Lessons from the military on how to balance caring for patients against the risk of personal harm

“If not me, then who?”

That was the answer Marine Corps First Lieutenant Travis Manion gave when asked why he decided to serve in the military. He was killed by a sniper in 2007 while serving in Iraq as part of Operation Iraqi Freedom.

Thirteen years later, Manion’s words resonate with a new group of fighters: health care workers. As the Covid-19 pandemic continues to burden health care systems across the globe, health care workers find themselves in harm’s way while confronting an unseen enemy: SARS-CoV-2, the virus that causes Covid-19. Thousands of health care workers have already been infected by the virus, and many have died. These numbers will likely grow larger as we move into new phases of the outbreak.

Doctors, nurses, respiratory therapists, and many other health care workers on the frontlines of fighting Covid-19 now face the dilemma that has long bedeviled those in the military: How do I weigh the desire to serve against the risk of personal harm?

While there are substantial differences between the dangers and horrors faced by military personnel on the battlefield and those experienced by health care workers in hospitals, nursing homes, and other facilities, there are more similarities than you might think.

Conducting operations in a combat zone requires leaving the relative safety of your base and navigating a potential minefield while being watched by an enemy you often cannot see. That describes what some health care workers in the era of Covid-19 do every day: leave the security of their homes to work in an environment where they are threatened by an ever-present yet hidden foe. The difference between the two situations is that people enter the military knowing they may be putting their lives at risk, while most people in health care do not enter the profession expecting to do that.

We will never forget our first patrols while deployed. Donning protective gear like body armor and a Kevlar helmet carried new weight as we realized the gear was our only protection against bullets and explosions. As we left our patrol bases, every step was deliberate and the slightest unexpected movement would heighten our awareness and draw our full attention.

Health care workers in the Covid-19 era can relate to this feeling. The simple protection once offered by wearing gloves while examining a patient has given way to putting on layers of personal protective equipment, and improvising when it is in short supply. This gear now stands between them and a serious infection — and possibly bringing that infection home to their families.

We straddle the worlds of combat and medicine. Each of us has served in the U.S Armed Forces and are now students at Harvard Medical School. As part of the school’s Civilian-Military Collaborative, we were asked by a residency director how we might advise the program’s residents who worried about their safety as they faced the Covid-19 crisis.

A few themes emerged from these discussions about the similarities between the battlefields of war and of Covid-19: a sense of duty toward a greater purpose, a responsibility to others, and a sense of camaraderie.

Sense of duty. Many members of the military say that it was a desire to serve that propelled them to join the armed forces. This sentiment is easy to articulate but harder to understand. The desire to serve, to be a part of something bigger, drove us and many others to trade in much of what we had known for the unfamiliar world of the military. By the time we had deployed, whether it was to combat or elsewhere, we’d already been pushed far outside of our comfort zones. The same sense of service to something greater led us to pursue careers in the medical field.

But as we look around at our non-military colleagues in the medical school and in the hospitals we work in, we see the same sense of duty in them that we saw in our military brothers and sisters.

Responsibility to others. Another theme that drives service members and health care workers in spite of the risk to themselves is the knowledge that others are depending on them. That sense of shared purpose keeps people focused more on the mission and less on the discomforts and dangers they may face. That is especially true for those in leadership positions, whose responsibility extends not only to the members of their unit, be it a squad or a hospital ward, but also to their families and the American people who place their confidence and trust in them to do a job and do it well.

Camaraderie. A sense of duty or responsibility to others can feel abstract compared to the tangible stress provoked by combat situations, whether they are against humans or microbes.

The greatest strength on the frontlines of war are the people standing to your left and right. Deployed in hostile, unfamiliar territory, you are completely dependent on your teammates. If you give into the fear, depression, or exhaustion that you face, someone else — who is equally burdened — must carry your load. This makes succumbing to these challenges unacceptable as it inevitably places a heavier load on your teammates.

As the Covid-19 pandemic drags on, health care workers will continue to find themselves in the difficult position of putting themselves in jeopardy in the service of others. Having served in the military, and now serving in health care, we understand the burden now shouldered by health care workers. Our advice to them when the fear, stress, and exhaustion become too great: You can find the strength to continue in knowing that your work is for a greater purpose, in your sense of responsibility to the community, and in your camaraderie with your co-workers.

Confronting a deadly pandemic is not what most civilian health care workers signed up to do. But they can honorably and bravely heed the words of Travis Manion: “If not me, then who?”

Zachary Johannesson is a former Marine rifleman and rising fourth-year medical student, Gregory Galeazzi is a former Army infantry officer and rising fourth-year medical student, and Samuel Lyon is a former Army infantry officer and rising third-year medical student, all at Harvard Medical School.