Susan Smith, a pediatric ER physician in the Midwest who’s been in the medical field for 30 years, wasn’t expecting to retire soon. But then COVID-19 hit. Smith has dealt with the long shifts, the increasing influx of children sick with the coronavirus, and the usual emergency room traffic just fine. Coping with her young patients’ vaccine-skeptic parents is another story. Her experiences with the adults have left her shocked, disheartened, and ready to go to a job she once loved. “Even though this will hurt me financially, I’m done,” Smith, 60, told HuffPost recently. “I had hoped to do five or possibly ten more years, but the anti-vaxxers, Trumpers, and conspiracy theorists have just worn me down.” “I love working with children, and I knew I was truly helping children and their families and making a difference, but not anymore,” the doctor said.
In the last year and a half, she’s dealt with parents who shout and scream at hospital staff about mask mandates and safety precautions. Then there are the parents who pass on websites and the names of doctors they think Smith should look up so that she can “educate herself” and “know what’s going on.” They’re the minority of parents Smith sees in the ER, but they’re a vocal, sometimes downright hostile minority. One experience stands out more than the rest: A mom brought her 2-year-old daughter in because she wasn’t eating as much as needed. Smith and the woman were having a reasonably reasonable conversation about what could be done when she let it slip that she would never immunize her daughter.
“She said, I won’t do it because of the ‘poison you doctors put in the shots,'” Smith recalled the woman saying verbatim. “I was incredulous and had to confirm that she had said that and meant me, as well as every other pediatrician who administers vaccines,” Smith said. “I asked her why she had brought her 2-year-old daughter in to see us with a mild chief complaint if she ‘knew’ we poisoned children. Why would she want to hear what we have to say?” The woman didn’t answer Smith; she just held up her hand directly in front of the doctor’s face, mimicking a slapping motion and telling Smith to “just do your job.”
The encounter gobsmacked Smith, but she was even more taken aback by her colleagues’ blasé reaction to the story. “Most didn’t even act surprised or bothered,” she said. “They essentially summed it up as ‘that’s just the way things are nowadays’ and told me to put it out of my mind,” Smith said. But Smith couldn’t stop thinking about it: How starkly that interaction contrasted with her experience with her parents in the past. How the woman echoed, line for line, the anti-vaccine conspiracy theories she’d seen promulgated on Facebook.
“These days, we’re supposed to do our job exactly how they think it should be done, based on what they’ve gleaned from the internet and Facebook ― which, in their minds, supersedes our four years of college, four years of medical school, and three to 10+ more years of residencies and fellowships.” “And if they or their children get sick, they expect and know we will care for them,” Smith added. “I’m just tired of it.” Eighteen months into the pandemic, Smith’s experience with burnout ― because of the pandemic’s excessive workload and emotional trauma and because of run-ins with anti-vaxxer patients ― is common among medical workers.
Fifty-five percent of U.S. front-line healthcare workers reported experiencing burnout ― mental and physical exhaustion from chronic workplace stress ― according to a recent Washington Post/Kaiser Family Foundation survey of 1,327 workers. Sixty-two percent of the workers reported some mental health repercussions due to their burnout. If not managed, mental health professionals worry these issues could flare into chronic psychological problems: depression and anxiety or post-traumatic stress disorder have all been commonly reported among healthcare workers during the pandemic. Individual stories of doctors’ and nurses’ suicides highlight just how dire an emergency the COVID-19 pandemic has been for front-line workers. In an April 2021 study by Healthcare Jobs Marketplace, Vivian found that 4 in 10 nurses are considering leaving their roles in 2021. That figure is even higher among ICU workers.
“Every day I work is a nightmare.”
Sam, a 46-year-old registered respiratory therapist in Tampa Bay, has weighed leaving the field. Like many in this article, Sam, who asked to use his first name only out of concern for his livelihood, told HuffPost he’d switch careers in a heartbeat if he were younger. He mostly sleeps and cares for his two kids on his days off. “When I go out, all I see are people walking around without masks, knowing that they probably aren’t vaccinated, and all I think about is the hell I go through taking care of people like that,” he said.
To cope, Sam has started taking anti-anxiety and depression medication. He was seeing a therapist, but the surge in Florida has kept him so busy it’s been hard to keep up with appointments. (According to the Florida Department of Health’s most recent weekly COVID-19 data report, the number of new cases has dropped in the past week, but the weekly death toll has risen. The state continues to see a decline in vaccinations week-over-week.)
