Navigating COVID: a journey from academic intensity to healing

Springtime. Blooming trees. Green grass. Cool winds. Sunny skies. COVID.

That is where my mind wanders every year since 2020, when the season turns. I flash back to the drive between the hospital and my home. Every evening after fighting a losing battle at an academic institution hell-bent on ignoring and downplaying the horror that was about to breach our borders. I was a fighter then — maybe more in that moment than I had ever been before and have been since — and I was ready for the fight ahead of me. Of course, I was. I had been preparing for that moment all my life. The experiences and times of turmoil and tragedy that I had overcome with studying and intense drowning in my work were the perfect preparation for the work ahead.

I divorced myself from my personal identity and became Dr. King in mind, body, and soul. It was time to show the world that I wasn’t scared, that I was brave, and that I would lead us to battle, even if it meant losing my own life or my own health. I lit the match, burned the bridges to my past at that institution, and flew to NYC to join the front line of defense in a war that continues to this day.

I will never regret or downplay the role I played at the beginning of this pandemic as an academic intensivist. I led the charge at a local, regional, and national level. I approached this disease as I have approached anything and everything in my life, with a relentless pursuit of perfection. I took the pain of the years prior to 2020 and used it as fuel to the fire in my soul. I could not and would not be stopped.

And I didn’t stop for three years.

And then I did. Suddenly.

After burning out in a state of disgrace and infamy, despite my intelligence and clinical acumen in the ICU, I walked away. I left academics, the ICU, overnights, calls, holidays, and weekends. I left everything I had worked so hard to achieve.

I became a private practice salaried anesthesiologist. And my whole life turned upside down.

The downturn in the complexity of the work while also not having post-call days or weekdays off after ICU stretches led to strains in an already precarious personal life. I was working less and more all at the same time. I was seeing far more patients in a day while also losing skills I had spent years obtaining. It was such a profound dichotomy and almost a sick joke where I was both overwhelmed and bored all at the same time.

I was extremely uncomfortable. I was scared and embarrassed at what I was losing and what I was becoming. Who was I if I wasn’t the person out there fighting dragons and giants? I kept asking for more. I asked for more responsibility, more roles, more titles, more work … just more.

Because doing more meant I wasn’t failing, right? If I did more, I wouldn’t have to face my sadness and disappointment at what and who I had become. I had allowed myself to drown in the fiery hell of burnout and do what I had always promised I would never do: I chose easy, and I hated myself for it.

The problem, though, with that viewpoint is that it is profoundly disrespectful to my colleagues, my practice, and myself. Because it’s not easy.

Private practice or community practice anesthesia is profoundly difficult and stressful, especially in a world where there is a constant threat of private equity while ensuring the productivity of surgeons and proceduralists so hospitals can keep their lights on and doors open. All while the patient population is rapidly becoming sicker and less ready to undergo safe anesthetic care for the very surgeries they need to improve and increase their quality of life.

Though I hated myself for no longer taking care of 12 to 18 critically ill patients at a time, I couldn’t acknowledge the sheer amount of intelligence and perseverance I used each day to administer 20 to 40 anesthetics. I kept thinking that I had failed, that somehow this work was “less than” what I was trained to do or capable of performing. And then my life changed.

I found that I wasn’t as tortured or bitter. The stress I carried at work didn’t follow me home, nor was it incapacitating. I moved into my own home. I started really doing the work. I dug into the trauma work I had referenced in my nationally recognized presentations from COVID times. I started to do what I said needed to be done for us to heal from the pain and destruction of COVID.

I realized that not only was I undoing the damage of COVID, but I was actively trying to undo the scourge of intergenerational trauma and tragedy-driven addiction to work that led to such profound loss of self-respect and self-control in the wake of wave after wave of destruction.

The problem was not that I ran into the fire, but rather that I ran into the fire to balm the burns from previous fires.

As many of us know, once the burn is deep enough, the pain recedes, and the damage done is often less obvious, more complex, and harder to heal. The repeated self-inflicted injuries were a form of emotional cutting, a vicious cycle of running from one fire into another so that healing from the last fire was no longer necessary because you were just trying to survive. Akin to veterans who repeatedly volunteered to deploy, which was often simply the only thing someone could think to do when the transition back home was too difficult.

None of these realizations makes me a better or a worse physician. They do not determine the kind of person I am. They do not dictate my worth or my sense of self and necessary self-acceptance. But they do give me pause when I start sliding into the old mindset that I need to be doing more. Could this be healing? Or forgiveness? Or a recognition and realization that the pain Spring has carried for me since 2020 is simply a part of my story and not all of my story. The time I spent being and doing more was also the time I spent not honoring and taking care of myself. And in this time of less acuity, less intensity, and less trauma, I am allowed to find joy, be happy, and have hope for a future where I no longer balm my wounds with fire but rather with kindness and grace for the person that got me to this point: me.

Nicole M. King is an anesthesiologist and intensivist.

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