Doctors, nurses, chaplains, social workers: these are our new heroes. On the frontline with COVID 19, their mission is to sustain and save us. We all have heard the stories about the power of humans to rise in times of challenge. Our need for heroes in these days are great. But at what cost?

The cost of expectations.

These expectations encourage helpers and healers to believe they need to be invulnerable for our sake. They also  build a shield of silence that prevents the frontline from sharing their reality and encourages the adoring public to turn away rather than bear witness to their struggle.  

The cost of the expectations placed on the healthcare workers became evident on April 26 when Dr. Lorna Breen, an ER doctor at New York Presbyterian Allen Hospital, died by suicide. Rather than suffer in silence, Dr. Breen’s sister and brother-in-law, Jennifer and Cody Feist talked with Savannah Guthrie on the Today Show, revealing the reality frontline helpers and healers endure daily. Jennifer reported that health care workers today believe “we always have to be brave. We always have to be strong. It’s not okay to say that you’re suffering.” This belief led Dr. Breen and her colleagues to work longer than their 12-hour shifts, remain at the hospital, and take little time for themselves to recover from being infected. Hearing these stories, Jennifer pleaded with her sister to care for herself, but Dr. Breen didn’t. Despite mountains of research informing us of the dangers of the 12-hour workday, the increase in accidents and unprofessional behavior when working around the clock, and the importance of sleep, especially during times of great stress and crisis, Dr. Breen did not step away.[1]

Helpers and healers in healthcare struggled before the COVID 19 Pandemic

Although the stress and strain of healthcare workers may not often be featured on the Today Show, concern about burnout among helping professions is not new. Before the Covid-19 pandemic, burnout among physicians in the United States had been named a public health crisis by a paper published in 2019 in conjunction with the Harvard School of Public Health.[2]  These findings are not surprising given that a 2018 meta-analysis of forty-seven separate studies concluded that physician burnout is associated with a decrease in patient care and safety.[3]  Nurses also suffer these effects.[4]  Burnout in helping and healing professions isn’t new.

Implicit beliefs and assumptions prevent practitioners from following their own advice.

My Story

As a therapist and former pastor, I am no stranger to long shifts and the stripes and self-esteem earned from working longer days, striving to care for more people in crisis, and appearing calm in a sea of strife. Although self-care was a focus in both of my graduate school programs, what I read on paper I did not always see practiced. Too often the very institutions that preached self-care modeled working long days with an expectation of 24-7 availability. When doing my chaplaincy internship, I regularly worked an 8-hour day at my full-time job before doing a 12-hour overnight on-call shift. I prided myself on this and thought that I was building my resilience. At the time, my self-care consisted of Starbucks, frequent dining out or take-out, and an occasional manicure or pedicure. Treats were self-care. I’d earned these indulgences for all I had sacrificed.  

The price for this lifestyle surfaced over a ninth month period where earned three traffic violations—each of them after working a 12-hour shift. The scariest violation for me was a May morning. The night shift had been particularly grueling as the trauma pager beeped incessantly. I ran from death to death. Climbing into the car that morning, I headed back to the office where I would shower, work my day, and then go home to sleep. However, I barely left the parking garage before being stopped. I had driven right past a school bus—its lights flashing while children boarded. I remember wondering why I was being stopped because I did not see the bus. Thankfully, no one but my pride and ego were wounded in this incident. I’d like to say that this stop was a wake-up call that sent me home to bed rather than to work. It didn’t. Instead, I hung my head in shame and shared with only those closest to me that I needed to take a driving test again to get points removed from my license. My shield grew thicker. What would anyone think of a youth pastor and chaplain nearly losing their license?

Today I look back at myself with grace and compassion. Although my behavior was not healthy, neither were the expectations of the systems I was in. My body’s response to overwork and lack of sleep was health waving a flag that I lived in a dysfunctional system and had unhealthy ways of coping with it.

The problem lies in the system rather than in one individual person.

