The other day, I received my vaccine against COVID-19 – a novel mRNA vaccine that will without hyperbole likely someday prove to be one of the greatest achievements in human history. As I look at social media, I see a deluge of my colleagues posting selfies or photos of themselves receiving the vaccine. Many of them describe the relief, the liberation of burden, and the tears of joy they felt as they got injected with liquid hope. A few hours after my shot, I felt a noticeable muscle pain in my arm. But I can tell you, the pain felt good. I actually relished the pain. It represented the beginning of the end of this shit show.
Back in March, at the start of the surge, I can remember the first time I intubated a COVID patient. The donning and doffing of my personal protective equipment was done with simultaneous trepidation and exactitude as if I were defusing a dirty bomb.
As the outbreak escalated, true fear engulfed the hospital. One evening as I was arriving for an overnight shift in the ICU during the initial rise of COVID in Los Angeles, I passed a weary looking ER nurse in the parking lot about to start his shift. He had the look of fear in his eyes. I offered a perfunctory “How you doing?” He glanced at me and spoke with a crack in his voice. He told me he just heard today that two of his nursing school buddies had died from COVID infections in New York City. His friends didn’t have access to quality PPE and it was thought they got sick at work. “Crap- that sucks” was all I could think to say. I readjusted my N95 mask and approached the hospital temperature checkpoint with a reinforced feeling as if I was being sent off to war.
The reality is when a patient dies you feel bad, but when a colleague dies you feel scared. Over the course of the pandemic, something like 1700 healthcare workers have died from COVID. That’s what makes this whole pandemic different for frontline workers. We’ve never encountered anything like this before. Sure dealing with overwhelming death, human suffering, lack of resources, and a public that doesn’t seem to care really sucks. But what sucks even more is risking your life while doing all that.
What exacerbates healthcare workers predicament, even compared to most everyone else in society, is we are traditionally not good at choosing between our own health and the health of our patients. The natural instinct of a typical healthcare worker is to run to help their patient when they are in need.
One time I was summoned to the ICU to intubate two COVID patients back-to-back. The first intubation went smoothly, and since the second procedure wasn’t a dire emergency, I took a quick moment to go grab a drink of water. When I returned to the ICU, all of my protective equipment was gone- no one could find it. Someone had inadvertently taken it. I had nothing available to protect me for the second intubation.
I had a resident doctor with me and decided to use this as a teachable moment. I asked him, “If this lady suddenly needed an emergency intubation and she was about to code and we don’t have our PPE, what do you think we should do?” He said, “maybe you could just go in with a regular mask, or borrow an N95 mask, or even try to move quickly and hold your breath during the procedure.” I was impressed with his dedication to the patient. Then I confidently told him what I thought was the best answer- “Let her die.”
Anyone here who risks their own life for their patient’s life might be a hero, but is also stupid. Sounds harsh I know. At the beginning of the pandemic, many nurses, doctors, and others paid with their lives because they couldn’t quickly enough suppress their instinct to help others before themselves. Frankly many of them didn’t have access to the PPE or didn’t take the extra time needed to protect themselves and were effectively sacrificed. I still remember the lesson I learned from my lifeguard training at age 16: If a drowning victim panics and grabs onto you and starts to jump on top of you, pulling you underwater, you must push them off, and swim away. Only then can you try to save them from a distance. If they then drown, they drown. Don’t let them take you with them. You must choose yourself first.
The buried rage healthcare workers carry comes from now having to make that choice within the halls of the hospital.
The most difficult facet of the pandemic for healthcare workers has been balancing these choices. Each time I take care of a patient, either diagnosed with COVID or not, I am taking a risk with myself and indirectly with everyone I know. What risks are reasonable to take? What risks are too perilous ? This constant battle in our own minds has worn us all out and regretfully has affected how we sometimes perceive our patients.
You see, when you show up to hospital with COVID, if we are honest, in some ways we kind of hate you. You’re the drowning victim that is trying to push us under the water. We hate that someone has entered our lives that could, if things went bad, make our kids lose their parent. Even the idea of that immediately withers our empathy. As we do our best to help you, we also harbor a simmering rage toward your disease that we don’t know what do with.
When I newly round in the ICU, I unconsciously scan for the patient that might quietly satisfy my subconscious hope for schadenfreude. Where is that COVID denier who went to a party with no mask and is now suffering the consequences? I imagine saying, “See we told you, but you didn’t listen and hear you go…hope you make it.” Morbid I know, but without even knowing I look for a target on to which I can release my buried rage. But inevitably, as I look around the ICU, it is not filled with patients that satisfy my revenge fantasies. I see the poor Mexican immigrant who got infected at his factory job that had inadequate PPE. Then I see his wife and father-in-law who live with him and followed him to the ICU two days after he arrived. I see the nursing home resident who has long been close to death, that quietly seems to have been discarded, suffering at the end of a long life, alone. And I see the young man who has no idea how he contracted COVID, but is morbidly obese staring at the wall with constant fear. It is hard to direct rage toward these folks. So my rage remains buried.
Two days before I was scheduled to get my vaccine, I got a phone call from the ICU I was covering, that I needed to intubate an 85 year old guy with COVID. My first feeling after hanging up the phone was anger. Anger at the old guy with COVID for needing an intubation- an old guy who would probably die. Anger for making me take a risk right before I would get my vaccine. What if during this last intubation I somehow contracted COVID and then passed it on to my family and friends? As I entered the room and really saw him, I instantly knew he was not going survive this illness. These were his last moments on earth without sedation. He was drowning in his own breath. He had multiple failing organs. I am glad to say, my anger immediately evaporated. I no longer saw a COVID patient who was putting me at risk, but a man, who had a whole life story to tell, a life that was abruptly coming to end. I touched him on the shoulder as I looked into his eyes, pushed the medicine to make him sleep so I could place a tube in his throat and said “I am going to let you rest now.” He died the next morning.
For the last year, just about everyone in healthcare has had these conflicted feelings–a constant seesaw of anger and resentment mixed with true sympathy and love. It is a weird feeling to fear the person you want to help.
But if we are honest, we as healthcare workers understand how hard it can be to maintain these precautions. ICU workers go directly from treating COVID patients to break rooms. Inside we eat snacks without masks, joke and laugh- everything we say not to do. I’ve gone to those breakrooms. And those breakrooms have led to outbreaks. We fail- again and again.
