Like many healthcare workers, I (Meyer) emerged from the COVID-19 pandemic in 2022 feeling shell-shocked. There was a sense that I had been swallowed whole by something immense, heartbreaking, and utterly traumatic. It felt as though I had traveled to the edge of hell. I am a frontline emergency medicine physician, and I oversee the disaster preparedness program for 21 hospitals in California. So to say that I was busy during the pandemic is a magnificent understatement.
As a practicing physician for 20 years now, I trained in an era when medicine was considered a calling, and we were taught to give everything to our profession. Our joy in medicine was derived from the satisfaction of saving lives by pushing ourselves to the point of collapse. When the first cases of COVID-19 arrived, there was never a question regarding what I or my colleagues would do. Like recruits to the battlefield, we went to work. We were cowboys. We were heroes, or so everyone told us.
It wasn’t until 2022, consumed by a breathtaking wave of Omicron patients and my own misery, that I stumbled on my daughter’s high school essay and first began to comprehend, to my deep regret, the collateral damage of my compulsiveness. It makes intuitive sense that our children were set up for trauma during the pandemic. Beyond social distancing and the disruption of normal routines, our children lived with the fear of a parent’s infection (and possibly their own), resided in a house with a healthcare worker under unprecedented stress, and had a front-row seat to the alternate heroizing and vilification of clinicians. The children of healthcare workers experienced real time upheaval in their own worlds and vicarious upheaval through their parent(s). This was my daughter’s perspective:
It seemed as if her temper never came to a pause. When she was there, fire came out of her every breath as she relentlessly burned me, hard tears streamed down her face into a river with a current so strong I was left to drown, and her cruel eyes held blades as strong as swords invariably pointed towards me. But she was not there most of the time anyways. Usually, she was a woman of gold, an angel, a hero, saving life after life, working shift after shift.
“Your mom is such an impressive woman. You must admire her, must respect her so much.” Yes, my mom held an all-encompassing devotion to her work as a high-power doctor, but unfortunately, it was impossible for that same dedication to be carried into other parts of her life.
“I know, she truly is saving the world,” was the only response I could muster.
Behind closed doors, the truth of my mom’s reality relentlessly haunted our house. A slamming door was the first sign she was back from a shift, immediately followed by the echo of her bag falling on the kitchen table. When my door finally crept open, I would look up to see a fabricated smile sitting atop a face of vehemence, like a single drop of water helplessly trying to contain an explosive fire. These were the only times I really saw my mom — she missed games, academic and athletic achievements, awards, and holidays; the hospital was her home, coworkers were her family.
It was not always this way. When I was younger, her vivacious laugh lit up every room and her energizing optimism created a positive light within my house. Only when COVID hit did my mom’s joy begin to fade into depression. Her anger at everyone and everything boiled over into a violent mess that was inescapable. Her brutality burned through our relationship.
Gradually, as the COVID vaccine became widespread, the mass amounts of patients that overcrowded the ER began to recover, and my mom’s work as a doctor once again mirrored her previous normal. Until one day, my mom softly plopped down on the couch next to me. “I want to apologize to you, and explain.” She started to desperately speak. “When COVID started, my job changed like it never had before. Devastation reigned the hospitals every day with no remorse. The emergency room was cold and unforgiving, and what was once a job that brought me joy was no longer anything but an obligation. Everyday, I felt myself fail as another breath died out. Walking into work, I knew I would have to endure that awful constant beep of a stopped heartbeat. The burden of being a first responder, having to witness death on the tip of your fingers every day…”
As her voice trailed off, I felt my disgust towards my mom pause for the first time in 2 years.
“It did something to me. It changed me. After months of cynically watching the lines of patients get endlessly longer, enduring death so often my heart filled with pain, and feeling hopelessness crawl up the walls of the hospital, it seemed as if I would never be rescued from the burning house I was trapped in.”
Her toe tapped on the floor, and anxiety filled her face. I, too, was anxious — the desire to forgive my mom was in direct juxtaposition with the resentment I felt trapped in. Forgiveness was still impossible, but understanding sat between us, soothing the fire.
COVID and its subsequent consequences had not only burned me, but my mom as well. This combustion was never her choice, it was a burden she was forced to carry, an obligation that held great power over her and devoured her. With time, I hope that understanding can evolve into forgiveness. Most of all, I yearn to once again feel that my mom deserves to have a safe and compassionate relationship with me, filled with love and respect.
It was my daughter’s essay that finally shook me out of the deep anger I was drowning in. I have laid to rest once and for all the traumatized worker that I was. For the first time in my career, I put guardrails around my work. I decreased my hours. I stepped down from my position in disaster preparedness. In the meantime, the angry 15-year-old who wrote that essay just turned 18. She will begin college in the fall, and — get ready for this — she wants to be a physician. In October, she attended a disaster preparedness conference with me and unironically presented a poster on emerging infectious diseases.
My generation loves to bemoan the work ethic of younger physicians. They ask a lot of questions, don’t have the same intensity, and seem, well, fragile. On the other hand, the U.S. now faces a severe shortage of physicians due largely to the burnout in my generation. Two in five physicians will be 65 or older in the next decade, and surveys suggest we are likely to retire earlier rather than later. Almost half (44.2%) of all health workers reported that they were somewhat or very likely to look for a new job in 2022. Those of us that remain are tasked with re-envisioning our profession like a phoenix rising. At our best we embody grit, resilience, compassion, hopefulness, and a celebration of our shared humanity and mortality. We can also be our own worst enemies.
I find myself wondering if perhaps younger physicians, with their more measured approach, are on to something that eluded my generation.
I know that if my daughter one day enters medicine, I will caution her not to throw herself in so completely, to hold a piece of herself back and to safeguard that piece. I will remind her that it’s OK to clock out when the day is done. I will show her the guardrails I learned too late in my career. And I will tell her that it’s worth it. Then I will watch, filled with hope and curiosity, how her generation tackles my complex and extraordinary profession.
Mary Meyer, MD, MPH, is an emergency medicine physician and the outgoing director of emergency management for a large healthcare organization in Northern California. Carolina Fox is a senior in high school. She will matriculate at Tulane University in the fall.
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