I work mainly in the intensive care unit in a moderate-sized community hospital in a rural section of Ohio. Like many pulmonary and critical care physicians across the country, I continue to be immersed and consumed by COVID-19 and all of its destruction, with no clear end in sight.
When I became board certified in my specialties just three years ago, COVID-19 did not exist. But now my new norm and second home is a 24-bed ICU filled with COVID-19 patients on ventilators, medically paralyzed and flipped on their stomachs, with many more patients waiting to enter. Sometimes in the midst of the vital sign alarms blaring, overhead code blue alerts, and grueling end-of-life family meetings, I ponder how much longer this pace can be sustained.
As we embark on our third year of the COVID-19 pandemic, it is difficult to name all of the health care resources that have neared depletion, with ventilators, personal protective equipment, emergency room and intensive care unit beds, physicians, nurses, respiratory therapists, and other essential health care workers being just a few. Gazing at my colleagues’ somber faces and dispirited demeanor, it is clear that an underappreciated health care resource deserving mention, which is now quickly dwindling, is morale.
Health care professionals complete rigorous education and training to alleviate sickness and restore health to their patients. Rarely do these workers confront novel illnesses or syndromes that do not already have evidence-based remedies. Unfortunately, as we have seen with COVID-19, new and highly contagious diseases can surface quickly, spread widely, and wreak havoc on our lives.
Historically, when these unavoidable health crises occur, the entire scientific community ― scientists, researchers, health care professionals, and numerous others ― meet the necessary challenges with graceful determination, and this has again been demonstrated 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 in the last two years.
Enter the COVID-19 vaccine, which was widely implemented in the United States within one year of the first recorded case, and is documented to drastically reduce morbidity and mortality attributable to COVID-19. Again, hopes were surging; surely this was the panacea we all craved. Finally, life would be restored to some semblance of normalcy.
Not exactly, but to no fault of vaccines, which have exceeded all expectations. The vaccinated have been repeatedly shown to experience much less sickness and death from COVID-19 than their unvaccinated counterparts. To highlight, since the widespread adoption of vaccination, for every 20 deaths from COVID-19, 18 (90%) are unvaccinated and two (10%) are vaccinated, and for every 50 hospital admissions attributable to COVID-19, 43 (86%) are unvaccinated and 17 (14%) are vaccinated (see here, here and here for more).
This outcome disparity is so glaring that my conversations with emergency room doctors regarding potential ICU admissions are often condensed to simply asking, “Vaccinated?” A “Yes” versus “No” answer frequently conveys more information about the patient’s prognosis than any information I can find in the medical chart. Clearly, vaccination works, and throughout history we would be hard-pressed to find a treatment more effective than these vaccines.
“Hospitals continue to exceed capacity, exhaustion of vital health care resources persist, and human lives are still being lost. Why? The answer is simple ― albeit controversial and politically heated: Not enough Americans have been vaccinated”
Yet hospitals continue to exceed capacity, exhaustion of vital health care resources persist, and human lives are still being lost. Why? The answer is simple ― albeit controversial and politically heated: Not enough Americans have been vaccinated. Surprisingly, the paucity of vaccine uptake is due to unfounded vaccine skepticism and not from barriers that typically impede equitable access to health care, like cost, supply, or insurance restrictions.
Just last week I evaluated an unvaccinated patient recovering from acute respiratory distress syndrome (ARDS). Despite gasping for breaths from an oxygen tank and being completely debilitated and using a wheelchair, he adamantly rejected my vaccination recommendation, stating, “Oh, no, Doc. I’m weary of those vaccines.” My inclination was to shake sense into this man and scream at the top of my lungs, “Aren’t you weary of COVID?!?!” but I managed to restrain, bite my tongue, and politely nod with a mannered grin.
Our country had traditionally prided itself on free will, freedom of choice, and autonomy. However, it is clear that these sacred values are being twisted and are keeping our nation in peril. It is difficult to articulate the magnitude of frustration that this conundrum instills in us health care workers.