I think, as humans, during this pandemic we have always been destined to fail at socially distancing and wearing masks. It seems doable, but over time it is really hard. We may be super careful at the supermarket around strangers, but are less so at work or with our family. Remember these are the people we love, not the people who hurt us. But the highest risk for contracting COVID is probably in your own home from your own family and friends. But who cannot understand the husband who may not want to wear a mask and socially distance from his wife who just returned from a high risk activity? Potential death versus facing the wrath of treating your wife like a pariah? Those are no doubt equivalent bad choices.
It isn’t really people’s failure to always wear masks nor consistently socially distance that has fostered my pandemic rage. My anger is charged by stories of those who call COVID a hoax, or refuse to experience even the most simple of inconveniences, such a wearing a mask in public spaces. It’s not failure but rather open indifference that has fueled the brewing often silent resentment of healthcare workers.
The vaccine presents an opportunity to exorcise that buried rage. That is why we take selfies of us getting a shot. It is the start of our emancipation from the bonds of this plague. As we mitigate our own fear, we can finally let go of this resentment, this rage, and return to the empathetic caregivers we all once were.
As the hospitals fill up and death explodes around us all during this holiday surge, I can say that it is starting to feel different than it did March. And although the next few months are going to be terrible, draining, and probably bruise my soul, I feel like I have been injected with optimism. My rage is gone. Bring on the second shot.
You touched my soul with your beautiful words! I am 67 and have been a nurse all my life! I too was scared and angry that people are so ignorant, that they would put themselves and other people in harm’s way. I retired in June and a part of me feels guilty because I’m not out there with my friends and co-workers to help fight this disease. But I’m part relieved I am not working and putting me or my loved ones in danger! You are a wonderful caring person, and I thank you for your service and dedication.
First off- be glad you’re retired. You put in your work. Even just supporting your colleagues goes a long way. Thanks for the kind words
I retired 18 months before I planned on retiring and I am in my 60s. My husband has co-morbidities that would make him likely get a very severe case of covid if I brought it home from work. I am happy with my choice!
I am not sure how I stumbled across this post but something tells me a higher power wanted me to read this. I’m a nobody and have been unemployed because of this pandemic. I’m definitely one that has not wanted to wear mask and wasn’t sure if codified 19 was even real since I personally have not met anyone that had had it. The one thing I’ve wanted to do ever since this pandemic started was to visit a hospital and see for myself if the stories were true. After reading this post to the very end and also many many more reply’s from nurses and retirees. I now have a very good perspective that I have been a very ignorant asshole every time I made a comment like I personally don’t know anyone that has gotten this disease. After reading these post it’s come to my attention thst I am very freaking lucky I don’t know anyone that has covid 19! I can also say that I am also upset this whole thing has taken the lives of people that solely wake up in the morning to go to work and help others. People that are 100% opposite to being selfish. There sole purpose was to help others and this thing took there life after they have done everything right on this earth being selfless helping others. It would be impossible for someone to make up all these post and replies. I know that these are real and all I can say from the very bottom of my heart is you have opened my eyes and from now on. I am going to do my part and then sum. It takes a special person to be selfless and I need more of acting like that in my life. I can see that most people that have written in here are in the medical field in some way or another. Including family members of someone in the medical field in some way or another. I definitely do not fit into that mold at all and am being honest when I wrote that I didn’t understand how I came to start reading these post. I do believe in a higher power abs I am not 100% sure what that higher power is but I know there is one out there. I truly believe all your prayers and hurt feeling over the course of this pandemic has pushed me towards reading from people that are on the front lines and I truly thank you and there’s no doubt you are the true hero’s even though it doesn’t seem that way at times. Take it from a guy that wasn’t sure about all this. All it takes is for people to be shown the truth and let them see what’s behind the curtain so they can have some empathy for what others are going through abs suffering from. I wish I could take sone of this frustration off your shoulders, but after reading this I’ve learned that I can be apart of helping and that’s simply just doing my part. When this all first started I can honestly say I wasn’t on board and the only reason I have been wearing a mask is because It’s required. All I needed was to hear from the horses mouth if I may. That’s all it took from me. So the next time anyone has a problem with you guys and they know nothing like I feel I use to be like. Please just direct them to these post. If it opened my eyes than it’s gotta open more eyes. I will also do the same so others that aren’t on board can also be educated by the front line workers. Thank you again abs God bless you all.
Wow- that means a lot to hear that. Thank you. Stay safe. I really think we are about to round a corner, but the most dangerous time will be the next few months. Then hopefully we can back to curing the health of the economy. Thank you
Thank you for your honesty and well written essay. You probably just saved countless lives. And thank you for honoring the selfless medical profession. Bless your message… it will help to negate conspiracy theorists who question the reality of covid 19 and motivate antimaskers to mask
💞🙏
I love that you have grown and kept an open mind and have learned from others’ experiences and can now change. That is beautiful and to be commended!
I’m a 72 yo RN working as an Administrator of an OBGYN Emergency group. Little exposure for me, BUT do not diminish to work you can do by educating everyone you know about how to be safe – but just the facts. So much misinformation, politics with a shocking disregard for the damage it causes. A POWERFUL and HONEST look inward in this posting – my 77yo physician husband is still working with office and hospitalized patients who have Covid, but not only Covid. We both participated in the Pfizer trial. He got vaccine, I got placebo. I felt some of the same relief knowing my husband had a level of protection and selfishly, that he was unlikely to bring it home to me.
Stay on that soapbox of how to remain sane but safe. My face mask now has vaccine onboard written on it. Dose one on Monday.
Thank you so much for this I have been feeling like I am suffering alone. I’m an icu rn during these times and has been extremely rough can’t sleep cry often anger and rage arguing with antimaskers calling me a Liar it’s a hoax ect. I actually had someone from social media screen shot my interaction with them regarding their stupid comments “everyone dies get over it” well I snapped and raged on her for being ignorant ect. This person actually took screenshots of our interaction and found my BOSS AND SHOWED HER. I WAS EVEN MORE ENRAGED NOW THIS FOOL IS TRYING TO GET ME FIRED!!!! AS I PUT MY LIFE ON THE LINE DURING HOLIDAYS NOT SEEING MY OWN KIDS. I HAVE HAD ENOUGH. I DONT WANT TO BE A NURSE ANYMORE. 20 years in. And I feel done exhausted left out to dry and die and no one cares. No one. Us nurses are taking a beating all the way around.
