The Sisyphus Year

It's been a brutal time to be in medicine. The start of the pandemic caused an unexpected and precipitous drop in patient volume.

Those docs who ran their own practices and relied on elective or non-emergent procedures for their livelihood faced significant adverse financial consequences for the evaporation of their patient base, although the Paycheck Protection Program offset some of that pain.

In our ER, we had been staffing up for year over year increases in volume that averaged 15% annually, only to find that sick people feared the ER and stopped coming in for their care until they were critically ill. Our acuity increased while our overall numbers dropped significantly.

Then came the winter of 2021, where over 2/3 of our hospitalized patients were for COVID. We were on the verge of having to allocate ventilators to ICU patients when loans from LA County as well as a sister hospital came through in a critical moment.

Thankfully, we avoided the situation that Alaska now finds itself in, although a new variant could change that calculus in a heartbeat.

It's frustrating to go through the experience the first time, when you have minimal knowledge of the pathogen, colleagues are falling ill, and every shift haunts you with the possibility that you could bring the plague home to those you care about most.

That horrific feeling is exponentially worse in this post-vaccine era where we have an effective means of prevention, yet we find ourselves once more in a period of tremendous avoidable suffering and death.

Science is distrusted...up until the black magic fails, at which point the critically ill believers knock at the temple they renounced begging to be let in - and even then, the distrust remains.

I listened the other day as a critical care physician, one who has been through the ringer over the past year, described how a dying patient entered the ICU and expired despite heroic efforts.

The family threatened to sue the physician for failing to offer a therapy that has no evidence to support its use but has gathered a popular following nonetheless.

The physician fully expected to prevail in court.

But the adversarial relationship with patients - the fact that so many don't understand that we entered this field to advocate on their behalf - that's just crushing.

We're on the same team.

We need to push in the same direction.

If you keep pushing the boulder down the hill, one of these days it's going to flatten your doctor.