How ironic it is to be applauded for keeping our oaths

As an emergency medicine doctor who trained in the Bronx, I decided that I must return to NYC in solidarity. This is the first time I have taken an assignment with my colleagues’ collective burnout as the focus of my intention. Previously I have placed the needs of my patient population first. As this COVID-19 pandemic continues to burn throughout the human species, I marvel at how crisis breaks down the artificial walls we erect to segregate ourselves from our shared humanity.  Structural inequalities and injustices are paradoxically highlighted and blurred.

While writing this, I hear New Yorkers clapping and clanging at 7 p.m.; I tear up. Thanked by family, friends, and strangers waiting for the bus, I shuffle to and fro in scrubs.  While I wish I could ease everyone’s fear, I cannot down-play it.  We have lost good people, brilliant minds, and selfless servants. We will lose more. I often explain to well-meaning loved ones who ask me to stay home, not work, and protect myself; this is what I signed up for.  I trained for this. This is why I am a doctor. This is how, in my small way, I advocate for our humanity and why I chose to practice emergency medicine. My ER door is always open. I will take care of you whether you have health insurance or not, even if you are rude, no matter your creed, political identity, or ethnicity, whatever nationality you hold.  We often say the ER serves as society’s imperfect safety net. Until there’s a tsunami, and then we realize how vulnerable and fragile our society is.

Both as doctor and human, I have been torn between anger and disgusted hopelessness while witnessing our federal government’s lack of disaster planning, lukewarm response to support health care needs, and disrespect towards the scientific community.  Supposedly the richest, most powerful nation on Earth, and this is the best we can do? Really.

What has become most glaring is that my colleagues and I took an oath to first do no harm.  Increasingly, I have realized that we are the only layer in this system that did take that oath.  We do put others’ lives ahead of our own safety.  The politicians do not. The insurance companies do not. The CEOs of major hospital systems do not. The hoarders of N95s and hand sanitizers trying to cash in for resale do not.

How ironic to be applauded by holding to my oath. I appreciate being thanked by everyday people in the street, the restaurants donating food, and people sewing us surgical masks. But oh, it is so lonely on an institutional-structural level to know I can save a person’s life, but I cannot guarantee he or she will not fall into poverty from medical bills. I cannot guarantee my medically vulnerable patients won’t be evicted if rent is not paid, nor can I be certain they can afford the medications I prescribe to maintain a level of health. Why? Because the rest of the system does not value my patient’s life as much as I do.  At least that is the messaging I have heard lately.

Are we really “health care heroes”? My colleagues are being fired, furloughed, paid less to work more, and forced to cut hours in order to save the health care system money.  Yet, we are expected to maintain the same standard of care, professionalism, and are held accountable for patients’ health outcomes.

I am so grateful I still have a way to earn money, so many millions currently do not.  However, I suspect market forces will continue this trend. Thus, after rising to the occasion in this pandemic, we most likely face a future of lower wages and more job insecurity.  I can’t help but wonder, as health care professionals, if we are expected to keep treating and seeing patients because our oaths equate moral duty.  What about society’s moral duty to each one of us? Or are each of us a commodity, replaceable cogs in the great economic wheel?

Let us learn from the present times. Let us see that we need a basic universal health coverage with controlled pharmaceutical costs that covers everyone among us, in order to protect us all.  Let us guarantee a living income so my patient can pay for food, rent, and insulin and not have to be readmitted every month – that saves us all money as a society.  Let us call out the lies that damage our humanity.  Let us take care of each other as we hope others would take care of us in our darkest hours.  Let us not suffer in vain.  Let us protect our environment from degradation.

Most certainly, we will face another COVID-like threat again; we will continue to encroach upon and imbalance ecosystems, to connect remote parts of the world in an ever-increasingly tightly-knit fabric of transaction and transportation and we will continue to contract novel diseases that our immune systems do not know.  Let us be smarter, kinder, prepared, and more humane next time.

Sara Lary is an emergency physician.

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