Well, for one thing, you are definitely not alone. It is tough to get metaphorically kicked in the face and then ask to stand up and help someone in need. Take a moment to care for yourself first. You will get through this.
Sending 💞🙏
This happened to me too!!! I almost got fired for arguing with a stranger on fb. He called the compliance line for my hospital’s corporate overlord. I have a good manager who stuck up for me ❤ But I also am not so sure I want to be a nurse anymore. almost 10 years in, and I was in a DNP program. I dropped out and am evaluating other career options.
Please do not give up, you are all we got. Close your ears to the ignorant people, try not to give them your precious energy. Try to see yourself as super-people with a higher cause, “love and good” must win, not our common enemy “hate and greed”. You are fighting a virus “covid” let the rest of us fight the other virus “ignorance “, together we are strong. I am just a regular person, an admirer of all of you and all you do. Please keep the eyes on the ball, let me be the one fighting on facebook. We are and will forever be in debt to you. I can not for a millisecond understand or put myself in your shoes but I do know that I look at you as heroes, our saviors, our glimpse of hope. I am among the majority and we love, admire, appreciate everything you do, we see the sacrifices you have to make, we understand the emotional toll you have to endure daily. You have our support, we are right here sharing you all on. THANK YOU, words will never be enough for the appreciation we feel for you all. 🙏
Thanks for the kind words. All the healthcare workers can use them now.
I Thank you for your dedication, and service. I feel for you. My son is an EKG moniter. He doesn’t even have contact with patients. However, he gets harassed everytime he goes to the store/gas station in his scrubs. I’ll pray for you and the Frontline workers.
Thank your son for his work. Everyone has been working hard- I think harder than they even give themselves credit. Funny- I don’t wear my scrubs to the store because I thought I would get the same reaction.
Bless him 💞🙏😘
I wholeheartedly agree! I am currently on day 14, hospitalized with COVID-19. If I get up to go to the bathroom, my sets drop into the low 80s on 10 L of O2. I can manage 3 to 4 L at rest, but I can’t lay down. Not flat. I have an exploding headache. I am exhausted. I am the breadwinner in my family, so worried about how I’m gonna pay my bills in the next few months. I was on a travel assignment in Colorado with the DOC. They needed staffing help. At first, they did not even want to test Agency nurse for Covid and said we were on our own. They did not fit Agency nurse is for N 95s.
Like many of us, I am the nurse that always goes above and beyond regardless of someone’s situation. I had to use the same PPE gown when I was passing medication’s to quarantine patients. I flew home to help my husband through surgery, a week later, I was sick. Someone actually said to me “that’s what you get for getting on an airplane“. I have never been so infuriated, hurt and angry! I pray that I get through this, but right now I am so sad and depressed over all of this Going to sleep and not waking up sounds so inviting!
God bless all of you! You’re so strong! We can do this together!
Hang in there. You’ll get through this and get better. It looks dark now, but it will pass. Just know that so many folks understand the risks you took and the price you now paying. But you will get through this- so dig deep for strength.
You seem unstable. Perhaps you should retire.
Perhaps…
I don’t believe that you are a doctor, but if you are, you shouldn’t be. Why post destructive comments on a thread like this? This doctor is sharing his humanity and shows courage through humility.
He doesn’t. He seems smart and resourceful and resilient. He is exactly the type of doctor I would want to care for me.
“a doctor”. Your comment lacks class and shows poor judgement. If you are actually a physician I recommend retirement.
Signed,
A better doctor than you
Thank you so much for sharing your story. Many of us are tired and feel this way. I did over 80 hours last week. This week is going to entail even more hours. I received my vaccine this morning and I’m tired achy and miss my kids and husband. We have just begun the battle…the war is yet to come with Christmas holidays and shopping going in effect full force. For all those that don’t believe in the vaccine , please pause and look around. We healthcare workers are living proof.
Thanks for the words. Hang in there. We will get through this.
Amen I can’t wait for my Injection also and bless all the health Worker’s that put their life on the line for all of us
Hi Chris,
I have to say that I was waiting for your post. You express the situation that Covid caregivers are dealing with and the conflicting emotions that your coworkers are feeling with such clarity.
I retired from my critical care pharmacist job at Cedars 3 yrs ago working weekends on 6/7 SCCT. We worked together on many of those weekends. I have had you all in my thoughts everyday since this pandemic started. I’m so concerned and angry for my coworkers in the ICUs. Everything you wrote rings painfully true. Thank you for ability to speak for those who can’t articulate the feelings you’ve expressed. And thank you for the work you continue to do. I have so much respect for you.
Thank you,
Patty Craychee PharmD
Thanks you so much for your kind words. I remember our weekends together on the unit. We will all get through this
Fantastic piece of writing that cuts deep… it’s hard to suppress the tears as I read this. I shared this piece yesterday after getting my first vaccine injection and have had such a strong outpouring of appreciation for what you’ve written. I’m curious Chris, what do you see as the next steps we need to take as healthcare workers to begin the healing process? I think acknowledging these negative emotions is the first step, but I want to be hopeful that I’ll be able to have the same type of optimism and empathy that brought me to medicine in the first place. I feel like we need a12 step program for healthcare workers to help us find community and share our passion in a safe setting. I think writing and personal reflection is a great place to start so thanks for doing your part.
Oh there will definitely be some PTSD for us all. But I think it has been a bit taboo to talk about how angry you can be at your patients (even if their situation is not their fault). I think we all need to realize that feeling that way is not a failure- it’s normal. We are all in the same boat (some of us are just in the flooded engine room). When empathy dissolves, you are burned out- Ive had that happen to me once even before COVID. The good news is, it can return. So maybe that will bring you some optimism. Hang in there. Thanks for reading.
ENT doc here. Docs in Asia still remember watching their patients suffocate to death from SARS a decade ago as they ran out of vents so they took this for around a lot more seriously. Sadly we will be the same. For many of us masks will be a way of life forever. I feel naked now when I leave my house without one. Thanks for the personal reflections we’ve all felt those emotions. Even worse in small towns in rural America where there is actually violence and abuse directed toward doctors and medical professionals who are advocating masks. I think we both know what I’m taking about. There people are slowly slitting their wrists and don’t even know it. I mean it makes me angry … but also sad at the same time.
