Banner by Nancy Xiao

The Cost of Compassion

By Varsha Kumaravel

In March of 2020, hospital intensive care units in the United States began accepting their first COVID-19 patients. The United States had watched with bated breath as the virus ravaged its way through China and Europe. Eventually, the virus seeped into Washington state. As intensive care units started to fill up, healthcare workers geared up to fight the virus with fresh determination and courage. 

About two years later, healthcare workers continue to fight. It has gotten a little easier since there is finally a vaccine to combat COVID-19. But, over time, there has been a shift in hospital atmospheres. Healthcare workers still fight the virus to this day. They are still dedicated and brave. But they are tired. 

When the pandemic first hit the United States in full force, healthcare workers were running on adrenaline. Two years later, healthcare workers are now running on fear of the pandemic resurging. Burnout and compassion fatigue in the healthcare industry are reaching all time highs. Burnout is a universal term that describes general fatigue and loss of interest in a person’s job. It is not a medical diagnosis, but rather a type of emotional and physical exhaustion that results from work-related stress. According to Mayo Clinic, burnout is characterized by “a sense of reduced accomplishment and loss of personal identity.” Compassion fatigue, on the other hand, is a more specific term that describes the fatigue that manifests in people who are in professions that require them to be constantly compassionate towards others, where they are continually exposed to the trauma and pain that other people experience. 

Burnout and compassion fatigue levels have always been relatively high in the healthcare field, even pre-pandemic. According to The American Association of Medical Colleges, reasons for these high levels of job dissatisfaction include “too much paperwork, too many long shifts, and too little time to sleep, exercise, or relax with family and friends.” These factors can push healthcare workers to cut the number of hours they are working, retire early, or change their careers entirely. The American Association of Medical Colleges reported in 2017 that there had been a 25% rise in burnout within four years. If the burnout and compassion fatigue numbers were bad then, the pandemic has only helped those numbers skyrocket. 

In the context of the pandemic, burnout and compassion fatigue often start from the interactions between healthcare workers and patients. Autumn Moss-Corcoran, director of the Hospital Elder Life Program (HELP) at West Penn Hospital, says, “We believe family members and caregivers are important, [and] need to be here to keep the patient comfortable. So, that was something that we had to work on to make sure that these patients were still getting the type of care they needed when they were in isolation. I think we [healthcare workers] took more of that on ourselves. And that can lead to burnout and compassion fatigue.” 

But what makes healthcare workers take more of their patient’s pain and difficulties on themselves, to the point where they endanger themselves mentally? According to Psychology Today, empathy is a valuable trait for anyone who is working in a service-related profession. However, the more an individual opens themselves up to another’s pain and sadness, the more likely they are to share that person’s feelings. This can lead to mental and physical exhaustion. For many healthcare workers who have spent the past two years in close contact with patients suffering and dying from COVID-19, the mental and physical ramifications have been extremely costly. 

A recent study published in October 2021 by Frontiers in Public Health found that the rate of depression amongst healthcare workers is “alarming when compared with that of the general population and is closely related to high levels of occupational stress.” Due to the pandemic, almost 25% of healthcare workers now suffer from anxiety and depression, and almost 45% suffer from sleep disorders. These mental conditions increase the risk of suicidal ideation and alcohol dependence or abuse, and the rates of these risks are notably “higher among physicians than in the general populations.” 

Shauni Johnson, a registered nurse and University of Pittsburgh alumna, is a healthcare worker who has been on the frontline and the administrative side at West Penn Hospital. “At the beginning of the pandemic, I’d say I was much more administrative than I was clinical. I felt tired because I would ask the same string of questions to patients. I had this setup of questions in my inbox that I would ask about each patient every single day,” Johnson says. The list of questions included inquiries such as the baseline mental status of the patient, if they had any discomfort, and if they needed any activities or supplies. 

“It was frustrating to me, because the burnout wasn’t that I was asking these questions over and over,” Johnson continues, “it was that I had to ask the same nurses these questions about the same patients every single day. And I think the nurses got tired of hearing me. So that was really difficult because I wanted to be in a support role, but the only way I could support was to contact nurses.” 

On the frontlines, however, the experience is starkly different. In Johnson’s case, the burnout and compassion fatigue came from seeing so many critically ill patients struggle and suffer. Many of the patients that Johnson and other healthcare workers saw during the peak of the pandemic were so critically ill because they had listened to the media that told them to not come in unless they truly needed a hospital bed. Instead of coming to the hospital when they first started seeing symptoms, patients would wait a month or longer. The hospital would then get a lot of patients who were farther along with their illness than they should have been had they come in sooner. 

