A version of this opinion piece was published in the San Francisco Chronicle on December 2, 2020.
By Lingsheng Li and Elizabeth Dzeng
COVID-19 cases and deaths are breaking records around the country and already traumatized healthcare workers are bracing for this onslaught with dread. Frontline clinicians have already seen too much death and suffering. A nurse who worked in New York during the first surge told us, “Nobody lived, that I know of. I don’t feel like I actually helped anybody.” Another said that in just one night, there could be a “code blue”, signifying a patient with a cardiac arrest, called every 15 to 20 minutes. Another doctor clarified, “Every time there was code, it was basically a patient dying.”
As two physicians and palliative care researchers working at the University of California, San Francisco, we have gathered stories of doctors and nurses interviewed as a part of a research study to understand the experiences of volunteer clinicians who were deployed to New York City during the initial COVID-19 surge in the Spring of 2020. These were not reports of medical miracles or accounts of professional fulfillment, but rather narratives of profound grief and suffering at hospitals that were described as “war zones” again and again.
A critical care doctor recounted her worst day, as tears streamed down her face during the interview, “We just watched her die and we were the only people there when she died. I was kneeling there with her hand in my hand, sweating and crying, goggles fogged, and N95’s soaking.” These dedicated doctors take on guilt and self-blame for their futile efforts in the face of this virus that has already killed millions, “I blamed myself so intensely for the decisions I’d made in trying to take care of her. I owned her death.”
As the U.S. experiences its third wave, we fear that the idea exalted in the initial phases of the pandemic of “heroes in scrubs” provides a false narrative that frontline clinicians are the last line of defense against whatever bungled public health response the current administration throws our way.
Healthcare workers are not heroes. Not even close.
They are exhausted, burned out, and barely holding it together. The emotional strain was obvious throughout the majority of the stories we gathered. One nurse said, “I cried every day I got home. I was mentally exhausted.” Another said, “You get really overwhelmed and just start to cry. I didn’t feel I was helping. I’d wake up the next day and say to myself, ‘All right, let’s put on some hip-hop and get into the hospital and be a badass,’ and don’t let anybody know that you felt just completely defeated.” These clinicians put on a brave face every morning, but inside they’re breaking.
We like to think of heroes as glowing, Superman figures swooping in at a moment’s notice to save the day and protect the public. As COVID-19 cases continue to rise, frontline clinicians, including those who have retired, are once again called upon to step into unfamiliar roles and inadequately equipped hospitals. However, unlike superheroes, we cannot change the inevitable outcome by stopping a fast-moving train from crashing and burning. We are just trying our best to pull off as many passengers as we can before that train reaches a devastating halt.
You can count on us to show up to work, hold your loved one’s hands, grit our teeth, put our heart and soul through yet another surge, but there may not be much more left in us. ICU capacities are maxed out again in cities and towns across the country. Our colleagues who have not yet beaten back the first wave of the pandemic haven’t yet recovered enough to endure yet another battle.
Because we understand the consequences, we cancelled holiday plans and took rain checks with friends and family, saying “I’ll see you when this is all over”. After several of his staff members tested positive for COVID-19, my 70-year-old father-in-law, who is a practicing physician in Georgia, self-quarantined four separate times for several days by sleeping in a leaky RV parked outside of his house, afraid of bringing the virus home. “Healthcare workers are ignored. I don’t want to be a hero. I just don’t want to die,” he says. Our colleagues do this on a daily basis, only to have, as one Nurse Practitioner from Texas noted on Twitter, a patient ask after testing positive for COVID-19, “what should I do? I went to a wedding this weekend with 200 guests.” What an utter mockery of our efforts.
We may not be heroes but we will do everything we can to treat and to comfort, even when we cannot cure or fix. Trust that we will do our best but we desperately need your help. The holidays will be different this year. Do not let this be the last Thanksgiving or Christmas you get to spend with someone you love. As the holidays approach, protect yourself and others around you by wearing a mask correctly. Follow CDC tips and think about your risk of getting infected or infecting others with the virus before planning any celebrations. Be wary of exposures over time in enclosed areas without air circulation. Find ways to safely connect with people, especially older adults who may be particularly isolated at this time. Be mindful of others in your families and communities who may be extra vulnerable. We also implore local and national leaders to institute mask mandates and endorse social distancing.
Healthcare workers are not heroes who can singlehandedly save the nation from this virus. You can do far more to stop COVID-19 than we can.
Elizabeth Dzeng, MD, PhD, MPH 