High Tide

I painted “High Tide” at the edge of finishing my emergency medicine training, when COVID still shaped the world, and work meant living at the waterline. In the image, my face is submerged with water over my nose and mouth, speechless and breathless, feeling as though I cannot surface. My eyes are closed, hoping it's a dream and that waking will make it different. I felt helpless, unsure how to use my voice against the atrocities we witnessed in real time. Burnout and moral distress deepened as I cared for patients who looked like me, stood beside colleagues who shared my experience on the front lines, and spoke to more families who lost their loved ones. Each of us is grieving the past and coming to terms with the new norm. This piece marks a transition from trainee to early-career physician and from survival mode to acknowledging the costs of survival. During the pandemic, I watched a system stretched thin fail the people who most needed care: elders alone in their hospital bed, essential workers clocking unreasonable hours, neighbors without a safe place to isolate. It also failed the people who were asked to hold it together: nurses with pressure lines etched into their cheeks, residents rationing PPE, and attendings carrying impossible choices shift after shift. Too many were lost to burnout, to sickness, to death, and those of us who remained learned to be very still so the water wouldn't tip over our heads. In painting myself half-submerged, I wanted to tell the truth about that season without surrendering to it. The horizon is dark, but the water also carries its own light. It reflects light, distorts it, and sometimes, with help, lifts us. The closed eyes are not defeat; they're a deliberate pause, the moment you gather a lungful of air before dipping under again, or the quiet minute in the ambulance bay when you feel your pulse slow and your feet find ground. “High Tide” is my invitation to talk openly about the in-between places of training: the stretch between idealism and moral injury, between being called a hero and feeling expendable, between finishing residency and figuring out how to practice medicine without losing yourself. It asks what it would look like to build departments where coming up for air is not a personal failing but a practice, where staffing, mental health care, debriefing, and rest are treated as safety equipment for both patients and clinicians. Even as COVID recedes, new swells keep raising the waterline: long ED wait times, boarding, understaffing, and healthcare cuts that test our breath again Figure 1. Many of us have known that private moment, eyes closed, water at the edge, waiting for breath. This is mine. I'm choosing to surface. The author declares no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.