Taking care of COVID patients has been an awful, traumatic experience for frontline clinicians, due in part to new realization of how helpless they can be. Awareness of inadequacies (personal, professional, institutional) accompanied every COVID admission and every moment caring for patients dying despite current technologies. However fatigued and pained, nurses and doctors were helpless to change the circumstances obligating them to provide inpatient care (“heroically”), struggles made more difficult by inability to change others’ attitudes about their rights to ignore pandemic guidelines. Frontline workers’ professional skills were honored, their dutifulness and altruism expected, but meanwhile they were largely unable to find a hearing for their emotional and moral distress. It should not be a surprise that the prospect of suffering through a third surge of COVID has some considering a change in careers.
COVID magnified predicaments that already existed for practitioners – here is another example of a little-addressed quandary: in New York State, life support interventions cannot be limited or removed without family consent, almost regardless of “futility” (a term that is fraught at best). One of the most helpless experiences for front-line staff on chronic ventilator wards, unrelated to the pandemic, is the care of patients whose families insist “unreasonably” on continuing life support. A change in perspective might help: family members being “unreasonable” might be wishing to avoid the trauma of loss, and could be suffering from insufficient emotional, spiritual or social resources to cope. Within this perspective, families and those tasked to relieve it both are victims. Health care workers and families both are submitting to a system that does not seek to understand and care for suffering, an experience of damaged personhood1.
A natural and social disaster such as this pandemic might, with awareness and effort, bring positive changes to attitudes and practices, changes applicable beyond the care of COVID patients. Einstein said, “No problem can be solved by the same consciousness that caused it in the first place.” The change of consciousness needed is recognition that suffering is ubiquitous, present in patients as well as healers. It is important to say its name, acknowledge its presence, and also acknowledge the strengths that persons have to cope with it. Thought leaders like Diane Meier2 and Cornel West3suggest that trauma-based care and a compassion that allows suffering to speak, can create more just, supportive and meaningful relationships. Caring to care about patients and each other must be the heart of health care, as patients and health care workers are always in the presence of suffering and losses that do not seem manageable.
Individuals and institutions do not change easily, especially as circumstances that insulate one from awareness of suffering can in fact add to suffering in others. In health care, administrators, regulators and payers can distract from individual suffering by focusing on population measurements; clinicians are less spared. Physicians rotate among services, and can avoid prolonged contact with “hopeless cases,” but nurses, PAs and NPs often cannot. Practitioners with more seniority and financial and professional security can reduce their clinical time or even change jobs, but youngers ones are less able to do so. One can identify many other ways (wealth, race, and social status for instance) in which circumstances that allow distance from personal suffering only forsake others to less support for their suffering.
The generic problem is with callousness – not caring to care. Callousness to suffering might begin as a means to cope with feelings of helplessness, but it can lead to habitual and obstinate distancing from sources of suffering. The heart of health care should be in the care of patients –persons made vulnerable by illness, aging and dying. It thus requires compassion, an attribute that acknowledges the presence of suffering, and shows up to offer help. Compassion knows that suffering is eased when there is someone to share it with: it is a truth that healers have known across time. Ultimately, the problem of suffering is not a philosophical, psychological, administrative, political or social problem: it is a spiritual problem. What are we meant to do with the presence of suffering?
Let suffering speak. This message is mainly for those parts of society with more agency – like those reading this piece. When those entrusted with authority and knowledge initiate efforts to listen and respond to those who are vulnerable, they model a compassionate example. Clinicians build patients’ trust through efforts to listen to their struggles caringly; leaders build their team’s trust through listening for problems and caring about their welfare. We can hope to be less unwitting partners in callousness when everyone by turns can model support and be supported. To the degree we incrementally want to and do, we can enhance both camaraderie and meaning in the work we do.
References:
- Cassell, Eric J. The nature of suffering and the goals of medicine. New Engl J Medicine 1982;306:639-645.
- Meier, Diane. Covid has traumatized America. A doctor explains what we need to heal. New York Times, 24 March 2021 and https://www.capc.org/blog/covid-has-traumatized-america-a-doctor-explains-what-we-need-to-heal/
- West, Cornel. There is joy in struggle. https://hds.harvard.edu/news/2019/05/31/cornel-west-there-joy-struggle#