related accidents, suicide, psychosis, depression, and anxiety is real. Those who had fragile mental health to begin with are worse, and many who were mentally stable have become destabilized because of the back-to-back traumas and isolation of the past two years.
Many mental health workers are quitting or getting taken off the front lines because they have Covid. Almost all are burned out and experiencing compassion fatigue. Every therapist I know has an overbooked practice with a waiting list, and because so many doctors and therapists are empaths to begin with, it’s overwhelming to read the emails and listen to the phone messages of desperate patients seeking emergency help, when they have no openings and don’t know anybody else they can refer those patients to. Our emergency backup systems are overloaded and those who need help are going unhelped, sometimes with tragic endings.
My colleague Jeffrey Rediger, MD, the medical director of Harvard’s McLean psychiatric hospital, said, “Those who work in mental health are facing burnout on top of burnout because of the unending pandemic and now the extreme contagiousness of the Omicron variant and its decimation of hospital staff. So many patients and outpatient clients are looking for mental health support and there’s just not enough help to meet the need. It’s heartbreaking to see children and adolescents spend days, even weeks, waiting on cots in emergency room corridors for psychiatric beds that don’t exist.”
Unlike many in the general population who run away, avert their eyes, spiritually bypass, avoid or otherwise turn away from suffering and pain, doctors, nurses, and therapists are wired to lean in and try to help. We find meaning in our work because sometimes, we can help, and it’s nourishing to be of service and ease suffering when someone is scared, vulnerable, and in pain. But we’re not so good at feeling helpless, powerless, and defenseless in the face of an invisible enemy we cannot beat, especially when we wrestle with feeling responsible for someone’s death, disability, or mental health crisis. Because we tend to take too much responsibility for the outcomes of our patients and clients, we may revel in every cure, but every patient we lose feels like a failure to us, and every failure can be demoralizing.
What You Can Do To Help Front Line Health Care Workers Heal
First, if you want to help those on the front lines suffer less, GET VACCINATED! Unless you have medical exemptions, get your booster so you’re less likely to wind up taking up one of the few open hospital beds.
Second, if you know anyone on the front lines of health care or mental health care and you’re resourced to do so, reach out. Think of what has helped you when you’re in crisis, and open your heart to showing up for them the way you might have felt helped when you were in crisis in the past. Maybe you can thank them sincerely for their service and their sacrifice. Bring casseroles over. Offer them a gift certificate for takeout or invite them to use your vacation home for a weekend. Volunteer child care so they can get a break. Offer money if you have extra, so they can afford to take a little time off and get away somewhere quiet and restorative. Check on those who have been on the front lines. Help them feel appreciated, safe, nurtured. If you’re all vaccinated, include them socially in restorative time with friends and family so they don’t feel so ostracized. Give them permission to talk about their experiences- and don’t turn away, even if it’s uncomfortable to hear how hard it was. Listen generously if you can. Open your heart. Tell them you’re so sorry for what they had to go through. Say, “I’m so glad you survived.” Make sure they know you mean it. If you have an offering that can help someone heal, offer a massage, an energy healing session, fresh flowers, and a card that expressed your care, a soak in your hot tub, or whatever might feel healing to someone burned out and exhausted from front line service.
I just spent the past two days with a friend who is a front-line Covid ER doctor in the midst of the latest surge. He treated 84 people in their cars recently because there were no beds in the ER. I invited him to come paint with me in my encaustic art studio. He had not made art since he was a child, but he took to the healing practice of art-making like his life depended upon it. I cooked him meals and put roses by the side of my guest bed and listened to how it’s been for him.
Heal The Healer At The Whole Health Medicine Institute
At the Whole Health Medicine Institute, we’re doing our part to help front-line health care and mental health care workers heal and thrive after two of the hardest years of most of their lives. Our graduates get certified to facilitate the Six Steps To Healing Yourself, but they also get to be the guinea pig of this healing work, practicing on each other and engaging in ongoing trauma healing recovery work themselves. One of the three pillars of this training program for physicians, nurses, and other health care providers is “HEAL THE HEALER.” We provide trauma recovery programs, train our students to learn and practice cutting-edge trauma healing modalities like Internal Family Systems (IFS) and the energy psychotherapy Advanced Integrative Therapy (AIT), as well as training to practice a trauma-informed approach to treating patients with life-threatening and chronic physical illnesses. We also bring practitioners together so they can share stories, feel safe, open up, be vulnerable, and feel less alone in the struggle to practice medicine inside a broken system, especially during a pandemic.
If you’re a health care provider or mental health worker in need of healing, we just opened enrollment for the Class of 2022, which will be 100% virtual because of our respect for those still battling the pandemic and our sensitivity to the risks of travel and in-person gatherings. Since our students are all over the world, we will be offering this year’s curriculum, including three virtual retreats, from the safety of Zoom.
Learn more and apply for the Whole Health Medicine Institute here.
If you’re not a health care provider but you’d like to fund scholarships for health care and mental health care providers who might not be able to afford the tuition fee, you can offer a tax-free donation to the scholarship fund here.
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