Burnout and the burden of life-and-death decisions have driven some exhausted front-line staff to the edge. In this long-form piece by Financial Times writer India Ross, Dr. Wendy Dean lends her expertise as a psychiatrist and the framework of moral injury to contextualize the deep trauma facing healthcare workers today.
Co-authored with Elena Perea, M.D., a psychiatrist and adjunct associate professor at the UNC School of Medicine.
The country of the United States is experiencing complex trauma. That trauma is silently influencing how we think, how we make decisions, and how we act in powerful ways that are predictable to experts in psychological trauma, but often obscure to those in the midst of it. Drs. Dean and Perea explain how this dynamic occurs and how to best address the challenges that accompany it. The world is in deep trauma due to COVID-19.
The COVID-19 pandemic has deeply burdened mothers – perhaps more so than first anticipated or expected. Dr. Dean shares her perspective, one that holds the framework of moral injury: “what working moms are facing is not identical, but it’s similar, and a consequence of “our society’s decision to pursue profit at all cost.”
Originally used to describe what soldiers experience in wartime, moral injury in health care began to be applied to health care even before the pandemic, says Wendy Dean, MD, a psychiatrist and the president and co-founder of Moral Injury of Healthcare, a nonprofit devoted to reframe clinician distress as moral injury — and to work to improve the source of it, which she and others say is the health care system itself.
“We came onto the pandemic already with distress, and the pandemic hit on top — an acute layer of distress,” Dean says.
Burnout and depression are still serious problems among physicians, especially amid COVID-19. More than 12,000 physicians told us how burnout has affected their relationships, career, and happiness. Dr. Wendy Dean helps frame this conversation with moral injury.
The collectivist spirit of sewing masks and applauding health care workers from the spring has given way to vitriolic politicization of basic public health measures like mask-wearing, said Wendy Dean, a physician who co-founded the nonprofit Moral Injury of Healthcare to highlight issues of clinician distress.
Wendy Dean, M.D., a psychiatrist and president and co-founder of Moral Injury of Healthcare, says that following the long period of rigorous training, focusing on independent, critical thinking with strict adherence to algorithms based on reimbursement policies can be grating.
Beyond the big systemic hurdles that must be crossed to bring this issue under control, Dean recommends that physicians learn how the incentives are aligned at their health care institution.
Mending that internal rupture requires a deliberate effort to reassess our expectations and search for purpose as we await the post-pandemic era, says Dr. Wendy Dean.
“All of us have the need to feel normal,” she says. “But we’re continuing to demand as much of ourselves as we did before – to be the perfect parent, the perfect worker, the perfect student. People have to find a way to have forgiveness for themselves and recognize that they’re doing the very best they can.”
Michael’s Chicken Noodle Soup for Your Soul! As referenced in the Moral Matters Podcast Episode 6 with Michael Fedor.
Large stock pot (not less than 16 qt) Rolling pin (if you’re going to make your own noodles)
Ingredients 1 whole chicken roaster or fryer 3 T butter (salted preferably) 2 yellow onions 2-3 garlic cloves 3-4 carrots (2 – 3 c chopped) 4-5 celery stalks (2-3 c chopped) preferably with the leaves, which are going into the soup 3-4 chicken bouillon cubes Water32-64 oz of chicken stock or broth 2-3 bay leavesSalt and Pepper Fresh bunch of parsley or dried parsley (1 tsp)
The key to great soup is patience and time. Don’t rush it. Given each set of ingredients time to reduce down.
I find this results in a better soup than boiling it all together at once.
Clean and dry the roaster/fryer.
Fill the stock pot about half-way with water.
Add in the fryer/roaster so that it is submerged.
Bring to a rolling boil, then simmer 45-55 min.
Carefully remove cooked chicken as in-tact as possible from pot and allow to cool on a platter.
While chicken is cooling, chop onion and garlic and add to the stock pot water in which the chicken was cooked. Bring to a boil. Chop celery, leaves and carrots.
Add to the water which should continue on a rolling simmer. Add in bouillon cubes and half the chicken stock you plan to use. Add salt.
This is going to be to your taste but don’t be shy. At least 1 tsp. Maybe 2. And a healthy amount of pepper. 1/2 tsp for startersNow pull that chicken off the bone, adding as much meat (white and dark) as you can remove from the bones and into the pot. Stir!
Now we are looking for consistency. Too thick? Add more broth/stock. Add bay leaves some chopped or dried parsley to the pot and butter and allow to cook on low / medium for at least an hour.
Place a sample into a bowl and taste. You want a richness and full flavor in that first sip. Too weak? Add remainder of broth/stock. Simmer another hour on low.
While you are waiting for it to cook, make your noodles if you’re going the homemade route. These are simple.
Ingredients: 1 egg 2 T water 1 c flour Salt (1/2 tsp or less)
In medium bowl, whisk together egg, water and salt. Then gradually fold in flour with a wooden spoon. Switch to your hands to knead the dough. You’ll know it’s done when it is smooth and still moist. Set aside for 15-20 min.
Halve the dough, then roll it out onto floured surface, creating 1/4” to 1/2” thick circle dough. Using a knife, cut in strips, then to lengths of about 2” or less.
Taste the soup. How’s it doing. Needs more salt and pepper most likely. Soup needs to be exciting not bland, so don’t be shy with the seasoning.
About 10 min before you’re ready to eat, toss in enough of your noodles for two servings per guest.
Noodles cook IN THE SOUP. How about that? When the noodles float, they are ready and the soup is ready to serve.
Always serve soup hot and with salt and pepper for further seasoning per serving/guest.
If you do not feel up for homemade noodles, consider a hearty egg noodle for your soup. Boil in a separate pot and allow people to fill their bowl with noodles before adding the soup to their individual bowls.