I mainly work in the intensive care unit of a mid-sized community hospital in a rural section of Ohio. Like many pulmonologists and intensive care physicians across the country, I continue to be overwhelmed and consumed by COVID-19 and all of its destruction, with no clear end in sight.
When I obtained my certification in my specialties just three years ago, COVID-19 did not exist. But now my new normal and secondary home is a 24-bed intensive care unit filled with ventilated, medically paralyzed and tipped-over COVID-19 patients, with many more patients waiting to enter. Sometimes amid vital signs alarms, air code blue alerts, and grueling family reunions at the end of life, I wonder how long this pace can be sustained.
As we enter our third year of the COVID-19 pandemic, it’s hard to name all of the health care resources that are nearly depleted, with ventilators, personal protective equipment, emergency beds and care. intensive. , doctors, nurses, therapists and other essential health workers are just a few. Looking at the grim faces and downcast demeanor of my colleagues, it’s clear that an underrated healthcare resource worth mentioning, which is now dwindling rapidly, is morale.
Healthcare professionals undergo rigorous education and training to alleviate disease and restore the health of their patients. These workers rarely face new illnesses or syndromes that do not yet have evidence-based cures. Unfortunately, as we’ve seen with COVID-19, new, highly contagious diseases can quickly surface, spread widely, and wreak havoc in our lives.
Historically, when these inevitable health crises arise, the entire scientific community – scientists, researchers, healthcare professionals and many more have met the necessary challenges with gracious determination, and this has been demonstrated again in our current pandemic. The unprecedented innovation in scientific research and medicine has been nothing short of remarkable, and never before has the health science community seen such rapid discovery, testing and distribution of disease-specific therapies as over the past two years.
Enter the COVID-19 vaccine, which was widely implemented in the United States within a year of the first recorded case, and is documented to significantly reduce morbidity and mortality from COVID-19. Once again, hopes were soaring; it was surely the panacea we all dreamed of. Finally, life would regain a semblance of normalcy.
Not exactly, but without fail the vaccines, which exceeded all expectations. Vaccines have been repeatedly shown to suffer far fewer illnesses and deaths from COVID-19 than their unvaccinated counterparts. Note, since the generalization of vaccination, for 20 deaths due to COVID-19, 18 (90%) are not vaccinated and two (10%) are vaccinated, and for 50 hospitalizations attributable to COVID-19, 43 (86 %) are not vaccinated and 17 (14%) are vaccinated (see here, here and here for more information).
This disparity in results is so blatant that my conversations with emergency department physicians about potential ICU admissions often boil down to a simple question: “vaccinated?” A “Yes” versus “No” answer often gives more information about the patient’s prognosis than all the information I can find in the medical record. Obviously, vaccination works, and throughout history we would be hard pressed to find a more effective treatment than these vaccines.
“Hospitals continue to exceed their capacity, the depletion of vital health care resources persists and human lives are still being lost. Why? The answer is simple, albeit politically controversial and passionate: not enough Americans have been vaccinated ”
Yet hospitals continue to exceed capacity, depletion of vital health care resources persists and human lives are still being lost. Why? The answer is simple, albeit controversial and politically passionate: not enough Americans have been vaccinated. Surprisingly, low vaccine uptake is due to unfounded vaccine skepticism and not to barriers that generally hinder equitable access to health care, such as restrictions on costs, supply, or insurance. . .
Last week, I evaluated an unvaccinated patient recovering from acute respiratory distress syndrome (ARDS). Despite being out of breath in an oxygen tank and completely weakened and using a wheelchair, he flatly rejected my recommendation for vaccination, stating, “Oh, no, Doc. I’m sick of these vaccines. My urge was to shake this man up and scream at the top of my lungs, “Aren’t you tired of COVID ?! ? But I managed to hold back, bite my tongue and politely nod my head with a mannered smile.
Our country has always been proud of its free will, its freedom of choice and its autonomy. However, it is clear that these sacred values are distorted and put our nation in danger. It is difficult to express the extent of the frustration this conundrum arouses among us caregivers.
