To my health care colleagues in South Dakota

I see you, and I am honored every day I get to work alongside you.

To the frontlines: As the hospital gets busier and busier, I can feel the anxiety. People are sicker than ever with COVID and non-COVID illness alike. Seeing the new diagnoses going up every day and knowing that portends an influx of increasing COVID cases 1-3 weeks later feels like watching an advancing onslaught you are powerless to stop. I know you say you’re ‘fine’ when I ask, but I can see the fatigue from extra shifts, higher volumes, and higher acuity.

To the clinic physicians: I know you’re as busy as ever as care delayed earlier this year has finally come due. I see your heartache as you diagnose your patients with COVID and your anxiety as you wonder which of your long-term patients won’t be here come spring.

To the specialists: I see you trying to navigate how to take care of your chronically ill patients in this new landscape where patients may be nervous to see you. Things like surgeries, oncologic care, and chronic disease management that was delayed need to be done, but how do you do it when COVID keeps taking all the resources?

To nursing and other clinical staff: I know you are working SO. HARD. You’re picking up extra shifts and taking care of more and more patients. You may even be asked to work differently or do things you’re not accustomed to do. Often, you’re doing extra duty as emotional support for patients who can’t have visitors because of COVID.

To nursing home staff: I know you’re terrified. You know what happens if COVID gets into your facilities. One small breach could be a tragedy. On the other hand, residents are lonely, and families are frustrated.

To the students and the residents: I’m sorry your education has been interrupted. PPE concerns have put you further away sometimes than normal. You’re worried you’re not learning exactly what you thought you’d be learning and sometimes struggling to find your place.

To the clinical leaders and administrators: I know you’re making difficult decisions every day. There’s no manual for the decisions you’re being asked to make, and only time will tell if you’re making the right ones. There’s no “off” when you’re the only person responsible for important operations decisions.

To the non-clinical staff: I know so many of you are doing completely different things than normal. You’re having to reach completely new levels of flexibility in both what you do and how you do as many of you learn to work from home or on reduced hours.

To our essential workers two times over (i.e., food services, custodial services, etc.): I see you showing up every day and keeping everyone going. You’re in the middle of a pandemic you didn’t expect, but you push on even though this means learning new techniques to get the work done around COVID.

It isn’t going to get better anytime soon. It’s going to get worse. You know that. It isn’t fair. You all bear so much of the work and stress COVID brings. But, you show up every day and give everything of yourselves. How could you not? Not everyone can do what you do, and ultimately, you’re not caring for “patients.” This is a small state, and you’re always caring for family, friends, and neighbors. The deaths always hurt, but they hit even harder when you live in a place with no more than 3 degrees of separation.

It’s sometimes difficult to explain what we do at work to those who can’t see what we see. Some people will try to explain that it’s all been overblown. But you know this isn’t “business as usual.” I see how hard you’re working, and I appreciate you.

I know you have an abundance of compassion (you don’t come to this work without it) but make sure it extends to yourself. It’s easy to forget when we’re stretched 150 percent, but I’m here to remind you. While you’re taking care of everyone else, please take care of yourself. You’re amazing, and I want us to all get through it together.