Is COVID bringing up any kind of guilt in you?
There are all different types of guilt: Catholic guilt, Jewish mother guilt, ate-the-last piece-of cheese-cake guilt, being too successful guilt, and so on. It seems we can feel guilty about pretty much anything.
Today I felt guilty for taking 4 bags of brown rice off the shelf at the grocery store, even though the sign said I could have 4.
This whole COVID thing is amping up a guilt that while not new, is coming into much sharper relief right now.
One could call it doctor guilt.
This guilt gets in your heart and mind, and grows in the darkness of silence. Like shame, it wants you to hide how you feel and question what you’re doing, or not doing.
Doctor guilt tells you….
You should be out there in the trenches, with your colleagues.
You should be doing more, like the ER and ICU docs.
You’re a traitor if you’re in a nonclinical career.
You’re weak if you’re relieved to be out of harm’s way.
It can also tell you…
You should be home with your family.
You’re putting loved ones at risk.
You shouldn’t be complaining.
Today I want to look at the ways guilt is showing up right now for some of you and offer an exercise for dealing with it.
Let’s dive in.
Dr. Stephanie Segal, a family physician at Kaiser, featured in the blog last week (who’s living out of a hotel), wrote to me saying,
“I feel constant guilt that I’m not home with my kids. That I’m putting myself at risk and they could live the rest of their lives without a mom. That my husband is suddenly a single parent of a 16, 14, and 10-year-old. But guilt paralyzes, so I look at it and then put it away.
I wondered if my post (the blog from last week) would incite feelings of guilt in others. As I was expressing myself about being on the front lines, I momentarily forgot who my audience was. I too was burnt out and almost left clinical medicine. That’s why I know Heather! Before leaving medicine altogether, I found a setting that is working better for me, and I’m grateful for that.“
Dr. Ben, a gastroenterologist, responded to my question about how he and his colleagues felt about physicians who are not in direct patient care by saying,
“Some of us are happy not everyone has to be on the front lines and some of us feel like ‘why am I having to do this?’ For me, I’m just happy there are some doctors who don’t have to subject themselves to this. And I have it better than the intensivists and ER doctors. For how this infection manifests in the late stages, you will not need a GI doctor to save your life. There’s not much I can do to help you. You need an intensivist or a hospitalist. Those are going to be the people who will be saving your life. My specialty doesn’t allow me to do this, which does make me feel somewhat guilty for not being a real part of the solution. After all, that is what most of us went into medicine for – to help people.“
Next, I spoke with Dr. Scott Meehan, a critical care physician and physician advisor in Tacoma, WA. He’s mentally preparing for what’s to come with seeing the sickest of the sick. He shared with me a conversation he had with a former EM doctor who’d left medicine and was feeling guilty not being in the emergency room. What he said to her was,
“Of course you feel guilty. You’re human. You went into a helping profession. Doctors are ‘do people.’ We feel like we have to do something. You’re not in medicine right now. We’re all where we need to be today. Life is unfolding exactly as it should. If you were slogging away in the ER you wouldn’t be doing what you are right now. If you aren’t seeing patients, there are other ways to help.“
I asked Scott if there was anything he’d like to say to my readers specifically, and he added,
“If you’re feeling guilty, know that a lot of us are thinking, ‘run while you can, get out.’ There’s a lot of fear. I’ve printed out my resignation letter, twice.“
What keeps him from turning in his resignation letter?
“Fear. Fear of looking cowardly in a time of crisis. Fear of not having a job.“
Personally, I don’t think it’s cowardly to want to run from danger. It’s a healthy instinct. It worked in our favor when there were wooly mammoths and hyenas to contend with.
Last night I talked with another physician who’s working in a hospital in New York where there’s a serious shortage of PPE, especially masks, and they’re being told to limit their use of masks. Those who have their own supply from home are being told not to wear them because it’s not fair to the other doctors who are going without. She said she’s writing her resignation letter… but will stay on through the crisis.
If you’re risking your health and life in this fight willingly or because it’s expected of you, you deserve to know you’re being supported to the fullest extent possible, and that your life really does matter to those in charge.
