A MARTÍNEZ, HOST:
With the highly infectious omicron variant sweeping across the country, many health care workers are facing a deja vu this winter. As American ICUs fill up with mostly unvaccinated patients, doctors and nurses are once again faced with difficult decisions. Dr. Daniela Lamas of Brigham and Women's Hospital in Boston worries that this prolonged situation could lead to compassion fatigue among staff. I asked Dr. Lamas about that phenomenon and whether it could affect patient care.
DANIELA LAMAS: Knowing that the patients who are critically ill and unvaccinated did not have to be critically ill, I think that entirely adds another level of stress, and maybe even more specific than stress but just a level of frustration and the feeling of futility. And I think that that weighs on people, certainly. And of course, there's also just a sadness to it, a sadness to the fact that this did not have to be for these people, and yet it is.
MARTÍNEZ: I want to read, Doctor, a part of your recent op-ed. I wondered whether, perhaps, one of the greatest risks of whatever surge comes next will be compassion fatigue, the dwindling ability to feel empathy for the unvaccinated. I wonder about this, about what impact it has. Though framing a patient as vaccinated or unvaccinated doesn't change the ventilator settings or the medications we give, I worry about the insidious effect of the frustration that we feel, and how we balance that real and understandable anger with empathy. So first off, explain what you see as compassion fatigue.
LAMAS: So you know, compassion fatigue is a term that we use to describe the cost of caregiving, you know? We treat compassion - we act like compassion is infinite and it regenerates, I think. In a way it is. But there is also something that is finite, where people who have been in rooms after rooms and were so excited about getting vaccinated, promoted getting vaccinated - and then seeing people who are suffering, who are struggling, whose families are devastated, because of what feels like a choice, which is not to get vaccinated. And I think compassion and empathy become harder when we see disease that clearly could have been prevented and disease that also, where that choice - that choice that was made not to get vaccinated - could also have harmed others as well. And yet, we must still care for these people with care and compassion. So I think that there's a tension that wears on people. And perhaps not acknowledging it wears on people as well.
MARTÍNEZ: Are you worried at all that compassion fatigue might be something that could affect patient care?
LAMAS: You know, I am. I think it is reasonable to be worried that compassion fatigue could impact patient care. And then the question, of course, is, how? And, you know, when we present a patient, when we say, this is a X-year-old woman who comes here with this, we now say vaccinated or unvaccinated. This is a 75-year-old, unvaccinated man - COVID. And of course, as I had said in the essay, that doesn't change what we write for medicine, et cetera, but it changes the framing. It changes the way we see this person. Does it change the amount of time we spend with them, with their family? I'm actually not sure. But I think it matters. I think those things matter to pause on. And they get in our conversation, you know, unvaccinated patients getting lung transplants. In a hospital, you'll hear a conversation where people actually ask aloud, well, should they even be eligible, you know? You'll hear people say on social media that if there is one available bed, they would prefer it to be somebody with heart disease who is sort of, quote, "innocent" - although, who really is innocent - rather than somebody who's unvaccinated and sick because of that. And, I think, in public, it is entirely appropriate to be angry, frustrated at people who have not been vaccinated. That being said, once somebody comes into the hospital, they are a patient. And it has to be different.
MARTÍNEZ: I mean, I'll admit, Doctor, when I hear about someone who is unvaccinated - who is staunchly unvaccinated...
LAMAS: Right.
MARTÍNEZ: ...In the hospital, I'll shake my head.
LAMAS: Yeah.
MARTÍNEZ: So for a health care worker, I mean, that's got to be a really tough spot to be in.
LAMAS: I think it is. And I think it's a really hard line to draw because I shake my head as well. And that's OK. That's totally OK for health care workers to shake their head. But then you have to switch. And once you're in the hospital and this patient is at the hospital, they're a patient who is deserving of care and compassion. And I've seen no evidence that patients are getting anything less. Like, I think that we are able to do this. And we do it gracefully. But I think it is another tension that is weighing on health care workers, on doctors, on nurses, is really having to hold both of those dimensions of thought - of deep frustration and anger, and then also having to care.
MARTÍNEZ: In your op-ed, you also went on to describe a scene from your hospital where an unvaccinated patient was discharged after a long hospital stay and finally agreed to get vaccinated. First, tell us about that. And why do you think it takes a near-death experience for many to take the vaccine?
LAMAS: Yeah. So this patient was a patient of a colleague of mine, actually. I had taken care of her one or two overnights but had not formed a relationship with her. And she's a mom of a couple of children. But, you know, there had been fear, distrust the medical system and just the idea that maybe it would be OK. Maybe it would be OK not to do this thing. And it was not. And she got very sick, nearly died and didn't ask for the vaccine, didn't say anything about the vaccine until my colleague opened the door by telling her that they were all rooting for her, and that she had made a mistake. She had gotten really sick. And it had been awful for her and for her family. But she could make that better. She could move on from that. And she then asked to get vaccinated. And I wonder, you know, was part of that trust - was part of that seeing that there was a doctor who actually saw her and did not see her with sort of anger - invited her to feel comfortable. Was that what it was that allowed her to get the shot? I'm not quite sure. But it was interesting that even the near-death experience itself didn't prompt her. It was this conversation of opening the door to saying, I see you. And you shouldn't feel shame.
MARTÍNEZ: That's Dr. Daniela Lamas, a pulmonary and critical care physician at Brigham and Women's Hospital in Boston. Doctor, thank you.
LAMAS: Thank you.
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