I don’t want to be a doctor right now. I am having serious regrets about going to medical school. I want so badly to be one of those healthcare providers proudly displaying images (or their illustrated equivalent) donning superhero attire with PPE overtop like those dominating my Facebook feed. But honestly, right now I cringe every single time I hear someone refer to healthcare providers as heroes.
Not to say in the current situation medical providers are not performing heroic duties, that is undeniable. My discomfort comes from a deep-seated fear that by adopting the persona of heroes we are giving the impression that we are okay with this. I am not okay with this.
I am not okay with there not being enough PPE. I am not okay with being told the solution is to lower our standards and resort to using bandanas and garbage bag gowns. I am not okay with only testing those we absolutely need to instead of all those we should in order to gather adequate representation to allow for informed decision making. I am not okay with my colleagues across the country being effectively told to keep your head down and your mouth shut when faced with the ethical atrocities arising from the Covid-19 crisis. I am not okay with medical professionals being told to “make it work” with what you have when what you have means the loss of lives that are within our abilities to save. I am not okay with being told that 1-2% of the nation’s population dying from this may be preferable to an economic depression. Most importantly, I am not okay with healthcare providers needlessly dying because their cries for help are being met with silence from hospital administrations and government leaders.
When I took the modern equivalent of the Hippocratic Oath during my medical school commencement, my eyes filled with tears. The gravity of my commitment to patient care transitioned from theoretical to reality. I love caring for my patients with a passion so fierce, it often threatens to consume me. Multiple times a day, I weigh situations by the principles of autonomy, beneficence, justice, and non-malfeasance. I pride myself on having high ethical standards for the care I provide. Serving my patients is an undeniably immense component of my identity. But I am also so much more than a physician.
I go home to a husband and a daughter. By supporting me, they valiantly help me carry my burden of commitment to service – without taking an oath and without much say in the matter. They need me in a way that is very different from, but no less vital, than my patients. I certainly owe no less of myself to them.
There is also the child that grows within me. A bouncing baby girl whose tiny mannerisms I have only yet come to know through internal bubbles of sensation and barely perceptible rippling of my stretching belly. She hasn’t even seen the light of day that awaits her, but already she has been intimately privy to every hospital encounter I have attended for months. Thereby unavoidably exposed to each potential hazard I encounter.
When we send soldiers into conflict, we very transparently demand a willingness to sacrifice self in an ultimate sense. Entering their service, they know that there is a very real possibility they will not make it home. We provide them with physical, emotional, and job-specific training that has been honed as an art form over millennia to prepare for and cope with the weight of their duty and the traumas of battle. We invest massive sums in the development of tactical and protective technologies decades in advance with the hopes of being prepared for whatever lies ahead. All in the name of protecting the citizens of our nation and the freedoms we enjoy. We rightfully honor these brave men and women for their service by providing them the highest quality weapons, protective gear, and supportive services we can.
There is a lot being said right now about a physician’s oath to lay down their life for their patient, to sacrifice family and personal well-being, to persevere in strength despite being on the verge of collapse. We celebrate our colleagues who do so, we call them heroes, look to their example, and strive to achieve their level of excellence. But at what cost?
I have revisited Hippocrates’ decree several times in recent days. I have reflected on my promises to treat patients to the best of my ability optimizing benefit and minimizing harm, to hold myself to the highest standards of privacy and professionalism, and to pass on the art of medicine to the next generation.
Nowhere in the Hippocratic Oath is this clause of self-sacrifice I keep hearing touted in conversations between physicians or proudly proclaimed in the media. I still hold these promises close to my heart and will defend them with all that I am. I cannot, however, accept an additional burden without first acknowledging that it is an imposter amongst those which I previously pledged.
In times of war, we talk about casualties. Inevitable losses of life on both sides of a conflict. When we refer to these losses, we do so with reverence, calling these soldiers heroes for their sacrifice.
Right now healthcare professionals across the globe are being called to war against COVID-19. We are expected to sacrifice ourselves without a second thought. Unlike our combat counterparts, however, our government has not been painstakingly preparing for this once potential, now very imminent threat.
We lack even the standard protective equipment, let alone best practice. Our government and hospital systems responded to a lack of supplies by decreasing standards and shifting policies to make accommodations–rather than rallying in support. They tell us that there isn’t money to materialize these resources – only money to be distributed in a stimulus package predominantly to assuage corporate needs, to staunch the economic hemorrhaging of our society.
Despite our service, we lack security in our own jobs and professional stability through this crisis. In many instances, there is no protection for us should we require quarantine, unless we can prove a direct link of disease contraction from a confirmed positive patient. A task made difficult as we are severely limited in our abilities to test all but those most stringently adherent to outdated testing criteria and are in many instances being encouraged to forgo what personal protective equipment we do have when interacting with “low-risk” individuals, many of whom are likely asymptomatic carriers, in an effort to conserve what little is available.
During times like these, we look to leadership for guidance. What is to be done however, when questions arise as to the transparency, honesty, and motivations of healthcare administrations nationwide? It has never been more apparent how much healthcare providers are but puppets in the hands of administrators. Too little too late a realization to backtrack from though, as physicians realize how little power they have to provoke systemic change amidst a looming crisis.
Resident physicians don’t even have the option to walk away or opt-out of caring for these patients. Not only would that be a death sentence to millions of Americans, but we would contractually forfeit our entire future careers. As residents, our ability to attain independence as a medical professional is bound to our completion of a training program. With skyrocketing graduation rates and nearly stagnant residency slots, there is hardly any opportunity for horizontal mobility. Not to mention the crippling debt many of us owe for our medical education that we could scarcely hope to pay off if we were to orchestrate a career shift at this point. Even taking a leave of absence is complicated, impairing our ability to meet fellowship deadlines and is ultimately contingent on program approval.
What, then, for those among us who do not consent to being potential casualties? Are we to pick up this additional oath without question? Do we have an ethical obligation as physicians to assume this very real risk of endangering our lives?
If you don’t like it leave.
This is what you signed up for.
You’re clearly not cut out for this.
No real physician would be so selfish.
These are the thoughts I have grappled with for the past week as I watch the situation unfolding around us. In many instances, they are also the comments of others I have seen or heard. Some even in conversations between healthcare professionals.
Reassigned to a less demanding rotation, outside the hospital setting for the protection of my unborn child, I am now in a unique position of privilege. I am a physician in an observatory role. I am watching, listening, and reflecting on our current situation, as my colleagues continue to carry on their duties despite the mounting dangers.
I am so proud of each and every one of you for your bravery and dedication. I feel this is a fight well worth fighting as no percentage of our population is too small to simply write off as collateral to this force of nature.
That being said, I also do not want us to lose sight of our own inherent value and purpose. None of us are simply physicians. Our contributions to this world far exceed those defined by our profession. And none of us, short of military affiliation, have taken an oath to sacrifice our whole selves.
Let us not stop being heroic – we cannot and should not abandon our patients right now – but let us expand the definition of being such to include self-advocacy and preservation. May we not allow political and media rhetoric to warp an honorable term into that of one representing voiceless suffering for the sake of others. Let us not pad our pride with a term being used to pacify our less humble motivations to the extent that we are blinded to the longterm consequences of doing such. Do not lose sight of the additional battles with hospital administrations and government agencies that we still need to wage after this pandemic has been quelled. Our ability to enact change tomorrow is dependent upon our behavior now.
It is okay right now if you are not okay with this. More than okay. And it does not make you any less heroic or any less a physician if you choose to pursue self-preservation. Another war looms on the horizon and we are going to need to be ready to carry on our fight.