Dr. Harry Reahl, a neurologist who recently transitioned into a nonclinical job, was on a work call where his colleagues were talking about what they’d do if their state asked them to go back to the front lines. He told me he found himself getting angry and said to his colleagues,
“I apologize for being a wet blanket on all this civic-mindedness, but I come from a perspective of a lot of anger towards my former health system, how I and other physicians were/are treated. No good deed goes unpunished. They and society are quick to turn to us when needed but after the disaster passes our help is forgotten and we are cast aside. That is not to say I would not help a neighbor, or help in ways I could, but I have no illusions I’d be valued by a system that didn’t value me previously, or that that system would enable me to take good care of patients now. In my new job I feel valued, my skills are being used, I’m contributing. The same administrators who mismanaged us mismanaged preparing for this sort of event, and are mismanaging the response.“
While not specifically about guilt, I included these last two examples to show some of the different aspects and perspectives on this COVID situation.
When we’re feeling guilty, we tend to see things as black and white, with blinders on.
While there are many different kinds of guilt, we can boil guilt down into two basic types:
Useless guilt and useful guilt.
Useless guilt is a feeling that gets us nowhere but feeling bad about ourselves and questioning our own worth.
Useful guilt is a teacher. A motivator. An impetus for change and growth.
To turn useless guilt into something potentially useful, I came up with an exercise you can do using the letters G-U-I-L-T to help you with this emotion.
Here are the steps:
G – Get it out of your head
U – Understand where it’s coming from
I – Inquire with others
L – Let go
T – Take action
G – Get it out of your head
Guilty thoughts can become a loop in your head that can keep you stuck. Guilt likes a dark nest. To deal with the thoughts, you have to get them out of your head, into the light. Write them out on paper. Talk to someone about them. A little separation from the thoughts gives you more perspective to see things objectively and rationally.
U – Understand where it’s coming from
We often don’t question guilt. We give it a key to the front door and roll out the red carpet. We assume because we’re feeling guilty that we did something wrong, end of story. Ask yourself 5 questions about these guilty feelings and see what the reality is. You’re innocent until proven guilty. Did you do something wrong? How would someone else feel? Is having 20/20 hindsight making what you did look wrong? Is feeling guilty a way to avoid doing something?
I – Inquire with others
We often make assumptions when we’re feeling guilty about what someone else is thinking. Inquire to find out the truth. You may be feeling guilty unnecessarily. You can ask others to give you their perspective on how they see the situation.
L – Let go of having to resolve the feeling
I read somewhere that the happiest people are able to hold conflicting emotions. In a lot of situations, feeling some guilt just means you care, that you have a heart and wish something were different than it is. Instead of letting guilt make you feel bad about yourself, can it just be one of a variety of emotions you’re feeling? Sometimes there is nothing we need to do differently. You can be relieved you’re not in a particular situation at the same time you feel guilty for not doing more. This is normal.
T – Take Action
If you’re feeling guilty about doing something truly wrong, take action to make amends, apologize, or see what there is to learn from the experience. If you’re feeling more of a generalized guilt, is there a constructive action to take that counters the helpless feeling guilt can instill? It may not be an action related directly to what’s making you feel guilty, it could be something that makes you feel better about yourself.
When I felt guilty in the store for taking the 4 bags of rice, I decided to pick up some extra groceries to give to someone in need. When I got home, I put a post on Nextdoor.com and found a woman who’d just had a baby and didn’t have any food in her home (trailer). Yikes.
I still feel like a hoarder with my 4 bags of rice, and I’m not saving any lives, but it felt good to do something for someone, even a small thing.
I’d love to hear how you’re doing. Let me know how I can help, and if you need any rice!
Thinking of you. Stay healthy,
Heather
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I haven’t gone to work since mid-March, and I don’t have a shred of guilt about it. Society gives us no respect anymore until it’s time to risk your life…THEN, the politicians all praise us and call us heroes. Then, those of us who die get a byline in the paper for a day, and are then forgotten.
Thanks, no.
Thank you for your comment Anonymous. I hear what you are saying. Unfortunately, there is a lot of truth to what you say.
hi.
this email came at just the right time. I have been mulling it over since. I gave up guilt for Lent so that did help!
I am trying to figure out where I can fit in without putting myself and my family in danger. As much as I took an oath to help people, I will do no good if I am sick or dead. Plus my family comes first. That is partially why I left medicine in the first place. So, I continue to part time teach middle school virtually, and take care of me and my daughter, husband, dog and guinea pigs. I will figure it out. Time will help me know what to do. I continue to think.