In addition to the culture that trained me, there was something more. A compulsion. A drive. I felt a need to be please and be perfect, dare I say, to be a hero. At the time my work is how I valued myself. Work was my worth. My identity so interwoven with what I did. The more praise I received the more I perfected and pleased. This vicious cycle was more intoxicating than any drug. It convinced me that I indeed had superhuman capabilities and maintaining this façade for others was how I could best care.  

What I didn’t know was that the role of the hero in family and communal systems brings esteem not only to the person but to the whole. The expectations placed on the hero shift weight meant for the entire community to one person or group of people. As the hero feels this weight, they often internalize their struggles and live with constant high stress. Any strong emotion a sign of weakness. Any hint of vulnerability a flaw.   

The role of the hero, like all roles in dysfunctional systems, becomes enmeshed with personhood. The hero lives in a constant double-bind: how is it possible to feel the very real feelings of humanity—grief, despair, vulnerability, fear—and also remain super-human?

Another Way is Possible

Shame and vulnerability researcher Brene’ Brown, demythologizes the correlation between bravery and invulnerability. Through years of grounded research Brown uncovered and discovered that we cannot be courageous without being vulnerable. More importantly, Brown highlights how shame, the belief that we are a mistake, leads us to the very behaviors that increase the likelihood of burnout[5]. When we identify with our mistakes and see them as a reflection of our worth, little room exists for creativity, curiosity, or compassion. The same is true for our successes. When we become too wedded with our behavior, it can be too easy to split into sinners or saints. All of us need permission to embrace the parts of us that feel like heroes and the parts of us that feel helpless. All of us need permission to be honest about our mental health.

Perhaps part of the stigma about attending to mental health is our tendency to describe it in all-or-nothing terms. In reality, mental health is on a continuum. When we experience symptoms of anxiety, depression, or burnout, they can be a wake-up call to slow us down and attend to ourselves. When I struggled through my year of full-time work and chaplaincy internship, the very symptoms that I pathologized were the parts of me waving the flag that something was wrong. The health in me whispered something isn’t working.  The illness in me insisted shove that down, smile, and soldier on.  I suspect it may be the same for our heroes today. Admitting our humanity and a need for a witness to our reality is a sign of health. Soldiering on is a road that will likely lead to mental illness.

From Hero Stories to Human Stories

None of us can know all the factors that contributed to Dr. Breen’s suicide, but from what we’ve heard on the news, she may have felt the burden to be super-human. During this COVID-19 pandemic, we’ve all been plunged into collective traumatic grief, and the people on the frontlines even more so. None of us—can fully integrate this reality without space, time, and support. Feeling emotional overwhelm is a normal response to these very abnormal circumstances. Let us free our helpers and healers from the weight of the superhero cape and instead invite them to share their human stories.

  [1] Vivenetto, G. & Stump, S. (29, April 2020).  Family of New York ER doctor who died by suicide: getting COVID ‘altered her brain.’ Today.  https://www.today.com/health/new-york-er-doctor-lorna-breen-s-family-speaks-out-t180289

[2] Jha, A., Iliff, A., Chaoui, A. Defossez, S., Bombaugh, M., & Miller Y. (2019). 

A crisis in health care: A call to action on physician burnout.  Massachusetts Medical Society, Massachusetts Health and Hospital Association, Harvard T.H. Chan School of Public Health, and Harvard Global Health Institute.  https://cdn1.sph.harvard.edu/wp-content/uploads/sites/21/2019/01/PhysicianBurnoutReport2018FINAL.pdf

[3] Panagioti M, Geraghty K, Johnson J, et al. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Intern Med. 2018;178(10):1317–1331. doi:10.1001/jamainternmed.2018.3713

[4] Simpfel, A., Sloane, D., & Aiken, L. (2012).  The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction.  Health Affairs.  https://www.healthaffairs.org/doi/10.1377/hlthaff.2011.1377

[5] Brown, B. (2018).  Dare to lead. Random House.