When Dr. Peter DeBlieux searches his mind for a high point over the last two years, he thinks back to a phone call between a priest and a dying man. A critically injured patient was being treated in the trauma center at University Medical Center, and it soon became clear that he wasn’t going to make it. As he approached the end of his life, the man looked to DeBlieux and quietly asked: “Could the priest come?” He was then put on a ventilator and no longer able to speak. As the hospital’s chief experience officer with training in both emergency medicine and pulmonary critical care, DeBlieux was no stranger to helping patients and their families make the transition from this world to the next as smoothly as possible. But because of the COVID-19 restrictions at the time, the patient’s father and sister couldn’t be with him, and neither could a priest. Fortunately, through happenstance—or a miracle—DeBlieux knew the man’s priest. So, he gave him a call and held the phone up to the patient as he took his last breaths, aided by mechanical ventilation. “The last words that he could hear were that of the priest praying for him and with him. And the priest knew him, knew the patient,” DeBlieux said. “Understanding how horrific that setting was for the family, for the patient, and to be able to tell them, that their family priest that they love, was able to offer that comfort to their loved one, I would say that that was a bright light during that time.” For all of us, the COVID-19 pandemic has come in stages, in waves. We’ve all felt worried, concerned, impatient, frustrated—maybe even angry—at times. Things would start to improve, restrictions would ease, and then another surge would bring more lockdowns and remind us that the virus wasn’t yet done with us. But through it all, through the ups and the downs, the highs and lows, the nation’s medical professionals were there to care for the sick and help ease the passing of those who succumbed to the disease. This is especially true for emergency medicine doctors—the ones in ERs, on the frontlines, battling the virus every day. And perhaps none more so than right here, in New Orleans, one of the first “hot spots” of the pandemic. Dr. DeBlieux remembers those early days vividly, back before there were vaccines and when vital medical equipment like PPE and masks were in short supply. He said it was inspiring. The large crowds and revelry of the 2020 Carnival season spread the virus like wildfire. And while New Orleans experienced some of the worst during the first, initial wave, the support was almost overwhelming. “It was really, really powerful, the public support at the hospital and the care providers and first responders in the early offering of the pandemic. People would send food, they would send cards, they would send well wishes from across the country,” DeBlieux said. “People sending shields and making masks and just feeling part of something bigger.” But it wasn’t long before the outpouring dried up—not because of a lack of concern or care, but because those resources were needed elsewhere. As the virus spread, New Orleans, like everywhere else, would have to make do with what they had to deal with the crisis. Hospitals quickly filled to capacity and emergency medicine doctors were working nonstop, around the clock, trying to care for COVID patients as best they could. Unsurprisingly, the demands took a toll on their mental and physical health. “Initially the first wave of the COVID-19 pandemic had a very high morbidity and mortality. People were dying every day in the emergency department,” said Dr. Elisa Arrillaga, an emergency medicine physician at Touro. “My training and emergency medicine prepared me for this first wave. However, the fear of serious illness, incapacity or death was very real.” Founded in 1852, Touro Infirmary is a medical monument in the city, a bastion that has been caring for New Orleanians for 170 years. Entire generations have taken their first and last breaths, from newborns to old age, within those hallowed halls. And Touro is no stranger to crisis in the city—they dealt with nearly annual yellow fever epidemics at the turn of the century, and international events like the 1918 influenza pandemic, commonly known as the Spanish flu. But even such an established institution struggled to keep pace with the flow of critically ill patients coming through its doors. Arrillaga said that she and her fellow doctors had to come to terms with the very real possibility that the regular exposure they experienced as they cared for patients could cause they themselves to contract the virus. She said she and her family had to have some tough conversations. “My husband is a nurse in the emergency department,” Arrillaga said. “We had very real discussions about who would take our child if both of us succumbed to COVID-19.” And it wasn’t just the virus itself that doctors were battling. They also had to contend with misinformation, disbelief and anger from the general public. DeBlieux said that was the toughest part for him. “In the emergency department, ICUs, and the floors and the clinics everywhere, we would be watching patients die without family members. And just the horror associated with that,” DeBlieux said. “And then to leave the hospital and hear social media and hear...this pandemic is contrived. This isn’t real. When you were seeing people die daily, and people would argue how nonsensical it was to wear a mask, or to be vaccinated. That was absolutely debilitating.” Arrillaga echoed DeBlieux’s sentiments and added her very real fear of facing physical violence for her work. “After that initial wave of the pandemic it was scary to see a shift in the attitude of the patients,” she said. “In general, in the United States there has been an increase of 45% in violence against healthcare workers.” That isn’t hyperbole. Multiple studies have shown an increase in workplace violence against hospital workers during the COVID-19 pandemic, which can be attributed to patients’ or relatives’ anxiety and mental states following the onset of the pandemic, an increase in waiting time since the pandemic began, lack of hospital resources to care for everyone and the inability to visit critically ill relatives with COVID-19. “Emergency medicine is always stressful—that’s what you sign up for,” said Dr. Jennifer Avegno, director of the New Orleans Health Department and practicing emergency physician. “But even those of us used to the grind of 12-hour shifts, long nights, and endless streams of complex patients were not quite ready for the additional demands of the pandemic.” As the leader of the city’s health department, in many ways, Avegno is the medical face of the pandemic in