A Letter From A Doctor To Literally Anyone Who Is Listening

Dearest Centers for Disease Control, American Heart Association, individuals in hospital administrative positions, and at this point, anyone! This is a letter from a doctor to literally anyone who will listen.

Healthcare Workers are tired. We really are. We are two years into this pandemic and feel a lot of the same pain that we did in the beginning.

We all remember when we were begging and pleading for the bare minimum safety efforts –  masks, downs gloves and many other other things.e. As we were raising the alarm bells to the public and anyone who would listen to us, we were simultaneously caring for people  who were dying from an illness that the world knew little about, except that we could also get it ourselves and meet the same fate.

As the world shut down and stayed in place, we left our families and witnessed the horrors of this illness firsthand – and for many months, we didn’t have a vaccine and we were using crisis standards to safeguard our own health.

cropped-Dr_HEATHER_IROBUNDA.jpgI remember very vividly in medical school that my first patient on my Internal Medicine rotation as a third year student was an HIV positive man with respiratory symptoms. It could’ve been pneumocystis carinii (which is an opportunistic infection that can occur in patients with AIDS), but there was also a concern for tuberculosis because there’s a ton of TB circulating around New York City. It was at that time that the resident that was in charge of me taught me how to wear full PPE for airborne pathogens. I was instructed that my N95, gown, gloves, and hair covering were supposed to be used only once, just when you go in to see the patient, and then promptly disposed of. If I needed to see the patient again, I would need to get dressed up in a new set of all of these things to see him. 

It was daunting and anxiety provoking, but I was told that this was the best way of ensuring my health and safety and also for other patients or people I would come in contact with. I was told that reusing these masks, gowns and other protective safety equipment would put other people at risk of getting the airborne pathogens that I was protecting myself from.

Oh how far we have strayed. 

And do you know why I didn’t put up a fuss in the past 2 years about how we’ve had to reuse our PPE? Because I know we are in crisis mode. Because last Spring, something was better than nothing. And even now, I know that there is not an endless amount of these supplies in the supply chain. So I, and so many of my colleagues, have adjusted. We listen to organizations like the CDC, WHO, and others for guidance. We respect the science behind it. And we also respect that we are in an unprecedented situation right now.

Then came the vaccine last December. I remember that I had a brief moment of hesitancy in the fall because just like many others, I was concerned about how fast these vaccines had been rolled out. But I looked over the data available and spoke to people who were experts when it came to virology, immunology, and vaccines, and decided to get it as soon as I could. Because at that point, seeing all of the death and disability that COVID had rained upon us, I was certain that taking my chances with this vaccine would be infinitely better than taking my chances with COVID. I’ve stayed up with the data and the research on the vaccine and shared it widely because again, I believe in the science. 

Meanwhile, I had heard some of the dark tales from some or my colleagues all over the US stating how some of their non-clinical-facing staff members were getting vaccinated before they were. These are colleagues of mine who are ICU, Emergency Med physicians, nurses, medical assistants, respiratory therapists, radiology techs, and many more. I reassured them that they would get their shots as soon as possible and although it was messed up that they were not prioritized in the distribution, just keep pushing through, this will hopefully pass soon

Oh, and let’s not forget to talk about how 2021 has unfolded. We have still been knee deep into this pandemic and due to many things, a major factor being credited to widespread misinformation and distrust of the medical community. As a result, not as many people have been vaccinated as we had hoped and expected. In addition to the lack of vaccination, there also has been a heightened distrust of the medical community which has in some cases, become downright abusive. 

And in many ways, as much as people openly voice their frustrations at the government and organizations like the CDC, they have taken out most of their frustrations on healthcare workers. We have experienced it in clinical settings when we have been yelled at and threatened by patients and family members when discussing vaccination or COVID. 

We have seen it online, when we share information about these topics. I have personally been physically threatened by members of the public due to my work to share reliable information about COVID and the vaccine, while doing my part to combat misinformation. I have friends who have been threatened, who have had their home and work addresses shared online to anti-vaxxers who have made threats to them. I have friends who have their kid’s names and school addresses leaked online for the same purpose – to threaten and/or inflict harm. And where has the CDC, government, or any medical organization been to protect us?

And now, changes to some key protections.  Did you know the American Heart Association has said that we can start CPR without having proper PPE on? This, again, flies in the face of common mantras such as “put your oxygen mask on before you help others put theirs on.” And most of these recommendations come from weighing science and potential risk, in the setting of what is going on in the real world, but again, we are feeling like we are being sacrificed. Don’t protect yourself first – save the patient. Deal with the consequences later. Who cares if you get long COVID? That’s what it feels like.

Oh, and let’s discuss the CDC’s recommendations for healthcare workers. So the recommendation that has been swirling around that most places are adhering to is that if a healthcare worker has a Sars-CoV-2 infection and is asymptomatic or mildly symptomatic, they can return to work in 5 days. The biggest beef I have with this is “mildly symptomatic” because that leaves way too much room for interpretation.

Prior to this pandemic, many physicians came to work pretty sick. As long as we didn’t have a fever, we were always instructed to come in. I have come to work many times with laryngitis (completely unable to speak) because I knew that I would be looked down on if I didn’t come in. I have come to work vomiting. I even came to work when I had appendicitis as a resident (and knew that I probably had something that severe). This is because the culture of medicine doesn’t promote taking care of ourselves at all – it’s all about others. And again, we can deal with the issues later. And oftentimes, there will be no one there from these organizations or administration when the later issues come.

I have already seen and heard these CDC recommendations in effect within the past few days. And it’s heartbreaking. Because there are HCWs that are back at work after 5 days of testing positive with COVID who continue to have symptoms. And I’m not sure what is classified as mild, but these HCWs could probably have used a few more days of rest before returning. Because right now, due to the rise in infections and those with symptoms, there are a lot of people out sick with COVID, meaning that we are all working super hard – covering more than normal. And we have people who are not quite over their COVID back at work. 

So many HCWs I have been talking to are ready to quit medicine for good. We came into this line of work to take care of people. We knew that we could get exposed to infectious disease. We knew we would have to make sacrifices. But its been two years of this and many of us haven’t seen the things that we were promised last year. We haven’t seen the hazard pay. We haven’t seen the loan forgiveness. We haven’t seen improvement in the behavior of the higher ups. It’s all so unfortunate. And the next generation of HCWs are watching and are not looking forward to joining our ranks. We need better for our caregivers.