Nine months into the coronavirus pandemic, as the number of cases soars, the economy sputters, and everyday life refuses to come unstuck, they face the same obvious yet complicated question that shadows each of us: Where does a person find hope?
Their answers, if varying in details, revolve around the common theme of connection. Our daily interactions – deprived of spontaneity and typically filtered through masks, Zoom, or both – remain a source of reassurance as the uncertain present lurches toward a blurred future.
About these ads "There is a sense of being in the foxhole together," says Dr. Megan Ranney, an emergency physician at Brown University in Providence, referring to her fellow health care workers. "It sometimes feels like we're in a war for our patients and for ourselves. That tightens the bond."
Still, even for the most resilient among us, persevering week after week in our socially distant existence poses a struggle as another round of stay-at-home orders hits several states. The country's vast political divide further inflames our grievances as officials at every level send conflicting messages about the pandemic, giving rise to personal distrust and, at times, public animosity.
Truth, lies, and insurrection. How falsehood shakes democracy. The damage inflicted to the spirit and a loss of faith in others can contribute to people experiencing moral injury. Mental health experts describe the condition as a "wound to the soul" that exhausts an individual's emotional reserves and provokes intense doubts about life's worth.
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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, a psychiatrist and co-founder of the nonprofit group Moral Injury of Healthcare.
"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."
Bearing witness Dr. Ranney has learned to downshift from the 18-hour workdays she pulled during the early months of the outbreak. Yet as cases spike again, the vitriol aimed at doctors and nurses by those who question the severity of the disease – or its existence – marks an unsettling contrast to spring, when the country united in lauding front-line responders.
"It's a very dark, difficult time for health care workers, who are working at the edge of their physical and emotional capacity," she says. More than 1,400 providers have died from the coronavirus, and thousands more have chosen to leave the profession. "It sometimes feels like we're the Little Dutch Boy. We're trying to keep our finger in the dike to stop that dam from breaking – and now we're having tomatoes thrown at us and being told we're making this up."
Moral injury, a term most often linked to veterans of military conflict, occurs when individuals commit, fail to prevent, or witness an act that violates their ethical beliefs, or when those in positions of authority betray their trust. The behavioral, emotional, or psychological toll that lingers can at once distort self-identity and sow suspicion or disdain of others.
A new report from National Nurses United examines risk factors for moral injury among medical providers as the pandemic drags on. The list includes inadequate preparation by and support from government agencies and health care employers, lack of social support, and emotional trauma related to the deaths of patients.