Stop calling it burnout: COVID denial and the wounds ER doctors carry [PODCAST]

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An emergency physician bought a new iPad and found 53 phone numbers he had forgotten were there. Each one was a family he put on a video call to say goodbye before he intubated their loved one. Howie Mell is an emergency physician with a master’s degree in public health. This episode is based on his article “COVID trauma in emergency physicians can surface suddenly,” published on KevinMD. You will hear why he says he never wanted to be thanked for the work but did not expect to be attacked over it. He explains why he wants the word burnout retired, what he believes physicians are actually carrying, and why he never expected anyone else to say me too. He also describes what happened when he published the piece and his inbox filled with colleagues telling him their own version. He closes with the three things he tells physicians who have been carrying this in silence, starting with what to call it.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Howie Mell. He’s an emergency physician. Today’s KevinMD article is “COVID trauma in emergency physicians can surface suddenly.” Howie, welcome to the show.

Howie Mell: Hey, man, thanks for having me.

Kevin Pho: All right, let’s start by briefly sharing your story and then telling us why you decided to write this particular article on KevinMD.

Howie Mell: So I will try to get through it without crying. How about that? In all honesty, I chose to write this because we’re seeing a lot of revisionist history. I’ve heard somebody describe it as living in a post-truth era. But COVID, for those of us in the emergency department and for those of us in medicine in general, but definitely in the emergency department, was an incredibly tough time.

And we are living at a time when people are suddenly saying, “No, it was just a cold. There was a lot of hullabaloo about nothing. The vaccine did nothing. Nothing was that bad. I don’t know what you guys were talking about. This was all an overreaction.”

Kevin Pho: And as an emergency physician, tell us how you feel about that.

Howie Mell: Well, first of all, it’s not right. I mean, look, I came up in my career in the back of an ambulance. I was in the Chicago suburbs. I was a firefighter-paramedic. I was running the 3:00 a.m. calls nobody remembers in the morning. I’m used to working in the shadows. And nobody goes into emergency medicine expecting a thank-you. If you go into emergency medicine expecting a thank-you, you’ve gone into the wrong profession, because nobody remembers my best work, right? The person I managed to keep alive so that they could get the intervention, or the person I managed to bring through the crisis so they could heal in the ICU, no one’s going to remember that.

And I work nights on purpose, which makes me either a masochist or an honest man, depending on who you ask. I’ve spent my whole life showing up to other people’s emergencies and not asking to be thanked for it. But COVID has turned into almost the other side of it, right? I don’t want to be thanked, but I also don’t want to be attacked.

I mean, it has gotten to a point where the very real experiences that we all went through, the things that we saw and the things that we did, we’re suddenly being told didn’t happen. And that’s tough to sit with.

Kevin Pho: When you say that you were attacked, literally or proverbially, what have you experienced?

Howie Mell: Literally and proverbially. I mean, starting back in the days when COVID was going on. So, a little about my background: I have a master’s degree in public health, and what was actually very odd is that my research, my capstone, was on treating viruses like occupational toxins. I studied RSV, or I studied CMV and HIV, as examples of airborne and liquid toxins, and I treated and analyzed them for my capstone the same way you would a chemical.

So when this all happened, I got very active in sharing what I knew about respirators, but I also knew the rules of public health, right? I understood what the epidemiologists were striving for in a way that not all physicians do, because not all physicians have a degree in public health, right?

So initially, and it was actually written up in the New York Times at the time, I was one of the community leaders in my area trying to reach out to people and explain that when this first started, we didn’t have an ICD-10 code for COVID, right? So you had people who were dying of pneumonia and it was COVID, but that was because we didn’t have another way to chart it yet. In the whole discussion of whether they died with pneumonia, or died with COVID, or died from COVID, I literally had patients screaming and yelling and waiting for me to show up to work because they wanted their loved ones’ death certificates changed, because we were lying about this COVID thing.

And with the things that have happened politically lately, and I don’t want to get into national politics, that’s not why I’m here, this has become revisionist history, right? You go on social media and you say, “Well, you know, get your COVID shot. I’m seeing COVID again in the emergency department.”

