The Little White Line

Article by Sarah Beth Edwards

There’s a presence that has loomed in the background of my consciousness for twelve years.  I’m not aware of it every minute, or even every day, but it flickers there at the edges, waiting for me to acknowledge it, appearing in my peripheral vision more and more often with each passing year.  I first became aware of it the day that the honeymoon phase of my career in healthcare ended abruptly; it appeared when an irate patient threw a heavy ceramic plate at my head, along with several creative obscenities, and an apple that was supposedly brown.  Since March of 2020, it has become less hazy and unformed, but rather a solid mass that I can no longer ignore for months at a time.  In the year of COVID that followed, there has rarely been a day that it hasn’t been at the forefront of my mind, if only for a few moments at a time.  I call it the little white line.

It’s a concept that most people who work in healthcare are probably aware of, although I don’t know that they call it the same thing that I do.  The buzzword for it in HR circles is probably “burnout” or something similar.  At its core, the little white line is that line in the sand where you finally say to yourself: “I cannot do this anymore.  I cannot go back into that hospital.  I cannot work another shift like that one.  I have given everything that I have to give, and they still want more, and for my own sanity, I have to cry ‘uncle.’”  

Once you cross it, you can never go back.  You may never leave healthcare entirely; we’re like the mafia that way.  Maybe you transition to management, or education, or work as a remote nurse for an insurance company.  Or maybe you do leave—maybe you’re one of the lucky ones who doesn’t cross that invisible boundary until you’re close enough to retirement, or until you have a different career path to fall back on.  All too often, though, we leave not knowing where we’re going, not knowing what we do want, just knowing that it isn’t this. We have reached our breaking point.

I don’t think that patients realize that they have the power, with every interaction, to push healthcare workers closer to or further from that little white line.  Every time you scream at someone for something completely out of their control, every time you demand more than we can give, every time you choose abuse and entitlement over kindness and compassion towards other human beings, we get a little closer.  Patients, nurse managers, and the people who write the Press Gainey Survey (the survey which determines how much federal funding hospitals receive) all like to forget that nurses, Certified Nursing Assistants, physicians, respiratory therapists, x-ray technicians; all of us working at a patient’s bedside, are human beings.  We are not robots, as much as accreditation bodies such as  The Joint Commission may wish that we were. Some days, all it takes to bring us back from the brink of that line is an understanding smile, a “please” or a “thank you” tacked on to a request.  Even a simple “I know that you can’t change what I’m going through, but I appreciate that you’re facing it with me.”  Meanwhile, the opposite may be all it takes to push us over the edge.

Before the COVID pandemic erupted onto the scene in 2020, I could go months without thinking about the day that I would need to leave bedside nursing forever.  It wasn’t the traumas or cardiac arrests or medical mysteries that kept me going—it was the everyday miracles – making a cranky old man smile when no one else could; holding the hand of an elderly lady with dementia, helping to orient her to her surroundings until a family member arrived.  It was having a pediatric patient remember me from their last visit and not being panicked about their blood draw anymore.  Walking into work and seeing that all my favorite nurses would be on the floor with me that day were often enough. It didn’t take much to keep us happy; we never needed the hero worship, the free meals delivered in the early days of the pandemic, or the “Heroes Work Here!” signs that went up all over town.  Simple human kindness and connection go a long way.  But as COVID lingers on and resurges, as people tire of masks and social distancing, as politics play out on the evening news, turning us from heroes into money-hungry villains, those small kindnesses are disappearing faster than ever.  And droves of us are moving closer to that little white line by leaps and bounds rather than inches.

I know plenty of good techs, nurses, and physicians, too, that have already crossed it.  Some left after being let down by health care systems that weren’t doing enough to ensure their safety.  Others, having spent a lifetime in service to others, found that being villainized by their patients was the one storm they could not weather.  Still others were forced out, either by furloughs or the lack of childcare due to school closures in an already precarious childcare system.  Each month brings new faces to my hospital, and as fewer and fewer of the old guard are left, I can’t help but wonder how long this can be sustained.

It’s no secret that healthcare is in dire need of new bodies—this was true before the pandemic.  Nursing schools have been recruiting with the motto of a nursing shortage since I was in middle school.  Now, in the aftermath of the pandemic, we’re beginning to lose healthcare workers faster than we can train them.  And I hate to tell you, but it isn’t just poor management, the high cost of training, or low wages that are to blame.  It’s the public.  No one wants to go to work to be belittled, threatened, bullied, and screamed at every day, especially not by the very people they’re so invested in serving, and certainly not after going thousands of dollars into student loan debt for the privilege. 

For now, at my hospital, I’m still replaceable.  And for a time, that will still be true.  At this moment, although I can see the little white line in the distance, they don’t need to replace me; I’m not there yet.  I sincerely hope that I’m wrong, and the next time someone in your family has a heart attack, or needs a surgery, or breaks a bone, there will be enough of me and mine to take care of you.  And the time after that, and the time after that, on and on forever.  But the sad truth is, I don’t think I am wrong. 

I wish that I were.  I wish that I could believe that these tiny stressors that have continued to build throughout the pandemic will disappear as quickly as they came.  I still dare to hope that someday, I will look back on these last few years as nothing more than a dark spot over a bright and fulfilling career, that the haze of time will make the happy memories sweeter and take the sting out of the more bitter ones.  But I’ve been in this business too long to hold my breath; I’ve seen the direction things are taken, seen the toll it has taken, and I think that I know what comes next.  

I believe that these everyday unkindnesses are continuing to build, and that the next healthcare crisis won’t be another coronavirus, Ebola virus or even natural disaster, but a mass exodus of healthcare workers.  There are too many run of the mill sick people, and soon, there will be no one to care for them. It will have been death by a thousand tiny cuts, and we will all have just stood by and let it happen.

The next time you find yourself in a healthcare facility, I’m not asking you to kiss anyone’s feet, or worship the ground they walk on, or bow and scrape to get the care you need.  I’m just asking you to pause; just take a breath and remind yourself that you are interacting with a human being.  Another person, with a life as rich and complex as yours, who has devoted eight to twelve hours of their day to care for people in need.  Take just a moment to think about that little white line, and how close they may be to it.  Because I promise you, none of us want to live to see the day that too many of us cross over it.