I find myself less and less guilty and more and more angry. Very angry. My friends are working extra hard, putting themselves at risk and the children and loved ones they have, all for what? Answer: The insurance companies, the federal and local government, the “man”…the people who contributed to stress and burnout and abuse now want the medical field to save them. Fuck them. Really? You want more from us? Granted, there are many many more patients- I get it- but…you should have treated us better. Why didn’t you see our value a long time ago? Now you want more??? You got a lot of nerve. I am very bitter. (One day I may let that go.)
I am secretly hoping that after this is ‘over’ that the health system will suddenly realize what they have been doing wrong and fix it. I know, it is a dream, but as the cliché says: it could happen! There certainly will be a change but I don’t think it is going to be what any of us expected or wanted. Meanwhile I am glad I left the broken system behind. My colleges tell me not to come back. “You got out at the right time” some say.
So, each day I watch Corona unfold. I pray. I run with my dog. I wonder where we will be in a few months.
Thank you Danielle! I think a lot of physicians feel the way you do, betrayed by the system and angry at the abuse that has been going on for a long time. I feel for the doctors who are out there sacrificing so much for a system that by and large doesn’t really care about them, only sees them as a way to make money. Physicians don’t really have any rights, but they have all the responsibilities, and then some. Who else can’t unionize, who else can be required to work days without sleep? Put their lives at risk? Be publically harassed without the ability to defend themselves? And then be told they are going to be fired or furloughed if they aren’t willing to risk their lives for a system that was willing to sacrifice theirs? I understand your anger! You gave a lot of your life to medicine. You get to choose. I don’t know if the system will change on its own from this, but I am hopeful doctors will become more vocal and organized to fight for themselves. Change can happen.
Thank you for putting a name “Doctor Guilt” on what I was feeling. My family wants me to volunteer, my Governor (and yours) needs our help. But, I am a single parent, a 24/7 parent of a pre-teen, and I need to stay alive. Plus I am not an Intensivist. Not an ED doc. Not a Hospitalist. I am rationalizing my lack of action. But on the other hand, the surgical suites are empty, the primary care clinics and urgent care centers are empty. Everyone’s been discharged to SNFs thanks to Medicare removing the 3 day requirement. No more pre-auths. My colleagues and I are furloughed. We do peer to peers , denials, and medical necessity second level reviews- not needed right now, as no one is coming in, or this need has been “waived” thanks to declaration of national health emergency. So I study for my Utilization Management and Quality Assurance Board Exam, catch up on family medicine CMEs, do my yard work… and read this blog and comment for the first time ever. And be so so thankful that I am home, not leaving my kid alone for the 6 week+ stay at home order form my County, and not in harms way.
Hi Lara! Good to hear from you! Thank you so much for deciding to comment, for the first time ever on this blog. Your sharing your situation is very helpful for others. We need to know what others are experiencing and to feel free to speak up about what’s going on in our world. You have responsibilities as a single mom and no one should tell you how to prioritize your family’s needs. Sometimes we are called to go out and fight the fight and other times we need to be home and tend the hearth, to keep those fires alive.
This really hit home Heather. My son is working in a COVID unit in Boston as a surgeon/ intensivist so I feel guilty that I’m retired and selfish because I don’t want him in harms way. But if not my child then who’s? I’m using my super powers to motivate my rural Mexican hospital to get ready. I’ve been beating my head against a lot of brick walls; Mexican patriarchy, fear of economic collapse and a heavy dose of “don’t tell us what to do gringa”. I only have a few bruises while my colleagues are risking their lives. I could feel guilty about this but I don’t, my community is two weeks ahead of the rest of Mexico in putting precautions in place. We are leaders and teachers and that’s our super power. Thank you for your post today. I needed to look at this and put that guilt out on the table. I can’t protect my son and it isn’t my job. I can speak truth to power and advocate for my most vulnerable neighbors.
I’m on my way back to the US as I type this and I feel relief mixed with a heavy dose of guilt.
Thank you for coming to my inbox,
Tracey Delaplain, MD
Thank you so much for sharing your experience and perspective here Tracey. You give nuance to this situation. There are many ways we can be helpful and your story is a great example of the different roles we can have, even in other countries! Two weeks ahead of schedule could me lives saved – both of patients as well as doctors, nurses and staff. I hope your son stays safe and you as well. Thank you to him and you for your contributions.
