The PTSD-like Affliction That’s Traumatizing Health Care Workers

The invisible wounds of moral injury run deep for those on the front lines

Photo: San Francisco Chronicle/Hearst Newspapers/Getty Images

“Some experiences imprint themselves beyond where language can speak.” These are the words of psychiatrist and trauma expert Bessel van der Kolk. This is also the experience of many health care workers ensnared in the Covid-19 pandemic.

“I just can’t… can’t find the words… there simply are none,” whispered a doctor friend working in a hospital in New York City’s viral epicenter. We were Zooming — both of our backgrounds dark. Through the screen’s dim glow, I watched her head fall into her hands and rock back and forth. Her shoulders slumped forward, and she started to shake.

Marie, I’ll call her, and I had worked together in California’s Bay Area when I was doing palliative care chaplaincy and clinical ethics work. She was never at a loss for words. In fact, to call her highly verbal would be an understatement. And yet what she has recently witnessed, been forced to do, and could not prevent on the Covid-19 front line has brought about some kind of internal preternatural silence. “It’s as if part of my soul had been shredded with a knife,” she told me when she finally could speak; “the part that holds me in relation to my Hippocratic oath and personal values.”

Marie, like many health care workers, entered the field of medicine because, as she would say, she cares about doing good and not doing bad. From the day she started medical school, she had a clear vision of who she was and how she could serve humanity. But after “death by a thousand cuts” from a pandemic that has made her betray her vow to “do no harm,” she’s now questioning who she is, who other people are, and what life is all about — generally speaking. Some might call this experience a loss of innocence — a recognition that the world is more of a babel of bad than Marie originally believed. What I also know is that this suffering is a moral injury.

Moral injury is a transgression of conscience. It is what happens when a person’s deeply held values, beliefs, or ways of being in the world are violated. That violation could result from things the person did themselves, things they experienced, things they were made to do against their…