On March 9, 2020, Dr. Dhaval R. Desai returned to his job at Emory Saint Joseph’s Hospital after a 10-day paternity leave.
On his mind was a new mysterious virus, and what if a patient who had been traveling showed up in the emergency room with COVID-19-like symptoms? He felt a sense of calm having seen other viruses such as the H1N1 flu outbreak causing hype and hysteria but were ultimately managed — and contained.
Why would this time be any different?
That’s where Desai’s story and memoir begins. “Burning Out on the COVID Front Lines: A Doctor’s Memoir of Fatherhood, Race and Perseverance in the Pandemic” (McFarland & Company, $29.95) is being released this month and takes readers inside some of those terrifying, chaotic and difficult days of the pandemic.
“I want people to realize that we demand and expect so much from front-line workers,” said Desai. “The reality is all of us who provide care are human and can struggle. I want people to know it’s OK to be vulnerable. We have spent far too long marching forward without processing what has been happening.”
All author proceeds will go to the Dr. Lorna Breen Heroes Foundation, started in honor of Breen, an ER doctor caring for COVID patients early in the pandemic in New York and who died by suicide.
Here are excerpts from Desai’s book along with an interview with The Atlanta Journal-Constitution with his reflections on the pandemic and what his life looks like now, nearly four years since COVID-19 swept the globe. The excerpts have been edited for length and clarity.
Credit: Ben Gray
Credit: Ben Gray
Chaos ensues
On hospital days spent in meetings and caring for patients all day, the question looming largest was, Am I taking the coronavirus home with me? My son was only three weeks old, and his immune system was still developing. What if he got COVID?
My wife, Yogita, and I talked, and came up with a plan. I would change out of my scrubs into street clothes at the hospital, to protect against any remnants in the car. (Hospital laundry was done separately.) Then, at home, I would disrobe in the garage and go take a shower before touching anyone. We adapted to the new and strange.
Caring for patients with communicable diseases was not new, I had done it for years; and I never took extra precautions beyond the basics. Yet even with these elaborate protocols in place, we worried. Should I isolate myself at home? We couldn’t be sure. I had colleagues staying with friends or at hotels, keeping themselves away from their families for days after working in the hospital. For me this was not an option. I refused to separate from my family. I am a father and husband first; and I need them.
Credit: custom
Credit: custom
Even with all the exhaustion and stress, I still felt a sense of exhilaration in those first early months. I was officially part of the pandemic and leading a team of frontline physicians. This was a once-in-a-lifetime opportunity. Colleagues advised me to take a day off, away from anything hospital-related, but I couldn’t detach, even when I tried. The drama was (and is) unfolding directly before me and I need to stay, to be part of whatever happens next. I felt paternal working with my team: I could advocate, navigate, advise and ultimately protect them — a huge responsibility, that kept my fire lit during those chaotic first weeks.
During subsequent weeks, my colleagues and I had a small stash of PPE that we kept in our offices, acquired from our homes, stores or through individual donations. We first had to protect ourselves before we could protect others. We were communal by nature and team players all, but given the risk of depleting PPE, we had to look after ourselves and I encouraged it. I wasn’t worried about getting in trouble with the administration for procuring and stashing our own limited supply, but I was indeed worried that we well might run out.
Credit: custom
Credit: custom
Not finding joy
I don’t have time or energy for this!
My daughter needed me — right now — to take her outside to ride her bike, and this was my first thought. What I needed most was to lie down and close my eyes, if only for a few precious minutes. Outside was sweltering, ninety degrees. It didn’t matter. I couldn’t say no.
I had come home to a sink full of dishes, the TV on, toys strewn helter-skelter, and nothing put away. “Hey” was all I could manage to my wife as I brusquely moved past her to go change my clothes. I felt tense, angry, frustrated and exhausted. I know she felt that way too.
Kaiya, though, wanted to go outside, so out we went, under a blistering sun. I helped tighten her pink Barbie helmet, and she got on her bike, pushing slowly on the pedals, wobbly and anxious, with me running behind and holding her from the back.
“I’m scared, Daddy!” she squealed as I ran, sweaty and short of breath. Reassuring her, at last I let go, hoping for that magic moment of momentum when, sustained by the pedals, she would maintain her balance and ride free, unencumbered.
“Pedal, pedal!” I yelled — but she wobbled and fell, her own fear preventing her from moving forward. How to get past it, this hesitation and dread, the fear of falling?
We do it again, and try a little harder.
Credit: cutom
Credit: cutom
Watching and helping Kaiya learn to ride a bike does make me proud, yet I failed to feel any joy or excitement. In fact, I was barely smiling, and had to force out a Yay! for my daughter. I just wanted to go inside, get evening chores done and move on to whatever was next. In that moment, I catch myself and see that my mood is off, but I can’t snap out of it. Instead, I soldier through, trying hard to reassure myself that tomorrow will be better.
