If the Pandemic is War, I guess My Neighbors are Vichy?

The war analogy in regards to the pandemic is a little worn out. Cable News screamed it for too long in the early days for it to resonate much now. Nonetheless, I am going to lean on it in an attempt to convey a few things.

Most of you are probably involved in healthcare and know all to well what I am about to describe. But, it is something I just need to write down. The whole point of this blog is catharsis, after all.

Morale is Low in the Trenches….

From the beginning of this pandemic, those of us working in healthcare have been told we are on the front lines of some epic battle against a deadly foe. It is as good an analogy as any other, I guess.

Like most wars with an aggressor foe, we began underprepared. It was disheartening, but not surprising. Few organizations could have been adequately prepared (though we could have certainly been much better prepared).

Either way, we could deal with the lack of PPE, staffing, etc, as a temporary setback as we struggled to adapt to fighting this new challenge. It was something that would get better, and it did.

For months, we settled into trench warfare. We threw a few salvos of recovered patients out in the world, and the world threw some different ones back. Staff got sick or exposed and had to quarantine, and we had to fight with one hand tied behind out back. It was grueling, but manageable. Most importantly, we had reinforcements, staffing agencies, PRN staff, locums, etc, could be called in.

Unfortunately, we have entered a new phase. Everywhere is surging at once, no reinforcements are available. Hell, urban hospitals are asking us to be reinforcements and surge capacity. We try.

The reality is, for the most part, this is all still manageable (at least where I am). It is stressful, but we signed up to take care of sick of people. Sometimes periods are busier, and then you get slower times to recuperate.

What is becoming unmanageable is a crisis of morale. Burnout has been taking its toll in healthcare for years, so morale wasn’t great to begin with. But now, it is reaching crisis levels.

When Your Neighbors are your Enemy’s Supply Lines

In my corner of the pandemic, I feel like I am resistance in Vichy controlled France. My countrymen, people with whom I should feel a brotherly bond, have decided to capitulate to the Enemy en masse.

When possible, they gather in groups as large as they can get away with. Fully half abhor mask wearing. Which, beyond its well-documented benefit of reducing the spread of the virus, makes me feel like the resistance fighter living among neighbors who provide succor and assistance to an enemy invader.

6 months ago, Paul Revere ran through the countryside yelling the British are coming. In the intervening months, apparently half of us have decided not only refuse to help the Minute Men, but actively feed and clothe the British.

Hell, sometimes they even seem to be setting up a nicely outfitted afternoon tea for them.

Inside the hospital, you never know if enough nurses are going to show up to staff the hospital and/or the nursing home from day to day. At any minute, the Locum Doc or Traveling Nurse you were depending on to give you break may call and say they have tested positive or been exposed and need to quarantine.

Nerves are raw.

Rural healthcare runs a shoestring in the best of the times.

If only 3 docs work in a community responsible for the ED, hospital, Nursing Home, and Primary Care, you are one person away from more than 30% of your medical staff being down.

In the best of times, you live on the brink of disaster.

Now, we are stressed at all times about whether or not we are wearing adequate PPE, our nursing staff is permanently understaffed, and there are no replacement to be found. Add to that, the communities we are supposed to serve seem to view the simple inconvenience of wearing a mask as too steep a price to pay to let us know they have our backs.

We hear the message loud and clear: We are on our own.

The post-modern consumer-patient tells us, “Well, its your job, they pay you, what is it to me?”

Already, I am having to wait half a day to get a person with a Hemoglobin of <4 transferred to somewhere with endoscopy capabilities. That might be you tomorrow, or two weeks from now. It might not, you might be lucky.

At this point, I don’t even care if you don’t think wearing a mask is effective at slowing the spread of the virus.

If you could just do it to send us the message that you have our backs, that you aren’t feeding the Enemy.

Ask the Vichy, capitulation never ages well.

I am not here writing this to descend into politics, culture war, or even evidence based arguments. I am just a tired Doc in a small town asking you to wear a mask to let us know we aren’t alone out here, that someone gives a shit.

Photo: WW2 US Government Propaganda.