I worry that burnout can’t be reversed and has fundamentally changed me as a doctor and a person

It took me four months to write this sentence.

I wanted to capture my feelings as a doctor in training who has been bludgeoned by the Covid-19 pandemic the last year and a half. But I’ve been too burned out to write about burnout.

It first hit me a year ago as I was going to work at my primary care clinic in Chelsea, Mass., a city just north of Boston that was walloped by the pandemic.

Most days I stroll through the clinic halls greeted by the medical assistants — “What’s up, Nuti?” I see patients who are me minus the years of education, the medical degree, and the elevation of a family that sacrificed the little it had for me to stand before them in my white coat. They come from my background, immigrants who don’t have much but hope for a better life.

I remember my mom and I going to the doctor when I was a kid, concerned that any illness could rob us of the opportunity to achieve our American dream, so I treat every one of my patients as if I were back in time, helping my mom and me. Staying late in the clinic to discuss someone’s struggles with mental health. Waiting on an endless hold with the specialist’s office to ensure an appointment is on the books. Making phone calls to navigate clunky websites to get a patient a free Covid test. It’s the least I could do as the poor kid who made it.

But on that September Wednesday, standing inside my apartment after having been sequestered for a month within the walls of the hospital, I pat the pockets of my white coat for my stethoscope and phone, futilely smooth my ceil blue scrubs’ maze of wrinkles, and feel for the first time that I don’t want to go to the clinic. I put on my mask, notice my wilting pothos’ silent plea for water, and rush out the door so I won’t miss the shuttle, again, all the while wondering what has happened to me.

The National Academy of Medicine defines burnout as “a syndrome characterized by a high degree of emotional exhaustion and depersonalization, and a low sense of personal accomplishment at work.” In medicine, there’s a lot of talk about burnout because it is so prevalent. It’s especially common among trainees like me, where an 80-hour workweek is the expectation. I’m supposedly among the up to 75% of trainees who experience burnout, but I find it hard to imagine that 25% of residents are feeling hunky-dory during this pandemic. And Covid-19 has only increased stress and burnout among interns, residents, and other trainees.

It’s not like vaunted medical institutions like the one I’m working for don’t know about burnout. They devise all sorts of ways to reverse exhaustion, like free dinner for a week, listening sessions, or a thank-you-for-working-during-the-pandemic Patagonia jacket, imagining my life can be fixed with an opportunity for reflection and another fleece.

There’s an underlying assumption in burnout discussions: that it can always be remedied with some notion of self-care. What’s never spoken is that burnout is the remnant of a fire. I’ve never seen a piece of charred wood and thought that some time by itself and some water will restore it to its former state. Burning can cause irreparable damage, and I haven’t heard anyone admit that about becoming burned out.

What happens if burnout can’t be reversed. What if part of me as a doctor has been fundamentally changed and can’t go back? What if I’m charred?

That’s how I feel. Sooty, brittle. Burned to the point that I won’t be the same again. And I’m scared about who I’ve become, and who I’m going to be.

I guess that’s what happens when you see death over and over and over, standing helpless as you fail to preserve life after life despite your every effort.

I cannot forget John, who I cared for early in the pandemic. An elderly man with multiple medical problems, he came to the hospital because he was short of breath, one of dozens with the same story. Fluffy patches decorated the X-ray of his lungs, a pictogram of the Covid-19 I knew he had without any test results. His trajectory was a common one: ever-increasing need for supplemental oxygen, confusion, and the inability to communicate for himself.

I called John’s nephew, a physician himself, every day. “He’s still on high flow, and he isn’t getting better. We are doing what we can, but honestly there isn’t much more we can do.” But then came a glimmer of hope: the hospital was given a limited supply of remdesivir — a now-standard therapy — to treat the sickest patients via lottery. John was one of the lucky ones chosen to get it.

But the remdesivir didn’t work, and John got worse. His nurse and I wore our N95 masks, face shields, and protective gowns as we brought in an iPad so John’s family could see him, a man with liters of oxygen blowing into his crusted nostrils, the video camera angled to avoid capturing his arms tethered to the bed so he wouldn’t rip the oxygen lifeline from his face. The end was near and, after many conversations, we focused on his comfort. He died, alone, accompanied only by the serenades of Elvis that his family asked to have playing in the background.

I took care of John after John after John. I hate that they all blend together. I feel like I should remember every person I cared for month after month as a way to honor them. But I can’t, recalling only a flux of wires, masks, ventilators, iPads, and the tears of family members over telephones and Zoom calls. Maybe they’re blending together because I stopped keeping count of the number of my patients who died. Because in the abacus of my future and my hope, every lost patient would take something away from me, until there was nothing left.

When I signed up to be a doctor, I knew I’d work long and hard hours to be on the cutting edge of health care and bring people the cures and hope that medicine promises. It was worth the years of learning to conquer the inequities that kept my family away from opportunity because I could gain the agency that my background denied me: the ability to bring health to those most in need. Covid-19 torpedoed that agency. I have every right to be disillusioned. The pandemic has taught me a ton about medicine, but it also erased what I expected of myself. I was not a healer, just a messenger of death.

Perpetual anxiety filled the early days of the pandemic. I still think about how health care workers didn’t have N95 masks in the beginning. I laugh, as if it were a fever dream, that the same surgical masks I now wear to shop at Whole Foods were what I was using when people were coughing SARS-CoV-2 particles in my face in March of last year. I worried every day about being exposed to the vector of demise by patient after patient, wondering when it would get me, too.

Medical school teaches physicians to save the lives of others, but not what they’re supposed to do when they must put their own lives on the line. Pandemic 101 isn’t in the course catalog.

Caring for people with Covid-19 didn’t stop at work. The virus infected my loved ones, one after another, here and in India. I called my grandparents daily, acting as their virtual doctor, googling the names of Indian medications to provide recommendations to keep them out of hospitals that had no beds. There was no opportunity for rest.

I became a servant to anxiety, and it still has me shackled. When can I see my family and friends, do the things that bring meaning to my life? Am I literally toxic, my presence in their lives exposing them to the disease I work with and afflicting them with the suffering it portends? What would I do if I gave my mom Covid? I still don’t know the answers to those questions, so I’m resigned to the reassurance of a negative Covid test before I see the people I love and to dining outdoors in perpetuity.

I worry, too, about the impact this char has on my ability to be with someone else. I’ve been confined to online dating. Swipe, swipe, like, like. A match, a date, a relationship, a breakup. The first breakup because of discordant values during a pandemic: she prioritized social connection, while I prioritized health. The second because of my inability to meet expectations: clothes left on the closet floor, lunch unplanned, dirty dishes in the sink.

“Hey, I’m sorry,” I said. “I’m not myself; I’ve been in survival mode, and I’m doing my best.”

“I know your work is hard,” she said, “but if that’s your best, then it isn’t good enough.”

Ouch.

I realize that it’s hard to expect empathy from someone who hasn’t been living on the frontlines of pandemic hell. Nevertheless, a darker thought remains: Has this virus made me into a person who is no longer enough?

Covid-19 has turned my life into an arson scene. My hands leave soot on the clinic keyboards, black dust on patients’ bed rails, small pieces of me falling to the ground, stepped on and carried away in the grooved sneaker bottoms of people intent on saving lives.

I feel like I’ve gone from doctor to debris.

Sudhakar Nuti is a resident physician in internal medicine and primary care at Massachusetts General Hospital in Boston and a public voices fellow with the OpEd Project. He was named a STAT Wunderkind in 2019.