Burnt Out

One of the many Intensive Care Unit (ICU) attending physicians in a Midwestern state was being interviewed on Monday about the current state of affairs at his and surrounding hospitals. He was quite articulate. He described the patient census in the ICUs and the changes in bed designation made to accommodate the overflow of CoVid-19 patients.

All of the ventilators they had or could borrow were being used.  The physicians, nurses, physicians’ assistants and other staff available to man the overflowing hospital were working 12-hour or longer shifts. All elective procedures were canceled.  And so it went. It was a familiar litany of horrors being enumerated by an obviously skilled and experienced administrator. 

We have been listening to this description of a healthcare system in collapse for so long that we have become desensitized.  Indeed, this physician sounded so matter-of-fact about the situation that he was reporting that one had to wonder if he was listening to what he was saying. The lengths of stay, complication rates, deaths all sounded like factoids read off Wikipedia. None of it seemed to be connected to the human toll exacted by the virus and our lack of preparedness for a pandemic. But then the reporter asked the most obvious of questions: “What will you do if there is a train wreck or major highway accident with numerous injuries.”

The physician stared straight ahead without responding immediately. He looked as if he had been sucker-punched and was trying to catch his breath. He tried to speak but could not form any words. He was choked up. At last, he broke the awkward silence by forcing out the unavoidable cliché, “We’ll do what we have to.”

That ended the interview. The man was too distraught to continue. For those who do not know what that statement means, allow me to translate, “We will choose who we believe we cannot help, and we shall do nothing to help them, except load them into the refrigerator truck morgues parked outside the hospital as soon as their pulse fails.”

I have seen numerous interviews with nurses, doctors, hospital administrators, etc. that follow this same pattern. First, there are some indigestible facts, then there are the “if only” statements, and finally, there is the emotional collapse. Healthcare providers that face tragedy and gore every day that would make Attila the Hun vomit are burnt out. Simply put, we are sad as hell and can’t take it anymore.

I remember the first patient for whom I was at least partly responsible who died on my watch. I was a student, and that man had a real doctor making most of the decisions regarding his care. The patient was an unemployed, middle-aged, alcohol-abusing man who had no visitors and no apparent interest in surviving his latest bout of liver failure. He never spoke to me or even looked at me with any discernible interest. When he died, I felt no sadness, remorse or sense of loss. 

No one came by to say, “Thank you,” or “Why did you let him die?” No one seemed to care whether he lived or died, and I was frankly surprised by my lack of emotional response. It was like the first time I stuck a needle into a patient’s arm and was surprised that it did not hurt me. When he died, I felt nothing.  He was a stranger, who had never spoken to me or tried to elicit my concern. He may have had friends or family, but I never met any of them.  He may have accomplished much in his life or nothing at all. I never had any background information on him.

And so, of course, you ask the obvious question, “If this stranger’s death did not touch you, why do you mention it 50 years later?” To which I would answer, “Get out! This interview is over.”

Our spirits are like exquisitely polished, marble statues. At birth, they are flawless, but then life happens, and they get damaged. For a healthcare provider, every misfortune, regardless of how uninvolved we may tell ourselves we are from the event, leaves a mark. There is no mechanism to polish out the defect. It is there for life. You may not feel it when it happens, but when you look in the mirror that is your life, you see it. The defects accumulate until you are unrecognizable to yourself.  It is like the portrait of Dorian Grey, constantly being disfigured, not by sins, but by losses.

Our political leaders have assured us that this pandemic will end. Perhaps it will.  Perhaps the BioNTech and Moderna vaccines will work. Perhaps the virus will simply mutate itself into a harmless strain. Some of these leaders have told us to ignore the virus and get on with our lives. That’s right! Ignore the family, friends, neighbors and colleagues killed or crippled by the virus and get out there and fight for our economic recovery. If you die, it will increase the likelihood that we shall achieve herd immunity. As I listen to these leaders, I suspect they are already infected and have suffered profound brain damage or are soulless apparitions sent from hell to recruit us for eternal suffering.

And so, “We’ll do what we have to.” The healthcare workers who survive this nightmare will be different. Some will look back on the experience as an ordeal that left them tougher. Others will simply look straight ahead and try to breathe.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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