Critical Care Doctors Are in Crisis

As a critical care physician, Kelli Mathew knew her days were spinning in the wrong direction. For one thing, her well of empathy was dry. When unvaccinated people came to her, suffering the effects of COVID, Mathew began snapping back. She had run out of comforting or even neutral things to say.

“In my mind, it was like, ‘This is your doing. You chose not to get vaccinated and here you are,’” says Mathew, who works at Deaconess Henderson Hospital in Henderson, Ky. “I would say, ‘You’re probably going to die and this could have been preventable—how sad is that?’ I would walk away. And that’s not who I am.”

In the end, Mathew reached out for help, entering counseling to try to understand what had happened. Her doctor-patient relationships were crumbling in front of her, and she knew she was the reason why. “I’ve always been the most empathetic, compassionate person to a fault,” she says. Clearly, something had changed.

For nearly 18 months, critical care workers have been on the front lines of one of the worst medical crises in American history. The intensive care unit (ICU) death toll for COVID-19 patients is almost unimaginable: a mortality rate of approximately 35 percent, according to one meta-analysis. Nurses in the ICU have served, suffered devastating loss and ultimately left the profession in droves. We have read their stories of grief and pain.

Only now, in the long tail of COVID’s run, are we beginning to understand the depth of the toll the pandemic has taken on the physicians on the front lines. Although hardly surprising, the news is not good.

“ICU doctors are experiencing among the highest levels of stress, burnout and fatigue from COVID-19, says Greg Martin, president of the Society of Critical Care Medicine. “Perhaps more than any other specialty, they continue to experience the full brunt of COVID-19.”

Over the past few weeks, I’ve had conversations with many intensivists, mental health counselors and other health experts. The agreement is nearly unanimous: COVID is devastating some of our critical care physicians.

In a recent national survey of roughly 12,000 doctors, more than half of critical care physicians reported burnout. Staffing and personal protective equipment (PPE) shortages, the death toll, personal safety concerns, a feeling of inadequacy in providing emotional support to patients and their families—all contribute to a wave of difficulty that, deep into the summer of 2021, continues to build. The current surge in cases across the U.S. and the emergence of the Delta variant virtually assure that these scenarios will repeat, as ICUs again fill and, in some places, push beyond their normal capacities. “It really is a retraumatization,” says James Jackson, a leading authority on depression and post-traumatic stress disorder at Vanderbilt University Medical Center.

“I have seen many ICU physicians with somewhat uncharacteristic outbursts, apathy and sloppiness in patient care that I haven’t seen before,” says Gabe Wardi, a critical care specialist with the University of California, San Diego and two smaller facilities. “I think as doctors, and ICU doctors in particular, we pride ourselves on being able to handle any task or patient load. COVID was a reminder that we need to lean on others for our own mental health and patient care.” Wardi struggled with the fear of carrying infection home to his pregnant wife and young child, and he felt guilt over the amount of time he was spending at the hospital. His medical school roommate, he says, only recently returned to work after a year away, driven from his job by the trauma of seeing so many COVID patients die in his ICU.