In the emergency department, you learn to function under pressure. You compartmentalize. You prioritize. You override your own nervous system in order to keep someone else alive.

During COVID, that skill became oxygen.

We worked in zones of four to eight critical patients, all unstable, all needing constant vigilance, or we were assigned to the lobby and hallways, managing 50 or 60 patients triaged as “non-critical,” knowing any one of them could turn on a dime. We drew labs in waiting room chairs. We started IVs against walls. We medicated, reassessed, monitored vital signs, and watched for the subtle shift that meant someone was about to crash.

The relentless escalation

Patients only received ER rooms when they were actively trying to die.

ICUs were full. Floors were full. The emergency department became the ICU, the step-down unit, and the waiting room all at once.

There was no decompression. Only escalation.

In one stretch, we cared for a family where the father and adult son both died of COVID. The mother was intubated in the ICU. I never found out if she survived.

There was not time to process that. There were call lights. Alarms. Another ambulance backing in.

When people talk about trauma, they often mean capital-T trauma, the single catastrophic event. But sometimes trauma is lowercase. Sometimes it is prolonged exposure to death, uncertainty, and moral injury. Sometimes it is functioning at maximum capacity for months without pause.

The lingering impact

Studies continue to show elevated rates of PTSD symptoms among health care workers following the pandemic. Many of us operated in sustained crisis mode without structured opportunities to process what we were witnessing. We were praised for resilience and heroism. We were applauded at shift change. But very little space was created for integration.

The nervous system does not distinguish between what is “over” and what has simply stopped making headlines.

Long after visitor restrictions lifted and case counts declined, I noticed something in myself. I startled easily. I scanned rooms unconsciously. I struggled to fully rest. In quiet moments, my body still felt braced.

Hypervigilance had been adaptive. It had kept patients alive. But outside the hospital, it no longer served me.

Lowercase PTSD

Lowercase PTSD does not always look dramatic. It can look like irritability. Exhaustion. Emotional blunting. It can look like competence paired with an inability to soften.

Health care trained us to override our internal signals. To suppress hunger, grief, and even fear in order to continue functioning. That override switch is not easy to turn off.

What complicates it further is the cultural narrative. We were called heroes. We were told we were strong. And strength, in medicine, often means endurance without complaint.

But endurance is not the same thing as integration.

I am proud of the work we did. I am proud of the patients we stabilized, the hands we held, the families we updated in impossible moments. I would choose the profession again.

And still, something happened to us.

Healing through recalibration

Naming that does not diminish our resilience. It honors our humanity.

For me, healing has not looked like dramatic catharsis. It has looked like small recalibrations. Allowing my body to rest without earning it. Letting myself feel grief that was postponed. Noticing when my shoulders rise in ordinary situations and consciously softening them.

It has also looked like speaking about it.

Because I know I am not the only one who walks into a grocery store and instinctively notes the exits. Not the only one who still feels a flicker of adrenaline when a phone rings unexpectedly. Not the only one who learned to survive so well that survival became the default setting.

The pandemic required us to build extraordinary coping mechanisms. Those mechanisms were necessary. They were intelligent. They were lifesaving.

But now, many of us are in a different phase. The crisis has receded. The nervous system, however, may not have received that message.

There is no shame in that.

If anything, acknowledging lowercase trauma is an act of professional maturity. It allows us to move from unconscious reactivity to conscious regulation. It allows us to remain in health care without being quietly eroded by it.

We were trained to keep others alive. Now we have to learn how to feel alive again ourselves.

That may be the next evolution of resilience.

Amy Dinaburg is a retired emergency department nurse.