Artist: Kirk Robey, Golf Professional
We Still Have Hope
Do we stand a chance moving forward in the face of a strengthening pandemic? Can one person's experience prove a tipping point for us all?
In February 2021, I sat with a colleague who I had met just years ago. Back then he was eager, happy, jovial about work. His fresh energy and capable zeal was a breeze blowing the door open in my maturing years in medicine. He eagerly juggled the mania and madness of medicine’s good days and rare overly challenging days. He said, “Yes,” to everything asked and replied often with solid, “Will do.” This is part the fire of novelty and a sustainable love affair full of give and fair takes.
By February of 2021, he was a shortened measure and fragile shell of who I had a pleasurable breath with before. The exterior was a kind of hardened that seems also with the right pitch poised to shatter. He was edgy and exhaustion laid like a miserable fog. It was the volume, the sheer avalanche, the brutal emotional toll of stacked, repetitive and often unnaturally progressed conversations balancing loved one’s guilt, fear, loss, fatigue laden logic, during the blooming waves of COVID in 2020 that drained his face of a decade of promised vigor. The COVID pandemic thus cost him his vitality and sped up and decayed his interest and ability like a banana in the sun, leaving left of center the spark and the calling to medicine that lays like the Olympic torch the duration of a physicians career.
By February of 2021, he was beside himself and I sat across that rendition of him
“I need you to take some sick days. I need you to rest up and find your way away from the edge. I need you to see your own human limit spent because you’re better than this but also more is coming,” I asked of him as we visited the blood letting we just had in the first rounds of COVID surges.
He took my advice it to heart like a wise and mature leader would. He was not lost with disorientation or completely hopeless.
“I’m just tired,” was all the descriptor he could manage. Whereas The Physician Foundation survey found in 2020 8% of practices closed, translating into 16,000 offices and 4% more threatened to in the 12 months to follow, he was just surprised how spent he had become in only one year’s toil. 1
“Frankly,” I calculated, “you are exactly where you would be in 10 years of practice. You just arrived there violently in one turn of a year and two tours of COVID.”
COVID, under the modern microscope of information without discernment, social media with the power of swift tsunamis to give and amplify opinion regardless of peer review or authentication, and a decision making tree with seemingly heavier branches then a once well grown trunk can support makes for a kind of never before experienced task master whipping without reprieve the weight lifters of human prosperity and problem solving. We did not stand a chance to walk away from the first waves of the pandemic feeling remotely capable of new norms evolving or to reason our new roles in society as all right amongst no clear and complete turns of solutions.
In a world where we cannot support our wishes and thoughts with linear lines and have to compromise and qualify our certainty and expert execution for immediate gratification and relevance, the human body’s complexity, human poetic timeline, and the human capacity or incapacity rather that cannot catch up with the speed of wayward constructs of enemies like viruses, we did not stand a chance. Humans have not caught up with the disseminating technology it surrounds itself with and that technology is threatening to lessen our potential. What advantages we gain erode instantly with misuse of bandwidth, powers, and agendas to gain only a few marginal victories, against a virus in a society riddles with poor insight and, thus, poor judgement.
The last lines on any training review during residency is “Has good clinical judgement.” That scale moves over training to represent the totality of what thoughts and therefore actions we train to execute and collaborate on. Did you realize this qualifier has all but been supplanted by a hollow and poor substitute sold as information dissemination visa Internet?
We did not stand a chance.
We have but a chance; a chance to plug away knowing that time and sheer valor tells a tale paler and past tense in years to come. We have a chance to come out the other end and that is all the chance we need to keep working with what we have.
Did you know my esteem colleagues that you career aged rapidly this last 18 months? Did you see the trauma a now constant bedfellow? Do you know why you awake at the verge of another viral wave whether as high or more drawn out in different months of a never ending string of years evolving with an edge in your voice you cannot dampen?
We did not stand a chance at perfect. More now than ever we need to forgive ourselves and each other for the imperfections of being human and working with constraints that move and argue.
We are truly traumatized but we are not done and we are manifesting the very vigor in our nature to practice medicine even against feelings of impotence, betrayal, bitterness, uncertainty, and personal losses. We have no choice even if we did not stand a chance to take this chance before us now.
By July of 2021, he had taken 10 days off. Rested, he returned to the critical care unit he had trained 6 years to man and had previously practiced happily in for 7 years until COVID arrived. He returned for only 5 days and the census soared with COVID again. His wife warned him he had changed. His son wanted to know when he would be home to go to Target and buy Bakugan trading cards.
“Leave Daddy alone. I’ll take you,” his wife rescued the moment and gathered all the puzzled children. He sat feeling distant and ashamed about being relieved to have a reprieve. His personal joys slipped from him and he then awoke.
By that same July of 2021, we sat again together. He had not resurfaced as before and I was concerned he was permanently twisted.
“Something is wrong,” he sat across from me.
“It’s actually natural what has happened. It just happened too fast and too early. You are where you would be 10 years from now but by then you would logically be winding down accepting a steady burn of last fumes,” I reassured. “We are some place new. We must do something new. The bill is due for society and the bill is high. Physician shortage is real. Physician suicide is real. Leadership is clocking out at 5 pm and society has no idea what it thinks it wants and cannot speak intelligently of the magnitude of problems to solve at once. Leave it. We were always ephemeral. We just never knew it so starkly. Tread lightly from now on and expect to end of your professional clock earlier than your once self had assumed,” I reasoned.
Physician suicide rages like a fire. One recent study on five years of CDC date from 27 states estimates each year 119 doctors take their own lives; an entire medical school class wiped out. Other estimates place the number at 300. 2 Burn out is highest according to Medscapes survey with critical care (44% in 2020) and infectious diseases (45% in 2020). Rheumatologist likely dealing with long haul symptoms are have also high burn out rates ( 46% in 2020). 3
Women physicians have consistently reported higher percentages of burnout than men but this year the disparity was high with 15% more women than men expressing exhaustion resulting from additional pandemic duties taken as gratis. 3
But I am not here to tell you what you already have experienced to only leave you lost to ride another wave after wave trying to reconcile your worth in this war.
We DO stand a chance moving forward.
These days are not the death of us. They dare to change us in ways we must resist in novel ways of both rebuke and steadfast certainty that things do not work ways they do not work no matter how much the new world order wants it to or how much we used to do things that way before. We must see our trauma descending on us, bedding with us. We must use the trauma to tell us why we are right, wrong to be short, short on patience for the massive ignorance of a world wanting a virus to behave for convenience and lack of interest. We must rally not to be super human but to be fully human in an otherwise predetermined failure. We must decide that our trauma is something we integrate and mount.
“I know what I need to do to be in medicine with purpose,” he saw clearer. I felt him let go of some intangible things and slowly he returned before me the way we need our called to physicians to persist. Those tangible things we could declare truce, social compromise, and ownership not of burden but of our calling which burns still like an Olympic torch. It is the time of reconciliation of resources and reserves for our good and the good of the years of doctoring we must provide. It is time to learn to ride bulls better and measure our resiliency by seconds.