Beyond the "Hero Narrative": Recognizing the Pandemic's Toll on Healthcare Workers
As she reflected on the past several months of the pandemic, A grappled with what it meant to be a doctor in this brand-new context. She spoke candidly about the difficulties, both personal and professional, that healthcare workers have faced during COVID, which she explained have been magnified by a "broken" medical system that was unequipped to handle the crisis. High demand and expectations for healthcare during the pandemic, combined with the overwhelming number of unknowns about this novel virus, have resulted in a sense of vulnerability unlike anything medical professionals have experienced before.
"I don’t think anything in my medical training or residency training prepared me for this. This is all very new. We didn’t get any course or lecture on pandemic preparation or infection to this degree. [...] I feel like it’s definitely been a revelation, and also a blessing that at least I’m still in my residency training, learning about this and making sure to incorporate this into my clinical practice. I mean, nothing prepared me for this. We’re just learning as we go—we’re learning on the fly. And I think people think 'Oh, doctors have the answers, and they know what they’re doing'—no. We have no idea."
-A, on the unprecedented nature of the COVID pandemic
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One of the most salient issues A described was an alarming lack of institutional and governmental support for healthcare workers, who were soon overwhelmed by how many people needed treatment. In lieu of any formal guidance, A recounted how medical professionals turned to unconventional sources of information, such as Facebook, in a desperate attempt to gather enough information about the virus in order to effectively treat it. Facebook groups were created specifically for doctors to post case reports and discuss treatment methods, patient outcomes, new discoveries, and other COVID-related information in real time. Although A credited these groups with helping her "prepare for what was coming" in the early days of the pandemic, they were a stopgap measure at best, not an adequate replacement for information from official sources.
"Facebook helped [...] connect doctors from all over the world to talk about what’s going on in their country and how they’re treating patients. [...] There were quite a few physician leaders who led this effort in spreading the word, and getting people to join, and sharing what’s going on in the rest of the world on how to treat COVID patients, and posting science articles, evidence-based medicine, or even just case reports of things that they were doing, say, in Italy, or in Spain, or how serious the pandemic was. Because we weren’t getting any of that accurate information from the government, or from hospital administrators. It was just all on our own to figure it out."
-A, on the importance of the COVID Facebook groups created by doctors, for doctors during the pandemic
(Image created by David Yu)
A explained that the information they gleaned from their counterparts overseas, combined with the U.S.' systemic failure to adopt an aggressive approach to COVID from the outset, worried many medical professionals—herself included—and prompted them to preemptively "sound the alarm" about the virus. However, their warnings went largely unheeded by the public, and the federal and state governments continued to downplay the virus until the death toll grew too large to ignore. A identified the COVID peak in New York, one of the first American epicenters, as a turning point in the country's acknowledgement of the pandemic. The city's plight became "an example to all of us," she said, and "it showed us that it can happen anywhere."
As the pandemic continued to worsen, healthcare workers were applauded for the enormous risk they assumed in continuing to do their jobs, especially when treating COVID-positive patients. Paradoxically, however, this heightened danger resulted directly from the nation's unpreparedness, which medical workers themselves had predicted would lead to shortages of personal protective equipment (PPE) and ventilators, staffing shortages, and improper, rushed training for workers not used to treating intensive care patients, among other issues. As such, when we refer to healthcare workers as heroes during the pandemic, we are essentially praising them for working in dangerous conditions that they were involuntarily and unnecessarily subjected to, which is neither fair nor ethical.
The front page of The New York Times from March 20, 2020, conveyed healthcare workers' desperation as the pandemic continued to rage across the country with no end in sight.
(Image Source: https://www.reddit.com/r/medicine/comments/fltxg8/the_front_page_of_todays_new_york_times/)
"I think what I remember most was, there was an article that was written about two Chinese medical workers—one was a doctor and one was a nurse—and one survived COVID and one didn’t. But both their ages were really young, and when people were like, 'Oh, it’s just like the flu, people are going to get it and then get over it,' I’m like, 'No!' A 27-year-old doesn’t get the flu and die—that never happens with the flu. I tried to bring that up even at my hospital—we need to take this more seriously, we have to have some contingency plans, some sort of protective measures, and I think slowly they came around, and they understood that."
-A, on the sense of urgency she felt at the beginning of the pandemic
Despite the risks posed by COVID, healthcare workers often have no choice but to go to work, because "we have to keep seeing patients, we have to keep making money, and that's how we survive," A said. She emphasized that not even medical professionals, on whom the public has depended to save lives, have escaped COVID's economic destruction unscathed: "[My hospital has] lost a lot of revenue, and the PPP [Paycheck Protection Program] helped us through the last few months, but now that we don't have that anymore, I think we're going to see more cuts," she said. "And doctors are not immune to that—a lot of doctors have lost their jobs because of this, or have had to get pay cuts and work fewer hours throughout the week to sustain themselves and their practice."
Many struggling hospitals, citing financial difficulties, have also refused to compensate their workers with hazard pay, which normally accompanies work done in especially dangerous conditions. A Wall Street Journal article, published in April 2020, quoted Herbert Lepor, chairman of the urology department at NYU Langone, as telling his exhausted residents that he was "not indifferent to your anxieties but personally feel [that] demanding hazard pay is not becoming of a compassionate and caring physician." Dr. Lepor's sentiment exemplifies the problematic nature of applying the economic theory of "compensating wage differentials" to care work, which scholars Nancy Folbre and Julie A. Nelson explore in their article, "For Love or Money—or Both?" Folbre and Nelson write that the assumption that healthcare workers "enjoy caring" leads people to believe that the workers "will be willing to accept a lower wage to do these activities, essentially taking part of their 'pay' in good feelings." This idea merges well with the hero narrative, because the theoretical hero is completely motivated by altruism and does not require compensation for going above and beyond. However, I posit that this argument is clearly untenable during the COVID-19 pandemic. As A and many other healthcare workers have explained, regardless of how much they enjoy their jobs and care about their patients, they did not go into medicine seeking a dangerous position on the front lines of a global pandemic, nor did they foresee being unsupported to this extent if a public health crisis did occur. Therefore, in order for us to expect quality healthcare from our medical professionals during this time, it is only right that we provide them with ample compensation in return.