“So many of those patients, even today, will still say ‘I’m disappointed that I’m here. Somebody else could use this bed. I shouldn’t be here.’ And it’s like, ‘No, you’re sick, you need to be here,’” says Johnson. “I think a huge part of the burnout as a clinician was that patients almost didn’t have the healthcare knowledge necessary to come in when their illness started to get bad.”

By the time these patients showed up to the hospital, they were so ill that not much could be done to save their lives. This was something frontline healthcare workers were seeing on a daily basis, and it was very difficult for many frontline workers to cope with the fact that they could have done so much more to help these critically ill patients had the patients come in earlier. “I think we lost a lot of older adults… and so that was really hard to see. All these critically ill patients were coming in too late instead of coming in when they were less acutely ill,” Johnson says. 

Moss-Corcoran, on the other hand, has grappled with burnout and compassion fatigue as a healthcare administrator. There had been an elderly patient in the HELP program with dementia who relied on her daughter to complete routine tasks. The patient was COVID positive and in isolation. As a result, Moss-Corcoran set up a Zoom call for their family. “I was able to get all of them together and it made me feel really good. I was so happy they could connect, but you could see how tough it was for them, with [the daughter] not being able to be there with her mother to see her and take care of her. I think that compassion fatigue comes from realizing that there is only so much you can do. It’s a wonderful privilege to be able to be that person who helps to connect loved ones with their families… but I can only act in the middle. And when you have a lot of that going on, it can get tough.” 

Being compassionate for hours on end, especially during the pandemic, can be mentally taxing for healthcare workers. It takes perspective to understand why healthcare workers are experiencing such high levels of burnout and compassion fatigue in a job that requires them to selflessly dedicate themselves to serving others.

“It seemed like a lot of people in the outside world, because they weren’t seeing [the conditions within hospitals], didn’t care as much or weren’t taking the proper precautions,” says Moss-Corcoran. “And I think that leads heavily to the feeling of burnout and compassion fatigue in the sense of, well, why are we doing everything we’re doing and working so hard just for everybody else to not be taking the pandemic as seriously as it needs to be taken?”

That is the undercurrent flowing in hospitals ever since the pandemic began. Unfortunately, many COVID-19 patients have become increasingly difficult to deal with, even two years into the pandemic. Today, most COVID-19 patients are unvaccinated. While some did not have a choice when it came to getting the vaccine, the people who did have the choice “are often belligerent and vocal” when it comes to the virus, writes Ed Yong in The Atlantic. They are more likely to resist basic medical procedures, only to eventually struggle because of oxygen deprivation.

Since the pandemic first struck the United States, the World Health Organization instructed that the population needed to flatten the curve of positive COVID-19 cases to avoid a catastrophic population purge. Yong reported in November of 2021 that, while population purges were narrowly avoided multiple times throughout the pandemic, the country still blindly walked into repeated COVID-19 surges. These surges left hospitals overrun and countless healthcare workers in a traumatized state. 

The gravity of the situation could not be more serious. The U.S. Bureau of Labor Statistics projected that almost half a million workers in the healthcare sector retired or quit since February of 2020. According to the World Health Organization, well over 100,000 healthcare workers died from COVID-19 between January 2020 and May 2021. These workers are not just physicians and nurses, either. They include all hospital staff, from physician assistants and healthcare administrators to cleaning staff, food service associates, and housekeepers.

With all the difficulties and tragic losses that healthcare workers have gone through and are continuing to go through, how can the public help? While it is tough to be a healthcare worker, especially amid a pandemic, Moss-Corcoran believes that the public can still help out even in the smallest of ways. It is helpful when people take the pandemic seriously. That does not mean to panic, she emphasizes, but that people wear masks, social distance when appropriate, and do their part to mitigate the spread of the virus.

Johnson encourages people to continue washing their hands. She also feels that we need to have more generalized medical information available to the public to educate people about medical conditions. “[The public] needs to hit on other things like what heart failure looks like, and this is when you should get to the hospital, and these are what alarming symptoms that you have, and that you may need to see a doctor about this,” she says.

Giving to charities can also help. Many nonprofit organizations are raising money to help support hospitals, such as Medical Teams International and Anera. Donating blood is another way to help hospitals, especially during crises where blood donations can be critical for patient care. Supporting legislation and policies that are beneficial towards healthcare workers and public health can make lasting changes in the healthcare industry.

The situation is tough, but there are so many ways to help. The more people there are standing alongside healthcare workers and doing their part, the faster the pandemic can end. Healthcare workers are not, and should not, be the only ones fighting COVID-19.