Last February, Dr Bryce Meck, 30, would lock herself in the bathroom to cry for five minutes when her patients, whom she had watched over for weeks in the medical intensive care unit, were dying from Covid-19. They begged her to tell people in their community to get vaccinated. Of the 20 patients with Covid-19 in her care, only three survived.
Each week, Meck’s frustration grew when she saw patients in a Columbia, Missouri, primary care clinic. They expressed vaccine hesitancy, shared misinformation or told her that their friends were pressuring them to remain unvaccinated. “If only the patients in the clinic could just meet the people who are suffering in the hospital,” said Meck, who continues to experience long-term effects of the virus herself.
Now more than ever before, medical professionals are drained from the relentless grief and trauma of the pandemic. But it’s more than the volume of patients that’s the problem: they’re dealing with the dissonance of unvaccinated patients, and constraints of the health system, leaving them without the tools to do their jobs the way they were trained to do. The stakes are high for a workforce facing this psychological and emotional toll – doctors are given little support or leeway for mistakes and suffer professional consequences when they disclose mental health problems.
Some of what they’re experiencing can be encapsulated in two terms, experts say: moral injury and compassion fatigue.
“Compassion fatigue is the feeling, ‘It’s hard to care when you’re overloaded but still dedicated to the task,’” Dr Kernan Manion, executive director of the Center for Physician Rights, said. “Moral injury occurs when the nurse or doctor feels that, ‘The patients I’ve dedicated my life to treating are now here because of their own negligence and now they’re imposing upon me and my team to treat them, while also exposing us to continued danger from this virus.’”
These days, Meck knows that first-hand. She is seeing more children with Covid-19 at her Missouri hospital than ever before. At 46%, Missouri has one of the lowest rates of full vaccination in the country. “I don’t even get the chance to try to show you all the split-second decisions and critical thinking and compassion I’m capable of,” Meck said. “Practising mindfulness is not going to fix moral injury.”
In Kansas, ICU beds are occupied with more Covid-19 patients now than at any other time during the pandemic, morgues are overwhelmed in Oregon, and doctors in Palm Beach county, Florida, pleaded with the public in a news conference to trust them and get vaccinated.
Dr Anita Sircar, a California-based infectious disease doctor, can’t help but feel angry at patients that are life-threateningly ill from Covid-19 but could have avoided their illness by taking the vaccine. “Compassion fatigue was setting in,” she said in a widely shared op-ed. “For those of us who hadn’t left after the hardest year of our professional lives, even hope was now in short supply.”
So far, nearly 660,000 people have died of Covid-19 in the United States. With the current spike in cases, that number is expected to rise by another 100,000 by December, according to Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to President Joe Biden.
Medical school didn’t prepare Dr Michelle Suh, 29, an emergency medicine resident, to tackle misinformation. “We didn’t have any magic tricks up our sleeves so it felt demoralizing and helpless,” she said, reflecting on the Covid-19 surge in Houston last summer and the impact it had on her patients. “That’s what makes this wave of the pandemic so hard to watch, because we have a vaccine and we know that it works.”
Dr Leah Brown, 46, “received every vaccine known to man” when she was on active duty in the military for 12 years. Now the Arizona-based orthopaedic surgeon is frustrated by the unvaccinated population that is making the pandemic feel like a battleground. “Medicine is based on science and experts. I don’t know when expert opinion or expert knowledge took a backseat to politics,” Brown said.
The consequences of the Covid surge are severe for Brown’s patients. She is forced to tell them that they can’t have their shoulder replaced or a spine operation because there are no ICU beds or nurses to do the surgery. She worries that people will continue to get sicker and stressed without timely care.
As this weighs heavily on doctors across the country, their own options for seeking help can be limited. Unlike other professions, physicians exposed to the occupational hazards of their jobs face multiple barriers to mental health care. They can be asked invasive questions about their mental health history in applications for a state medical licence, hospital privileges, credentialing by insurance providers, and medical malpractice insurance, or risk their medical records being subpoenaed in the event of a lawsuit. They can be sent to a Physician Health Program (PHP), controversial programs that were established to help doctors in difficult times. Doctors die by suicide at the highest rate of any profession.
“We probably have the most liability of any profession, so if you don’t follow the standard of care, not only are you judged and ostracized by your peers, we are punished,” Brown said. “We’re having to work through all of that in the face of navigating willfully non-compliant patients who would rather poison themselves [with therapies that haven’t been tested] than help with a public health disaster.”
“There is such a stigma and it’s so reinforced for these doctors that they don’t believe the rules are in their favor,” said Corey Feist, co-founder of the Dr Lorna Breen Heroes’ Foundation, which advocates for the wellbeing of physicians. The organization honors Breen, medical director of the emergency department at a New York City hospital who died by suicide on 26 April 2020.
She was terrified of her professional reputation being damaged “if anyone got a whiff of a thought that she can’t keep up”, Feist said.
Dr Mona Masood, a Philadelphia-based psychiatrist, co-founded Physician Support Line, a free, confidential peer-to-peer phone service staffed by 800 volunteer psychiatrists. Prompted by the crisis physicians faced early in the pandemic, they have given nearly 10,000 minutes a month of help to doctors. The support line doesn’t have to report the callers because the volunteers don’t have a formal doctor-patient relationship, enabling many physicians to get some help without the fear that their private conversations and medical conditions will be disclosed.
“There has been a definite uptick in calls” during the pandemic, Masood said, with many conversations centering on compassion fatigue and a breakdown of the doctor-patient relationship. “There is a feeling that ‘I’m risking my life, my family’s life, my own wellbeing for people who don’t care about me,’” she said.
Meanwhile, Beck says physicians and other medical professionals need confidential mental health care to cope with the moral injury they’re suffering during the pandemic. Healthcare workers are managing with so few resources that all they can do is triage, which is similar to functioning in a humanitarian disaster.
“This wasn’t avoidable for Detroit or New York [because the vaccine wasn’t available], but it’s avoidable now and yet here we are,” Beck said. “That just kills people’s souls.”