Ashley Bartholomew, a registered nurse in El Paso, takes a brief break between back to back codes on ... [+]
Here is something we don’t say out loud as healthcare professionals enough: we have reactions, feelings, and emotional responses. We feel angry or depressed or anxious and may not link these feelings to the news. We have worries about what is going on in the world right now and how it affects our patients. We also have feelings about what we are seeing and what we experience on a shift, and they often catch us off guard. Perhaps this is because while they can be expressed outwardly, our emotions are more often are suppressed and held inside. After all, we are supposed to be stoic caregivers.
Ashley Bartholomew, a registered nurse in El Paso, broke that mold recently and showed her emotions in front of a patient, which she wrote about it in a now viral post on twitter. She unexpectedly cried in front of him after explaining what it had really been like to work in a Covid-19 ICU. Before this, he had just told her Covid-19 was “no worse than the flu,” despite being in the ICU for it.
She wrote, “I tell him in 10 years of being a nurse I’ve done more CPR and seen more people die in the last 2 weeks than I have in my entire career combined. His tone changes, he seems to have understood the gravity of what I’m saying. He apologizes. I cry.”
When he said “fake news” to her, she thought of her recent realities as a nurse. How she had never seen such high volume or acuity (severity of illness) of patients. How she saw the post-operative recovery area for surgery close down overnight in her hospital and at the same time the preoperative prep area was converted into a Covid-19 ICU. How she would leave work after 14 hours on shift and see “restaurants and bars and shopping centers bursting at the seams with people just like the hospital was bursting at the seams.” She felt physically and emotionally exhausted.
She explains, “It’s hard physically, you’re in personal protective equipment (PPE) all day long and you’re sweaty, and then it's hard emotionally. People are dying and their family members aren’t with them, and you kind of feel like there’s not a lot of options, because we don’t have a lot of treatment options and you see what you think is someone doing well and then they crash.” This all compounded to make for a very different, very stressful work environment.
Another difference, she adds, is the layer of worry of getting sick yourself and bringing it home to your family. Ashley is the mother of a 7 year old and twins who just turned four. Getting sick herself or getting them sick was never something she used to worry about on the job before.
And so, in the moment, she cried. It didn’t matter that she usually put on a face as a nurse and just went room to room caring for the next patient no matter what she saw or experienced. It didn’t matter how much she told herself what she was seeing was “normal,” when, deep down, she knew it simply wasn’t. It also didn’t make a difference that nursing taught her emotions were unprofessional and she shouldn’t carry her own feelings into a patient room and so she hadn’t done so for 7 or 8 years, and very rarely had anyway.
With that patient, in that room, things lined up (among them, it was her last day!) and she decided to be vulnerable and with it came tears. Mostly, however, she cried about how he represented the bigger picture. She says, “I thought if he believes that, there's hundreds, thousands, millions more that do and we’re in trouble. And it kind of made me hopeless in the moment.”
Despite her feelings being a completely normal reaction to the situation, and one anyone would agree would make sense, as soon as she cried, she explained her emotions away, like she was trained to do in medicine. She wrote, “I apologize[d] for tearing up and compose[d] myself.”
But, she had nothing to be sorry for. All her feelings were valid, and, crying is actually quite common in medicine (even if it isn’t talked about out loud). Plus, looking around at medicine right now it is clear she is not alone in those feelings of hopelessness and burnout.
Twitter conversation between Shannon McNamara, MD and Alex Anderson, MD
She is not the only one seeing the rising cases and feeling concerned. She is not even the only one experiencing disheartening situations with those denying Covid-19.
Dr. Jay-Sheree Allen, a Family Medicine physician in Central Minnesota and host of podcast Millennial Health, explains she had a family member of a patient refuse to wear a mask to enter her primary care clinic. She wanted the family member present to help provide additional information about the patient’s condition, however, the family member, instead, opted to participate by phone, in the parking lot, because they refused to wear a mask. She explains, “It was shocking to realize that this individual chose to not fully support their loved one through a medical visit because of their strong personal objection to wearing a mask for a 20 minute clinic visit.” Dr. Allen explains she always has the patient’s best interest at heart, but these encounters only add to our existing burnout and fatigue as clinicians.
