Why moral injury in health care outlasts the pandemic

History deserves honesty.

Years have passed since the height of the COVID-19 pandemic, and with distance comes a natural desire to reflect on what happened. We should absolutely evaluate the decisions that were made. We should question policies, examine the evidence, and learn from our mistakes. That is how science grows, and health care improves.

But there is a difference between learning from history and rewriting it. Lately, I have watched with growing concern as some public conversations, and at times even official statements, seem to minimize what health care professionals lived through. It is one thing to debate decisions with the benefit of hindsight. It is another to suggest that the suffering, exhaustion, impossible choices, and heartbreaking losses were somehow exaggerated or never happened. They happened. Those of us who stood at the bedside remember.

Long before COVID-19 became part of everyday conversation, my own life had already been turned upside down. The transition from 2019 to 2020 became one of the hardest seasons I have ever experienced. My newborn daughter required intensive care and mechanical ventilation. As both her mother and a physician, I suddenly found myself on the other side of the hospital bed. Nothing prepares you for watching your tiny baby connected to machines while wondering if she will survive. Then my own health deteriorated. I nearly died.

My daughter was discharged before I was. I remained in the hospital, trying to recover physically while processing everything our family had just endured. Experiences like that never leave you. Most people never knew that part of my story.

Just a few days later, I returned to work in a limited capacity. Like countless physicians, nurses, respiratory therapists, pharmacists, paramedics, laboratory staff, environmental services workers, and so many others, I came back carrying invisible wounds. There was no time to recover fully. Patients still needed care. Hospitals and clinics still needed staff. So we showed up. We remember.

There is a growing tendency to view the pandemic through the comfort of hindsight. Debate is healthy. Science evolves. Policies should always be reviewed. But let us not rewrite history.

I remember watching my newborn daughter fight for her life on a ventilator. I remember nearly losing my own life and remaining in the hospital after she went home. Shortly after, I was back on the front lines caring for patients.

I remember one courageous woman who had battled cancer for years. She endured treatment after treatment with incredible strength. Then COVID-19 became part of her story. Within weeks, she was gone. I still remember her face. She is one of many patients whose stories remain with health care professionals around the world. Their names may never appear in history books, but they live on in our memories.

People sometimes ask why so many health care workers continue to struggle years after the pandemic. The answer is simple. Trauma builds over time. Grief builds over time. Moral injury builds over time.

Before the pandemic, I believed that working harder could solve almost every problem. If patients needed me, I stayed longer. If there was more work, I did it. If someone else was overwhelmed, I carried a little more. For many years, that approach worked. Until it didn’t.

As the pandemic unfolded, I continued doing what physicians are trained to do. Keep going. Compartmentalize. Serve. Sacrifice. Repeat.

Day after day, I carried my own pain while helping others carry theirs. I absorbed fear, uncertainty, frustration, and grief while trying to remain calm for every patient who walked through my door. Even then, for some people, our best efforts were not enough. There were accusations. There was criticism. There was anger.

Some expected health care professionals to have perfect answers during a once-in-a-century global health crisis, even though the evidence was changing almost daily. That is not how medicine works. Science changes because new evidence becomes available. Recommendations change because our understanding grows. That is not a weakness. That is the strength of science.

Eventually, something inside me broke. Not because of one patient. Not because of one difficult shift. Not because of one disagreement. It was the weight of hundreds of painful moments, each one adding to the last. Any one of them should have been enough to make someone stop and recover. Instead, I kept working. Until my body decided for me.

Toward the end of 2020, for the first time in my professional career, I stepped away from medicine. I did not step away because I was lazy. I did not step away because I lacked resilience. I stepped away because my health depended on it. My life depended on it.

Looking back, I now understand that what I experienced was more than burnout. It was moral injury. It was compassion fatigue. It was the result of spending years placing everyone else’s needs ahead of my own until there was very little left to give.

That experience changed me. It changed how I practice medicine. It changed how I define wellness. It is why I speak openly about burnout today. It is why I encourage health care professionals to care for themselves with the same compassion they offer their patients.

Our relationship with ourselves matters just as much as our relationships with our patients, our families, and our work. No one can keep pouring from an empty cup forever.

To my fellow health care professionals, I want you to know this. I see you. I remember. Your sacrifices mattered.

To every physician who held the hand of a dying patient. To every nurse who became family when loved ones could not be there. To every respiratory therapist who fought hour after hour to keep patients breathing. To every pharmacist, laboratory technologist, cleaner, porter, paramedic, administrator, public health professional, and every member of the health care team whose work often went unnoticed. Thank you.

I also want to acknowledge the public health leaders and scientists around the world, including Dr. Anthony Fauci, who carried enormous responsibility during an unprecedented time of uncertainty. Leadership in a crisis is never perfect. No one had all the answers.

Reasonable people can and should debate individual policies. Healthy debate helps science move forward. But we should never erase the lived experiences of those who stood on the front lines. We should never pretend the trauma was not real. We should never dismiss the sacrifices made by health care workers across the world. History should remember both the lessons we learned and the price that was paid.

Most health care workers never asked to be called heroes. We simply wanted to care for our patients. What we ask for is much simpler than recognition. Remember honestly. Remember the patients whose lives were cut short. Remember the families who said goodbye through phone screens. Remember the health care workers who carried fear, grief, and responsibility every single day while continuing to show up.

Because history is more than policies and headlines, it is made up of real people, real lives, and real sacrifices. Those of us who were there will never forget. I hope that the world never does either.

Disclaimer

This article is for informational purposes only and does not constitute medical advice. It is not intended to diagnose, treat, or cure any condition. Always seek guidance from a qualified healthcare provider about your health. This article was originally published on KevinMD by Dr. Tomi Mitchell.

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