Since the beginning of the coronavirus pandemic, more than 90,000 health care workers have been infected with the virus, and many have died. To name a few, these have included: a beloved doctor who came out of retirement, a patient transporter in Illinois, a pharmacist in upstate New York, and a nursing home worker. And those are just the deaths from physical illness and don’t take into account mental health consequences.
If you follow the news, you’ll read and hear over and over again that we are at “war” with the virus and that physicians like us, along with other essential workers, are soldiers in battle.
The term “front-line workers,” which has been used to describe those in health care during this pandemic, comes from the military, describing people putting their bodies at the front of the battalion, facing down the enemy. “Redeployment” has been used for physicians and nurses being asked to practice in areas outside of their specialty in response to the demands of the pandemic. Even President Donald Trump has made this comparison, saying health care workers are “running into death just like soldiers run into bullets in a true sense, I see that with the doctors and the nurses and so many of the people that go into those hospitals, it’s incredible to see, it’s a beautiful thing to see.”
Using this analogy is understandable. War metaphors are frequently used to describe diseases. Wartime physicians have compared the actual daily work, the frenetic environment, and the sheer volume of death, code blues, and tragedy we are currently experiencing to the chaos and trauma of combat.
All this makes it tempting, this Memorial Day, to hold front-line workers we’ve lost in this pandemic up against the sacrifices of fallen soldiers. But comparing doctors and nurses to troops is not a fair or helpful comparison.
Though both soldiers and health care workers prioritize duty and service to others, health care workers do not enter their jobs with the expectation that they will be asked to put their own lives (not to mention the lives of their families) on the line to care for patients. Medical trainees, who must train in hospitals in order to graduate on time, did not expect that they would risk exposure to Covid-19 as a part of their training (and some even have to waive liability for it). This is not business as usual.
Just as it would be unwise to go into war without weapons and appropriate armor, we do not usually go to work without effective treatments for our patients or protection for ourselves. We still do not have enough personal protective equipment; beyond masks, we also need gloves, gowns, and hair and eye protection. We still do not have enough testing or even hand sanitizer. We also do not have any preventative measures or therapies for a health care worker who contracts the coronavirus, thereby forcing some to isolate from their families and put themselves at risk indefinitely.
There is little guidance as to how to protect people from catching the coronavirus, and we are still sorely lacking reliable data on how best to care for patients who have it. The day-to-day decision-making on the ground as a health care worker is ever-changing as the science is evolving. This leads to significant uncertainty as to what optimal medical care is. Should we place patients on a ventilator early or wait as long as we can? Should we put them on blood thinners or does that lead to too much bleeding? Should we treat them with tocilizumab or remdesivir or the latest drug of the week? Everyone is desperate for a solution but no one knows what to do.
Yet, often the public chooses not to turn to science for guidance. On top of worrying about treating the patients we have in the hospital, we also worry that many people listen to the off-the-cuff recommendations of government officials and either begin taking the wrong medication for the wrong reasons, or inject something like a disinfectant, which is dangerous. This is all happening against the background of an uncoordinated federal public health strategy. Moving forward, we have, at best, vague plans for “safe” reopening. Even masks, which are safe and lower risk, are not currently widely accepted, partly because there is no unity among our leaders on their utility. As if this were not already enough to rattle even the most serene among us, many hospitals have also implemented pay cuts and furloughs, even for front-line staff.
While images of health care workers running into death may seem “beautiful” to some, frequently hailing health care workers as heroes and praising our sacrifices suggests that our lost colleagues were expected to be human collateral damage in the fight. As if the California nurse who ran into a code blue to save a patient and died from lack of PPE is a martyr whose tragic death should be celebrated. In reality, as we’ve argued before, none of us chose to be in this position. Rather, we have been thrust into roles where we have to risk ourselves and our families, largely because leadership has failed, and continues to fail, to protect us.
With stressor after stressor compounding, it feels more useful, in a sense, to compare health care workers instead to the walking wounded. While some have suffered from physical illnesses, not all of our scars are visible. Working without adequate PPE, with few tools at our disposal to treat patients, and feeling unsupported by the government has taken a toll on our mental health.
So has all the tragedy we’ve witnessed. Just as you can’t see what soldiers have experienced, you don’t see a health care worker’s memory of a patient’s son’s crying face as he said goodbye to his unconscious father through the phone. You don’t see her memory of being unable to touch her wife or children, even in her own home. And you don’t see the images of those patients taking their last breaths before leaving this world. But that is what many of us are carrying with us, everywhere we go. These patients and their families are with us at the grocery store. They are with us when we try to sleep. And they are there, reminding us of our own fragility, when we try to spend time with our own loved ones.
Health care workers may not have enlisted, and we may not be in a real war, but we have served. Like soldiers, we are traumatized by our experiences in a way that those who haven’t been on the front lines with us can really understand. And what everyone needs, really, is to be seen and supported for our respective lived experiences. This Memorial Day, instead of praising the sacrifice of essential workers, it would be really nice if we could just protect each other.
Arghavan Salles, MD, PhD, is a scholar in residence at Stanford University School of Medicine. She is also a surgeon frequently found on Twitter @arghavan_salles or Instagram @arghavansallesmd.
Jessica Gold, MD, MS, is an assistant professor in the department of psychiatry at Washington University in St. Louis. Find her on Twitter @drjessigold.