As the medical system groans beneath the burden of the pandemic, conversations have appropriately turned to burnout among healthcare professionals. Most dialogues point to external systems, e.g., the shrinking workforce, limited supplies and political contentions over vaccines. While these forces exert significant influence, and indeed pose a crisis in many parts of the U.S., deeper and more personal dynamics are at play.

Even without the demands of a global pandemic, the responsibility of stewarding life can drive us to our knees. Failures haunt us in healthcare. I can still remember the panic in the eyes of a young girl I treated a decade ago before she closed them for the last time. I can see the anguish on a mother’s face, the agony in a husband’s eyes, when I told them my hands were insufficient to restart their loved ones’ stilled hearts. Such moments linger with us long after we’ve shut off our pagers or hung up our white coats. When we lose a patient, we consider our flimsy books, our hands that could not deliver, and the full weight of our sin bears down upon us, stealing all breath, and sight, and hope. Such moments pitched us into despair and fueled burnout, long before COVID became a household name.

History teaches us that the burden of guilt is not only common among doctors, but also recurrent. In a recent paper in the New England Journal of Medicine, medical historians identified three key obstacles to physicians’ emotional health since the 18th century: medical exceptionalism, medicalization and emphasis on individual responsibility. To illustrate this final point, the authors quoted Governor J. Proctor Knott’s graduation speech for the Kentucky School of Medicine in 1890:

“No other calling…demands a more absolute self-negation than the one you have chosen. No other vocation—not even the sacred ministration of religion itself—requires a more constant exercise of the higher faculties of the human mind, or a more earnest devotion of the purer and nobler attributes of the human soul.”

As Christian discipleship calls us to die to self (John 15:13, Ephesians 4:22-24), at first glance such lofty declarations of altruism may resonate with us. But a fallacy lurks between the lines, one that our field has perpetuated throughout the centuries. In upholding medicine as an ultimate virtue, one that surpasses all other vocations in its pursuit of excellence, we ignore the truth: we doctors are still fallen in sin. Not all our treatments will cure. Not all our sutures will hold. Our painstaking hours in the hospital cannot reassemble cell membranes that have burst or restore new life to necrotic tissue. Try as we might to “do no harm,” if we were to present our deeds before the Lord, we would crumble beneath the weight of our wrongdoing (Psalm 130:3). And so, guilt bears down upon us daily, twisting us from within, confronting us with our failure to stamp out what only Christ can overcome (1 Corinthians 15:54).

When we shoulder guilt without the respite of the gospel, our souls buckle beneath the burden. In his article in JAMA Internal Medicine, University of Pennsylvania psychiatrist Lawrence Blum writes the following about the role of guilt in burnout:

“Medical students and physicians soon face life and death clinical responsibilities, many circumstances in which no good outcome is possible, inevitable errors in clinical judgment, torturous if often preposterous malpractice suits, and endless bureaucratic criticism and interference. These are all things that frustrate physicians’ efforts to do good and provide abundant opportunity for guilty self-blame. No wonder physicians struggle with burnout, depression, and suicide…[W]e also need to consider who we are, why we go into medicine, and what prompts us to sacrifice ourselves in the small ways essential to good medical care and in the extreme, self-punitive ways that lead to substantial suffering, depression, and even suicide.”

Blum suggests that to counteract burnout, we need to assess not only the system but who we are. As Christians in healthcare, this question is essential. Who we are in Christ drives us toward careers in healthcare, as we seek to love neighbor and care for the downtrodden and afflicted (Mark 12:30-31).

And who we are in Christ also guides us toward hope when the world seems bleak.

When the inadequacy of our own hands leaves us trembling, and our minds balk at our own failings, Christ washes us in righteousness (2 Corinthians 5:21). Through His triumph at the cross, He scatters our filthy rags like waves breaking from behind a ship, leaving only His righteousness shimmering in their wake. Jesus accomplished what we cannot. He came, because however ardently we may strive for the “purer and nobler attributes of the human soul,” we are fallen, broken and desperate for a savior. He will come again to make all things new, because God’s steadfast love endures forever (Psalm 118:1, Revelation 21:5).

As the pandemic rages on, burnout weighs down our limbs and slows our steps. Guilt troubles us, and memories stir us to wakefulness, but God does not abandon us in that darkness. He remains with us, through all the harrowing nights (Matthew 28:20). In Christ, “He has delivered us from the domain of darkness and transferred us to the kingdom of his beloved Son, in whom we have redemption, the forgiveness of sins” (Colossians 1:13-14, ESV).

As the travails of this world press down upon you and steal your breath, cling to the truth: Christ has overcome the world (John 16:33). You are fallen, but yours is a gracious God, and a merciful God (Jonah 4:2). In Christ, you are forgiven. And nothing—not your shortcomings, not your failures, not even the strains of a pandemic—can wrench away God’s love for you in Christ Jesus (Romans 8:38-39).