This is so honest and raw. Thank you for sharing. I appreciated every word. I work with surgical patients, hours or days prior to their surgeries. I contracted COVID in July. My hospital received 1000 vaccines and I was in the 1st tier to revive my vaccine, but I was turned away while in line to receive my vaccine because I was COVID positive over 5 months ago. I understand there has to be an algorithm to administer these precious doses that were allocated to us, but there isn’t enough evidence to show how long the antibodies last or to what extent past the infection the antibodies help us from reinfection. I’m getting an antibody test in 4 days when everything opens back up after the holidays to see if I even have antibodies and I’m scouring my local pharmacies and health department to see if I can receive my vaccine elsewhere as a healthcare provider. I feel left out to dry and abandoned. Would anyone else feel the same? But, all I can do is take care of myself and find it somewhere else.
Wow- that is not great. You’ll probably be OK, but your right- your antibody status could depend on how sick you got with COVID when you had it. (or not). Hopefully when your hospital gets another shipmen, you can convince them with enough complaining that you are still high risk. Good luck.
😘🙏💞
You literally struck every cord of my being . Thank you for posting what we all feel.
Thanks for reading
Thank you for your honest words. I recently told my friend that I just want this to be over so I can stop hating people. I feel better knowing I am not alone in my feelings.
You are not alone.
The creation of priority lists among health care personnel is creating massive anger and resentment. Is there any science showing that ICU personnel deserve the vaccine before outpatient physicians and staff? I see outpatients daily in my allergy clinic. The only screening is a temperature check when they first enter our clinic. I wear only a paper mask. What is the risk that I get infected versus ICU staff in full PPE? Luckily our county health department asked all physicians to come in together and made no attempt to stratify risk of Covid-19 infection. It was first come first serve. There was no anger or resentment among physicians. However, i heard that Stanford decided to put staff before residents. Our residents were treated just like any other physician. There should be no elitism among physicians or other staff.
Thanks for reading. I think your tales of resentment among healthcare workers is prophetic for what will soon occur in the general population. I wish I could say that folks are giving the vaccine to ICU doctors, nurses and staff first because they believe those people are higher risk and they want to protect them, but if you think about it that is not the reason on any level. The reason is solely because as a healthcare system we cannot afford to have these particular healthcare workers all call in sick. Right now if I asymptomatically test positive for COVID, I would be out for 7-10 days. If that happened to a bunch of staff at once, there is no one to replace them. Then you would have to recruit people who have never stepped in an ICU taking care of these patients- that happened in some hospitals in NYC and led to massive increased mortality-despite their best intentions and tremendous efforts. Also I think you are correct. I think being in the hospital ICU in full PPE is less risk for the provider than an outpatient clinic- especially now with an increasing prevalence of COVID. I would buy yourself an N95 for the next month or so- as COVID is truly exploding- and stay safe.
Thank you for a beautiful piece of writing. Like one of the previous commenters I was moved to tears by the honesty and genuine emotion. No amount of thanks seems adequate for the work you do.
Thanks so much for reading
I am a retired NP who worked through part of the HIV/AIDS epidemic ( 1990-2012) and I can more than imagine your anger , fear and frustration. The pandemic you fight is so much more risky than the one we endured. I give you so much credit ,respect , support and gratitude for the risk you are taking every day when you treat your patients. I have said to others that if I were still working I would just be furious and resentful to have care for those people who refused to comply with CDC recommended behaviors to help prevent transmission. I have wondered if I could even do it. I am so glad there are doctors and nurses like you who are caring empathically for these patients. This whole country owes you a huge depth of gratitude to you and your family that watches you walk out that door every day to care for our people whether they deserve it or not. Please do not give up. We need you. I am so glad you got your first vaccination and pray for your safety.
Thank you!
thanks. And stay safe yourself.
Thank you for your post. It touched so many points.
I am a pediatric sub-specialist in an outpatient setting, mainly. I am happy to carry on my mission to take care of my patients at this time. I am old enough that many of my cohorts are beginning to retire and I am financially comfortable for old life that I could retire. I work to take care of the patients, as there is a shortage of my folks in my sub-specialty, and to support my junior partner with the work and expenses of running an office, until we can find a replacement physician for me.
What infuriates me are the parents who don’t feel that they need to protect me from their potentially infectious children as I risk my life and my family’s life to take care of their child(ren) I sit approximately 1.5 feet away from their faces. The children who are less than 2 don’t wear a mask and sometimes will scream right in my face. The older, developmentally disabled children sometimes won’t wear a mask and often will also scream in my face. Many children have ill-fitting masks that slide down their noses constantly. Many adults have ill-fitting masks also. One parent complained to my front office staff because I kept adjusting the child’s mask to cover their nose. Another parent complained to the front office staff that if I wasn’t willing to take risks I shouldn’t be doing this- after she told them that she wanted to physically harm me.
It is difficult to use my instruments with a face shield or goggles.
I will always take care of my patients. I have been in medicine for 36 years. I have put my patients ahead of my family way more than I probably should have over the years. The indifference of some families to my health, and the health of my office staff demoralizes me and makes me reconsider retirement.
I received the vaccine 12/23/20. I was so excited! That was the most relief and joy I have felt in many, many months.
Wow-that pretty much summarizes it. People can be really disappointing sometimes. I try to make myself believe it is because they just don’t understand- maybe.. maybe not. Stay safe. Try not to punch any parents either… cause I might of I was in your shoes.
I read your words who speak for most all of us. Btw, I had to remove myself from social media. How could these people I’ve known and loved de-bunk my daily pain and horror? I cried with relief when I received my Pfizer shot. See you on the other side of this pandemic, colleague.
See ya on the other side…
Thanks for writing this, and thanks to those who publish it. I am so fed up with all that you have described PLUS the often repeated articles saying how since medical professionals know how to stay safe, they should NOT be on the high priority vaccine list. Your article should be required reading for them.
Great article that speaks volumes. Thanks for your realistic tone. Thanks for your optimism. Thanks for your perseverance!
ER doctor here..Wow- you so eloquently described the daily experience of treating covid patients. Early on it seemed easier to compartmentalize- those with covid , who might kill us, and those without. Lately as things have escalated, I now feel like /assume everyone has it, and despite wearing full PPE I can’t help but count the seconds I spend with each patient and wonder if my respirator is properly seated, and wondering how long I have in the room before my mask is overwhelmed (there must be a limit?) sometimes it’s so overwhelming I can’t really remember a thing that the patient tells me. Eventually a combination of the triage note and a host of superfluous CTs and labs gives me the information that I used to be able to get from a 5-10 minute bedside exam. If nothing else I hope the vaccine will allow us to again spend more time connecting with and helping our patients.
