Giving care during a pandemic was always going to be tragic.
I’m thinking back to something I wrote in the first week of these logs. “We’ll lose colleagues to this virus. Both to illness and possibly to moral injury later. I worry about everyone’s mental health.”There has been some speculation amongst psychiatrists I work with as to the possibility of a physiologic, neuropsychiatric effect caused by COVID19. After all, the loss of sense of taste and smell in many patients suggests that the virus can target the nervous system.
We’ve all known colleagues who worked until their water broke, and then still finished their day because the contractions seemed far enough apart. Physicians who found out their parent died and then showed up an hour later to start a 12-hour night-shift. We all know these stories, because we tell them ourselves in a kind of one-upmanship of commitment. This kind of pride must be the result of a sort of medical Stockholm syndrome.
We’ve all seen things that can’t be forgotten. We all have the names and faces of those human beings we met and lost within the span of hours, or minutes, lodged deeply in our hippocampus. That detachment we cultivate is what keeps us going. But that doesn’t make it adequate coping. And it doesn’t mean that one day, those hardy memories won’t overtake the landscape, leeching the color from our well-tended gardens.
The question often used to justify the punitive nature of disclosure is: What if a physicians’ mental health concerns lead them to be incapable of providing adequate care? What if it puts patients at risk? For me, I write about the things I see. I have always written about the things I see. Often, I don’t know what I think until I write what I think. I don’t know what I feel until I write what I feel. And in doing so, I discover the veneer of detachment is blocking the way to a number of often difficult and complicated thoughts. It keeps my honest with myself. It keeps me connected. Stories are a place for my dead to rest. Even there, they have a way of becoming restless.
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