In the beginning of the pandemic, through all that was bad, we had energy and resolve. Each day brought a new wrinkle (or ten), but we rose to every single challenge. When one of us was weak, another was strong, and we pulled each other back up. We even sewed our own scrub caps. We just kept attacking the problems, because that’s what we always do, and were fueled by our collective naïveté that it would not last forever.

After many hard months, we were getting weary but then the vaccines arrived and our hope rose exponentially. I’ll never forget going up to the vax clinic for my first dose. It was such a celebratory atmosphere. We were so happy! A light at the end of the tunnel, we thought.

We were so wrong.

Now we are bewildered, beleaguered, and just plain beaten down.

• Supply chain issues leave us scrambling to improvise necessities for patient care. Some substitute items delay care. Some decrease safety and increase risk. The public complains about un-stocked favorite items at the grocer as though it were life and death. In healthcare, it actually is.
• New realities of healthcare have led to widespread staffing issues as nurses leave stressful positions or the profession altogether. The lack of staffing (besides the obvious problems for those on duty) leads to multiple texts daily begging for help. An essential day off is peppered by these requests. Answer the call or not? Save your team or save yourself?
• Increase in patient census across the board (yes, due to COVID! Let’s face it, even if the patient isn’t a ‘COVID patient’ the vast majority are in some fashion COVID-related: delays and avoidance in routine care causing worsening of chronic conditions, mental health decline due to pandemic stressors, patients who became sicker because their surgery/procedure was delayed because elective procedures keep getting canceled due to COVID…) coupled with staffing holes and compounded by supply issues make for a perfect storm.
• Behavior of the public at large: if the terrible trifecta of increased patients, decreased staff, and inadequate supplies wasn’t enough… stir in an angry, unhinged public for the ultimate recipe for disaster. Those of us still showing up are met by a rude, unreasonable, out of control clientele and their entourage. We already routinely suffered verbal and physical abuse from patients and families. Now, with regard to COVID-related topics and the current environment of care, we are yelled at, lied to, scoffed at, and scorned. Our advice and requests are ignored, questioned, and ridiculed. The ‘Most Trusted Profession’ is now the ‘Profession Still Trying to Save Your Lives, Even Though You Won’t Save Yourselves, and While You Beat Us Down in the Process’ — (which is quite a mouthful and won’t fit on any of our badges).
  
  As volumes rose once more over the last several months, we got even more creative and opened every nook and cranny possible. In fact, an equipment room was repurposed as a curtained area we call The Closet. It’s cramped, there’s little if any privacy, and it can’t house infectious or critical patients, but it lets us move a few more people through and provide care sooner than we would otherwise be capable of providing. Part of its not-so-charming-charm is that if one bay needs the lights off for ultrasound, all of the bays are in the dark, so some other work (like closure of a laceration) is done by cellphone light. Read that again: cellphone light — because we just keep going, using whatever means necessary and available, to care for our patients.
  
  Today was the worst in an almost two-year series of ‘worsts’. At one point, we had 43 patients in the waiting room and more waiting to be registered. Wait times reached more than 8 hours. They were frustrated, tired, angry, and hurting.
  
  So were we.
  
  The various inpatient units were full (every bed filled and unable to take any more patients because there were zero empty beds). But there is no such thing as ‘full’ in the Emergency Department. Every exam room was ‘full’ (of ED patients and inpatient ‘boarders’ awaiting beds upstairs) and the waiting room was ‘full’ — but the ambulances kept rolling in, and individuals kept walking in. And the line went out the door.
  
  We don’t have a Closed sign. There is NO ‘full’. Instead, there is a constant state of overflowing — because we are drowning in patients to whom we truly want to provide timely and excellent care, but there is not a single space or staff member who isn’t already in use and stretched beyond limit, while more patients just keep coming. And coming. And coming.
  
  That energy and resolve we had?
  
  Most of us are having an awfully hard time finding even a little bit anymore. We are not okay. But — we are still showing up for all of you.
  
  Who will show up for us?

Main image by SJ Objio on Unsplash