When the sprint becomes a marathon: Stress and gender in critical care physicians during a pandemic

The role of critical care physician is stress-inducing under the best of circumstances. The ICU concentrates the emotional intensity of frequent end-of-life conversations with high stakes medical decision-making at an incredibly high frequency (¹). Stress can occur when demands exceed abilities, which can help intensify focus, but can be deleterious when too intense or too prolonged. The coronavirus disease 2019 (COVID-19) pandemic added new layers to the workplace stress of the ICU, with heightened fear of infection and transmission to vulnerable family members, uncertainty about the most appropriate treatment for patients, and resource limitations in personal protective equipment (PPE), medications, physical supplies, and staffing in settings that had not experienced these limitations in recent history. These additional stressors were not applied in a vacuum, as disruption to society included massive unemployment, upended school and childcare routines, severe restrictions on interpersonal interactions outside of the home, and heavy limitations on leisure activities. Beyond that, the nature of the pandemic meant watching with dread as reports came in from one hotspot to the next before reaching the immediate surroundings. Early in the pandemic, the zeitgeist was one of self-sacrificing heroism, with messaging similar to motivational propaganda during wartime focused on shared suffering and passionate support from those left at home. But as the pandemic endured and the deficits in physical supply chain were filled, the donated meals and 7 pm shouting of support from neighbors faded. The parts of the country that had been spared in the spring wave were suddenly all the same shade of red in maps of viral activity. With the breadth of activity also came the inability to load balance from one region to another, as nationally hospitals filled. The layers of additional stress were different, and the workplace stress resembled the grueling back half of a marathon more than the pounding thrill of a sprint.

In this issue of Critical Care Medicine, Gray et al (²) describe the stress experienced by critical care physicians during these unprecedented times and how things evolved over time.