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Life in Emergistan

Life in Emergistan

Tired of the Pandemic, Tired of the Judgment

Leap, Edwin MD

doi: 10.1097/01.EEM.0000800528.24008.36
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    COVID-19, EP life, medical misinformation
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    I am tired. Like many of you, this pandemic has drained me. Admittedly, we have different kinds of exhaustion. Many of our colleagues are tired of the endless intubations and deaths. My colleagues and I have experienced that as well, but the biggest stress in rural America is the feeling of utter hopelessness: no beds, few specialists, and nowhere to send patients when they need more than we can offer.

    I was even told by a transfer line that I couldn't have a cardiology consult. Not even a phone chat; I was left to my own devices. As I left shift one day, the ED was full of holds, and five ambulances were staging outside waiting for our night shift physician. The exhaustion in her eyes was palpable.

    Sometimes I wonder, here in year 28 of my career, how much more I want to do this. The voice that answers is uncertain. I'm committed to the job I have loved for most of my life, but I'm tired. I'm not just tired of the work. I'm tired of what this pandemic has done to people.

    I'm particularly tired of the judgment and cruelty that has risen up in the hearts and minds of too many of our colleagues. Following social media posts and reading columns, I see physicians actually suggest that the unvaccinated be denied care, ICU beds, and ventilators. They suggest these people have brought all of this on themselves and strained the system too much, and, I suppose, must pay a hard price.

    When the pandemic first rose up, a newborn Cthulhu that would wrap its tentacles around the world, I read a comment from a physician that suggested we really needed a kind of Thanos moment to thin the herd. I found that to be cold and dark, even for people like us for whom dark humor is a constant coping mechanism.

    A Dangerous Shortage

    I am now no longer surprised at what I see, which includes accusations and disdain, insults and dismissiveness toward all disagreement. I see remarks about how stupid and murderous other people are. Adding to that is the tendency to suggest that any physician who deviates from accepted ideas about the pandemic should be punished with loss of license and livelihood.

    Hard times bring out our demons. Perhaps this is just an emotional tsunami that is taking our professionals into a disordered way of thinking, born of fatigue and fear. It's also more than that. I believe this growing hardness of heart is born of a sense that everything is inextricable from politics, and everything becomes political because we are a polarized country. A refusal to be vaccinated might signal that one's political leanings are “improper,” and deserve at least to be called out, at worst to be punished, perhaps even with the withholding of care. This at least seems to be the fantasy of some physicians, who, as compassionate professionals, seem to have a certain desire to say to the dying, “This is your fault; deal with it!”

    Some of my views on this issue come from looking at the strange, dangerous land of social media, hardly an accurate sampling of human thought and behavior, even though all sides use it as if it were. It may be that only an infinitesimal fraction of physicians would deny life-saving care to the unvaccinated. I hope that's true. If it isn't, we have a huge problem.

    After all, we are willing to overlook the personal, cultural, and financial costs of substance use disorders, gang violence, obesity, and other things that bring patients to us. We never, ever suggest these individuals don't deserve care. We are cautioned not to fat-shame and are advised to call IV drug abuse by the gentler IV drug use. We are hesitant to discuss diet and exercise, preferring the fiction that everyone is fine just the way they are, knowing that's not true from a health standpoint.

    Beware Groupthink

    Choosing not to be vaccinated against COVID-19 seems to be viewed differently, and perhaps this is because it poses a direct threat to us at the bedside. But so do violence, HIV, and hepatitis. The costs of so many things are astronomical, just spread out over a wider curve than the sudden devastation of COVID-19. Whenever I mention this to someone, I am told, “Yes, but COVID is so much worse.” Maybe, maybe not. What I fear is that this way of deciding whose decisions deserve punishment may not stop with the pandemic.

    It may become a habit of thought, a dangerous paradigm by which we decide that many should go to the back of the line. Medicine is a competitive, costly endeavor, and it could easily be decisions would ultimately rest with a select group of connected and wealthy people who can afford higher education and would ultimately wield the power of life and death by virtue of their positions in medicine.

    That's dystopian and probably a bit dramatic, but I have a bad habit of making good predictions, and these are dystopian times. We must beware. Beware disease, beware misinformation. Beware groupthink and the Balkanization of culture from any side. Anger and conspiratorial thinking are on both sides, and the blame can be shared. Mostly, we have to beware the darkness in our own inevitably biased hearts.

    I'm tired of COVID. I just hope I'm wrong and won't have to be tired of a growing chorus of cruel physicians for the rest of my career.

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    Dr. Leappractices emergency medicine in rural South Carolina and is an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available athttps://amzn.to/2T60WET, and Working Knights, Cats Don't Hike, and The Practice Test, all available atwww.booklocker.com, and of a blog, http://edwinleap.com. Read his past columns athttp://bit.ly/EMN-Emergistan.

    Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
    • njgsan1:14:23 PMThank you, Dr. Leap! The routine dismissal and additional shaming of our vaccine injured should make us all think long and hard about the future of our profession.
    • sfrench1:20:14 AMAgree. Worrisome trends for the health and safety of our patients. In the far distant past of two years ago, we had robust debates about the safety and efficacy of novel medications. In this dim, uninformed past, we used to expect long-term trials for novel medications, particularly for our children, who are not little adults. Premodern physicians used to follow the science, and would evaluate all the literature and current on-the-ground experience, and not just rely on drug company studies. In this ancient and ignorant past, we would not ignore the fact that with the COVID-19 pandemic there has been a 25 percent increase in suicides for our youth and a 35 percent increase in overdoses, far more than the number of COVID deaths in this same age group. A long time ago, after the Nuremberg trials of Nazi physicians, we all agreed never again to mandate medications and instead expect informed patient consent of experimental medications. Medical schools would engage in debates and challenge groupthink. Perhaps the media and national health leaders are now more infallible and brilliant in this enlightened age.