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Jan 25, 2022, 2:08:56 PMJan 25
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I'm An ICU Doctor In Rural Ohio. This Is The Horror I Face Every Day Due
To COVID-19. “Coming back tomorrow?” I heard one bedside ICU nurse ask
another. “Absolutely not. I’m off. You couldn’t pay me enough to get me
here tomorrow.” Jason Chertoff, M.D., M.P.H. By Jason Chertoff, M.D.
M.P.H., 01/08/2022 07:30am EST | Updated January 8, 2022.

I work mainly in the intensive care unit in a moderate-sized community
hospital in a rural section of Ohio. Like many pulmonary and critical
care physicians across the country, I continue to be immersed and
consumed by COVID-19 and all of its destruction, with no clear end in
sight.

When I became board certified in my specialties just three years ago,
COVID-19 did not exist. But now my new norm and second home is a 24-bed
ICU filled with COVID-19 patients on ventilators, medically paralyzed
and flipped on their stomachs, with many more patients waiting to enter.
Sometimes in the midst of the vital sign alarms blaring, overhead code
blue alerts, and grueling end-of-life family meetings, I ponder how much
longer this pace can be sustained.

As we embark on our third year of the COVID-19 pandemic, it is difficult
to name all of the health care resources that have neared depletion,
with ventilators, personal protective equipment, emergency room and
intensive care unit beds, physicians, nurses, respiratory therapists,
and other essential health care workers being just a few. Gazing at my
colleagues’ somber faces and dispirited demeanor, it is clear that an
underappreciated health care resource deserving mention, which is now
quickly dwindling, is morale.

Health care professionals complete rigorous education and training to
alleviate sickness and restore health to their patients. Rarely do these
workers confront novel illnesses or syndromes that do not already have
evidence-based remedies. Unfortunately, as we have seen with COVID-19,
new and highly contagious diseases can surface quickly, spread widely,
and wreak havoc on our lives.

Historically, when these unavoidable health crises occur, the entire
scientific community ? scientists, researchers, health care
professionals, and numerous others ? meet the necessary challenges with
graceful determination, and this has again been demonstrated in our
current pandemic. The unprecedented innovation in scientific research
and medicine has been nothing short of remarkable, and never before has
the health science community seen such rapid discovery, testing, and
distribution of disease-specific therapies as in the last two years.

Enter the COVID-19 vaccine, which was widely implemented in the United
States within one year of the first recorded case, and is documented to
drastically reduce morbidity and mortality attributable to COVID-19.
Again, hopes were surging; surely this was the panacea we all craved.
Finally, life would be restored to some semblance of normalcy.

Not exactly, but to no fault of vaccines, which have exceeded all
expectations. The vaccinated have been repeatedly shown to experience
much less sickness and death from COVID-19 than their unvaccinated
counterparts. To highlight, since the widespread adoption of
vaccination, for every 20 deaths from COVID-19, 18 (90%) are
unvaccinated and two (10%) are vaccinated, and for every 50 hospital
admissions attributable to COVID-19, 43 (86%) are unvaccinated and 7
(14%) are vaccinated (see here, here and here for more).

This outcome disparity is so glaring that my conversations with
emergency room doctors regarding potential ICU admissions are often
condensed to simply asking, “Vaccinated?” A “Yes” versus “No” answer
frequently conveys more information about the patient’s prognosis than
any information I can find in the medical chart. Clearly, vaccination
works, and throughout history we would be hard-pressed to find a
treatment more effective than these vaccines.

“Hospitals continue to exceed capacity, exhaustion of vital health care
resources persist, and human lives are still being lost. Why? The answer
is simple ? albeit controversial and politically heated: Not enough
Americans have been vaccinated”

Yet hospitals continue to exceed capacity, exhaustion of vital health
care resources persist, and human lives are still being lost. Why? The
answer is simple ? albeit controversial and politically heated: Not
enough Americans have been vaccinated. Surprisingly, the paucity of
vaccine uptake is due to unfounded vaccine skepticism and not from
barriers that typically impede equitable access to health care, like
cost, supply, or insurance restrictions.

Just last week I evaluated an unvaccinated patient recovering from acute
respiratory distress syndrome (ARDS). Despite gasping for breaths from
an oxygen tank and being completely debilitated and using a wheelchair,
he adamantly rejected my vaccination recommendation, stating, “Oh, no,
Doc. I’m weary of those vaccines.” My inclination was to shake sense
into this man and scream at the top of my lungs, “Aren’t you weary of
COVID?!?!” but I managed to restrain, bite my tongue, and politely nod
with a mannered grin.

