Hot, dripping sweat, donned in maximal personal protective equipment (PPE) with a gown, mask, face shield, essentially screaming to a patient trying to gather more history on their respiratory illness, which was suspected to be COVID. They were deemed a “PUI” or person under investigation since there was a high probability that they would test positive for COVID. It was the early spring of 2020, and I had no idea what was beginning to unravel before my eyes. Scurrying from one patient to another, prematurely discharging patients who didn’t want to be in the hospital as they feared they would catch COVID, surviving hour to hour between patient care and administrative meetings dinging constantly on my phone. It was all never ending, while I mostly worried that I would catch COVID, or even worse take it home to my wife, daughter and newborn son.
Administratively, we were at the edge of our seats day-to-day trying to stay organized and ahead of it all. Separating news headlines, medical guidelines, internal system guidance and the rumor mill about COVID was a full-time job in itself. Leading a hospital medicine group, my goal was to communicate often and clearly, advocate for what was needed (including once hoarding a stash of PPE in our office) and remain calm. System-wide and nationally, PPE guidelines, treatment guidelines and disaster scenarios (that often became reality) were all buzzing and changing.
The dynamic state that it all represented led to a pure adrenaline surge for me. We had entered a historic pandemic, and the streets were filled with signs and celebrations deeming all the healthcare workers to be heroes. People needed us, celebrated us, and recognized the impact of the risk we were taking working in hospitals.
The adrenaline resulted in my “on switch” never turning “off”. When I was physically at the hospital, I was wondering what was going on with my two home-bound children (one who was merely weeks old) and my physician wife who was a supermom on maternity leave. When I was home, I was thinking about my colleagues who often called and texted me with real-time challenges and just feeling pure fear. My mind was saturated.
Time was a weird prism during that first surge. We were going fast, yet slow. Naively, it felt like the pandemic was going to be short-lived. We would peak with cases in a few weeks and then recede if everyone remained “sheltered in place”. That infamous “curve” was going to flatten. It was simple enough epidemiology, right? But it never was as it took years through multiple subsequent intensifying surges to gain control over this virus.
By summer of 2020, it felt like Groundhog’s Day. We were in a repetitive pattern from sheltering, masking and planning, all while thinking we could return to normalcy soon. In the public eye, sheltering at home was no longer sustainable. Everyone was going stir crazy, all while cases were exponentially increasing once again.
At that pivotal point in the summer, I was exhausted as the adrenaline had waned. I was moody, irritable and struggled to keep up on all fronts. I couldn’t find joy at home and at work. I didn’t feel fulfilled or satisfied. Teaching my then four-year-old daughter to ride her bike. Feeding and playing with my adorable 5-month-old son. It all just felt like I was just riding out motions, instead of enjoying it. With the support and love from my wife, I acknowledged and owned that I was struggling from a mental health standpoint. I became a patient and met with my primary care physician, who was keenly aware of my reality and had almost foreshadowed it. I started medication to help with my mood, and eventually also started therapy. It’s been a work in progress.
Around the same time in 2020, I learned of the tragic passing by suicide of Dr. Lorna Breen. Dr. Breen was a brilliant ER physician and medical director in NYC. The New York Times published her story detailing the days around her death. Reading line to line, I could sense my muscles tensing and becoming nauseous. Why? Dr. Breen’s fate could have been any one of us. It was a wakeup call that burnout and mental health issues among physicians were really an epidemic of their own.
Physicians were struggling everywhere. We were not only burnt out in the occupational hazard sense. So many of us were also struggling emotionally with our mental health. The witness to suffering and burden had carried into our personal lives, taking away joy in marriage and family life, creating conflict, and so much more stress.
Thousands of healthcare workers have left the workforce since the start of the pandemic, with some retiring early and others shifting careers. Hundreds to thousands left their hospital jobs for more lucrative travel gigs, essentially monopolizing the market leading to healthcare systems paying thousands upon thousands of dollars more for labor. Our workforce was forced to reinvent themselves. Hospital cultures changed overnight with new staff. It was all so disruptive.
Reflecting on the past five years, for me personally, it’s clear and obvious that healthcare is now more complex than ever. Physicians frequently are fighting the same battles as patients with insurance companies, access issues like scheduling and more. And importantly, our compassion and humanity are needed even more in a system that has become more transactional, treating patients like objects rather than people. Patients need their physicians now more than ever.
It’s also more imperative than ever that we focus on the well-being of physicians and all healthcare workers. Encouraging well-being does not mean just teaching yoga or meditation, as those are only tools to manage stress. The burnout mitigation movement needs to focus on advocacy to ensure direct patient care on the frontline is more seamless.
Several movements have already started with digital innovation, AI for documentation and more. Most importantly, physicians need to advocate with employers, organizations and licensure boards to support themselves and their colleagues to seek mental healthcare without feeling ostracized and stigmatized. Progress is being made already with efforts from organizations like the Dr. Lorna Breen Heroes Foundation, but it’s work that needs continued momentum and support.
The COVID pandemic proved how sensitive the healthcare workforce is, how easily it can be disrupted, and how fragile healthcare workers’ well-being and lives are. To have the most talented and expert workforce to ultimately care for all of us, the movement of focusing on mental health, wellness and burnout mitigation must keep growing, sustaining and be at the forefront for lawmakers and executive administrators for years to come.
Dhaval Desai, MD
Dr. Desai is a Med-Peds physician, serving as Director of Hospital Medicine at Emory Saint Joseph’s Hospital and as a Pediatric Hospitalist at CHOA. Author of Burning Out on the COVID Front Lines: A Doctor’s Memoir of Fatherhood, Race, and Perseverance in the Pandemic, he donates all proceeds to the Dr. Lorna Breen Heroes Foundation, where he is an ambassador. He is passionate about physician well-being and the human experience in medicine.