So, as another wave of this pandemic is upon us, health care workers again find themselves inundated with unprecedented levels of grueling and traumatic sickness, disability, and death ― most of which is entirely preventable. Unbeknownst to some, health care workers are not superhuman or robots, and are subject to human feelings and emotions just like everyone else. Never before have I endured such resentment and cynicism at unvaccinated patients and their reckless, selfish choices. Choices that enable this pandemic to propagate and destroy lives and families. Thus, it is only natural that throughout the country we are seeing widespread staffing shortages across all health care disciplines.
Unlike many problems with workforce staffing in other fields, the solutions to these medical staff shortages do not seem to lie in financial rewards. Never before have health care workers been offered such high salaries, stipends, and bonuses to do their jobs, but still the shortages persist. They persist because money fails to address the crux of the problem, which is that the morale and resolve of health care workers are at all-time lows.
One quick anecdote I overheard at the end of a 12-hour shift encapsulated the issue at hand perfectly: “Coming back tomorrow?” asked one bedside ICU nurse to another. “Absolutely not. I’m off. You couldn’t pay me enough to get me here tomorrow.” Truly, is there anything more demoralizing than repeatedly being exposed to preventable sickness and death on this grand scale that is now mostly due to illogical and irresponsible choices?
Perhaps there is. Due to the burdens that this pandemic has imposed on our health care system, more and more sick patients are having difficulty accessing care. Unprecedented emergency room waiting times, a dearth of available hospital and intensive care unit beds, and a scarcity of vital resources typically taken for granted are becoming commonplace. Common and easily treatable in-hospital medical conditions like diabetic ketoacidosis, myocardial infarction, stroke, and sepsis are being neglected and placed on the back burner, as our system languishes in the pandemic’s wreckage. Just yesterday I had to turn away a 19-year-old in a diabetic coma due to a lack of available ICU beds and appropriate staffing, and I’m sure many similar examples will follow. With this naturally comes frustration, not only from patients and families, but also with health care workers. Being unable to care for patients due to resource limitations is something many health care workers have never experienced. It is a tough pill to swallow for many of us and adds to the unsettling nature of our new reality.
“Never before have health care workers been offered such high salaries, stipends, and bonuses to do their jobs, but still the shortages persist. They persist because money fails to address the crux of the problem, which is that the morale and resolve of health care workers are at all-time lows.”
I, like many other health care workers, am frustrated and concerned about our nation’s path as we enter year three. Most of us are not seeking accolades or financial rewards. We simply desire answers to our many unanswered questions. I can’t help but think of Franklin Delano Roosevelt, his fireside chats, and the confidence that these broadcasts instilled in millions of unnerved Americans during the Great Depression and World War II. Through honest, clear, and inspiring communication, FDR was able to instill hope in times of widespread fear and despair.
Our health care community is currently wounded and in dire need of uplifting leadership and direction, similar to others that have experienced crisis in our nation’s history. So, to those supposedly in charge, I plead with you to talk to us and remind us why we chose this profession in the first place. Assure us that we still serve a purpose and that together, we can work toward a better future. Unlike most political deadlocks that plague our nation, accomplishing this is not some insurmountable task that requires congressional approval. All it takes is inspired and motivated leaders willing to connect on a humanistic level with the disgruntled frontline workers. This small investment of our leaders’ time will help to restore our community’s morale, which will assuredly lead to countless downstream benefits as our nation strives to recover.
Dr. Jason Chertoff is a physician board-certified in internal medicine, pulmonary medicine, and critical care medicine. He completed his undergraduate studies as a biology major from Tufts University in 2000, received his medical degree from Tufts University School of Medicine in 2004, and obtained a master’s in public health from Columbia University in 2010. Dr. Chertoff’s professional interests include management of sepsis and septic shock, ARDS, interstitial lung disease, asthma, bronchiectasis, and other lung-related pathologies. When he’s not working, Dr. Chertoff enjoys spending time with his wife and twin 5-year-old children.