“We appreciate your tireless efforts in these difficult times.”

Eyeroll. No, you don’t. I don’t need another meeting or committee. I don’t need a “Burn-Out Committee Action Plan.” I don’t need a “token of appreciation”— a pair of socks? (Really? How much did that cost?) I don’t need another seasoned and respected nurse leaving to travel and make bank or going to some made-up administrative role. I don’t need to come into my shift with three-quarters of my beds being occupied by boarding patients. I don’t need yet another email about which COVID test to order that contradicts yesterday’s email. Or how to “creatively see patients in unconventional treatment areas.” Or reminding me that boarding patients need to be reassessed and have their meds adjusted. Maybe you can even discharge them home after forty-five hours of boarding? Oh, you’re not a hospitalist? Well, too bad; deal with it. Don’t expect to get paid for it, but please accept all medico-legal risks.

At what point does unprecedented become precedented? Clearly, not in year one or year two. Perhaps in year three. I can’t imagine not wearing a mask at work ever again. Maybe not the N95 for ten hours uninterrupted, hydration and PO intake be damned. I may be in the minority of providers (readers of my previous essays will be cognizant of my aversion to this corporate buzzword) who still do that, but I’m attempting to keep my body healthy for its designated slot on the schedule. That’s what I am, one of Henry Ford’s interchangeable parts, replaceable and exchangeable with a few hours’ notice. Perhaps a bit more difficult to replace than the cashier at the local drive-through, but not overly so. Hell, the EMR has alerts to tell the user when the patient might be septic. Or what their HEART score is and what I should do with that information. Did you consider their CHADS2-VASc score even though they are bleeding out of both ends? Artificial intelligence and machine learning are the new hot topics in the medical literature. Perhaps computers can replace the critical thinking of physicians. And the few remaining human physicians can be reprimanded when they stray from the computer’s strict algorithm. Maybe the computers can even be smart enough to solve our current boarding and staffing crises. Or maybe the humans could solve them if we just had more meetings, committees, focus groups, and working groups.

“I don’t want to play this game anymore” is not an acceptable attitude to have. Or so I’m told. Ongoing “trying times” force one to consider alternative avenues of revenue. There are certainly easier and less stressful ways to make a living. Getting paid tens of millions of dollars to throw a football or play pretend on a movie screen sounds pretty good. Or how does one become an “influencer”? It seems like such a shame and waste to throw away decades of medical training so you could always “pivot” (another corporate buzzword that I despise) to urgent care, a med spa, utilization review, expert witness, Big Pharma, or Even Bigger Insurance Company work. Label yourself a “life coach” and charge thousands of dollars for your opinions. Or open your own IV hydration bar, charge $200 for a banana bag, and call it anti-aging and immune boosting. Unfortunately, medical school does an abysmal job teaching the business of medicine. And I’m too old and unmotivated to go back to school for an MBA. No wonder so many health system CEOs are not clinicians.

So we have no choice but to go on. Health insurance is mandatory, and its existence is expensive. One day at a time, just like prison. Was going to work ever enjoyable? Hard to say, but I know it (and I) wasn’t always this miserable. Come home late from the night shift. Strip in the garage. Walk through the house naked and turn on the shower. Go to the kitchen while the shower heats up and drink a bunch of water since you’ve had none since ten o’clock the night before. Shower. Eat something. Take an unhealthy amount of Benadryl and melatonin. Sleep fitfully while neighbors make noise. Change beds repeatedly. Curse not being able to sleep. Tell yourself to avoid alcohol. Ignore that advice often. Toss and turn while second-guessing your decision-making from the previous shift. Give up on sleep. Get up to check your email and log into EMR remotely to see what fresh hell awaits you tonight. Begrudgingly put scrubs on and drive to work. Suffer for ten hours. Repeat.

I’m trying. I really am. If I knew the solution, I would certainly implement it. Maybe I’m weak. Or soft. Or have “poor coping skills.” Or am inadequately prepared. Or am persistently serotonin deficient despite pharmacological interventions. Maybe ivermectin would help. Speaking of which, if I had been a veterinarian, I could at least have a dog at work, making it exponentially more tolerable. It only took me nine years to realize that one of my emergency departments has a “zen room.” Who has time for zen?

I write this not only for myself but also for my colleagues in the trenches who may feel similarly. Don’t give up. Keep going. We’ve come this far. You matter. Take care of yourself and those you love. Take a break and breathe. Do something pointless and mindless. Appreciate all that you’ve done to get here. Yes, it’s terrible, and yes, everyone is burned out. Put on your “token of appreciation” socks and make it happen, just like you have so many times before. Celebrate the little victories and know that it has to get better. No matter the intensity or duration of the storm, it is always temporary. Please keep going.

Stephen Rancour is an emergency physician.