HI Heather – hope you are doing well.
I am a colorectal surgeon so have been doing a lot less since about 3 weeks ago when our hospital started to close down all elective operations. Oddly, the usual emergent situations we often deal with have completely stopped.
I am feeling a baseline level of anxiety no matter what.
My way of dealing with this is try to focus on projects that are neglected ( research projects) etc. Also i have volunteered to take night shifts in a newly formed MICU. Clearly, not my specialty, but there is such a need. Actually there is more of a need of bedside nurses. But i am doing my part the best I can. I am even studying critical care this week to prepare for my upcoming shifts. Also working with the hospital leadership to work on triage plans.
i did donate blood last week which I have not done in forever – another small way to support.
I do feel good that my Hospital system has been able to create so many new ICU beds and so far there is enough PPE.
I think its not guilt people are feeling but anxiety and as physicians we are not use to feeling so powerless. Usually we are the calm ones knowing what to do and getting it done. Honestly – I think the most important thing we can do as physicians is to stay home and share with others the severity of the situation.
Its also scary – I have never felt quite so vulnerable at work. I do not even want to go near patients.
stay well,
Amalia
Thank you for writing about your situation Amalia! It’s very good to hear from you. I admire your courage in preparing to work in the MICU. I think you are right that there is a lot of anxiety. And you make a good point that as physicians, we are looked to as the ones in control, with that answers, and the keeper of the calm. As a surgeon, you some well-practiced skills for calming yourself down when there are sudden changes or emergencies. In spite of the anxiety, I imagine that even in the unprecedented times, you will be a steady and stabilizing presence. Good for you for donating blood. I’d been meaning to go myself. Thank you for the reminder.
Guilty….yes, I feel it too! As a pediatrician, I should be helping my patients and their parents always, but even more now. Unfortunately, I am on an immunosuppressive medication and, therefore, cannot do my usual job. I should be able to be doing telehealth to at least help them that way, but my employer (a large pediatric practice) cut my hours, and is not allowing that….more guilt! So, I am at home, doing the requisite social distancing, and not helping my patients. Guilty….the reason I have not left my current employment even before the outbreak. I have communicated with Heather in the past about alternate careers and “call Heather again” has been on my to-do list for months (prior to this pandemic) but meanwhile have been looking on my own for other opportunities. I do some peer reviewing for IROs and some volunteer telehealth, but none of that is enough hours to leave clinical medicine. Now, I’m wondering, do I really want to leave my patients…being home and missing that connection and what I know how to do best…seeing patients, watching them grow up (30 years in practice), helping them in so many ways….guilty! Thanks, Heather, for asking us to write about this, and thanks to everyone who has already posted. Debbie
Debbie it’s good to hear from you! Thank you very much for contributing here. What I’m seeing from hearing online, and offline from so many of you is that physicians care very deeply about helping others. There wouldn’t be so much guilt – and it is not because we’ve done anything wrong, but we are torn when we aren’t giving everything to patients. We were told to put patients first, never ourselves and not taught to take care of ourselves, so it is almost like a bit of brainwashing that gets in our head. We feel bad when we aren’t doing everything possible for patients. Keep on listening to what is right for you regarding seeing patients. You’ve given a lot already. 30 years! Very impressive. Be proud of that.
I wish I had read your email last week instead of just skimmed it. I’ve been on information overload.
I wish I had read it because it might have influenced my decisions. But it might not have.
I call myself a “burnout survivor”, and have not worked clinically since last July. Instead, I published my first novel and started my coaching practice. I have been healing. The book was cathartic (about corporate medicine) and the coaching gives me a chance to help others. A couple of months ago, I accepted an offer and am scheduled to go back to work part time in an urgent care on June 1. I need health insurance.
I was feeling incredibly guilty for doing “nothing” during this period. 10 days ago, I emailed my future employer to see if they needed me sooner, no response. Four days later, I texted one person (on Friday) who said he would call back, but did not. Tuesday I texted the other partner and he called me back 4 hours later. We chatted for about 20 minutes and he assured me they were not short-staffed, and they have plenty of N95 masks, plastic gowns and reusable hard plastic face shields for necessary cases. He also told me I was doing a great service with my coaching practice, and he advised me not to volunteer to help, because the places they will send me do not have adequate PPE. So I thought: God has spoken. Stay home.
