My seven year old has a favorite tree in our backyard. It is an expansive tree with full branches of lush waxy, dark green leaves, providing the best shade on sunny, cloudless days. When every other mature tree was cut down to build our new neighborhood, it was somehow spared, and left to thrive in our backyard. My daughter lies in the hammock under that tree on hot, summer days and reads or swings and sings songs (loudly). The strong breeze on this hill we live on whips the leaves and makes a melodic swishing noise on days when it is fiercely windy. It’s expansive power and the way it takes up space is mesmerizing. It seems this majestic tree is sturdier than most things when the storms come through.

But last week, a storm crashed through unannounced, uprooting rows of the most beautiful old, pine trees that lined familiar worn streets and lay flat large trees on the roads. We awoke in the morning and saw that my daughter’s favorite tree had lost some of its fullest branches while other branches were left sagging and nearly splintering off the trunk. The leaves still remain green and lush on the branches that survived, but this amazing, steadfast tree full of shade has taken a hit. It is slightly sparser and slightly weaker than before. Maybe if you didn’t know the tree like we do, you wouldn’t notice. You wouldn’t notice these branches that once lifted up towards the sky are heaving low and nearly touching the ground. My seven-year-old hopes that it heals and returns to the way it used to be. I hope so too, but I’m not so sure.

It is the day after an evening shift and I am so tired. I am spent. I think about my over-a-decade of practice in Emergency Medicine. It has never been like this. I have always felt pride for the steadfast rhythm of our emergency departments; we have always provided shade for every patient we see. We have had extensive branches, full of leaves and life and have been unwavering. We have weathered winds and storms and bounced right back without blinking. But this storm is really taking its toll. Every shift leaves us slightly more weathered. 

I cannot pinpoint or describe to you in one concise sentence what we are experiencing on a daily basis. It is a litany of factors that beat down on us like the cold, sharp, pelting raindrops in a torrential storm. It is the patients that have had to delay their surgeries or medical care that are now desperately and emergently in need. It is the extra weight thrown on those that show up of being short-staffed and lacking essential resources. It is every single hospital being well over capacity, with no place to admit patients that are suffering from the delays in care. It is the ambulance crews that work tirelessly to reach every patient in crisis in the community and bring them to hospitals already overstretched and struggling to manage the load. It is the backlog of patients piling up in the waiting room that are in distress. The waiting. The anxiety. The emergencies that are stacking. The limitless time stuck in a holding pattern.

We all make our own choices about vaccines. We all have strong opinions and will unlikely be changing our minds based on the information we have interpreted as truth. But in the ER, we have no choice but to absorb all the repercussions of opinions and choices that present as shortness of breath that feels like suffocating, fatigue that leaves people devoid of energy to perform daily tasks, body aches that grip patients’ every joint, vomiting that leave people craving for a sip of water to stay down, the unbearable internal heat of uncontrolled fevers, weight loss and muscle loss from not being able to eat, unrelenting intolerable headaches, severe chest pain that causes insomnia, coughs that won’t abate and leave lungs burning and permanently scarred. In the most devastating of cases, we internalize the heartbreak of death, loss, and loneliness. We treat absolutely everyone no matter how their beliefs and adamant choices have affected the condition in which they present. But it is undeniable that what our patients choose has greater than a simple ripple effect—it is tidal wave after tidal wave that is crashing on our shores. They grab hold of us and pull us down with them in this steep downward spiral they have inadvertently chosen. We continue to show up and are unquestionably here to support and temper this downhill slide, but only time will tell if it is too late or if they will make it up from this downward side of the coaster.

We are doing this all while we are navigating our own steep hills. All of this is wearing on us. We are leaning on our own communities and family that carry our weight through this heaviness. We have spirits and stamina of steel. But much like my daughter’s favorite tree, our branches are heavy and sagging. We will show up daily, provide our shade, and stand upright and tall and do what we methodically know we are trained to do with everything we have behind masks, eye shields, facemasks, gowns and gloves. But even the sturdiest of trees will meet its storm.

Our roots are deeply secured and extensive. We hope this storm will pass and not leave us uprooted.