Moral Injury Is an Invisible Epidemic That Affects Millions

In early 2021 emergency room physician Torree McGowan hoped the worst of the pandemic was behind her. She and her colleagues had adapted to the COVID-causing virus, donning layers of protection before seeing each patient, but they’d managed to keep things running smoothly. The central Oregon region where McGowan lived—a high desert plateau ringed by snow-capped mountains—had largely escaped the first COVID waves that slammed areas such as New York City.

Then the virus’s Delta variant hit central Oregon with exponential fury, and the delicate balance McGowan had maintained came crashing down. Suddenly, COVID patients were streaming into the ERs at the hospitals where she worked, and she had to tell many patients she was powerless to help them because the few drugs she had didn’t work in late stages of the disease. “That feels really terrible,” McGowan says. “That’s not what any of us signed up for.”

It wasn’t just COVID patients McGowan couldn’t help. It was also everyone else. People still approached a health-care emergency with the expectation that they were going to be taken care of right away. But in the midst of the surge, there were no beds. “And I don’t have a helicopter that can fly you between my hospital and the next hospital,” she says, “because they’re all full.” A patient with suspected colon cancer showed up bleeding in the ER, and McGowan’s inner impulses screamed that she needed to admit the woman immediately for testing. But because there were no beds left, she had to send the patient home instead.

The need to abandon her own standards and watch people suffer and die was hard enough for McGowan. Just as disorienting, though, was the sense that more and more patients no longer cared what happened to her or anyone else. She had assumed she and her patients played by the same basic rules—that she would try her utmost to help them get better and that they would support her or at least treat her humanely.

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