Bearing witness: the physician’s role in a time of crisis

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Like many physicians not initially on the front line of the COVID-19 pandemic, I watched with growing dread as stories from doctors and nurses started coming out from hot spots first in China then in Italy and then Seattle and New York. Seeing their faces and hearing their voices, I was struck by their exhaustion and fear but also by their sense of responsibility and duty. I wanted to help, to be useful, but I felt powerless. When New York City started calling for volunteers to work in their beleaguered public hospitals, I signed up, flew to New York, and spent a month working in an emergency department in East Harlem.

In 2014, I had been working in a hospital in Monrovia, Liberia as part of my disaster medicine fellowship when the first patients with Ebola came to our hospital. It was the start of an epidemic that would ravage the country and spread beyond its borders. I spent a few more weeks in the country before returning home and watching from a distance as Liberia became overwhelmed, and a number of my friends died, including the head of the emergency department, Dr. Sam Brisbane. I was struck these last few months by the same feeling of impotence as I felt then.

Returning home from New York, I’ve had lingering doubts about the impact I made and am capable of making as a physician, not only during this pandemic, but during my non-disaster work too. It’s not just that numbers were declining by the time I reached the city, or that this is a novel disease against which our treatments are limited; it’s that the numbers are overwhelming. Even if I can care for dozens of patients a week, when the numbers of patients are in the millions, what impact have I made? If our struggle against this disease is likened to war, then I’m a single foot-soldier firing pot-shots against tanks and cannons.

I’ve seen this nagging sense of futility in my colleagues too. Once after a draining shift, one of my co-workers wearily asked, “What difference do you think we made tonight? How many of our patients’ lives changed because they came to see us?” As emergency physicians, we’re seeing mental health patients we can’t appropriately triage, victims of gun violence we can’t stop, a staggering number of overdose deaths. We resuscitate and perform invasive procedures on elderly patients close to the end of their lives, we’re primary care providers for the homeless and uninsured, and we care for patients unable to afford insulin or unwilling to be vaccinated against the flu. Every epidemic – viral, or social, or traumatic – ends up on our doorstep. It’s daunting.

But the inclination to quantify our worth as physicians comes from a flawed assumption: that our impact can be fit into a spreadsheet. This is understandable – history commends those who impact the most lives (I remember learning about Norman Borlaug, “the man who saved a billion lives”); news media and epidemiologists measure devastation in death counts; actuaries make adjustments based on quality-adjusted life years. Added up in a balance sheet this way, our impact would have certainly stretched further if we had been researchers or drug developers, if we had used our time and talents to grow rich and become philanthropists. In this pandemic, the value of any single physician will be slight compared to a smart public health policy or a robust economic stimulus.

This isn’t who we are, though. We aren’t dire accountants, tallying our impact on patients in minutes and hours and years. And the war metaphor is also inadequate for what we do. We’re not soldiers, and there are no generals and strategists. Our role is grander and much broader: it’s to be present when there is illness and suffering and crisis. We confront the ills that are laid at our doorstep. We are present and bear unblinking witness to the lives of our patients.

After my friend and colleague died in Liberia, I learned that his wife and adult children lived in Ohio. I attended his memorial service, met his family, and cried with them. The work I had done in Liberia was small, but here I was able to tell his son that his father was a hero, that he was a role-model for me, and that he accepted his risk and sacrificed himself seeing to the people of Liberia. Sam Brisbane didn’t change the course of the epidemic, but he bore witness to and took care of the sick and dying. And I was able to attest to his life and his work.

We are already seeing – and will continue to see –  similar stories coming out of this pandemic. Stories of heroism and bravery, of suffering and death. Doctors are bearing witness to the lives lost in their community, to fear and exhaustion, to hope and resilience. We are attesting to scientific advances rapidly being made around this disease, to innovation; to the lack of supplies and critical infrastructure gaps in our healthcare systems; to the minority communities, the immigrants, and the prisoners who are being disproportionally affected; to the inefficacy and dangerous ineptitude of our politicians.

We should recognize that this is our vital role. It’s to sit with patients at their bedside and to hold their hand. It’s to see their lives and their struggles. It’s to note the importance of their existence, if not for the whole world, then for their family, if not for their family, then just for them. It’s to see trends of sickness and not only fight it, but also to speak firmly and with clarity about these struggles, to let the world know what is happening in the ED hallways and the ICUs. It is our vital role to advocate for those who don’t have a voice or resources to speak for themselves, for the victims of violence, the destitute, the mentally ill. Our role is to speak clearly and without wavering and say: Here is death, here is sadness, here is injustice, but also here is kindness and honor, here is humanity.

In this way, while we may care for a single patient, treat a single instance of disease, and even once in a while save a life, we are also bearing witness to our fellow humans. In this way, our impact on our patients’ lives, on our community, and on the entire world is immeasurable.

Josh Mugele is an emergency physician.

Image credit: Shutterstock.com

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