Before the covid-19 pandemic, if I was asked whether I still would have chosen to become an emergency medicine specialist after 10 years of practice, I wouldn’t have felt even the slightest doubt before enthusiastically responding, “Of course I would.” Now I am not so sure. Even though covid has not yet affected me physically as a disease, working through this pandemic has deeply affected me mentally in ways that I never could have imagined. 

Having witnessed the deaths of several colleagues and individuals of all different ages, I’ve developed an inner monologue that constantly reminds me the next time it could be me. Seeing the deep grief of families whose loved ones are terminally ill with covid-19, and who they may never have a chance to say goodbye to unless it’s through a glass window, gives you a painful sense of how fragile life is.      

At the end of a long ER shift, I feel so exhausted that I can hardly drive. My husband has to give me a ride. On our drive home, I feel even more drained and frustrated when I see people not wearing masks, as if they are indifferent to this devastating pandemic. 

As I get closer to home, I start to feel guilty that my job as a frontline healthcare worker may be putting the health of my 2 year old daughter and 70 year old mother in danger. I chose medicine because I wanted to help people, but I never ever envisioned that I might risk the lives of my own family with that choice.

I arrive home and my daughter runs to the door to give me a big hug, but I have to stop her because I need to ditch my contaminated clothes and shoes and run straight for the shower. After all, I don’t want to contaminate my home, no matter how low the risk might be. 

As I step out of the bathroom, I notice a couple of messages on my phone. I’ve had a call from a family friend who is worried they’ve been exposed to someone with suspected covid-19. There is also a text message from a relative who is unsure whether she needs to seek urgent care or not. I return the calls and do my best to help safely triage these individuals on the phone. The work of trying to manage covid-19, and the emotional labour it requires, doesn’t end with my shift.

I can now finally spend quality time with my daughter. She has recently learnt to play hide and seek and she loves the game. She wants me to play it with her right now, but after a gruelling shift I find myself completely unable to summon the energy to hide or to seek. A few minutes later, she rolls a ball to me. I roll it back. She keeps rolling the ball, but I give up after a few times since I feel so utterly exhausted. It torments me that I am unable to even be a playmate for my only child whom I have been missing the whole day. Months of coping with this pandemic have depleted my stamina.

Many people’s hopes are pinned on a covid-19 vaccine as a solution to this pandemic, particularly in wealthy countries, but the prospect of a nationwide vaccine rollout seems uncertain in the country where I live—Iran—particularly in the context of our country’s economic crisis, and with the lack of adequate planning for mass vaccination.

This pandemic has unleashed a mental health crisis on frontline healthcare workers. With a frustratingly murky endpoint for covid-19 in Iran, it is extremely challenging not to give up in the fight against this virus. As I write these lines, I am not even sure if I can survive to the time of this article’s publication. I used to think of hope as the seed of my identity, yet now I am not so sure. Yet still my inner voice whispers, “The darkest hour is just before the dawn.” And I go to work another day.

Farzaneh Shirani is an emergency medicine specialist in the Department of Emergency Medicine, Shariati Hospital, and Prehospital and Hospital Emergency Research Center at Tehran University of Medical Sciences, Iran.

Competing interests: none declared.