Naheed, palliative care physician

"We will never have a healthy workforce if we don't take care of the hearts and souls of health workers"

Naheed’s story

I’m Dr. Naheed Dosani, and I’m a palliative care physician and health justice activist.

I spend a lot of time providing palliative care for people who experience structural vulnerabilities like poverty and homelessness. I spend a lot of time not just medically caring for people, but talking to the people I care for, talking to their caregivers, providing emotional support. It is a privilege and an honour to be able to be part of such a vulnerable time in people’s lives, and I take that very seriously.

I got to care for a lot of people who were sick with COVID-19. I saw an amount of suffering that I’ve never seen before. And I’m not sure if we’ll ever really get space to talk about it, other than maybe this conversation right now. 

I remember conducting a test for a man who ended up testing positive. And the recommendation was to isolate. He became very sad and I said, “I’m so sorry about this result. What’s upsetting you most about the situation?”

And he said, “Well, to be honest doctor, I actually don’t have a home. I live in a shelter where multiple people are in one room. So I’m just processing what this means for me. And I guess what this means for me is that to isolate, I’m going to have to leave the shelter. So what I’m going to do is, I’m actually going to sleep on the street for the next few nights so that I don’t get the people that I live with sick. So I can make sure that they’re safe and they’re healthy.”

I couldn’t help but cry in that moment. He cared so much about his friends and roommates at this shelter that he was going to sleep on the streets to protect them?

That’s another moment when I realized that this COVID-19 pandemic is not impacting us equally. That people who lack privilege and the resources to support themselves are going to be disproportionately hit and they’re going to be hit hard. 

It affected me in some ways that I still can’t put in words. I remember coming home to my wife in the early days, changing out of my clothes and showering and separating and then connecting with my wife and trying to put words to what I saw that day — and I couldn’t. I would just fall into her arms and cry.

I stayed up many nights thinking about the many people who have suffered, not just due to the COVID-19 pandemic and that virus, but due to the policy decisions that led to many more people having to suffer — as a result of inaction, as a result of a lack of clarity around policies and a lack of our governments stepping up to support and help people. I’m convinced that many more could have survived had we acted sooner and in a more appropriate fashion.

You know, you can only do so much as an individual health worker. And that really, really made me upset and made me really, really question the system. It demoralized me, actually.

I channelled those feelings into activism. I wrote op-ed articles advocating for things like the collection of race-based data. I advocated for improved policies to support people who experience homelessness, to advocate for those who are most vulnerable and didn’t have the privilege of, for example, just staying home. 

The activism really did help because I was able to convert feelings of anger, sadness, and resentment into feelings of productivity and change and hopefully inspiring people in our communities.

But remember that this was all on top of my regular day job. And so this was an extra role.

In some ways, it felt unfair that we were health workers who were already dealing with the brunt of the pandemic on the front lines, having to see so much sickness and suffering. And then on top of that, we were health workers who in our free time had to advocate around health equity and improving conditions for people who didn’t necessarily have the resources to advocate for themselves.

On one hand, I’m grateful to have had the opportunity. On the other hand, that’s kind of unfair when you think about it — to put that burden on people who are already so burdened.

I know many health workers — friends, colleagues that I talked to — who felt the same way, and who are still dealing with the ramifications of that. I’m not sure if the public really realizes the impact that this pandemic had on us while we were working — but also while we were not working. It’s the conversations we were having at the dinner table, the conversations we were having on Zoom family calls, and what we were doing out there publicly on social media, as we advocated for public health even when our governments didn’t necessarily have our backs. That takes a toll on people, and I wish more people would talk about that. 

One of the approaches that really helped me through the pandemic to be able to work through my moral injury was the fact that we held grief circles. What would happen is we would descend on that site — it might be a shelter, it might be a healthcare facility, for example. We would light a candle, hold a minute of silence, and then we would cry together. We’d laugh together. We’d remember what it was like to care for the person.

As the pandemic went on, we actually moved our grief circles to virtual grief circles. And it really helped.

While I know that these grief circles just scratched at the surface of what many health workers were experiencing, many people — my friends and colleagues would say, “This is the first time I’ve been in a space where there was a structured space for us to grieve.” 

And it got me thinking about why in healthcare, talking about grief is so…not common. Why is that the case? 

I’m lucky to work in an environment with colleagues where we talk a lot about our social contract as society and our accountability — or what we call social accountability — as we deliver healthcare.

I think that’s really important, to have a connection to your moral code. And you know, why we do this thing called healthcare. We’re more than technicians. We are dealing with human beings, we are dealing with people who are dealing with some of their most vulnerable moments. We work in spaces like a hospital or an emergency department where all of society’s feelings tend to crash into this one place in space, whether we like it or not.

We will never have a healthy workforce if we don’t take care of the hearts and souls of health workers. That’s so key. That’s so crucial.

A special note of thanks from Healthcare Salute

Over the course of the COVID-19 pandemic, healthcare providers from across Canada have participated in our research on “COVID-19-Related Stress, Moral Injury and Minority Stress in Healthcare Workers and Public Safety Personnel in Canada.” Their struggles, heartbreak, courage, and resilience have inspired and moved us, and formed the bedrock of our research for this project. We are deeply grateful and committed to sharing their experiences.

We would also like to express our heartfelt thanks to our funders, the Public Health Agency of Canada, for giving us the opportunity and the autonomy to share our research with the larger Canadian audience without bias or restriction. This work would not have been possible without their generous and arms-length funding support. We also wish to thank our collaborators and supporters — McMaster University, St. Joseph’s Healthcare Hamilton, Homewood Health, and Homewood Research Institute.

After viewing, visit “Applying cultural competency in practice,” an education module for mental health providers and peer supporters.