Picture courtesy of Lenore Stutznegger and Norman Rainock (Norman Rainock Art Ca.)

COVID, the hallways are eerily empty because of you. At night, where there normally exists an air of calmness as patients sleep, the hospital walls that surround me instead convey a sense of uncertainty. It is palpable. It is heavy. It is unlike anything I have ever encountered as a physician. Perhaps this is because deep down in places where fear and dread reside, we know you are there watching and studying our patterns of behavior. All the while, you silently spread yourself at exponential rates, knowing that our testing capabilities, while ever-growing, still fail to keep up with you. For this, you mock us. You are learning the truth about the American healthcare system as it stands. On the outside we are strong, with sophisticated buildings, fancy technology, and state-of-the-art equipment. To nearly any onlooker we appear to be thriving, at the top of our game. Yet you aren’t fooled by this; no, not at all because you have already penetrated these walls, exposing the hidden prison behind the shiny facade of our healthcare system.

COVID, this allows you to see America’s healthcare workers in the state no one is allowed to see, chained and handcuffed to the very system we serve, done so on the exclusive order of our system’s prison warden: Healthcare Administration and its Administrators. Our warden works hard to suppress us by minimizing our voice, and maximizing our work output.

For as long as I have been practicing medicine, America’s healthcare system has operated on a model of just enough. There always seems to be just enough physicians available to care for patients, just enough nurses to aid patients at the bedside, just enough staff to operate at maximal output with minimal input. Always, just enough of what is needed to marginally practice the art of medicine. Ironically, however, the just enough model never seems to pertain to the warden, his funds or his needs. For decades, the shortcomings of our healthcare system, which restrict the physician’s capabilities to practice medicine autonomously and restrict others' ability to deliver the care patients need, has been blamed on us, the healthcare workers. But the prison walls that imprison us are deteriorating as we speak.

As for you, Warden, you have spent decades manipulating and corrupting the system where healing is meant to take place. You have been exceptionally successful at profiting off of the herculean work ethics of physicians, nurses, and all other healthcare employees. You take advantage of our ability, our willingness to be malleable, and to offer care to any and all who are in need. You exploit our altruistic tendencies, knowing they leave so many healthcare workers vulnerable to accepting your often impossible demands. Cunningly, cynically, you leverage this, turning our altruism against us, turning it into monetary gain, knowing we will always be there to fill in the gaps you intentionally leave in the system and economic budgets you operate. You allow us to shoulder the blame for society's dissatisfaction with the healthcare system, even though it very rarely has to do with us. Instead, this dissatisfaction is almost exclusively because of your actions and decisions. Yet still, you refuse to take ownership of what you have created, remaining hidden in the background allowing those who come face-to-face with patients to take the fall. Yet every day we take punches that are not meant for us, punches really meant for you. Your financial wealth shelters you and shelters society from the truth. You are the cause of physician burnout, the source of the low morale that permeates our hospitals and clinics.

For so long, Warden, we have kept quiet about your actions, about the secret chains and handcuffs you imprison us with, because we feared you and what havoc you could cause on our careers. But, your lack of action in protecting us and society from COVID has forced us to take action separate from you. Healthcare workers will no longer hold your burdens nor be held accountable for your lack of preparation and unethical decision making. We no longer fear your retaliation or retribution, because society is on our side, already supporting us, giving us the strength to reconcile the deficits you have left behind, the deficits you have expected us to fill ourselves. We surrender into the shelter of those we heal because the broken state of how you have left us can finally be revealed. Because of them, it is now safe to share the secrets you tried so hard to coerce us into keeping. Our voices can now be heard.

***

Attending Physician, WA: "I was in the middle of doing an exam on a patient when an administrator from my hospital interrupted the visit to speak to me. He asked if the patient was at high risk for COVID infection. When I explained that he was not, he told me to immediately take off my mask. When I refused, he ripped it off my face, stating: 'You are giving patients the impression that COVID is far worse than it is.'"

Physician Assistant, VT: “I work in a community hospital. I was wearing an N-95 mask I brought from home since our hospital was out of stock. A hospital administrator told me I could not wear one because unless I had enough with me to give to everyone, no one could wear them. He put a written complaint in my file when my response was, ‘I have heard of share-day in preschool— but must have missed the It's share-day in the ER memo.'"

Attending Physician, NY: “I was just placed on administrative leave indefinitely because I sent an email to the entire administrative team of the health system where I work, questioning (firmly) why they had yet to create an operationalized system that hospital staff and physicians could follow so positive COVID patients in our hospital could be separated from those who did not have it."