Thats my hope too. It’s hard to care for others while you need to care for yourself first.
Serving in the military and as a surgeon, maybe putting others first seems obvious or natural. I also have a strong faith in Christ so I’ve had none of the feelings of anger, rage or offense you describe in this article. Even though I’ve done multiple endoscopic procedures and tracheostomy procedure on covid positive patients without ideal PPE? I Truly dont relate or understand your feels? It seems like a ton of negative wasted energy?
This is just one more challenge we face. Not to sound callous, but almost 8K people die every day in this country of all different factors and causes.? I also have a pretty logical mind and understanding my actual risks as a 45 year old, healthy person (I dont know the age or health of the author). I’m also skeptical if not flat our annoyed at those that view masks as the fools proof solution to this pandemic. The arrogance and confidence of this tenant is almost offensive (take about a God Complex)?
The emperic science is suspect. If it was overwhelming the WHO and CDC wouldn’t have needed to change their recommendations on mask use by the general public mid stream earlier this year. Its laughable frankly how polarizing mask use has become. I wear one not because I think they do much good other than to help put those I’m working with at ease.
I’ve read about 40 articles on the topic and pretty much all the articles that recommend their use are theoretical and would be considered level 4 evidence at best for therapeutic intervention. Additionally mask mandates and use appear to have no correlation with actual infectious growth and propagation within a community (ditto for lockdowns).
I was personally offered the vaccine last week given my position in the hospital working in the emergency department on call. I declined. I think it makes a lot more sense to give it to elderly and infirm first.
A little less anger, judgement and condescension about you patients will probably make you a much happier, healthy and effective doctor.
Hey thanks for the note. Glad to hear you have gotten through this without having these feelings. You’re probably correct- less anger would be better. I agree evidence is not conclusive on a lot of stuff with COVID, but you need to take a risk/benefit approach I think. Less viral load probably means less serious disease for some. I’m 45 too. I’ve seen people similar to me die. And I’ve seen a lot more people, go through just an awful medical course that they will never forget. I also know many folks that have had nothing. It’s kinda boggling. Some day we will understand why certain folks are getting super sick, but we don’t now. Thats why people are scared and that’s why they get angry. It’s a human response. I would take your vaccine- if you get sick and have to call out who is around to do an emergency on someone without COVID when its needed? That’s really why you’re offered first-not because anybody cares about your wellbeing:) Thanks for reading though and good luck
“…who is around to do an emergency on someone without COVID when its needed?”
Back up call or if it’s a minor procedure, same folks who get all the surgery hand-me-down non-operative cases: interventional radiology.
I get that- if you only need one person to a procedure and you have ten surgeons rotating call that’s easy- but what about a place that has 60 nurses and now needs 30 of them every single day for 12 hours. You don’t have much wiggle room- or you ask someone to work everyday when they already have been working beyond their limits for last 9 months. In a lot of places they are at the breaking point.
Your gracious reply to this post only adds to my admiration for your reflections on being a physician at this unprecedented time. I’m glad that Doximity picked up on it, and I hope this gets shared to those outside of our profession who don’t know what so many medical workers around the world are experiencing. Bravo!
Oh Superspreader Jared. The author is much more generous and mature than I would have been in his reply to your condescending pov. I guess I am also one of the angry, ineffective doctors burnt out from this pandemic. Many of us are not perfect like you and perhaps we are too busy working to read “40” papers (which is not a lot-I reviewed and I rejected several this year) and maybe that’s why we feel human, vacillating between being human and being vessels of saving other helpless humans .
Yes, evidence level is weak for several aspects of this pandemic but the basic science is not weak. Superior level of evidence for definitive clinical progress, within days/months, is often ethically impossible in the middle of a pandemic.
I acknowledge your faith in whatever may offer hope and emotional blanket but we have a right to be upset, feel emotions because our response as a country has led to an interminable sense of dread about this pandemic until these vaccines came along..they are not the only means to end this, but it helps to palliate the emotional turmoil we face daily. Especially worried about bringing shit home.
So, I urge you to get off your soapbox, take the vaccine, exercise some of.your golden empathy to your colleagues who are deservedly venting and maybe stop spreading this virus to others.
-another Otolaryngologist who doesn’t want to trach another covid body or participate in palliative care discussion. Or attend the zoom funeral of a colleague he intubated.
Well said, DO. In his acrid, self-important, sanctimonious, and frankly factually incorrect post, Dr. Thaler serves up the textbook view of this virus and pandemic that continues to get people … not charts or cases, but people … very needlessly dead. I’m wondering if he has any experience conducting a RCT during a pandemic, when patients in both the control and treatment arms are actively dying? It never fails to astound me when I hear ‘doctors’ who have gone so far into the westernized reliance on ‘Level 1 evidence’ that they abandon clinical judgement (if such was ever present in the first place), or simple common sense.
In his post, Jared makes the righteous claim that he believes in Christ. How is that helpful?? You know how many COVID patient’s I’ve seen die with a Bible or a crucifix in their hands? This virus doesn’t care who or what you believe in. We took an oath when we became physicians, and that oath is non-denominational. I am not a Christian. And I find the sanctimoniously hypocritical views that people like Jared rotely vomit to be frankly nauseating. But I do know what Christ supposedly said in his Sermon on the Mount, and it revolved around the concept that in order to live a groovy life, we should do unto our neighbor as we would have done unto ourselves.
Wake up, Jared. You’re spreading poison.
SMT – interventional cardiologist
I second DO’s response to Jared Theler.
Amen, Doctor! In our profession, we should put the care of our patients before our own interests. I am a 78 year old retired anesthesiologist, and I have volunteered as a PCP in a clinic for the indigent elderly and at a clinic in a homeless shelter. I have not missed a day, nor have I hesitated to examine and treat these less fortunate human beings. That’s what we do, isn’t it?
Wow.
I am so sorry to read this post.
Ask Singapore, Taiwan, Korea, & Japan if masks help.
The writer was incredibly gracious to your callous post.
