Critical care physicians have been through hell

It was a cold winter morning in January 2021. Another day in the ICU, another day caring for critically ill patients with complex medical conditions, another day caring for patients on their death beds, another day interacting with patients’ families and their emotions, another day of putting on a strong face for my patients, their loved ones, my ICU family and my trainees, another day of giving bad news to patients and their families.

One of the many patients is not doing well. I reach out to my anesthesia colleagues to help me. Two male anesthesiologists come by; they talk for about 15 minutes about why I am wrong and why they are right. They make me feel small. It almost feels like I am this little girl once again being looked down upon and talked down to. We agree to disagree, and we go about our day. Then the anesthesiologist colleague decides to email everyone in his department about the interaction and again, why he was right and why I was wrong. This email is forwarded to my chief, who then forwards it to me. I then write a long email with specific details explaining my rationale. This is on top of my already 80 plus hour workweek.

This interaction feels heavy because I feel depleted. I have carried the burden: my critically ill patients and their families’ physical and emotional burden. It has been almost a year since COVID 19; our society has been through a lot. My critical care community has been through immense stress, which cannot really be put into words.

The following thoughts are a constant for me: “Is the cardiologist going to feel upset when I ask for an echocardiography for my COVID patient who just had a cardiac arrest and was ‘successfully’ resuscitated? Is the anesthesiologist going to get upset when I ask them for an intubation for a patient we have tried on non-invasive ventilation for 3 days to avoid intubation? Is the surgeon going to be upset when I ask them for a chest tube or a tracheostomy? Is the gastroenterologist going to be upset when I ask them for an EGD for a bleeding COVID-19 patient?” If each of the consultants opts to lecture the poor, depleted, exhausted critical care physicians and email their higher-ups complaining about them, it will break the critical care community.

It is exhausting to keep our brains “on” all the time — always thinking about our patients — caring for a patient as a person, optimizing to the best of our ability, their every organ system, as well as their emotional needs.

To my consultant colleagues: Do you see us as your equals, do you see us as female physicians inferior to you, do you see us a moms/ wives/sisters/aunts/daughters? Could you show us some grace and some kindness? Would the world fall apart if you did not email your department heads complaining about us? Complaining that we asked for your help in saving my critically ill patient? Please understand that this is not about who is right: It is all about the patient. We are all here for our patients.

A bit more support within the physician community would help with the moral distress we critical care physicians feel.  My plea to our physician community: Please show us some grace. We have been through hell. We could all use some kindness.

The author is an anonymous pulmonary and critical care physician.

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