The reality was, I couldn’t escape the overwhelming daily stress of being at once a father, husband, physician and leader.
No amount of medication could fix that; and frankly, part of me was disappointed. I still wanted to be able to do it all. I was trained to do it all. I was trained to not show defeat or make mistakes. I couldn’t accept defeat. A wise leader even told me, more than a few times throughout the pandemic, “Don’t be afraid to say no and walk away when you need to.”
Walking away wasn’t in my vocabulary. My entire approach to this point had been to keep working, under any circumstance. I had come this far by doing just that, is how I would always rationalize it: after all, this is what makes me a doctor, correct?
Moreover, this is no time to stop. It’s my turn now to show that I can lead by example. That means showing that I can persevere through any challenge. I wasn’t afraid to show weakness, but the thought of caving to the stress in the eyes of my peers filled me with unnamable dread.
Compassion fatigue, like burnout, is real and had become an epidemic of its own among healthcare workers, including me. Clearly, the ongoing COVID surges and threats had brought out the worst in the best of us. With no way to win or please everyone, what more could we possibly do? Colleagues would come to me, desperately wanting to know, “What’s going to happen next? Are we all changed forever?”
Credit: custom
Credit: custom
Q&A with Dr. Desai
Q: A recent survey by the Centers for Disease Control and Prevention found health care workers feel burnout more frequently than they did before the COVID pandemic. Are you surprised?
A: I am not surprised. The pandemic brought such significant challenges to an already stressed system. The constant chaos from poor staffing, financial constraints, pandemic pressures, nonclinical work related to documentation and metrics continues to take health care workers away from what can bring them the most joy — caring for a patient.
It’s frustrating and demoralizing and challenges us all to reassess how to restructure the system and ourselves to ensure there is joy in practicing. Health care workers are front-line workers who have just as much stress as others from personal, family, health and social crises.
There comes a time when they can’t give more, and their mental health takes a toll.
Credit: arvin.temkar@ajc.com
Credit: arvin.temkar@ajc.com
Q: Can you talk about your mental health today?
A: I am far better than I was in the heat of the pandemic. As I talk about it in the book, it was a journey and realization for me that I’m no different than others. I realized that I needed to slow down and take care of myself. I still struggle with sleep disturbances associated with shift work and am working to prioritize rest and self-care (whether it’s exercise, meditation, napping).
There are times when I question why things can’t be a little smoother without so many variables and challenges to our daily work. It has helped me to set boundaries and align with the idea that I can’t control and change everything.
For me, I’m still on the journey to optimize all aspects of my physical and mental health. It’s how I maintain myself, and nothing has changed for me on that. I’m grateful to have shared my path and am sincerely hopeful it will help others to find their path. Mental health is health.
Q: What level of precautions do you take for yourself and your family and what about the future?
A: The No. 1 precaution that we, as a family, take at this point is vaccination. We follow all vaccination recommendations, including COVID and influenza this fall. I still feel it is the best way to prevent disease and even more so prevent major complications from disease.
If we are dealing with upper respiratory symptoms, we will work to mask in public to help protect others.
Do we currently mask everywhere? The answer is “no” because we feel that we are at a safer point and doing our part with vaccination and disease prevention.
We are also in favor of dialing up stringent masking based on community prevalence of COVID. And, of course, hand hygiene and vigilance on hygiene in general (especially for our children) is key.
Credit: arvin.temkar@ajc.com
Credit: arvin.temkar@ajc.com
Q: What are some of the challenges still in a hospital? What has changed? What needs to change?
A: There are still challenges with staffing issues. This is not unique to local health care systems, but it’s something I know that is happening nationally. We also see across the country increased threats towards health care workers, physically and verbally. I stand by and applaud the firm rule of “zero tolerance” policies against any violence (physical and nonphysical) towards health care workers. Most health care systems are doing this but sustaining it and actually acting on it speak volumes. Any patient who intentionally attacks or abuses a health care worker simply cannot and should not be allowed to receive health care in that institution.
For health care, with increased pressure on metrics, nonclinical tasks, and often being pushed to do more with less from pressures from insurance company regulations, it can be very challenging to find the energy to be compassionate.
Patients are so vulnerable, and they need and deserve a compassionate approach. Compassion and love come hand-in-hand, and I truly feel approaching my patients with love allows me to care, navigate, and advocate for them. I will continue to encourage this to my colleagues and hope to be able to coach the newer group of health care workers on the importance of loving our patients. It’s the fundamental way to feel value in our daily work.
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