In medical school we were taught hope. We were taught the infinite ways we could help a patient. We learned hundreds of medications, participated in surgeries, learned modalities, and were educated on counseling and rehabilitation. A notable piece missing from this education was how frequently medicine is a helpless pursuit and even more importantly, how sometimes it has no role.

The COVID-19 pandemic has taken the fast track of this learning to a new level. As a new resident, I am learning the futility of caring for patients with covid. We’ve all experienced the counseling of a helpless physician in the past when we presented with a cold. “It is just a viral illness and will resolve with time.” That helplessness was frustrating for us and infuriating for patients. They wanted antibiotics, a nasal spray, a referral. They’re desperate; they wanted something, despite the risk of harm.

During covid, we have learned this futility to the extreme. Patients are often grasping at any possible therapy to treat this disease-rheumatic agents and anti-parasitics not exempt. Despite this, a large portion of the population declines the overwhelmingly best strategy against covid: vaccination. Treating gravely ill patients with covid, knowing that despite your best efforts, your academic curiosity, your years of training, the staff’s endless proning and cleaning, trach care, donning and doffing, is excruciating. Initially I was broken by this. I would ask myself what I missed; what did I do wrong. Should I have asked nephrology for their input sooner? Should I have put him on an insulin drip sooner? Did I miss a festering superimposed bacterial pneumonia or a pulmonary embolism? I eventually accepted it wasn’t me and accepted the futility.

In the meantime I would cycle back to clinic in the afternoons after transitioning patients to comfort care, calling their families with depressing updates, watching their kidneys fail, their oxygen requirements increase. I would go to clinic and then battle patients on the vaccination. I would tell them the stories. I would tell them I have seen too much death too early in my career. I would tell them I lose sleep knowing they are not vaccinated. Reassure them the only reason I bring it up is because I care and I am scared for them. Largely they ignored me.

I am tired of this. My empathy is strained but nowhere near gone. I feel callouses forming, humor filling the place of grief. I find frustration where there once was inspiration, cynicism where there once was hope. I still grieve, I still lose sleep, I still care deeply. I love this job more than I ever thought I would but it weighs on me more than I ever thought it would.