By Molly Levene
“Heroes Work Here.”
Sometimes those three short words make me angry; other times they make me cry.
I was one among thousands of EMTs and paramedics who were deployed to New York through FEMA last year. Having studied public health in school and worked in EMS for over a year, I thought I had seen the extent to which we fail patients; I believed myself disillusioned enough to be prepared for any injustice or chaos I might encounter.
But last April, I quickly learned I was wrong. And when you feel complicit in such deep structural dysfunction, it is incredibly difficult to feel heroic.
When I read “Thank You Healthcare Heroes,” what I see is Queens Hospital Center on April 5th, an emergency department so full of patients breathing through oxygen masks that you could barely maneuver a stretcher. Patients sitting on chairs, packed together like sardines, surrounded by empty oxygen tanks. I see people on ventilators in the middle of the ED, some without proper sedation or standard cardiac monitoring. I see dead bodies, under a sheet on stretchers in the hallway, the morgue too backed up to process the deceased fast enough. I can hear the beeping of cardiac monitors, the whooshing coming from the oxygen masks, and feel the beads of sweat rolling down my back under my uniform and blue plastic gown. I can see the fear in patients’ eyes.
But I also remember crossing the East River and walking into New York-Presbyterian/Weill Cornell emergency room where it felt calm. It felt normal.
I remind myself that I only saw hospitals at a single moment in time. I cannot know what the ED at New York-Presbyterian looked like five minutes after I left. I did not see their Intensive Care Units or any of the other floors that had been converted to care for COVID patients. But I know, from the 23 hospitals that I went to across New York City during my 15 days there, as well as from journalists’ reporting since April, that the disparity between public hospitals and private ones across the city was — and still is — a nauseating and heart-wrenching chasm that I can’t forget.
Thinking about our dysfunctional health care system is so daunting and frustrating that I find it is easier to bury your head in the sand and only think about the things you can control in patient care. When I am in the hospital, I cannot change the many upstream causes of my patient’s illnesses. I cannot fix our horrible system of fractured insurance, our provider shortages, or our painfully inefficient bureaucracies.
But last April in New York City, my paramedic partner, Ainsley, and I had everything we needed to take a patient out of an overburdened hospital and bring them into Manhattan, where there were more resources to care for them. That was something we could have had control over. Except we did not. We went where we were told, and we brought patients where we were told to bring them. One of our goals as part of the FEMA deployment was to spread patients out across the many hospitals in the city. And we did that. We just didn’t spread them out between the hospitals that had resources and the ones that did not.
Returning to Boston last April felt like whiplash. The first time I walked into the Cambridge Hospital ED, it was mid-morning and almost empty. As I looked at the vacant beds, I saw the overcrowded hospitals in Queens, Brooklyn, and the Bronx; I thought about evacuating Jamaica Hospital late one night because their oxygen system was on the verge of failing; I remembered leaving through the ED, tasked with transporting a ventilated patient and flight crew back to JFK, where the patient was being flown to Albany. As I peered around the corner of the ambulance bay, I saw a line of ambulances twisting around the corner and out of sight, waiting to pick up patients and bring them elsewhere. I could see the flashing lights, smell the exhaust fumes, and feel a hand on my shoulder as the Incident Command Officer stopped me to record where we were taking our patient.
That morning at Cambridge Hospital, I went into the bathroom and cried.
I cried for the patients who received care in overcrowded hospitals when there might have been room for them at a hospital two miles away. I cried because at this point, early in the pandemic, we still had a “we’re all in this together” mindset, and that felt like total bullshit. I cried because I felt trapped in an understanding that we were just at the very beginning and not the end, all while Massachusetts was discussing its reopening plan. Standing in that bathroom, I was hit with a wave of burnout, spinning underwater, waiting for the crest to break when I would come up to the surface, take my first breath of freeing air, and remember why I want to spend my life working in health care. I began to dread every shift, and felt like my capacity for empathy had disappeared.
I was fortunate to take three months off over the summer as I geared up to start nursing school. At the time, I had doubts as to whether I could continue in the field. I started reading about moral injury in the context of working in health care. I felt catharsis coming to understand the trauma associated with witnessing or participating in events that go against your moral beliefs or expectations. My time off was healing; stepping back from health care and processing the trauma allowed me space to remember why I got into the field to begin with.
But moments bring it back; the guilt, the anger, the isolation. Like when an ICU nurse was honored at the Superbowl in a stadium packed full of people. Performatively honoring a health care worker at a potential super spreader event only amplifies that abandonment most of us feel. It is sickening to feel like you are set up to fail, while also lauded for your hard work and contributions.
I do not want to be called a hero; I want real support for health care workers — hazard pay, PPE, vacation, mental health services, and, most of all, the resources to actually provide patients with the best care possible.
Molly Levene is a graduate entry prespecialty nursing student in the Family Nurse Practitioner track at the Yale School of Nursing. Prior to nursing school, she received a Masters in Public Health from Tufts University School of Medicine, and worked as an Emergency Medical Technician at Pro EMS in Cambridge, MA.
This post is part of our digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce.