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,