New Orleans. She said the uncertainties she and other medical professionals faced were unprecedented. At first, they didn’t know exactly what the virus might do to patients. Then, they didn’t know the best methods to treat it, and later, how to anticipate the huge surges of sick patients overwhelming not just one hospital, but entire systems—all while trying not to get sick themselves. “Those of us in public health faced additional 24/7 demands of trying to prevent illness and death and protect the lives of an entire community. So there was, and is, no ‘off’ time,” Avegno said. “It’s akin to working a 12-hour night shift on a busy weekend at the highest volume emergency department in the city, every day, for two years. You really don’t get a chance to reflect, recover, or relax in between.” Because many in the city and region associate Avegno with restrictions and lockdowns meant to slow the spread of the virus and keep people from dying, she’s faced a lot of angry backlash—including threats of violence. After she was named as the 2022 parade queen for the raucous and rowdy Krewe du Vieux, Avegno was forced to step down after threats caused her to be concerned for her personal safety and the safety of krewe members. In a letter to the krewe, Avegno wrote that the “re-imposition of mitigation measures, the level of negativity and hatred” directed at city officials “has significantly increased.” At the time, the city was in the midst of yet another surge, and cases were skyrocketing. “I do not want to create a security risk by my participation,” she wrote. Still, Avegno said she has no regrets for any of the lockdowns, especially in the early days. “During that time, we ran a model based on what we understood of the virus’ transmission and lethality, and it predicted 1,300 New Orleanians dead within eight weeks if no mitigation measures were put in place,” she said. “That jolted me into action. As painful as the initial lockdown was, it would have been horrifying to lose so many of our friends and neighbors within two months; the scale of that was staggering.” For Avegno, the science has helped guide her decision-making process—and given her peace of mind. “Continuing to rely on data and objective analysis during an ever-changing pandemic has helped me stay focused on the health and lives of the people around me,” she said. That focus has helped her keep her resolve, but she’s also found other ways to both distract and strengthen her mind, including planting a garden. Avegno started a vegetable and herb garden that she said brings her solace. She said there’s something healing about tending to and growing things from tiny seeds that restores her faith in the world—creation in a time of destruction, as it were. She also started exercising in the mornings a month into the pandemic. She said it’s been tremendously helpful for her. “At first, I’d simply walk down the neutral ground and cry. There was no one out and the streets seemed so desolate, but it was good to get those feelings out,” Avegno said. “No matter what’s weighing on my mind when I wake up, after exercising it seems a little more manageable.” Exercise has been a helpful outlet for Arrillaga as well. She’s relied on it to temper the stress of the job throughout her career, and during COVID, she said it became even more important. On top of that, she said she’s fortunate to have the support of a husband who understands what she’s dealing with. “Because Chad works in the emergency department he understands the stress of the job and we lean on each other to decompress after difficult shifts,” Arrillaga said. Support is critically important for doctors who work in emergency medicine—they wouldn’t be able to do the job without it. And perhaps nobody knows that better than Peter DeBlieux. In addition to being responsible for not only the experience of patients and families, and being a practicing emergency medicine doctor himself, DeBlieux is also charged with looking out for hospital employees and providers. For both doctors and patients at UMC, he is that support. “My whole thing that I think is essential is one of the terms that has been coined now called self-care,” DeBlieux said. “[You have to make] sure that what you’re doing for yourself creates a wholeness.” DeBlieux uses a bucket as his analogy. “You can’t continually reach into the bucket and pull out compassion, pull out care, pull out empathy,” he said. “You have to refill that, or you’ll create burnout for yourself.” For DeBlieux, he refills his bucket with religion, exercise, and downtime with his family. He encourages providers—and anybody else he talks to and works with—to find what refills their buckets, whether it’s a garden, exercise, or just catching up on episodes of their favorite shows. For DeBlieux, self-care isn’t just about refueling your own resolve and avoiding burnout. It’s about creating a resiliency that allows you to bring compassion to the job. He said compassion is empathy in action. For doctors who work in emergency medicine, it’s not enough to understand a patient’s struggle, to feel their pain. The job also requires them to channel that energy into compassionate care that can save their life—or ease their suffering. But the work isn’t over. And now, more than ever, doctors are experiencing a crisis of trust they’ve never seen before. The past two years have been tough on everyone, and medical professionals are seeing that manifest as distrust, anger and frustration. Many people just don’t trust their doctors. For Avegno, she wishes people could see how hard they work, what they go through when they show up to the job each and every day. “I do hope the public knows how hard we work and how we truly hustle for our patients, using every possible resource in a part of medicine that is woefully understaffed and underfunded,” she said. “As doctors, we love getting up every day and doing it all over again—until the toll gets to be too much. Which for me, I hope, is a long time away.” Emergency medicine is one of the most difficult medical fields to work in. Even outside of a pandemic, emergency medicine doctors see humanity in its most raw, vulnerable and violent form. They treat everything from gunshot wounds to broken arms and organ failure. “We see people on their worst day, every day, and witness every kind of tragedy imaginable. That is an honor and a privilege,” Avegno said. But still, she said it can take a toll if you let it. “You must look for the small moments of humor, the tiny kindnesses that patients often show us, the fact that the shift always ends, and you get to go home to a safe, comfortable space unlike many of those we treat.” In other words: you have to keep your bucket filled.