I have a video visit in the pulmonary clinic with one of my favorite patients. I ask her how she’s doing and wave to her husband sitting in the background of the living room where she is set up.

Deborah says, “We’re good. We’re healthy. We are staying home. We miss our grandchildren and have been doing a lot of Facetime. And we get our groceries delivered.”

A wave of relief washes over me, and I nod approvingly with each piece of information. Most of my clinic patients are elderly with chronic lung conditions, and I have watched them psychosocially sacrifice more than others from their strong commitment to staying home.

Before I can move on to ask Deborah about her breathing, she asks, “Wait. And how are you doing?”

I am touched by her thoughtfulness, take a deep breath and put on my brave face which, turns out, can’t be seen under my mask.

I give her the same response that I give to my other patients: “I appreciate you asking. We’re all trying to hang in here and take it one day at a time.” I crack the same lame token joke I tell everyone: “This is why we can’t have nice things,” causing Deborah to nod and slightly chuckle at the same time.

Deborah asks because she knows I also work in the intensive care unit. We are nearly eight months into the COVID pandemic, and the things that frightened me at the beginning I now can do without much thought or hesitation. I can sanitize my hands, check my PAPR battery, throw on my gown, gloves, PAPR hood, and rush into a negative pressure room without stressing if I have the order of the steps correct. I no longer internally cringe if I’m standing next to a person on a heated high flow nasal cannula or BIPAP, worried about aerosolization. I go to the grocery store and no longer strip in the garage and decontaminate in the shower immediately afterward. While there is much about patients with COVID we still don’t understand, we have a better grasp of what we know versus what we don’t know.

But my colleagues and I are exhausted. It’s taken me awhile to see that the source of exhaustion stems from the world outside the ICU. It’s more mental than physical. It’s reinforced by what I see around town and via my nightly doomscrolling (I have no one to blame for that but myself).

There is nothing more heartbreaking for health care workers than seeing young people with COVID on advanced life support. The exception is when we drive home after long shifts and see people town not wearing masks, college students gathered in large groups playing beer pong, and national COVID testing for athletes prioritized over health care workers. I watch my colleagues try to balance their increased workload with intermittent FaceTime calls from their children, asking for help with the Japanese multiplication method. As the numbers rebound, health care workers are asked to work more shifts, day and night, at the same time when salaries and benefits have been cut, and hospital colleagues have been laid off without warning.

The first time I saw the sign “HEROES WORK HERE” outside our hospital, it brought tears to my eyes. Eight months later, I don’t want the term hero to be confused with martyr. My initial dreams are muddled memories. Eight months later, I have recurrent nightmares where I join large groups of people maskless, and I panic. When the pandemic first started, my personal goal was for none of my colleagues or trainees to get sick. Eight months later, there have been casualties despite our best efforts to stay safe.

I recently saw Deborah for a follow-up visit. She tells me she’s experiencing “pandemic fatigue” but has stayed loyal to strict COVID-19 precautions. She catches me before we move on and says: “The numbers are bad again. Are you doing OK?”

“No. We are not okay.” My words slip out before I can stop them. I have been trying to rally the troops as we convert another hospital unit to an ICU, but the predominant mood is one of impending doom due to lack of control and burnout. Humans, not machines, define ICU care. My overshare surprises me, but Deborah seems to know to give me a brief moment of silence before we transition back to her issues.

The psychological toll on the frontline over the past months is heavier than the world realizes. Instead of hearing people thank us for our hard work, I wish they put their thank you’s into actions, including wearing masks correctly and avoiding large gatherings. We are not actually the frontline. My colleagues and I are downstream from your direct actions. We try our best to help save lives, but there may come a time where we may have to help you die.

Bonnie Wang is a pulmonary and critical care physician.

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