On November 28, 2021, scrolling through Twitter (now X, I suppose), I came across a tweet by @SailingKateMD:
“Checked my ICU list after being gone for a few days for the holiday … Every single one of my COVID patients died while I was gone. All of them.”
Reading that hit me like a truck. That evening, I was 6 years out of medical school and in my third year as an attending hospitalist physician. Just the year prior, as the first waves of the pandemic raged, I had felt so helpless as my team experienced more patient deaths than we ever had before, despite herculean efforts. In that instant, I heard the voices of families saying goodbye to their loved ones over the phone and could almost feel the deep impressions on my face left by my N95. Then the moment passed and, as I usually do, I packed it away in a mental compartment reserved for emotional things and went on with my day.
Well, almost.
As I walked into my kitchen, tweet still glowing on my phone, it felt like all the thoughts and helpless feelings filed away in that compartment came spilling out, like my mental lid was no longer holding fast. It rattled me, so I sought refuge from the deluge in my favorite mindless activity: I threw on some headphones, put on a podcast, and started doing the dishes, hoping the soapy water would help me dodge the mental tsunami.
It almost worked. The helplessness roared back moments later and every effort I made to drown it out failed. I quietly put the sponge down and removed my headphones. My knees felt wobbly. I gingerly walked to the living room, where my wife sat on the couch working. I barely heard her phone ring with her father’s usual nightly call. With that painful tweet in mind, I only heard myself saying, “I don’t think I’m okay. I don’t think I’m going to be okay for a long time.”
What happened next might have been comical if I had been watching from outside. I would have watched my wife blanch as her husband, who rarely cries, suddenly collapsed in tears. I would have seen her frantically (but politely) hang up on her father and scramble across the couch to take my sobbing, shuddering body in her arms. As we huddled together, I felt it all. Every dying patient, every piece of disinformation I saw on social media, and every pro-mitigation argument I had to make suddenly burst forth from me in desperate, pathetic moans. I had not cried that hard in over a decade. My tears subsided after a few minutes and we exhaustedly went to bed. But I still wasn’t okay.
A recent study by G. Camelia Adams and team looked at physicians who were involved in the initial peak of the pandemic and identified five major categories of coping strategies (both positive and negative). Among other conclusions, the researchers determined that “Despite efforts to employ adaptive coping, physicians’ rates of psychological and physical health difficulties remained high or worsened over 1 year.”
The study reminded me I was not alone: other physicians’ mental health had suffered due to feelings of helplessness. When things ramped up in 2020, I, like other physicians at COVID-19 centers, became an expert in diagnosis and treatment of the disease (or as much as possible with such limited and rapidly changing information). Beyond the hospital, I started blogging regularly and increased social media posting to provide education to my little corner of the internet. As I often tell people, “It was either that or cry in a corner” (actual incident of crying in a corner notwithstanding).
I have looked beyond myself and my personal “resilience.” If you work in healthcare and are like me, you probably hate that word. We saw the world go from nightly applause to hurling insults and accusations of “pharma shill.” When we finally figured out what reasonable protection and prevention looked like, it was undermined by lack of funding, poor institutional messaging, and a failure to employ actual public health principles as folks desperately tried to return to pre-2020 status quo. This all led to soaring feelings of helplessness among healthcare workers, which had a traumatizing mental health impact for many.
The old “medicine is a calling” adage lost whatever shine it had left when members of our own profession began spreading COVID disinformation. Our calling instead should be advocating for positive change within and beyond the field. Some of our colleagues advocate at the policy level, meeting with legislators. Some run for local or state office. Some, like me, combat disinformation online. As physicians, part of work-life integration must include time for change. I used to be less declarative with that. At times, I barely maintained my own sanity, so how could I tell people to do anything more?
Yet, it is exactly that struggle that drove me to write this. Fact-check that erroneous post. Call out that bogus claim. Perhaps create: anything from a tweet or Instagram caption to a full editorial or article. Get more good information out into the world.
It is not easy. Brandolini’s Law says, “The amount of energy needed to refute bullshit is an order of magnitude bigger than needed to produce it,” and this axiom has never been truer than what I experience while countering disinformation. It is much easier to write a catchy, sensationalist headline that sparks outrage (despite paltry evidence) than to write nuanced scientific messaging with higher-quality evidence, especially amid the cacophony of mean-spirited replies. That imbalance is what those who spread disinformation count on.
There are many frustrating, non-patient care-related aspects of healthcare — the things that make us say to ourselves, “Why can’t I just take care of my patients?” Countering disinformation can seem like one of those frustrating things, and the sheer number of misleading claims on the internet can spark feelings of helplessness in and of itself. Still, while individual self-care is incredibly important, we must also strive for systemic change to allow better delivery of care to our patients. This can fight the helpless feeling. We need to lift each other’s voices and use our ability to educate and empower patients on a much broader scale.
And maybe we can feel a little less helpless.
Joseph S. Thomas, MD, is a hospitalist with Buffalo Medical Group. He is also a clinical instructor at the University at Buffalo Catholic Health System in the Internal Medicine Training Program, and a deputy editor of Digital Media for the Journal of Hospital Medicine.
Please enable JavaScript to view the