Thank you for writing these words and thank you for your service. You have summed up what so many HCW have been feeling since March..
55 y.o. ER doc in Louisiana. Brutally honest and accurate. You put it in words better than I would have thought possible. I damn sure posted my vax selfie and have been going through/ feeling the same swirling mix of crap as you describe. Thank you.
I loved this article on rage and the pandemic. The rage is exactly my response when i see an unmasked person near me. And yes, it comes from fear. I’m 74, a retired NP, doing some RN work from home and talking to Covid 19s who don’t have to be hospitalized, and hearing their coughs and fatigue. I am not ready to die, but my age and my mod-severe asthma puts me at risk and the relief when i got my Moderna #1 was palpable. It felt like a drug high.
Can’t wait until Jan 20, when my 2nd Moderna is scheduled, then a few weeks of internal immunity processing and I’ll give up my friends shopping for me. I’ll try a grocery store, I miss choosing my own vegs – fully masked and handwashing like crazy, but less fearful.
It’s healthy to acknowledge the rage. Thanks for doing it and acknowledging the ambivalence we have for patients that we jump in to save even when their carelessness or poor choices caused their issue. It’s called loving humanity, warts and all.
I so appreciate your honesty and sincerity. I’m a retired critical care nurse. I do know what it’s like to be over census with high acuity; we pick up extra shifts, put our heads down and soldier on knowing that the situation will resolve in a matter of weeks. But NEVER have I worked in the midst of a lethal, novel virus pandemic and for 10 months. Many of my dear colleagues, as well as family members, are still practicing, MDs, NPs, RTs, RNs. etc.. I have had such a degree of concern and sadness as this event has evolved and revealed itself; all coupled with boiling rage witnessing the total arrogant disregard by Americans (and some in the US government) who defy and deny science and public health warnings. To know that 3,000 US healthcare providers have died during this event is a painful realization. Not that my forgiveness matters but I’m not so sure I can patiently understand or forgive those deniers and those believing this tragedy to be a hoax. I suppose the next hurdle for America’s public health system will be anti-vaxxers. Thanks for sharing your intimate thoughts, I hope your blog reaches many on the front line. Hang tight these next few months; many of us realize your sacrifice and your plight.
This was a well written and touching piece. As an almost 78 year old psychiatrist, I was able to move to a virtual practice..But I wear a mask when I am outside my home. With asthma and RUL atelectasis, I look forward to my turn in line. Communities where a high percent wear masks have less COVID load. Call it bad science or not. I think that intubating vius-positive people wearing bad PPE and remaining healthy is fictional or a case of colossal good luck. Also, as a psychiatrist, having strong negative feelings is not an avoidable condition. It may be a waste of time, but no science supports that point of view. It may also prevent or lessen PTSD by being in tune with your own rage and terror.No science to back that up either. I find it unpleasant to trivialize a pandemic and to trivialize the feelings of a majority of front line workers. Sorry, no peer reviewed refernces. I truly admire the peace of mind that comes from intense spiritual belief. Many of us are unable to achieve that either.
Well said, Doctor. Very well said.
Thank you. You’ve spoken out loud what, I believe, so many have felt and have been afraid to admit to themselves, let alone others. Going to work feels heavy, even oppressive, and more filled with uncertainty- about the science, about the emotions, about our roles, than it ever has been before. I’ll be sharing your thoughts widely with my Emergency Medicine and Pre-Hospital colleagues.
I often speak to my team about “the burden of knowing”. As a result of what we do and encounter we know that really bad things do happen to nice and good people, and simultaneously there is a whole segment of society that, if we didn’t care for them for a living, would be invisible and frankly unpalatable to us. The act of regularly witnessing other’s suffering produces a chronic cumulative low level type of PTSD in us.
We attempt to mange this by thickening our skin, with humor, and sometimes with other, less healthy, diversions. But every now and then, a patient interaction gets through these defenses into our oooey-gooey center, and when things go badly, hurts us.
Professionals learn to work through these feelings and continue to do their job well. Really good professionals are willing to do this and still get hurt again.
Our mental health colleagues tell us again and again, there are no “shoulds” when it comes to our feelings. Humans feel anger, even rage, when there is Injustice. The entire summer has been characterized by angry, energetic protests at injustice. That we should also similarly feel anger at the injustice of those we are risking ourselves to help when they ignore guidance meant to protect them and thereby by place us and themselves at risk, let alone openly reject and subvert our attempts to care for them; and attack the legitimacy of the severity of the suffering and loss that we see daily is anger-worthy and does not need to be apologized for.
Caring for others costs us. And rewards us. That’s why we do this for a living. But the pandemic has also made it scary in a new way.
We’ll continue to be professionals and give the best care that we can, despite the anger and fear. It’s what professionals do.
Thanks for your thoughts. Its funny- I also wrote a blog a while ago about how we deal with death in the ICU and we use inappropriate humor as a defense mechanism. The typical defense mechanisms are wearing thin now.
Feeling the rage and terror while still doing the work is what I admire. As a psychiatrist i think that your awareness of risk and your connection with your emotions may offer some protection from future PTSD. It is amazing to see science deniers and trivializers at work in medicine itself. This was a fine and important bit of writing.
First, thank you for this courageous article. People need to know that doctors are people too and although we (often) have the best intentions in trying to help others we also have feelings which are not discussed in polite society, like wishing the idiots who spread misinformation or who put others at risk by denying basic science and not following reasonable guidelines will have some sort of karmic retribution. Kudos for acknowledging and airing these feelings, which are neither good nor bad, but others will judge us in the negative for having them. This doctor as hero complex has been perpetuated too much and adds to the illusion that doctors only have positive feelings and intentions. And as to letting a patient die that is likely going to die anyway in order to protect yourself so that you will be alive and available to rescuee other patients who can actually benefit, as well as prevent infecting your friends and family, that is a concept that is also open to misjudgment, however utilitarian and logical it may be. It is basic triage. Countertransference–it is a real thing and I wish it was taught more extensively outside of psychiatry and psychology circles.
Thanks for reading. These can be a very nuanced ideas to get across- especially to those who have not been in these situations.
This is weeks and weeks of therapy. I don’t know if any words have ever resonated so purely and deeply in me.
Thank you for saying what I haven’t been able to understand enough to express.
Thank you for so eloquently and accurately and vulnerably articulating what I and other physicians on the front lines are feeling! My second vaccine is Jan 11th. I cannot wait!