“Every day I work is a nightmare of people dying and treating people close to death,” Sam said. “There aren’t many happy endings anymore. I see so many unvaccinated people dying. Most of this is unnecessary. I truly believe that COVID is mostly a choice now.” Conspiracy theories and vaccine misinformation are wearing healthcare workers down, making it impossible for them to treat patients while preserving their mental health.
Sam recalled a recent experience in the ER when a physician he works with had to tell a patient he was COVID-positive. The patient cussed the doctor out, saying it was all a hoax and that he was lying. A few hours later, medical workers were intubating him. The man never came off the ventilator and died a few weeks later. Sam said that watching so much unnecessary death takes a toll on your mental health, but so does having to listen to patients berate you and rant about the vaccines.
“We’re ridiculed for wearing masks and being ‘sheep’ for heeding CDC guidelines,” he said. “I’ve been in rooms where someone is less than a day away from being intubated, and they are FaceTiming their families, and the family member is asking them if they want any of that cattle dewormer.” He’s referring to ivermectin, a drug often used for deworming livestock that recently gained traction as an at-home coronavirus treatment despite the Food and Drug Administration warning against its use.
Sam said he couldn’t understand why the conspiracy-minded patients he treats are willing to try everything but the one thing that will save them. A recent Centers for Disease Control and Prevention study found that unvaccinated people are 11 times more likely to die from COVID-19 and 29 times as likely to be hospitalized for it as fully vaccinated. “It’s becoming tough to empathize or sympathize with these people,” he said. “I have to fake it sometimes.” At this point, he’s dealing with his burnout by looking far into the future.
“When this nightmare is over, I hope to get the joy of helping others back to somewhere close to what I had before,” he said. Carlie Russell, a registered nurse in the South Shore of Massachusetts, is sticking it out, too, despite feeling worn out. Looking back to the pandemic’s start in March 2020, Russell said she genuinely felt that Americans were on the same page and would fight the virus collectively. The pandemic would eventually reach an endpoint, thanks mainly to the development of a vaccine.
The vaccine is here — but the endpoint is becoming more elusive. “I never thought we would have to convince people this disease was real or that wearing masks is the best to help people stay safe,” she told HuffPost. “I certainly know that I never thought it would be as bad and stressful as it has been.” There’s a weird double consciousness. Russell feels like a healthcare worker; she goes about her day at work, seeing people intubated and dying with unnerving regularity. Then she leaves the hospital, returns to her community, and realizes her work is conversation fodder for people who downplay the COVID crisis.
“You don’t realize how upsetting it can be to hear people say, ‘It’s not that bad’ or hearing someone say, ‘This is the job you signed up for,'” she said. “It’s just created stress, trying to learn not to fight every battle.” Stephanie, a certified pharmacy tech and medication reconciliation technician in southeast Georgia, does frequent hospital rounds. The hospital is so overwhelmed that she recently couldn’t call in sick even with a doctor’s note, and taking your paid time off is frowned upon. The pharmacy tech said that her department has been trying to hire people but loses staff as fast as it can onboard them. Frustratingly, she explained, even many of her co-workers are averse to getting the vaccine.
“Even with the science behind it. Even with the FDA approval,” Stephanie said. “But we live in the Bible Belt, so it feels hopeless.” Stephanie is looking to leave her job ― she’s a streamer on Twitch and ideally wants to lean into that ― but she’s staying for now because of the insurance and because she still has a strong sense of responsibility to help people. “In general, I feel like people forget about the work the pharmacy and lab techs do,” she said. “We go to codes. We help intubate patients. We provide medications for the entire hospital. And being the only person making the drugs at night, I feel a huge weight on my shoulders since COVID.”
Others are worn out but more purposeful than ever.
Even mental health therapists in private practices are thoroughly exhausted during the pandemic. “For many clinicians right now, there are absolutely experiences of vicarious trauma ― trauma symptoms that can result from being repeatedly exposed to other people’s trauma and their stories of traumatic events,” said Kenya Crawford, a clinical director and clinical supervisor of a group therapy practice in New York City. During the pandemic, Crawford tweeted about her experiences with patients already navigating complicated new COVID-19 issues.
“Being a therapist in COVID is hard,” she wrote. “I’m witnessing clients terminate due to lack of income, falling back into depressive episodes due to social isolation, and increased exposure to abuse from being around abusers all day. I am exhausted.” Though Crawford said it’s still tricky to continuously listen and hold space for people experiencing a trauma that she, too, is experiencing, the last two years have solidified her desire to work as a therapist. “This has allowed me to show up for my clients in the peak of some of their distress, anxiety, and trauma, which I am very grateful for,” she said. Some therapists are experiencing vicarious trauma ― trauma symptoms that can result from being repeatedly exposed to other people’s trauma and their stories of traumatic events.