Dr. Jay- Sheree Allen at the end of a shift.
Similarly, Dr. Ryan Marino, an emergency physician and medical toxicologist at Case Western Reserve University School of Medicine, explains he has had many situations where he has been accused of lying to his patients and the public and profiting from Covid-19. He explains, “I have been accused of faking test results, of having a financial interest in the means of testing, and even of using the test to plant microchips and “5G” in people.” One moment that sticks out to him specifically was when he was accused by a patient of falsifying a test result, when he was trying to treat their multi-organ failure from Covid-19. He finds it both depressing and frustrating to see patients harm themselves because of falsehoods they were fed by someone they trust.
And, Ashley is also not the only healthcare provider told to hide their feelings. Melanie Rogers, RN, MPH, a public health nurse epidemiologist explains, “In nursing school I was taught that it was inappropriate and unprofessional to share my feelings with patients, unless it was some sort of shared joy (someone discharged, a baby born, etc).” She adds that while she has teared up when moved by a patient’s story, she feels nurses need to be careful about patients feeling the need to be caregivers to them, instead. She agrees, however, that “A certain level of honesty does lead to more connection.” Dr. Allen agrees stating that she does not think she was taught about feelings in medicine and, learned herself, through therapy, to set boundaries and tend to her own emotional well being, which helped.
In truth, no matter what training taught, it is simply impossible for healthcare professionals to push down their feelings all of the time. They often bubble to the surface, sometimes when they least expect it.
Like they did for this doctor on television. Or, this nurse.
Or this physician testifying to her state government.
Or in this TikTok.
We may be, like Ashley says, scared of being vulnerable and worry it can cause more pain. But, at the same time, healthcare workers are human. Dr. Marino notes, “Honesty is always the best policy, and being open about having feelings – even when it’s hard to do – is something that most people can relate to.”
And, that is just what happened for Ashley. Letting her guard down changed the mind of a patient, and one who might have seemed like he could not have had his mind changed at all. The success of her vulnerability makes you wonder if seeing the reality and the empathy of providers can somehow break through the misinformation. In other words, could showing our humanity we were so often told to hide actually bridge the gap with these patients?
Ashley says it is not that simple, even if she wishes it could be. She explains, “As much as I would love a victory and I want it to feel like a home run, the reality is, still, unfortunately, every nurse can’t have a heartfelt conversation with every denier and make a tour of the ICU on their way out the door. That'll take a thousand years.” That is especially true as misinformation continues to grow exponentially. Melanie adds, “It's like battling a hydra - just when you think you have one person set straight, three more victims of misinformation pop up.”
Plus, it is extremely tiring for healthcare professionals who are already burned out to constantly counter these narratives. Dr. Allen notes that while she believes it is possible to break through to these patients, it is important for clinicians to realize they have limited energy and cannot possibly do it all. She adds, “I do think we have a responsibility as physicians to promote the truth and share information as credible sources, but I think we also need to remember that we are human and on some level have to protect ourselves so that we can preserve our energy to care for our patients in the best way that we can, considering circumstances.”
Yet, even if we can’t get to every person individually, it is nice to think that there is some hope in a situation that can so often feel hopeless. That maybe if we can change one mind, they can go on to then change others. That is exactly what Ashley’s story tells us. She says, “It changes the ballgame if it is exponential just as much as Covid-19 is. Maybe that patient tells their buddy and they tell other people...and maybe it just gets the ball rolling in the right direction.”
Perhaps humanity and emotion, just like misinformation, could be contagious and help bring us together and bring trust back to medicine. For Ashley, the moment with her patient was real and she doesn’t think that was wrong. It felt like she was saying, “Here I am, as a human, doing the best that I can.”
In truth, patients and healthcare workers alike, are all doing just that- their best.