Q: "Were you ever afraid to go to work?"
A: "Oh, absolutely. I think when this first began, I was like, 'Oh, I don’t want to go to work, I don’t want to get COVID.' I think I still am afraid to go to work; especially on the inpatient side, I feel like I am definitely risking my life."
(Image Source: https://www.washingtonian.com/2020/10/04/covid-tribute-national-covid-remembrance-day-20000-empty-chairs-on-the-mall/)
COVID has unequivocally exacerbated the physical and mental exhaustion that medical professionals are already uniquely susceptible to during the normal course of their work. "Burnout in physicians [was] a real phenomenon" in the medical world pre-COVID as well, A said, because "the work does get pretty grueling. [...] There were moments where it felt like I was drowning—drowning in clinical duties, patient care, sleep deprivation, and whatnot." However, she noted that the virus has made healthcare workers' jobs even more difficult, as it has eliminated some of the human connections they have grown to depend on: the ability to initiate direct, face-to-face interactions with patients, for example, or to spend time with friends outside of work to decompress. The added emotional toll of comforting patients whose families are unable to come visit, treating the sheer number of critically ill and dying patients being admitted to hospitals, and confronting the misinformation circulating among members of the public about the virus, among other factors, have also contributed to the intensity of COVID-19 burnout, which has proven to be far more insidious than what medical professionals were used to seeing and experiencing before the pandemic.
"I think [the pandemic] has definitely strengthened us a lot—there’s a lot more camaraderie and support. But at the same time, doctors are human, and I think the stress of all this really gets to some people, and it manifests in a lot of different ways, such as burnout, depression, anxiety, or just being a jerk [laughs]. That does tend to wear other people down, so I think it’s important that you try to help each other get through this, emotionally and mentally, and even physically— making sure that everyone gets a break, and people are able to take a moment to detach themselves from the chaos that’s going on, and be able to restore their inner peace and come back more rejuvenated."
-A, on the importance of mutual support in combatting stress and exhaustion
A described the different ways in which healthcare workers have relied on each other throughout the pandemic, not only for information and patient care but for emotional support, as well.
(Image Source: https://www.usatoday.com/story/news/nation/2020/05/03/coronavirus-death-count-has-doctors-struggling-mental-health/3063081001/)
Furthermore, due to burgeoning caseloads and staff shortages, healthcare workers are often forced to take on multiple unfamiliar and difficult roles while treating patients—as one first-year resident told the Wall Street Journal, at one point he was acting "as an MD, a nurse, a respiratory therapist, and a janitor all at once." In doing so, these individuals shoulder the full burden of two different types of care work-related labor, both of which are equally strenuous: "spiritual labor," which is defined by scholar Dorothy E. Roberts as the emotional labor that is involved in caring for another human being; and "menial labor," or what Roberts describes as the physical labor involved in care work. These two entities are inextricably intertwined with the healthcare work being done on the front lines, and it is this distinct combination of intense emotional and physical labor that makes the hero narrative so potent when applied to healthcare workers during the pandemic. This rhetoric blurs the lines between care as a worker's choice and care as coercion by taking advantage of medical professionals' obligation to the aforementioned duty of care and duty to treat. The continuous portrayal of healthcare workers as heroes leads to the public expecting heroic acts, an assumption that is, in itself, exploitative and only contributes to medical professionals' feelings of despondency and guilt in the wake of negative patient outcomes.
Healthcare workers across the country echo A's sentiments about the magnitude of the pandemic and the havoc it has wreaked on the healthcare system as well as individual healthcare workers' physical and mental health. "I do believe that there is this reckoning with how vulnerable we all are to the virus, to the possibility of being overwhelmed by it. And death, I think, is something that I grapple with as a doctor, but it never became so tangible until now," one physician says (2:23).
(Video Source: https://www.youtube.com/watch?v=sQ8nv_LJN3s)
"COVID has definitely laid bare a lot of the things that are broken in medicine, and so in some ways it is very depressing at times. [...] You’ll never satisfy everyone, but some days I don’t feel as respected as I should be respected. Some days I feel like I’m risking my life and I didn’t sign up for this. Some days I think that maybe medicine is really behind the times and hasn’t progressed like other fields. I feel like a software engineer probably gets more protection than I do, and has more benefits than I do. And then, to top it off, a female physician gets paid less than a male physician, and it’s definitely disheartening. I think for me, it’s been a roller coaster ride, and I’ve been trying to stay grounded and center myself in why I started this journey, because it’s a big commitment. I mean, I’ve committed fifteen years of my life to this already, and it’s hard to give up. But sometimes, things happen that are painful enough that it makes you want to give up. Give up your career. I think as an individual, and also collectively, as physicians, we’ve definitely been reckoning with that—Is this career right for me? Is it providing me the support that I need and the satisfaction that I want? Is helping a patient enough for me? Or maybe it’s not enough, and I should find something else to do. I think these feelings are probably not going to go away for a long time."
-A, on the pandemic's role in exposing critical weaknesses within the healthcare system and her own struggle to stay motivated despite the hardships she has faced during COVID
(Image Source: Wix)