Back in January of this year, I was rotating through the thoracic surgery service while COVID-19 surged like a tsunami through our nation. The restricted unit of COVID patients hid behind closed double doors, posters plastered on the walls outside with red stop signs reminding all health care workers to wear the proper PPE. Since the beginning of the pandemic, I saved each mask I was given in a Ziploc bag, fearing the day our rural Texas hospital would finally run out of N95s. That day never came, but we were in the ‘red’ for weeks.

One particular afternoon, the attending and I were making our usual floor rounds. We had two consults in the COVID unit. We had to enter those starched white double doors. Slowly, almost reluctantly, we donned all the PPE that was available – trash bags full of rumpled reusable gowns, smeared face shields, our own personal N95s and double gloves. As soon as the second set of makeshift doors closed behind us, it felt like we were underwater. The heavy silence, broken only by IVs beeping and ventilators breathing, was deafening. Nurses and respiratory therapists peered at us with weary eyes as we shuffled through the unit, their masks weathered and worn. We walked by two dead bodies, both resting in peace with a thin sheet on top. Bodies that were someone’s grandmother, or father, or aunt. The expired bodies were next to other barely alive patients, laying prone and paralyzed, often maxed out on sedation and vasopressors. A disturbing picture, imprinted in the gray matter of my brain with permanent ink.

Throughout the pandemic, as a general surgery resident, I never considered myself a true frontline worker or hero, but I had my fair share of exposures in the trauma bay and the operating room (OR). With each exposure came a new wave of trepidation. Would I contract the virus? Would I pass it along unknowingly to a friend or patient? Worst of all, would I be the cause of my last remaining grandparent’s death? My mind would go numb as I assisted in the COVID OR during thoracotomies and bronchoscopies while anesthesia could barely ventilate because the lungs were so damaged from the virus. Performing a tracheostomy on one COVID-positive patient, staring directly into the dark airway of doom, was moderately traumatizing, to say the least; that patient later died. I was not the only one mentally scarred by the destructive virus. In a study of mental illness outcomes among frontline health care workers in China, more than 70 percent of participants reported psychological distress. Unfortunately, women like myself have been shown to report more severe symptoms of depression and anxiety. Females may also be more likely to develop post-traumatic stress symptoms as compared to their male colleagues.

Case numbers declined in Texas, just in time for the unprecedented winter storm. February slipped by as hospital workers carried on, trudging in for their shifts with masks and scarves as face warmers. Many of our valued staff members were let go. Others let go of the life they had built and moved elsewhere in hopes of higher pay. Maybe they just needed a change in hospital systems to rekindle their desire to rescue humanity. I found comfort in the familiar faces that remained and my own simple routine. Coming home after work, washing my hands up to my elbows. Feeding my lonely cat. Exercising while blasting classic rock. Scrubbing my tired body excessively in the shower. Sanitizing my hands again. For many of us, the cleansing rituals became therapeutic. As numbers dwindled, the temporary COVID unit closed down and positive patients returned to regular negative pressure rooms. The outbreak evanesced for a brief period, but the memories lingered.

Fast forward to the present day. Masks are now optional in most businesses. Restrictions have lifted across the United States and the world, including England, despite the new Delta variant causing an alarming increase in case numbers. The shared psychological trauma of COVID-19 has continued on for months. Humans have become desensitized to the danger, ripping off masks with a fresh vaccinated—or unvaccinated—sense of confidence. Fortunately, I received my second dose in January, before seeing the bodies. My car became a graveyard for gently used surgical masks. I cannot bring myself to discard all my Ziploc baggies just yet; the war on the virus is not over. As I write this, Cuba, our close neighbor, is struggling with a surge in coronavirus infections. Desperation and unrest appear to be at an all-time high. Hospitals in Central Texas are once again inundated with COVID patients, re-opening the isolation units as beds fill faster than ever before. How do we, as disgruntled health care workers, remain vigilant in the face of complete emotional exhaustion? How do we persevere?

Frontline workers may have temporarily experienced a heightened sense of personal success and gratification, but I doubt many of us are still able to feel satisfied at this point, after all the repeated moral injuries and losing so many patients. COVID-19 assuredly changed me. The virus changed my residency experience. It changed the hospital, and it changed the entire world. As Prime Minister Boris Johnson recently stated, “We simply cannot revert instantly…to life as it was before COVID.” We must try our best to carry on, cautiously, into the new unknown era of vaccines and virulence. For me, that means wearing a mask in public long after restrictions are gone. Face covered, eyes forward, and headphones on – I will be singing to the sweet electric guitar of the hit single by Kansas:

Carry on, my [weary one]

There’ll be peace when you are done

Lay your weary head to rest

Don’t you cry no more

Elizabeth Sarah Haberl is a surgery resident.

Image credit: M. Haberl