“Moral injury is present when:
(i) there has been a betrayal of what is morally right,
(ii) by someone who holds legitimate authority and
(iii) in a high-stakes situation.”
My friend, a nurse, sends me a text message.
‘Do you remember when you drove through?
We visited for the first time in years.
I was OK then.
I am not OK anymore.
They are firing us for bringing our own PPE to work, even when they cannot provide it for us.
I am not OK.’
“In the healthcare literature, moral injury refers to the accumulation of negative effects by continued exposure to morally distressing situations.”
My coworker is lying on the couch in the break room. It is the silent eerie hours in the depths of the night shift.
She has a pillowcase over her eyes to cut down the glare from the relentless fluorescent lights.
She says, ‘I don’t even want to work here anymore.’
She says, ‘I have never felt so defeated.’
She says, ‘I can’t believe they actually fired him.’
She says, ‘Who will speak for us now?’
Then she rolls over on her side and throws her arm over the pillowcase.
I quietly turn off the lights, and leave her to her grief in the darkness, for I have neither comfort nor answers to give.
“It is an injury to an individual’s moral conscience and values resulting from an act of perceived moral transgression, which produces profound emotional guilt and shame.”
She emails me and says:
‘I know I should have sent him away. I should have sent him and the baby away to stay with his parents. I should have kept them away from me. But it would have broken me.
Not having my family next to me would have broken me.
And were I broken, I could not work.
After every shift, I strip in the garage, bleach my shoes, walk straight into the shower, scrub myself raw, dry off, climb into bed.
And as I curl up with them I wonder if this is moment that I get them sick.’
“In healthcare professionals, the concept of moral distress has also been termed, ‘the ethical canary,’ to draw attention to the sensation of moral distress signaling a need for systemic change.”
- When you cannot stand up for what is right because it will cost you your job.
- When you cannot lose your job because it provides the only health insurance for your family.
- When you cannot lose your health insurance because your job is threatening your health and your life.
- And your job is threatening your health and your life because nobody can stand up for what is right…..
What you are feeling is moral injury.
Your violently simmering anger is a direct result of this moral injury.
Your sudden plunge into a relentless depression is a direct result of this moral injury.
Your self-loathing every time you punch in to work for a company you no longer respect is a direct result of this moral injury.
Moral injury is a soul in anguish.
Moral injury is a broken soul.
There will be time in the future, once the pandemic is over, when the flattened curve fades into an empty x-axis, when we can freely wander the streets and meadows of our world once again, for us to fight the oppressive and inhumane systems that force us to choose between living our true conscience or providing for our families.
To fight the oppressive and immoral legislation and representation that will protect the wealthy at any expense, particularly if the coin is paid by those who have nothing left in the bank to give.
There will be time. Let us not forget this rage, this anger, this horror at those who will preserve image and industry at the cost of the broken backs of the laborers beneath them.
Do not forget it.
But, for now:
Do not live in it every moment, every day.
You cannot survive on an endless diet of rage.
Be reassured that your anger, your grief, your heartsickness, your guilt and shame and distress are NORMAL responses to the stressors around you.
They don’t feel good. None of us like them. But you are not wrong. You are not strange, different.
You are not alone.
Seek comfort where you find it. Seek compassion from those who can provide it to you.
Find gratitude in one small, stupid thing, every day.
Reach out to those who suffer the same moral injury as you.
These are the people who will help you in the great collective soul repair we shall all undertake in the future.
You are not alone.
You are not alone.
Firing nurses for bringing their own PPE: https://theintercept.com/2020/03/24/kaiser-permanente-nurses-coronavirus/
Firing physicians for speaking out: https://www.usnews.com/news/best-states/washington/articles/2020-03-28/washington-hospital-fires-doc-who-criticized-virus-response
All quotes relating to moral injury are from Wikipedia:
Washington State Nurses unionized under the WSNA: If you are asked to work an unsafe assignment, forced to work with inadequate PPE, mandated to work beyond a time when you can safely do so, or find yourself in any other situation that threatens your life or your license, please fill out an ADO (Assignment Despite Objection).
Please fill it out EVERY time it happens. You can fill this out online here:
If you are a healthcare worker not represented by a union, do not hesitate to reach out to local unions for advice on other avenues for reporting these violations of worker health and safety.
~ ~ ~
New blog post 4/8/2020: Healthcare workers: Your silence is not your shame.
God bless you Martha. Thank you for saying what we are all feeling. Utterly powerless against this virus and against the red tape that constrains us.
Please don’t stop writing.
Thank you for naming the despair and anger I feel everyday punching in as a nurse. In long-term care we only have surgical masks, not N-95’s and not many of those. We are expected to wear home made masks and read a waiver, maybe sign it in the future, who knows? I have to work or I don’t eat. Thank you again… Diane
As an elderly ex nurse I find these writings very moving and so wish I were young enough to help. Instead of being in isolation.my prayers are for you all especially all the 9medics in my family in the thick of it god bless you all
thank you for this. you are saying all the things so many nurses want to say but are scared to say. just reading it alone, feels affirming.
may God be with you as you nurse on.