By now, most health-care workers have been vaccinated against COVID-19.* Physical immunity would appear to last for at least 6 months and probably longer. The physical pandemic for most oncologists is declining, with an end in sight. We are protected from the serious physical consequences of COVID-19 infection. Now we can refocus our energy to help patients with cancer; unlike COVID-19, cancer has no vaccine, and for some patients, valuable time has been lost.
No problem, we can now get on with our lives, or can we? The consequences of the pandemic are not over for those who have lost a parent, a colleague, a partner, a child, or a friend.
The consequences of the pandemic are not over for those who have lost a parent, a colleague, a partner, a child, or a friend.— Sir Murray F. Brennan, MD
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Emotional Effects Remain
The devastating emotional effects of a COVID-19 loss may never be over. Even for those who did not lose close family or friends, it is not over. The psychological damage for all health-care workers is not over. The hurricane may have passed through, but the remaining human destruction must be dealt with. This post–COVID-19 damage is vastly underappreciated. We can repair the cyclone’s physical damage; that just needs time. But what of the hopes, aspirations, and memories lost? “Where is my emotional vaccine?”
Burnout among health-care professionals was a problem before COVID-19; the post–COVID-19 emotional pandemic is already here. We read constantly of the health-care workers who can no longer cope with the devastation brought by their own previous experiences as well as the challenges of caring for themselves and their families. Who will help care for the caregivers?
Institutions provide help for those overtly troubled by the psychological disintegration of their lives by recent experiences. That does help those willing to seek help, albeit there are not enough professionals to cope with the serious demand by those who want and seek help. But what of those who are chastened but not so overcome by anxiety as to lead to depression and self-harm?
‘We Need Each Other More Than Ever’
Where can we find an emotional vaccine? How can we overcome the perceived impression that seeking emotional help is a weakness? How can we help the 10% who already are alexithymic? We must realize that we are children of the world’s family, and we need each other more than ever.
From the surgical fraternity of my generation, the mere thought that we would have emotional weakness or needs was unacceptable: “Big boys just never cry.”
Fortunately, the current generation has discovered a work-life balance that may protect them. How good is that protection? I am unsure. The needs of all health-care workers are similar; how do we resolve that? Can we possibly return to a time when sharing emotional support does not require a visit to a therapist? What can we do?
Opportunity for Change for the Better
How can we ensure that the Band-Aid of physical vaccination is not followed by emotional disintegration sufficient to retreat to excessive use of drugs and alcohol? Band-Aids do not solve major wounds. Drugs do not stop internal bleeding.
If any section of society should be able to be compassionate listeners, surely those who care for patients with cancer should be out front.— Sir Murray F. Brennan, MD
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The first step is to acknowledge there is a ubiquitous problem, and many need help. In families, vacations can defer disintegration, and they are less expensive than alimony, but they do not resolve troubled marriages.
Acknowledging the problem exists is easy; it is in every news source. Defining the magnitude of the problem is harder. Is it correct that 3 in 5 nurses are considering resignation and 3 in 10 of all health-care workers have or are weighing decisions to leave the profession (The Washington Post–Kaiser Family Foundation poll1)? Surely, the financial impact of that alone should get some attention.
I was never a great fan of “what does not kill you makes you stronger,” but with every challenge comes opportunity. Can we allow this awareness to be an opportunity for personal and societal change for the better? I believe so.
We can acknowledge the trouble around us. We can ask, “Are you having a tough time?” “Can I help?” But only if we mean it. The comment “Have a good day!” as you exit the elevator does not do it. Perhaps we could start with “You have a good day”? But that ends with the closure of the elevator doors.
Embracing Societal Empathy
I believe we need to become compassionate listeners, not authoritarian care providers. We need to listen and hear the pain. We may not remove emotional pain, and drugs alone are not a solution, but we can share it. We can ask that these experiences be learning experiences—ones that make us better friends and more empathetic caregivers.
Oncologists start with an advantage; they know what emotional devastation a cancer diagnosis can do to friends and families. Perhaps the time is right to help remove the tarnish on social media by having them embrace societal empathy. That should resonate with our trainees’ generation.
But we must listen; we cannot move directly to “you have a problem, we can operate.” We must be able to ask, “What do you need?” If any section of society should be able to be compassionate listeners, surely those who care for patients with cancer should be out front. Perhaps we went to medical school not just to help others but to help each other.
*It is worth noting that in a number of countries, there continues to be either a lack of vaccines or limited availability, even for physicians, nurses, and other health-care workers.
Dr. Brennan was Chairman of Surgery at Memorial Sloan Kettering Cancer Center for 21 years and is now Senior Vice President of International Programs and Director of the Bobst International Center, Memorial Sloan Kettering Cancer Center, New York.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
DISCLOSURE: Dr. Brennan reported no conflicts of interest.
1. Kirzinger A, Kearney A, Hamel L, et al: KFF/The Washington Post Frontline Health Care Workers Survey. Available at https://www.kff.org/coronavirus-covid-19/poll-finding/kff-washington-post-health-care-workers. Accessed May 19, 2021.