I posted something a little while ago about the first COVID death I’d had in a long time. An elderly person who had contracted COVID came in in respiratory crisis, and we couldn’t get them out of it. I found out that they died a couple of days later, and I posted this, and people started attacking me. They were calling me a liar: COVID is just a cold, they died of something else, I’m doing this for the money. It’s just, I don’t know.

Kevin Pho: It’s obviously incredibly difficult to even process and hear about what you and other emergency physicians are going through. Now, how do you pull yourself through whenever you get this abuse and this denial of what happened? How do you get through the day?

Howie Mell: Well, I think that’s one of the nice things about writing this article. The biggest surprise of the last few months is how many people said, “Me too.” I wrote the COVID piece assuming that it was mine. It was kind of a private thing that I was finally admitting out loud. And at least among my colleagues, my inbox filled up. People I respect, people who look completely fine on shift, every one of them told me they had their own version of this story.

Maybe it wasn’t fifty-three numbers in an iPad, but it was waking up in the middle of the night. It was the inability to watch “The Pitt” because it’s too triggering. They all had their own thing that they had filed away and forgotten until it came back. The surprise wasn’t that I was wounded. The surprise was how much company I had and how quietly everybody else has been carrying it.

I mean, emergency medicine, at least, is a profession full of people trained to run toward the thing everyone else runs from. And we don’t often say out loud that it hurt. And I’m finding out that a lot of my colleagues are hurt.

Kevin Pho: Now, you alluded to that story in the article about the iPad. It’s a very, very powerful and emotional story. For those who didn’t get a chance to read your article, just let my audience know what happened there.

Howie Mell: So this isn’t something that happened recently. This happened back in 2022. I bought a new iPad and went to the Apple Store to switch over. I always have my iPad with me at work. I have horrible ADHD, and I need something familiar playing in the background. So it’s very common for me, at the start of a shift, to look at the nurses and say, “What kind of a night is it?” And somebody will say Casablanca or Coco or Dropkick Murphys or Rage Against the Machine, or whatever the crowd is feeling that night. And I’ll start to play it on my iPad, not loud enough for the whole department to hear, just something that I can hear near my desk so that I have that little escape, right?

And so I upgraded. The time came to get a new iPad. The new iPad Pro came out in 2022, and I went and got one. I was upgrading it, and I went to the Apple Store, which is weird because I never go to the Apple Store, but I went, and they tried to help me move the stuff over from my current iPad to my new iPad.

And the guy looks at me, I think it was a guy, and says, “Hey, do you want to save all these FaceTime numbers before you move them over? You’ve got to save them into your contacts.” I said, “What? What FaceTime? What are you talking about? I don’t use FaceTime.” My kids usually like to FaceTime me, but we call or text, and they turn the screen toward me. Now, I travel for work. And when I looked at the screen, it was a ton of area codes from near the hospital where I worked.

And then I looked at the times, and it was all from mid-2020 through 2021, and it was unbelievable, because it all just came smashing back that I had used the iPad to let some people say goodbye before we intubated them. At the time, COVID was really hitting. It was the first two variants, and so many people were dying.

We weren’t even letting families come back into the ER. It was too risky. We couldn’t keep everybody safe. If you had a family member with COVID, they came in on their own. I mean, heck, we even had ambulance companies that weren’t taking people. And so one of my scribes, very early on, before I got rid of the scribes because of COVID, realized that we could use my iPad to let people at least FaceTime their families before we put them on the ventilator, to say goodbye or to say “I love you” or whatever else. And so I got in the habit of doing it.

I didn’t do it every time. I mean, the thing that I’ve wrestled with since I published the article, and I do remember that the number that I deleted was fifty-three, is that fifty-three was probably about a third of the people, because so many times we didn’t have the time to do it. Other times I didn’t think about it. Other times they were just too sick to take the time. But at least fifty-three times, these fifty-three numbers, I let somebody video call somebody before I intubated them.