Medical Assistant, CA: “After a Zoom meeting where we were told we no longer needed to wear PPE if we were not within two feet of an ill patient, I asked the director of health services in our healthcare system running the meeting if exceptions could be made for those individuals who were immune-compromised like myself, since I had just returned to work after a short leave due to treatment for breast cancer. His response: 'Do you think having cancer makes you special? If you don’t agree with these recommendations then you can self-elect to use PTO and stay at home.'”

Critical Care Physician, AZ: "As a critical care physician, I asked our hospital administration what they expected me and my colleagues to do if we were faced with a situation where our need for ventilators exceeded what we had available. His response: 'Do the best you can.' I questioned this by requesting something more procedural and in writing that physicians could follow but was told, 'We don’t have time to put together a protocol for a situation that will likely never happen. However, if this time comes, we can discuss it then.' Apparently being proactive is outside the scope of healthcare administrators capabilities.”

Registered Nurse, CA: “Our administrators said they would be working from home and would not be coming into the hospital. I inquired as to why. They told us that their contributions to the work flows at this time were not as important as ours as healthcare employees, and they didn’t want to risk increasing the numbers of those infected. Another nurse sitting next to me in the same on-line meeting asked, ‘If you aren’t as important as those of us coming in to work every day amidst this COVID crisis then why do you get paid four times more than what physicians do?’ The administrator ended the meeting without responding.”

Attending Physician, WA: “The administrators called an emergency meeting to discuss PPE. As an Infectious Disease specialist, I requested to be in attendance. I was told this would not be necessary, however, I was assured that no formal decisions as they pertained to PPE would be made without administration first gathering my input. Not more than an hour after the meeting was due to start, a mass email was sent to the entire hospital system workforce of nearly 10,000 people stating that masks would be given out on a case-by-case basis determined only by those on the administrative team. In other words, it wouldn’t be those with a medical or nursing degree determining who needed a mask and who did not, but instead those with a business one. Smart.”

Central Supply Director, KY: “There are approximately 20,000 masks sitting in our central supply storage with an expiration date of January 2020. Despite this, I made a recommendation that we redistribute them to other hospitals in our system who needed them. The next day at work, all the masks were off the inventory list and I was later told by my boss that I should not ask questions about system recommendations that are outside of my pay grade.”

Medical Clinic Manager, CA: “In the healthcare system I belong to, we currently have two CEO’s each making nearly $10 million dollars a year. They run the largest healthcare corporation in the nation, yet when I asked in January if we could be proactive about COVID, I was told by hospital administration that funds were tight and we wouldn’t be able to order excess PPE in preparation. As I was walking away from the administrator he said, ‘Take my advice, if you have stocks, start selling them.’ I didn’t understand what he meant by this until now. They knew this was coming yet did nothing to prepare.”

Attending Physician, PA: “I and my other surgeon colleagues each received a phone call from our hospital CEO that despite recommendations from the Surgeon General, under no circumstances were we to take it upon ourselves to reschedule elective surgeries. If we did, we would risk losing our jobs.”

Attending Physician, TX: “I overheard the CFO from our hospital system tell our hospital president that they were allocating insurance reimbursement money as a potential bonus opportunity to hospital administrators who were able to stay on budget without costing them more amid this COVID (and I quote) 'shit-show.'”

Attending Physician, SC: “I recently came down with a low-grade fever and chills. I emailed my clinic manager suggesting I be tested for COVID. I was told not to test due to the need for me in the clinic and to wait until I was showing signs of shortness of breath. I didn’t realize that the administrators running the show had in their spare time, obtained a degree to practice medicine.”

***

Warden, we will no longer wear your chains. COVID is dangerous, however the danger we fear by remaining silent is greater than any virus. As always, the physicians, nurses, physician assistants, nurse practitioners, pharmacists, respiratory therapists, physical therapists, speech therapists, nutritionists, environmental and food service workers, and all other designated healthcare employees, will march into the facilities you control and continue to do what we have always done. We will uphold our lifelong oaths of service and we will collectively continue to provide care to those who need us. However, we do not do this for you. We do this for them, our patients, our society.

Warden we have the attention of the entire nation, and the broken system you created is now exposed for exactly what it is. We are now under the protection of those we heal and no longer under the control of those we serve.

You have controlled the narrative of America's healthcare system for too long. It is now time for that narrative to be held by those who march in, not those who actively run out.

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