I live just outside NYC, on Long Island. We are quickly becoming an extension of the city’s madness. Every other day, I get a pleading email from Governor Cuomo (who I think is awesome) to submit a survey asking us to tell the state our skills and our availability, in the event we are needed. They will expedite reactivation of licenses and there are new laws that have been passed in NY State making it (supposedly) impossible to get sued during this morass, unless there is “gross” negligence (define “gross”…?)
Last night I broke down and filled out the survey. I wrote in it that I have a history of pneumonia X 4 and that I am turning 60 this year. I told them I would be willing to do telemedicine, work at an off-site testing facility, and can also provide coaching services to support coping strategies. But they know I do urgent care. I am hoping I can’t get drafted for something else… I hope I have the option to refuse if they do.
I just kept thinking: what will I tell my grandchildren one day, when they ask me where I was during the pandemic of 2020. I want to be able to stand up straight and look in the mirror, and know that I’m not cowering in the corner. And after 9 months off from clinical medicine, the burnout has receded, and I feel fresher (hence the return to part time urgent care— that, and the health insurance!)
COVID-19 is the great exposer. It exposes what kind of people we are on an individual and a corporate level. It exposes the callousness of our federal government and the compassion of many of our state governments. It exposes the greed as people hoard toilet paper and Tylenol, and it exposes the love between neighbors who reach out and take care of each other, even from a distance. It illumines our technology and resilience to keep connected while remaining apart. It illuminates the courage of the average delivery guy who brings our food, water, and necessities, and the cashier at the supermarket without whom we’d have no food. It exposes the arrogance of people who insist on ignoring recommendations because they themselves are young and healthy— or just callous and stupid. It shows us the incredible bravery of our colleagues fighting on the front lines and those who speak out against what is really happening.
Cuomo has told us that in order to get masks, he has to bid for them; then California bids higher and Illinois bids higher still, so he ups his bids even though New York is now bankrupt… until FEMA comes along and outbids everyone. So the N95 that used to cost 50c a mask is now $7 a mask. And that is where our tax dollars are going, to feed Big Business instead of to save people’s lives. The same is happening with ventilators and all other vital medical equipment right now. Our federal government could put an end to that in a heartbeat, if it were only willing to pass up this great “opportunity” for corporate monsters to make a few extra bucks.
I remember 9/11. I drove to work that Tuesday morning under the crystal clear cerulean sky and saw the North Tower burning as I came up the hill for my exit ramp a few minutes before 9:00. I was proud to be part of a community who desperately wanted to help. I called Albany and asked to volunteer. Me, and 40,000 other physicians. How the world has changed.
All the things I now hate about medicine are still out there and amplified. Everything that burned me out the first time is magnified by this pandemic. I hear physicians’ salaries are being cut while nurses are getting hazard pay. And no one is being taken care of optimally. Part of me had been so grateful I’m not in this mess right now. But then I reread the quote from Mother Theresa, “Do it anyway”. I pasted it below. The part that cuts me is the very end:
You see, in the final analysis, it is between you and God
It was never between you and them anyway.
I did what I felt in my heart was the right thing— for me. But I am totally terrified…
*****
People are often unreasonable, illogical, and self-centered.
Forgive them anyway.
If you are kind,
people may accuse you of selfish ulterior motives.
Be kind anyway.
If you are successful,
you will win some false friends and some true enemies.
Succeed anyway.
If you are honest and frank,
people may cheat you.
Be honest and frank anyway.
What you spend years building,
someone could destroy overnight.
Build anyway.
If you find serenity and happiness,
they may be jealous.
Be happy anyway.
The good you do today,
people will often forget tomorrow.
Do good anyway.
Give the world the best you have,
and it may never be enough.
Give the best you’ve got anyway.
You see,
in the final analysis it is between you and God;
it was never between you and them anyway.
So much food for thought in your powerful story and the poem Debra. Thank you kindly. I hope you are able to take care of yourself and not be put at risk. You really did the college try to offer your help. I really like the last line of this poem, it’s a powerful reminder to be internally referencing and follow your own reasons for doing or not doing.
Thank you for acknowledging this: the guilt is pervasive and naming it helps irregardless if one has chosen to leave front line clinical medicine or if one is still practicing. Thank you for your work on this blog, it is helpful and meaningful.
I’m glad if this post was helpful for you Lillin. Thank you very much for sharing your apprecitation. It means a lot.