Following the Battle of Hastings, fought in 1066 between Norman-French forces and English forces, Norman bishops issued a series of penances for the victorious army returning home.
“1. Anyone who knows that he killed a man in the great battle must do penance for one year for each man that he killed;…3. Anyone who does not know the number of those he wounded or killed must, at the discretion of his bishop, do penance for one day in each week…or, if he can, let him redeem his sin by a perpetual alms; …6. Those who fought [out of a concern for justice] (meaning for the ideals of the church, not for personal gain) have been allotted a penance of three years by their bishops out of mercy.”
Although the primary concern of the bishops was of a religious nature, one wonders whether there was great psychological benefit to this practice as well. The returning warriors, though surely regarded as heroes by their fellow citizens, could not simply resume normal life. The spiritual and psychological toll of battle needed to be reckoned with, and they required a path through which to permit the resumption of normal life.
The recent suicide of a highly-regarded ER doctor highlights the pressing need to examine, just as soldiers returning from war, how to best help our medical professionals through this crisis. As the coronavirus explosion hopefully subsides, the psychological and spiritual toll it took on the medical front line may also demand a reckoning. Their life-saving efforts are courageous and heroic, as they weather excessive physical demands and psychological pressure from balancing the medical and emotional needs of patients and their families—all while knowing that their own lives, and the lives of their colleagues, are potentially at risk. But, despite these herculean efforts, not all doctors and medical staff feel themselves to be heroic; indeed, for many of our best practitioners, their responses are more complex.
For some, there is a certain type of exhaustion—physical, mental, spiritual—that follows from these types of overwhelming experiences. The generic term, “burnout,” has been reported among medical professionals for years in both popular media and academic research, and is associated with depression, physical illness, and poor work performance. But this catch-all term does not fully capture the humanity of the medical front-line who are confronting the crushing force of patients coming through the door in various stages of illness.
This medical war has provided fertile ground for all types of complicated thoughts and emotions. One can imagine the guilt of a doctor who, before becoming aware that she had been infected, exposed other patients to this illness; of the nurse who missed the opportunity to put a dying patient’s family on the phone to say goodbye; of the testing clinician who did not use the proper procedure, which resulted in a false negative and increased community exposure to the infected individual. Those on the front lines may also contend with profound grief, as they witnessed both the physical suffering and loss of life that exceeded their emotional capacity. Others may experience worry about their own health, health of their families, or the health of colleagues who contracted the illness on the job. Many medical professionals also separated from their families to reduce the likelihood of spreading the illness, thus removing an important source of support in their lives. All of this is in addition to working long, busy shifts in uncomfortable gear with patients whom they may not be able to help.
As a psychologist who has worked both in hospitals and with medical professionals, the question arises how can we provide support for those medical professionals who are struggling to resume their regular work as their minds return to the times that they may have fallen short of their own lofty expectations? In more normal times, some hospitals have introduced supportive burnout-reducing programs, such as balanced scheduling, seminars on improving communication, and learning mindfulness. But, as we consider the scope of the challenge, it is clear that these efforts, important as they may be, are insufficient.
So what can be done? Just as the bishops did for their warriors, hospitals need to provide a framework for their staff to return to normal life. And just as the bishop’s system acknowledged that this process may take years, hospitals should also recognize that the effects on the medical team will not go away when the flow of coronavirus patients is eliminated. Indeed, it may be just the opposite; only after the pressure of the crisis subsides will the deeper struggles come to the surface. In addition to system-wide support for the medical teams, hospitals should establish networks of both mental health professionals and spiritual guides of various traditions to provide guidance confidentially to the medical staff. They also should have a system through which they can identify staff who are demonstrating signs of distress, and a way to be proactive in supporting these struggling staff members.
Recognizing the heroic actions taken by those who form our medical system does not negate the reality that they are people, with human responses, and may struggle with any number of aspects of the coronavirus pandemic. Putting systems into place now to support their psychological and spiritual wellbeing will help them continue their life’s work of providing life-saving care to our communities.