And the thing is, Kevin, a lot of people don’t get off the vent. And so these were like the last words of those fifty-three people. It just kind of hit me all at once, and I couldn’t delete them. I actually ran out of the store, which isn’t like me. I went home and I was bawling like a baby.

And my wife is a rock. By the way, she had breast cancer. This is a woman who got breast cancer in May of 2020 as a young woman and had to go through chemo and everything else under the COVID rules and restrictions. She and I sat there, and I just deleted the numbers one by one. I didn’t remember anything about anybody. I didn’t want to call anybody, but I just couldn’t see deleting them en masse. It just didn’t feel right.

And I honestly had forgotten about it, that this had happened, until all this BS started, and that this was part of how I responded in trying to meet my patients’ needs.

Kevin Pho: Well, thank you so much for sharing that. What goes through you now when people tell you things like the hospitals were empty, or there was no such thing as COVID? How do you react now? What goes through your mind whenever you have encounters like these today?

Howie Mell: It’s hard. I mean, to a certain degree, I’m getting old, and I’m not trying to pick up every banner that’s on the ground. I’m not going to stay up late at night trying to convince some stranger on the internet, who’s probably a bot from somewhere else, that something happened. But I think that to a certain degree, we do need to keep the memory of what happened alive in the broader sense, on bigger stages than individual experiences. Not only to honor those who passed, but to honor those who are still dealing with it, right?

You can love this work and still be wounded by it. Both can be true at once. And being wounded doesn’t mean, “Hey, I’m in the wrong field,” or “I’m weak.” It’s proof that I was paying attention, you know? And knowing how many people this has reached, how many people I’ve heard from and who have interacted with the story on various media, it’s been astounding. And it’s been something that I think is really important, for us to remind each other that it happened, and that we’re OK, and that we live in a strange time, but we can’t let the memories go away.

Kevin Pho: I am sure that sharing your story on KevinMD, and of course hearing you on this podcast, is already helping so many physicians who are going through and went through the same thing that you did, and having that shared community is tremendously helpful. Do you have any other tips for these physicians who may have suffered in silence and are going through the same things that you are when it comes to COVID denial? What kind of tips or advice can you share with these other physicians?

Howie Mell: I think it would come down to really three things to remember. Number one is to name this accurately, right? If you’re burning out, it’s not burnout, it’s moral injury. It’s being forced over and over to do less than we know is right. These are different problems with different fixes, but stop calling it burnout. It’s moral injury. Call it by its real name, or you’re going to treat the wrong thing.

The other thing is that one of the things that came out of this was a number of physicians who reached out and said that, although they weren’t necessarily my patients, they had said goodbye to loved ones over the iPad. And it’s forced me to remind myself, and also some of my colleagues, that our patients do remember us. We forget most of them. We have to, in order to keep going. But if we were the last steady face they saw at the worst moment of their lives, that’s not a burden. That’s the job. And we should carry it like it means something, because it does.

And then we need to really build in our agency wherever we can: an ownership stake, a side project, or even just how you interact in your shop, the ownership that you take of your shift, because the people who burn out completely are usually the ones who felt they had no say. And so get some say, be heard, and do what you know needs to be done to keep the passion that brought you here, right?

I mean, Kevin, neither one of us got through med school on some kind of abbreviated plan, right? We spent how many years of our lives driving toward the goal of being the best clinicians that we can be. And I think that we both spend our time studying and trying to stay current and everything else. And you can’t forget what drove you there, right? You can’t lose that passion. What you do is important, and it means something.

Kevin Pho: We’re talking to Howie Mell. He’s an emergency physician. Today’s KevinMD article is “COVID trauma in emergency physicians can surface suddenly.” Howie, let’s end with your take-home messages to the KevinMD audience.

Howie Mell: You can love this work and still be wounded by it. Do the right thing, and reach out if you need to. I’m here for literally anybody. If you’re having trouble dealing with stuff, man, [email protected]. Just don’t put it aside in silence.

Kevin Pho: Howie, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Howie Mell: Thank you.

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