You’re Not the Only One Feeling Guilty
Dr. Lucy Willis is an emergency physician and the Director of the Emergency Medicine Faculty Wellness Program at Weill Cornell Medicine in New York City. In this essay, she describes the sense of guilt and shame that has plagued emergency physicians during the COVID-19 pandemic, and shares the thoughts that have comforted her. “We are in this together,” she writes. “And I hope that we can heal each other.”
You’re Not the Only One Feeling Guilty
By Dr. Lucy Willis
Emergency Medicine News (EM-News.com: june 10, 2020)
My colleague and friend sent me a text with a photo and sad-face emoji. The gruesome message read: “We got a refrigerated truck.”
When I left my shift and walked past the truck, I felt a strong pang of guilt. After risking my health and working tirelessly in my uncomfortable PPE to take care of patient after patient with COVID-19, the refrigerated truck of bodies symbolized failure. I knew this feeling was not logical, but I felt it nonetheless.
The majority of us front-line providers are experiencing some amount of guilt. We traditionally hide our feelings and suffer in isolation, but this pandemic brings us an opportunity to unite in our shared experiences. I have found it comforting and healing to learn that my respected colleagues are having the same feelings.
We had created Doc Box, a casual peer support group, at our hospital nearly two years ago to cope with the emotional impact of our job. We hoped to alleviate the stress of medical malpractice and second victim issues by showing each other that we need not suffer alone. Until the pandemic began, we met quarterly at one another’s apartments. We learned that there is nothing more comforting than hearing that your colleagues have been through the same trying experiences as you. We learn coping mechanisms from each other, identify what brings us joy in our careers, and, of course, we laugh.
A few months ago, as the pandemic was starting in New York City, the tension was rising. We moved Doc Box to weekly virtual meetings. We have been fortunate to have a psychologist join us and add his insights and support. Over these seemingly endless weeks, the same unexpected emotion has emerged over and over: guilt.
While our EDs and ICUs were filling up with coronavirus patients and our faculty and staff were getting COVID-19 at an alarming rate, the world called us heroes. FDNY firefighters cheer and blast inspiring music outside our hospitals every evening at 7 p.m. One even rocked the Star-Spangled Banner on electric guitar atop a fire truck. I have never before felt so much love and appreciation in my professional life. It is truly inspiring and humbling. Yet, the guilt remains.
Despite being at the epicenter of the pandemic in the United States, we in Manhattan feel guilty that our colleagues in Queens are having more challenging experiences.
We feel guilty that patients are suffering alone. Even if we have significant face time with our patients, we feel guilty that we might contract COVID-19 and risk the lives of our families.
Those of us who have had to stay out of work for weeks while suffering with COVID-19 feel guilty about not being in the trenches. One of our beloved colleagues is currently in the ICU while I sailed through a mild course of the illness. I know that I bear no personal responsibility, but I wonder if we could have protected him more.
Physicians in administrative positions feel guilty about not being able to alleviate the fears of the front-line staff.
Many of us feel inadequate when we tell patients that the best medicine is oxygen. When I think about this rationally, I recognize that I am not personally responsible for curing COVID-19.
When I speak to my patients’ families and tell them the grim prognosis, the rational side of my brain dissolves. I feel like I am failing them.
We feel guilty that we are being called heroes. I still find the term uncomfortable. I even looked it up. One of the definitions is “a person who shows great courage,” but I prefer the definition “a large sandwich on a split roll.” Joking aside, I will admit that I think my colleagues and I have shown great courage during this pandemic.
After listening to us discuss these feelings, our psychologist noted that guilt is a nearly universal feeling among people who experienced trauma. Perhaps it supports our internal narrative that we have some control over the things around us. It suggests that we believe our actions have measurable impact. Many of us felt relieved as soon as he said that. The way I feel is normal and common.
Why do heroes feel guilt? As I understood it from our psychologist, guilt often helps us improve ourselves. Many of us probably wouldn’t have made it through medical school and residency without it. It encourages us to study and be better doctors. It helps us say thank you. Unfortunately, it also makes us focus too much on our responsibility for bad outcomes. Hearing others talk about their guilt and knowing that they are not responsible for those outcomes enables us to question our own responsibility as well. This is probably the greatest benefit of peer support.
After the tragic suicide of emergency physician Lorna Breen, MD, it seems all the more pressing that we check in on each other and acknowledge our shared guilt. By all accounts, she was as tough as they come. She and I once spoke about physician wellness, and it was clear during that brief call that she was vibrant and strong and cared deeply about her staff. Well-being was clearly a priority for her, and it should continue to be a priority for us.
In my role as a director of our faculty wellness program, I wonder what else we can do to reach those among us who are suffering in silence. It seems like our best chance lies in the creation of a culture of trust, safety, and tolerance for imperfection. Without that culture, no one will attend peer support groups or feel comfortable accessing mental health care.
The knowledge that we have common feelings such as guilt can be immensely healing. I see the courage and heroism in my colleagues, and now I see their guilt and shame. I understand that these qualities and feelings coexist. They also demonstrate how much we care about one another. We are in this together, and I hope we can heal each other with vulnerability, openness, and courage.
