On Being a Palliative Care Clinician During the Delta Surge

When my spouse and I were diagnosed with the Delta variant of COVID back in June, it was extremely frustrating. We had done everything possible to stay safe, including getting the vaccine when it was available to us. We masked. We washed. We distanced. Still, we got sick.

While I do not believe I got infected while working in the hospital—my spouse became ill first, so it was likely community spread here in Alabama—I had all of the symptoms, although I did not test positive. As a precaution, I quarantined for 10 days. This all happened five months after my second shot. It was pretty scary, because we both have underlying conditions. We were fortunate we did not need to be hospitalized. That said, COVID put us out of commission for nearly two weeks, and added an extra level of disappointment and sadness into our lives.

Almost a year and a half into the pandemic, we are all stretched thin. It is not like the “early days”, when people across the world were clapping, and banging pots and pans, to celebrate health care workers as “heroes”. Now, part of what helps us get through this difficult time are the victories that happen on an individual basis with patients and families, including when someone who can receive the vaccination decides to do so.

I tell our staff to make sure they take time for themselves. After recovering from COVID, I decided to take a vacation—the first time I had been on a plane in almost two years. While I did feel some guilt about going away, the rational part of me said I had to take some time away, to be able to show up mentally and physically at work.

While some of us were tired and a little frayed around the edges after the first wave, we did get back a tiny bit of breath, a little normalcy during a lull in the spring. Now, this surge is taking us back again. I am worried that this wave, and potential future waves, are going to cause more people to move toward true burnout.

Strategies for resilience are a little different this time. Our team knows we will continue to be flexible with work schedules, and when things get tough, we understand. We will continue to support each other and debrief, and not give a lot of weight to starting new projects right now, as we really need to hold our own. Of course, I am giving positive feedback when good things happen, and one of the biggest messages is “just have grace in yourself”, and allow team members to feel comfortable saying when they are tired, frustrated, or need to step away.

At the University of Alabama at Birmingham (UAB), we have a large palliative care program and team, and this wave has hit everyone differently. As its leader, I want to make sure everyone knows that we understand. We were just starting to nibble at the edges of normalcy, with socially distant in-person meetings, working more on-site, and welcoming volunteers back. Now it seems we’re going backwards.

At the same time, our staff has been tremendously responsive and flexible, and has stepped up whenever and wherever they are needed. That may mean the antibody clinic, volunteering to work surge units, or another place looking for volunteers.

We have to be hopeful that the virus will eventually subside. In the meantime, we hold on to and expand on some the good things that have come from resetting priorities and meeting in different ways (e.g., telemedicine, virtual staff meetings). We have to continue emphasizing the disruptive changes that have merit, ultimately increasing the visibility of palliative care.

This surge has added another layer of stress, and as stated earlier, it has been exceptionally draining in so many ways. We are going to have to apply more principles around burnout resilience and have grace in ourselves. It is almost like going through stages of grief.

During the brief lull this past spring, I thought we had found our “next normal”, but I am realizing that states of normal do not stick around for all that long. We will have to redefine how the next “normal” looks. While there is lots of uncertainty, I hope we are able to move toward acceptance, because COVID is going to remain with us as a public health issue for quite some time.