Hospitals are running low on yet another resource: Hope
Sarah N. Cross is director of the Birthplace at M Health Fairview Masonic Children’s Hospital and assistant professor at the University of Minnesota Medical School.
This is not the spring of 2020. I no longer receive daily emails warning how low my hospital is on personal protective equipment. We have enough PPE that we can discard items as intended. And I am less afraid that I will die of covid-19 or bring it home to my three young kids. We now have more knowledge about how to prevent and treat infections.
But there’s a new scarcity in our health-care system: We’re running dangerously short on hope. And it’s even more crushing than the shortages we faced at the beginning of the pandemic.
Consider, for example, that we continue to have a critical shortage of blood. Early on, this was because people were afraid to venture out. But what’s causing the shortage now? Are we using more blood because we have so many sick patients? Or are donations down? What has happened to the donors? Have they died? Are they sick? Are they exhausted and overwhelmed? Or no longer impelled to help?
I fear we are losing our capacity to persevere, and that is something harder to replace than masks. Even before the pandemic, physicians had twice the risk of burnout of the general population and had an estimated 40 percent rate of depression and suicidality. Now, 60 percent to 75 percent of clinicians experience symptoms related to depression, sleep disorders and post-traumatic stress disorder. The numbers are likely higher in nurses.
Some sources estimate that 30 percent of health-care workers have either quit or been laid off since February 2020. Thousands of us have died. The health-care employment sector has decreased by 450,000 workers since February 2020. While medical school applications are at an all-time high, a first-year intern cannot replace a physician with 30 years of experience.
The only solution left is for those of us who remain behind to work longer and harder. Indeed, the Centers for Disease Control and Prevention recently issued guidance to mitigate worker shortages, allowing us to work even if we are infected and symptomatic. There is such a thing as being too essential.
Instead of those daily emails about PPE shortages, I now get emails on hospital capacity. My health system has reopened its command center as if we were at war and not a hospital. A patient in labor recently called seven hospitals to find a place she could safely deliver.
Meanwhile, the executives of all the major Minnesota health-care systems, including arguably the most prestigious hospital in the world, took out full page ads in newspapers begging the general public to get vaccinated. But do they do any good?
Physicians promise to love their patients as much as they love themselves. We go to the hospital instead of the gym. To the operating room instead of to sleep. To the bedside of a dying patient instead of the bathroom. We skip meals, kids’ birthdays, anniversaries, soccer games and holidays. It has been an honor and a privilege to walk alongside my patients during their high-risk pregnancies. On my best days, it is precisely the drive to help my pregnant patients avoid and survive covid-19 that keeps me going. But other days, I wonder how we will all make it through.
At night, only the most essential people are at the hospital. The outpatient clinics have closed; the administrators have gone home. I have always loved the relative peace and quiet of the hospital at night. So many births happen then. So much joy and hope. Recently, I was walking the quiet hallways and passed by a closed office door. There was a poster with a Desmond Tutu quote: “Hope is being able to see that there is light despite all of the darkness.”
I look for a kernel of hope to bring to every patient encounter. Our ability to persevere depends on that sense of optimism. Many of us have survived the past 23 months precisely because we have been able to hold on to the promise that things will get better.
As we enter a third year of covid-19, that hope is slipping. It can be seen everywhere, but especially in the hospital. Medicine is not a one-way street; it is a relationship, a give and take. Health-care workers cannot keep showing up if our patients do not have faith in us. If that faith disappears, we will continue to lose doctors and nurses. And everyone will suffer as a result.