So, as another wave of this pandemic is upon us, healthcare workers once again find themselves inundated with unprecedented levels of grueling and traumatic illnesses, disabilities and deaths – most of which are entirely preventable. Unbeknownst to some, healthcare workers are not superhumans or robots and are subject to human feelings and emotions like everyone else. Never before have I endured such resentment and cynicism towards unvaccinated patients and their reckless and selfish choices. Choices that allow this pandemic to spread and destroy lives and families. So it is only natural that across the country we see widespread staff shortages in all disciplines of health care.
Unlike many staffing problems in other areas, the solutions to these health workforce shortages do not appear to lie in financial rewards. Never before have healthcare workers been offered such high wages, allowances and bonuses to do their jobs, but shortages persist. They persist because money does not solve the crux of the matter, which is that the morale and resolve of healthcare workers is at its lowest.
A little anecdote heard at the end of a 12-hour shift perfectly summed up the problem posed: “Are you coming back tomorrow?” A bedside intensive care nurse asked another. “Absolutely not. I’m leaving. You couldn’t pay me enough to bring me here tomorrow. Truly, is there anything more demoralizing than being repeatedly exposed to preventable disease and death. . on this large scale which are now mainly due to illogical and irresponsible choices?
There is maybe. Due to the burden this pandemic places on our health system, more and more sick patients are finding it difficult to access care. Unprecedented emergency room wait times, a shortage of available hospital and intensive care beds, and a shortage of vital resources generally taken for granted are becoming commonplace. Common and easily treatable medical conditions in hospital like diabetic ketoacidosis, myocardial infarction, stroke and sepsis are being neglected and put on the back burner as our system languishes in the rubble of the pandemic. Just yesterday I had to turn away a 19-year-old in a diabetic coma due to a lack of available intensive care beds and suitable staff, and I’m sure many similar examples will follow. This naturally comes with frustration, not only on the part of patients and their families, but also healthcare workers. Being unable to care for patients due to limited resources is something that many healthcare workers have never experienced. It is a difficult pill for many of us to swallow and adds to the unsettling nature of our new reality.
“Never before have healthcare workers been offered such high wages, allowances and bonuses to do their jobs, but shortages persist. They persist because money does not solve the crux of the matter, which is that the morale and resolve of healthcare workers is at its lowest. “
Like many other healthcare workers, I am frustrated and concerned with how far our country has come as we enter year three. Most of us are not looking for honors or financial rewards. We just want answers to our many unanswered questions. I can’t help but think of Franklin Delano Roosevelt, his fireside conversations, and the confidence these shows instilled in millions of angry Americans during the Great Depression and WWII. Through honest, clear and inspiring communication, FDR was able to instill hope in a time of widespread fear and despair.
Our healthcare community is currently injured and in desperate need of uplifting leadership and direction, like others who have experienced crises in our country’s history. So, to the supposed leaders, please speak to us and remind us why we chose this profession in the first place. Make sure that we are always serving one purpose and that together we can work towards a better future. Unlike most of the political stalemates plaguing our nation, accomplishing this is not an insurmountable task that requires the approval of Congress. All it takes are inspired and motivated leaders ready to connect on a humanistic level with disgruntled frontline workers. This small investment of our leaders’ time will help restore morale in our community, which will undoubtedly lead to countless downstream benefits as our nation strives to recover.
Dr. Jason Chertoff is a member of the Board of Internal Medicine, Pulmonary Medicine and Critical Care Medicine. He completed his undergraduate studies in biology at Tufts University in 2000, received his medical degree from Tufts University School of Medicine in 2004, and received a master’s degree in public health from Columbia University in 2010. Dr. Chertoff’s professional interests include the management of sepsis. . and septic shock, ARDS, interstitial lung disease, asthma, bronchiectasis and other pulmonary pathologies. When not working, Dr. Chertoff enjoys spending time with his wife and 5 year old twins.
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