Nidhi Singh is a Houston-based pediatric emergency medicine physician who’s been practicing for eight years. She’s taken the vaccine-wary parents in stride, even as COVID-positive children fill hospitals in record numbers as they return to school. (What’s “puzzling” is the handful of co-workers who also refuse to get vaccinated, Singh said.) In the world, struggles over vaccine refusals from parents are nothing new. Even so, she admitted she was utterly exhausted by the end of the workday. “I feel like a hamster on a wheel sometimes,” she said. “I still love medicine and would likely choose the same field if I had to do it all over, but there are days where I dread going to work at times due to the exhaustion, which is not unique ― the nurses and supporting staff I work with all feel the same.”
Establishing boundaries isn’t selfish. It’s self-care.
Melissa Russian, a licensed clinical social worker in Orange County, California, works with many healthcare workers. They don’t all go as far as to say they’re burned out but exhausted, which is a crucial component of burnout. “The dedication is admirable, but the levels of exhaustion that are starting to surface have most of my clients wondering if they have the energy to run what feels like a never-ending marathon,” Russian said. When Russia’s clients ask her, “How am I supposed to take care of myself when I have no time?” she reminds them of the importance of establishing boundaries. Sometimes, they balk at the suggestion.
“Boundaries is never a word that results in a positive reaction ― it’s viewed as harsh, selfish, and alienating,” she said. However, boundaries are not selfish. They are self-care. “Being in a helping profession, it’s in our nature to help,” Russian said. “The story that most medical professionals often tell themselves is that ‘it’s only one more patient’ or ‘I can help one more person or ‘one more shift.'” The therapist frequently said that taking that time off for themselves and saying “no” is the best choice for thehealthcaree worker and their patients.
“If you’re a front-liner, commit yourself to have one long weekend a quarter off and get a full count of sleep,” she said. “And if you feel unsettled by the word ‘boundaries,’ adopt the term ‘personal policies,'” she added. “It’s amazing how semantics can change the ability to embrace the practice.” Russia also encourages meditation and solution-focused mindfulness: Dedicate some time to mindfulness daily, whether deep breathing or using your commute to embrace the silence. Talking to someone ― a therapist or coach ― also helps. (There’s only so much venting that one co-worker at work can endure.)
“Hiding behind the mask of being OK only perpetuates the impact of the feelings of burnout, shame, and isolation,” she said. The Physician Support Line is a national, accessible, and entirely confidential support line service of volunteer psychiatrists who provide peer support for physicians. PeerRxMed is a peer-to-peer program for physicians and other medical workers that provides support, connection, and additional resources for those experiencing burnout. It’s a formalized buddy system for healthcare workers at their wits’ end.
“Talking about the impact of how the pandemic has changed your view on your career, life, and even people, in general, does not change the events that are going on around us, but it helps you realize that you are not alone,” Russian said. According to one recent study, 55% of front-line healthcare workers reported burnout — mental and physical exhaustion from chronic workplace stress. Sixty-two percent of the workers said some mental health repercussions. But what if someone’s burnout is more like occupational dread and “I’m this close to quitting”? Crawford said to ground yourself in your way. Ask yourself: Why did you initially choose this career?
“Whenever you start to feel periodically overwhelmed or stressed out, remind yourself why you originally got into the field,” she said. Maybe now is a good time to start a “job wins” journal to chronicle all the positives you’ve contributed to your field and patients’ lives. “I have a ‘therapist wins’ journal that I reconnect with whenever I feel like I am particularly burnt out or questioning my role in the field,” Crawford said. But if you’ve done soul-searching along these lines and no longer feel like your work aligns with your purpose, the therapist said it might be time to reconsider your role.
“If you do leave the ld, that does not make you weak or less than anyone else,” she said. “Making any decision for you is difficult, but it’s for you and not anyone else.” In any case, colleagues in the medical field for decades will likely understand. “I know that many of my health care colleagues have the stamina of the young to keep going, and many fortunately have a better Teflon covering than I do,” said Smith, the pediatric ER doctor who wants to retire early. “All the hypocrisy, attacks, and insults on our profession from patients slide off them.” But Smith hopes those burned out by those experiences take a moment to reflect on their careers and,e if needed, opt-out, change fields, or renegotiate their roles. “Do what you must to save your physical and mental health,” she said.