Thank you for articulating so well the cognitive dissonance of living with the barely concealed rage, while fighting with yourself to maintain the level of empathy that has defined you for all of your career. I am an office only OB Gyn who has struggled deeply with this and can only marvel at my inpatient colleagues who must be ready to explode, if they weren’t so exhausted. I celebrate every post of a colleague getting their vaccine, knowing that we are getting one step closer to a safer place, one person at a time. But, I really do worry about our collective PTSD, especially those who witness firsthand all this suffering.
I think Cognitive Dissonance might be the best summary of 2020.
Thank you for being able to express so well the feelings so many are having and not stating. I have been a PA in Emergency Med for 20 years. My brother, best friend and partner in crime died of Covid unexpectedly at home in November and my elderly nursing home mother contracted COVID shortly after his death and survived. I am struggling with all that elaborate on and have not returned to work yet. I received my 1 st dose of vaccine and 2nd tomorrow I am hopeful that it provides me some additional relieve to the COVID anxiety I have developed since my brothers death. Your Article helped to normalize the feelings I am having. Thank you maybe this is not the end of my career. Be safe.
My condolences on your brother. You are not alone in your feelings. Take care of yourself.
Sounds like you shouldn’t have become a doctor. You’re so callous and unkind to people who are struggling during a pandemic. Maybe save everyone and just retire. In your next life don’t chase money, instead chase a passion. 🖕
Thanks. Appreciate you reading and sharing your thoughts. You have a point about retirement- however I for sure cannot save everyone- thats the hard part..
Judgemental much? Or are you really in healthcare? Get off your throne, don the PPE, and get in the fight………then perhaps you’ll understand more what the folks dealing with this disease are feeling. Nowhere in his essay did he ever say he refused to perform his job, so I don’t see what your issue is.
You’re making a lot of assumptions in your comment, just remember when you pint one finger at someone, 3 are pointing back at you
Talk about being callous and unkind to those struggling during a pandemic? Hello pot
You’re calling him out for appearing callous and unkind to those struggling during a pandemic?! He is also struggling?! Hello kettle
Jared is hardly making a “righteous claim” but rather a truth claim. Christ said clearly that the one who seeks to save his life will lose it, and the one willing to lose his life will save it. Christ was neither lunatic nor liar but Lord. Those who acknowledge that reality can never see life or death as does Dr. Consilvio nor can they be filled with the bitterness so evident in the majority of the comments. Did we enter the medical profession with the expectation of personal peace and prosperity?
Actually, yes Carol, some of us did enter the profession to work hard, make a living and with the right help+training, save some lives as healthcare provider. We also have family who somehow found time to love us.
Hero virtue signaling from the pulpit of your comfortable office is boring and unrealistic.
Do you really believe the nonsense you wrote? I guess you do. Then go save people, maskless and without vaccine. Since you believe in this gross, unbecoming “christlike” behavior healthcare providers should adopt. Puke. This is simply objectively dementing
I’m off to therapy now. Toddles. And f off.
Thank you for your essay. As a fellow physician in Seattle, I’ve been impacted by COVID-19 since day #1 as the “Ground Zero” case was from my region (or so we thought, at the time). It has been utterly exhausting to worry about patients who lie to me just to get seen (I’m full time outpatient Internal Medicine) and I’m always anxious I will die or transmit COVID to my family. Yet, I haven’t missed a day of work and, in fact, am taking my first week off right now since July! I was moved by Mr. Floyd’s comment in this response column – so thankful he “sees the real story now.” Wish his experience would go viral but, sadly, it won’t. I fear February more than January. Lucky to have my Moderna vaccine #1 12/27, second one due 1/24, but won’t anticipate “being protected” until mid-February. Our advice to all remains: wear masks, don’t socialize, stay home (if possible) and don’t travel. I, too, am tired of seeing my patients die from COVID. My 97 year-old mother-in-law died, but we all know 97 is an amazingly long life. Not so for the younger folks in my practice. I cry every time. Footnote: I ran a program called “Menu for Change” for 7 years (alongside my full time IM practice) which included 2 NDs, 2 Acupuncturists, and RDNs. I ended the program last year due to organizational changes where I work, but now have a new website MenopauseMenu.com which pulls over some of the content (well, eventually…in my spare time). Happy to dialogue with you about Western/Eastern medicine!! Again, thank you for your poignant, raw, honest essay.
This really resonated with me. In October I retired after 40 years as an RN, mostly in the ED. The retirement was long-planned but couldn’t come soon enough after 8 months in Covid hell. I started my career before HIV and MRSA changed the way we practiced. Gloves were rare, needles were uncovered and sharps containers were only in the med room. But we learned how to protect ourselves because in a disaster WE are the most valuable resource. As they say…if you see someone having a seizure, run and help. If you see FIVE people having a seizure, RUN THE OTHER WAY.
Never, in 4 decades of this crazy job, have I seen such an active attempt to undermine our efforts to fight this disease. I feel like we are running into battle while others are putting their foot out to trip us.
I will wait my turn but will celebrate when it comes.
Thank you for putting these feelings into words. I have never been great at expressing things in written form, but this, this is exactly how I imagine all health care workers are feeling. I am a Medical Laboratory Scientist working in a rural hospital. We run COVID on site, we handle specimens daily. I have direct patient contact regularly but nothing on the level of an ICU nurse. Even so, I have the rage, the anger over this pandemic, the people it has stolen, the ignorance it has revealed and what it has done to our way of life. I got my first dose of the Pfizer vaccine on Dec 30. It felt just as you described, hopeful. Even amongst my skeptical coworkers. Social media is powerful enough to undermine our knowledge and make even scientists doubt. I know we will have to continue wearing masks and socially distancing until more of us are vaccinated but at least we can see the light at the end of this long dark tunnel.
Am an Internist in primary care in a small rural community. As the pandemic set in in the spring, my nursing home patients would relate to me the stress of spending their days relegated to their rooms, socially distanced as possible, watching intentional lack of national leadership mark them for death….. They understood the direct threat. And death came this October. 80% mortality for my collection of characters stuck in the centrally ventilated death trap that was their home.
Manslaughter.
I am so angry
Jeez-I am so sorry. That is so tough
Thank you for speaking what many healthcare workers have been struggling with for so many months. I am a pulmonary critical care doc in Texas and have been dealing with many of the exact same feelings and thoughts since COVID entered our lives.
