Thank You for Your Service

Hero treatment proves challenging in face of pandemic.

“Thank you for your service,” the food delivery man said, slowing slightly as he biked past me. I’m on the sidewalk waiting for a Lyft to take me to my shift, wearing my scrubs, with my hospital ID badge on my chest.

I buckle in the back seat and look up at the driver, sitting beyond a taped up plastic drape. He smiles with his eyes over his mask and also says “Thank you for your service.”

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Shifting uncomfortably, I reply “Thank you for driving,” a now familiar feeling just behind my sternum begins to rise.

I step outside the hospital at 7 p.m. just in time to hear the cheers from the NYC populace, meant for me and my fellow front-line workers and the feeling returns.

Later that night I video chat with my parents, and just before we disconnect my father, a retired hospitalist, pauses. “Thank you for everything you are doing for all of us, Doctor,” he says. I let out a little laugh, not sure how to respond, before wishing him a good night. Again, the feeling in my sternum reemerges.

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As a non-military emergency physician, I never expected to hear “thank you for your service” and I don’t know how to respond. In the few seconds after I am thanked for my service, an overwhelming rush of confusing emotions leaves me nearly speechless — instead taking up residence in the middle of my chest.

Our service these last few months, while taxing and dangerous, is just one of many essential services required during the COVID-19 pandemic. Yes, our job has changed and so have our routines. Instead of the simple hair back, pen-in-pocket prep of days gone by, our pre-shift ritual now involves the complicated donning of the PPE we will wear for far longer than it was ever intended.

All essential workers — meat packers, grocery clerks, transit workers — are putting themselves and their family at risk of infection. I recognize that my risk is likely higher than that of a clerk. After all, I am the provider expected to place my own face inches away from the COVID patient needing intubation- virus spewing from their airway. But the clerk’s risk is still significant, and the fear of contracting a deadly illness is very real and very justified. So, when thanked for my service, I find myself honored, but uncomfortable, and those feelings settle inside my chest.

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I have spent weeks trying to understand these feelings and identify my discomfort. At the start of the pandemic, it was an all-consuming sense of fear and anxiety. The ever-changing protocols, the fear of exposing ourselves and our loved ones to danger and the looming sense of the unknown, barreling slowly toward us, was enough to cause angina. These feelings were not unique to the healthcare worker, rather they were universal.

That fear and anxiety was complicated by isolation. Emergency physicians around the globe moved into garages, RVs and hotel rooms to protect their families. Even those who chose to stay at home with their families felt oddly isolated, keeping their distance even while sharing space — avoiding the usual touch and kiss goodnight. Travel plans to see extended friends and family were canceled. Conferences that bring us together, inspiring us and revitalizing our mission, were canceled.

Suddenly, when we most needed them, many of our support systems were ripped away. But this too, was felt by everyone. Indeed, if anything, frontline providers may have felt less isolated than most. We still had the luxury of routine, the ability to leave our homes and the ability to see friendly faces outside of our homes. We even got to touch these people, instituting “PPE hugs” in which we got a full body embrace once wearing top to bottom PPE.

The isolation felt quite unusual, however. Despite our state of physical quarantine, friends and family members emerged from the nooks and crannies of our past lives to send us PPE from across the country or spend time on a video chat. Everyone was desperate to help and desperate for connection. This outpouring was truly a blessing. But sometimes, it was emotionally taxing, on par with being at work. The early days of the pandemic felt like endless, endless work. Work at work and then work at home. Work to keep up with ever changing recommendations and protocols, work to consume the newest and latest literature, and work to advise and reassure our friends and family. It was a never-ending cycle.

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But even this work felt like a blessing. We had the luxury of continuing to do our work, to perform a valuable and important role. The role we have chosen and honed over years of toil. We had a mission. This work also was compensation for a feeling we were forced to face, and that we as emergency workers hate — helplessness. So often, we felt unable to fight back against this cruel and unyielding virus. We didn’t understand it, we weren’t prepared for it and we often could do nothing to stop it.

This helplessness would give way to feelings of guilt. We are not prepared to be unable to help. Emergency physicians are fixers and doers. In our training, we learn to connect to patients, to make them feel heard and understood, but we aren’t prepared to give of ourselves, emotionally, with the intensity and frequency that a pandemic required. This pandemic turned our role on its head.

Yes, there were days where we were intubating crashing patients right and left. But often, all we could do was lift a mask to allow a sip of water, or call and update a family. And if we didn’t do that enough, we left at the end of the day thinking we should have done that more. Thinking “I should have spent more time with the woman in 9B. I should have held her hand longer. I should have wiped her brow, she was so sweaty. I should have asked about her family and her life lessons. She will likely be dead by tomorrow.”  We are forced to prognosticate for an illness we have never seen before, make recommendations to families about palliative measures, always wondering if these recommendations were the right ones.

Being surrounded, even virtually, by destroyed families, being the last person to hold a hand before intubation meds were pushed, being fully aware that the endotracheal tube may never be removed, being mired for weeks in this death and despair, left us, at times, feeling shattered.

In addition, we saw an ever growing list of our medical colleagues around the world who were falling prey to the virus. On top of that, our community was rocked by two suicides. One, an attending emergency physician, an experienced provider and leader in her hospital. The other, a new, young EMT. Both had their lives cut short by the COVID-19 pandemic.

The loss of these colleagues was devastating, but perhaps not terribly surprising. And these losses left us feeling angry. Communication and messaging were challenging and changed frequently as more information was gathered. We feared an end to the supply of PPE as we watched the number of patients surge. We felt uncertain about how up-to-date we were on the latest treatment and safety recommendations. We were baffled by the delay in public health interventions that failed to prevent the wave of cases that we were somehow supposed to manage without washing away ourselves.

Some of us questioned decisions locally and nationally. Who was thinking of us?  This left some feeling betrayed by the entire system to which we had dedicated our lives. Perhaps some felt betrayed by their institutions, maybe by the government, or maybe by medical science in general? We were angry at the virus and angry to be placed in such a trying situation, and then felt guilty for feeling angry, and the complicated feelings continued to swirl. For me, just behind my sternum.

I guess I am uncomfortable being thanked for my service, because I didn’t march bravely into the fight like my imaginary version of a hero. I was anxious and afraid, lonely and overwhelmed, helpless, guilty, sad and angry. But like so many, I have turned to favorite heroes from literature and film to comfort me in this wild time. I think of Hermione and Buffy, Captain America and Captain Picard. I would never question their heroism and if I met any of them, I would eagerly thank them for their service.

Their stories are wonderful because they feel anxious and afraid, lonely and overwhelmed, helpless, guilty, sad and angry. But they still show up. They still fight the fight they were born for. As I look at my colleagues — the residents, nurses, clerks, cleaners and techs, the meat packers, grocery clerks and transit workers — I see them all as heroes and want to thank them for their service. So, while the complicated feelings living in my chest have yet to resolve, I am trying to allow myself to feel like the hero others thank me for being.