Our country had traditionally prided itself on free will, freedom of
choice, and autonomy. However, it is clear that these sacred values are
being twisted and are keeping our nation in peril. It is difficult to
articulate the magnitude of frustration that this conundrum instills in
us health care workers.

So, as another wave of this pandemic is upon us, health care workers
again find themselves inundated with unprecedented levels of grueling
and traumatic sickness, disability, and death ? most of which is
entirely preventable. Unbeknownst to some, health care workers are not
superhuman or robots, and are subject to human feelings and emotions
just like everyone else. Never before have I endured such resentment and
cynicism at unvaccinated patients and their reckless, selfish choices.
Choices that enable this pandemic to propagate and destroy lives and
families. Thus, it is only natural that throughout the country we are
seeing widespread staffing shortages across all health care disciplines.

Unlike many problems with workforce staffing in other fields, the
solutions to these medical staff shortages do not seem to lie in
financial rewards. Never before have health care workers been offered
such high salaries, stipends, and bonuses to do their jobs, but still
the shortages persist. They persist because money fails to address the
crux of the problem, which is that the morale and resolve of health care
workers are at all-time lows.

One quick anecdote I overheard at the end of a 12-hour shift
encapsulated the issue at hand perfectly: “Coming back tomorrow?” asked
one bedside ICU nurse to another. “Absolutely not. I’m off. You couldn’t
pay me enough to get me here tomorrow.” Truly, is there anything more
demoralizing than repeatedly being exposed to preventable sickness and
death on this grand scale that is now mostly due to illogical and
irresponsible choices?

Perhaps there is. Due to the burdens that this pandemic has imposed on
our health care system, more and more sick patients are having
difficulty accessing care. Unprecedented emergency room waiting times, a
dearth of available hospital and intensive care unit beds, and a
scarcity of vital resources typically taken for granted are becoming
commonplace. Common and easily treatable in-hospital medical conditions
like diabetic ketoacidosis, myocardial infarction, stroke, and sepsis
are being neglected and placed on the back burner, as our system
languishes in the pandemic’s wreckage. Just yesterday I had to turn away
a 19-year-old in a diabetic coma due to a lack of available ICU beds and
appropriate staffing, and I’m sure many similar examples will follow.
With this naturally comes frustration, not only from patients and
families, but also with health care workers. Being unable to care for
patients due to resource limitations is something many health care
workers have never experienced. It is a tough pill to swallow for many
of us and adds to the unsettling nature of our new reality.

“Never before have health care workers been offered such high salaries,
stipends, and bonuses to do their jobs, but still the shortages persist.
They persist because money fails to address the crux of the problem,
which is that the morale and resolve of health care workers are at
all-time lows.”

I, like many other health care workers, am frustrated and concerned
about our nation’s path as we enter year three. Most of us are not
seeking accolades or financial rewards. We simply desire answers to our
many unanswered questions. I can’t help but think of Franklin Delano
Roosevelt, his fireside chats, and the confidence that these broadcasts
instilled in millions of unnerved Americans during the Great Depression
and World War II. Through honest, clear, and inspiring communication,
FDR was able to instill hope in times of widespread fear and despair.

Our health care community is currently wounded and in dire need of
uplifting leadership and direction, similar to others that have
experienced crisis in our nation’s history. So, to those supposedly in
charge, I plead with you to talk to us and remind us why we chose this
profession in the first place. Assure us that we still serve a purpose
and that together, we can work toward a better future. Unlike most
political deadlocks that plague our nation, accomplishing this is not
some insurmountable task that requires congressional approval. All it
takes is inspired and motivated leaders willing to connect on a
humanistic level with the disgruntled frontline workers. This small
investment of our leaders’ time will help to restore our community’s
morale, which will assuredly lead to countless downstream benefits as
our nation strives to recover.

Dr. Jason Chertoff is a physician board-certified in internal medicine,
pulmonary medicine, and critical care medicine. He completed his
undergraduate studies as a biology major from Tufts University in 2000,
received his medical degree from Tufts University School of Medicine in
2004, and obtained a master’s in public health from Columbia University
in 2010. Dr. Chertoff’s professional interests include management of
sepsis and septic shock, ARDS, interstitial lung disease, asthma,
bronchiectasis, and other lung-related pathologies. When he’s not
working, Dr. Chertoff enjoys spending time with his wife and twin
5-year-old children.

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