COVID entered my life at a particularly vulnerable time. My wife, who is also a physician- she’s a nephrologist, and I had our first child in September of 2019. Our son was born with a severe form of ARPKD and had a terribly long and complicated hospitalization after birth. He was admitted for the first 6 months of his life.
It was during the middle of our son’s hospitalization in late December and early January that we first started hearing of a novel virus in China that was killing thousands. By the time we were discharging home in March 2020, COVID was finally reaching Texas. Words cannot describe the fear that gripped me at the thought of having to care for COVID patients. This fear was born not only out of concern for myself but more importantly the health of my 6-month-old son who had barely made it home.
As the weeks of spring leading into the summer passed, we were fortunate that COVID had been fairly minimal in our city. At my hospital we had the occasional COVID patient that needed intubation during this time, but the numbers were small.
Then came summer. We had a massive surge in COVID patients that started after the Memorial Day holiday. COVID had finally arrived in earnest and it was everywhere. The first COVID patient I intubated was an elderly woman in the ED who was dying. As I donned my PAPR I had to pause for a moment to force myself to not think of my wife and son waiting for me at home. Every day on my drive into work I would pray that today not be the day that I get infected, that God would have mercy on my patients and my family.
Now we’re in the middle of the winter surge with you and the rest of the nation. Everyone is sick and tired of COVID. Nobody wants this work; nobody enjoys this work. Nobody enjoys the terror in your patient’s eyes as they struggle to breathe, the rage and fear you try to swallow down as you start your day on the COVID ICU. Nobody enjoys hearing the panic in the voice over the phone as you explain that their husband, wife, son, daughter, mother, father is critically ill with COVID pneumonia. Nobody enjoys explaining words like oxygen saturation, BIPAP, HFNC, proning, intubation, the ventilator, DNR/DNI. Everyone is exhausted. But for the first time in the last 9 months, hope is kindled. The vaccines are our way out this dumpster fire. I had a mix of emotions swirling when I went for my vaccine, but what I felt strongest were gratitude and hope. Gratitude for having made it to December not having been infected and hope for an end for the suffering and death. Best of wishes to a better 2021, may you find peace and healing.
I work in Toronto at a hospital that dealt with the SARS outbreak in 2003. I remember at the time wondering if I would be wearing an N95 mask for the rest of my career. It did pass and much more quickly than Covid-19. We didn’t learn much from that episode. I hope we do from this one. At least this time I am mostly only wearing a procedural mask. (Those N95s are not very comfortable!) Hang on everyone! We are only asking you to keep up the social distancing, hand washing and mask wearing for a few more months. It doesn’t help to “Clap for Carers” as they say in the UK and then carelessly spread the virus around.
My husband is a US-trained physician and I am a Canadian. Throughout this pandemic we have felt unbelievably lucky and grateful that we ended up in Canada rather than pursuing a US path, as we fully intended to do for a while. It has been heart-breaking to watch the struggle of many of our nurse and physician friends. Not that that struggle is uniquely American. The medical field everywhere seems to draw in kind, caring people, encourage them to sacrifice of themselves to an absurd degree, then discard them as useless when they falter in any small way. Quite similar to veterans I suppose. But the pandemic progression in the US with its insane anti-science politics, divisiveness, cruelty, inaction and awful numbers has been painful to witness even from far away. All that to say, to anyone in the medical field, you as a person are of tremendous value and so is your personal wellbeing and continued survival. Your friends and family need you in their lives and your life is no less precious than that of your patients. If you need to, walk away, because the world is actually quite unkind to heroes. If after all this you still have any interest in your field but feel burned out at your current workplace, remember also that there are places in the world that would welcome you. No nation is perfect, but certainly some are considerably more humane to their workers.
cconsilov and all the others who understand the complex emotions it is to be a physician AND a human being at this time- Thank you, Thank you, Thank you.
I salute you for your honesty and compassion. May we all have the strength to continue with inner awareness, seek out and find empathic camaraderie, and carry on with this honorable calling. This is my prayer.
GREAT ARTICLE. THANKS FOR THE REMINED!!!!
One of the most powerful things I’ve read about this historical time. I found this essay beautifully heartbreaking and radically honest and I loved it so much. As a radiologist is now working from home, I feel so guilty and grateful every day that I’m not on the frontlines like you. I also know that, if I were, I would feel like you. No healthcare worker ever offer to sacrifice their life for another. The moral and ethical dilemmas that the pandemic has highlighted need to be deconstructed and examined. The emotional fallout and PTSD from this are going to haunt all frontlines workers until they are given voice and a platform to heal from their traumatic experiences. May your writing be a salve to comfort you- and also to ripple out to others to help a tipping point be reached where we can raise consciousness about boundaries for healthcare providers. Human first. Doctor second. That’s where I draw a boundary for me- and I did it long before Covid bc medical life just sucks the life out of medical providers. Sending you strength, gratitude, and compassion 💚
Hate is a big word. We treat the rapists, wife and child beaters, shooters, drug and alcohol abusers, COVID deniers with professional dignity and respect, even when it’s not reciprocated. We’ve had bloody bandages thrown at us. We’ve been spit on and shoved. We work insane hours.
Our personal life has been radically altered. Marriage wasn’t intended for social distancing. Thanksgiving and Christmas without your loved ones was sad for everyone. We appreciate their contribution to humanity and pray we all come out out this time emotionally intact.
Thank you for writing this story. I share your anger and rage, but for a different reason. I am immunosuppressed, taking chemotherapy medication for the rest of my days on earth. Prior to the pandemic, i kept myself active. I free lance worked, I went out with friends, I traveled. It is now the end of April 2021, and I have barely left my home in 13+ months. I had to learn to be a new person, one who could survive happily within the confines of my home. On the rare occasion that I venture out at 6:00 a.m. for “senior hours”, I am filled with rage when I see the person who refuses to wear the mask, or who insists to wear it under the nose. I am now fully vaccinated, but still with serious enough health backstory that I fear the morons who deny the Science. Maybe if I live another ten years, maybe I can then go back to yoga, or per diem employment? Your anger towards the covid deniers is equally shared by those of us who are told “stay home if you don’t feel safe”. Thank you for your service and your story.
A year later, how do we feel?
Well- not so much mad as tired of it all- just like pretty much everyone…