During the midst of the COVID-19 pandemic (April 2021), I became a high-school pharmacy technician. My senior year of high school ended in gray scrubs, gloves, and a mask. While I knew I was signing up for long hours of selling medication and administering COVID tests, I was not prepared for what else I would learn.

On my first day on the job, a couple approached me and asked about getting the COVID vaccine in broken English. Before I could respond, my coworker beckoned me away so that she could take over.

She asked the couple if they had health insurance. The woman turned first to her husband, then to me, and whispered “no.”

While I remained silent, my coworker ushered them out of the pharmacy. I could overhear her saying, “Well, you need health insurance to get the vaccine. Sorry. NEXT.”

In the numerous times that this memory has re-played in my head, I imagine how differently things could have been had I found the courage to speak. Despite it being my first day, I knew that COVID vaccines were free for everyone, including those without any health insurance. Yet, I bit my tongue, doubting that a teenage girl had any authority at all in a pharmacy where she was the youngest. I felt helpless, so I was silent.

It turns out that silence is a pervasive problem in health care. In a nationwide study conducted by VitalSmarts, more than 50 percent of health care workers reportedly witnessed their colleagues breaking rules, making mistakes, and displaying incompetence. But less than 10 percent spoke to their colleagues about the problem.

Following silence, there is often a period of guilt — an “If only I had” phenomenon. Patients and family members who experience or witness medical error often feel this sense of guilt. They are haunted by thoughts of “If only I had been there” or “If only I had said something.”

So then why are we even silent in the first place? If a family member sees their loved one receiving questionable care, why don’t they speak out? If a health care worker sees a colleague commit an error, why don’t they initiate a dialogue?

It seems that remaining silent and preserving the status quo provides psychological comfort. It’s easier to be accepted by a group of “experts” than to risk antagonizing them. This is why a family member stays silent, believing they don’t have the authority to question an “expert” doctor. In my case, I believed my age and inexperience invalidated my voice. Who was I to question those with more than 20 years of experience compared to myself?

There is also a sense of learned helplessness in health care. Karen Malcomson, a nurse at “City Hospital,” published an article describing her experience joining a new hospital. She was told, “nothing you do or say makes any difference” by her fellow nursing staff when she wanted to discuss the low quality of nursing care.

In my pharmacy experience, I felt similar emotions of helplessness that she described. After seeing the pharmacy dispose of perfectly good vaccines following last-minute cancellations, I proposed creating a waitlist. Individuals who were particularly at risk could sign up and receive priority on the list. However, I was told that it was “too much work to implement.”

One time a mother with a disabled son walked up to the counter. As I handed her the medication, I saw her eyebrows lower dejectedly upon reading the $500 copay.

“My son needs it; he is in pain. Is there nothing you can do?” she pleaded. I told her I could run it through some coupons, but I knew GoodRx would not save the day in my heart. She left the pharmacy empty-handed as I watched helplessly.

Following encounters like this, I realized that there was nothing I could do to improve the situation. Learned helplessness and the power of conformity reinforced my silence. It’s been about a year since I started that first day at the pharmacy, and I’ve since realized that silence is dangerous.

Just how dangerous has been answered by a study on members of the Association of periOperative Registered Nurses. Nurses/nurse managers reported witnessing actual harm come to patients as a result of shortcuts and incompetence. However, the percentage of nurses who took direct action was lesser than the percentage who witnessed the transgression and remained silent. In other words, patients are harmed when people stay silent.

I wish I could say that I found my voice during my time at the pharmacy. But I left in under half a year before I found my courage. My experience continues to haunt me, making me question what could have been better, both on a personal level and a societal level: How can we, as health care workers, find the confidence to use our voices? And once we do, and are shut down, how do we regain the courage to speak again?

In the meantime, however, we cannot conform and remain helpless. We owe it to our patients to do better. Every time I picture the couple leaving the pharmacy unvaccinated, I am reminded that true health care requires accountability and a willingness to challenge the status quo. That means challenging a “no” or “that’s too much work” rather than accepting it passively. If I could do it all over again, I would tell my 18-year-old past self that her voice is more powerful than she realizes. The same applies to any person in a similar situation who feels that their voice is not worth hearing. Our voices are our means to advocate for the patient. We must use them.

It took me over a year to find my own voice, but I’m finally raising it now.

This article is discussed on The Podcast by KevinMD: My experience as a teenage health care worker during the COVID-19 pandemic.

Ananya Raghavan is an undergraduate student.

Image credit: Shutterstock.com