Healing Soul Wounds: Moral Injury During COVID-19

Author: Justin Almeida, MDiv

As a chaplain I define moral injury as a “soul wound,” a wound to the conscience and spirit from which humans draw meaning, worth, and identity. Moral injuries are the result of trauma to our moral and ethical being, out of which pour guilt, shame, resentment, betrayal, and hate. For example, example, we raise a child with a core principle of identity, “Good people do not kill other people,” but when they turn 18 we place a gun in their hand and tell them to kill. While there may be many interpretations and exceptions to the principle, despite mental justifications and rationalizations the result is the same: a traumatic event which creates painful dissonance between “I am a good person,” “Good people do not kill,” and “I have killed.”

One of the first indications of moral injury I encountered was the shift in my chaplain care provision. Before COVID, it was common for 75% of chaplain time to be spent with patients and families and 25% on staff care and administration. This quickly shifted. Families were barred from bedside and waiting rooms. Hospital caregivers began encountering rising death tolls. Now, 60% of spiritual care is patient focused, and 40% is dedicated to staff.

Due to policies meant to reduce the risk of infection, caregivers (doctors, nurses, social workers, etc.) must now tell families “no.” No, you can’t wait in the lobby. No, you cannot visit your loved one. No, you cannot be at bedside as they die. Now, the chaplain enters the isolation room with several layers of PPE and a tablet to make a teleconference call to family and friends who press their hands to the screen in a desperate attempt to touch their beloved. And caregivers look on, knowing they were the ones who told the family “no.” The moral principle: “It is immoral to keep people away from their sick and dying loved one.” And I am keeping people away from their dying loved one. Is the policy necessary? Yes. And yet, the injury remains.

Another source of moral injury is “risk.” When I wake up in the morning, all I can think about is risk. Who am I encountering between home and the hospital? Am I bringing an infection into a hospital room with an immunocompromised patient? Am I gowning up correctly? Will I be infected? Am I bringing this infection into the next room? To my friends, my colleagues? As I go home, who am I encountering? Am I infecting them? When I get home, am I infecting my partner? My child? My mother? The moral injury from infection stems from a hyper-awareness that one small lapse in precaution could cost a life, including my own. The moral principle: “It is immoral to put human lives at risk.” And caregivers are asked to bear this risk daily.

Other sources of moral injury: the politization of vaccination, in one moment telling caregivers they are heroes, and in the next moment, telling them they are traitors. Forcing caregivers to make decisions about who lives and who dies because there are only so many ventilators and the unvaccinated are using them all leaving the rest of the sick and dying waiting. Caregivers enduring days and weeks of death with nowhere to put the bodies because the morgues are over capacity. All while removing the normal sources of support and healing because parks, places of worship, schools, parties, arts and music, once safe and sacred, are now sources of potential death.

An additional principle of moral injury is at work: the interconnected nature of being human. In the last two years I have participated in the human ritual of death and dying more than three-hundred times. When a human being experiences a death, it resonates with every other experience of death. As a mother watches her daughter die over a web camera, she talks about the death of her own father; and her husband; and her grandmother. As a child says goodbye to their parent, they talk about the loss of their other parent; their grandparents; their friend from high school. All grief is connected. And all moral injury is connected.

The pandemic has turned our medical system into a war zone, where ethical and moral foundations have been wounded due to unimaginable moral and ethical dilemmas. And we have seen in our 24-hour news cycle the results of our individual and collective moral injury as people succumb to their guilt, shame, and betrayal by turning to anger, resentment and hate. Because all our soul wounds have been torn open, and we are bleeding out.

What we are experiencing today is immediate and generational moral injury. The pandemic event resonates with other, deeper individual and cultural events. Racism. Poverty. Climate crisis. Sexism. Slavery. War. No one is immune because some wounds have never completely healed.

But all hope is not lost! Human culture has developed medicine to help mend soul wounds. The rites and rituals which cultivate spiritual healing and resiliency. Those practices and actions which slowly stich the soul back together through individual and collective grieving, meaning making, and relationship re-building. Which is why in the hospital chaplains have experienced a shift in the provision of our care. We have been trained to assist in healing the wounds of the soul; and the injured are not just our patients, they are our colleagues.

Like battlefield medics treating the front lines of conflict, chaplains triage soul wounds through prayer, scripture, ritual, sacrament, song, and word, doing so in sometimes creative and unorthodox ways. We are stabilizing our patients until they can reach safety; until they can reach you; their holy person and community.

I believe our call in this moment, as spiritual and religious leaders, is to harness the power of our human spirit once again and re-make our communities into places of spiritual healing. Transforming brokenness before it can be transmitted further. Drawing on the best of our traditions and using old and new ways to mourn our losses. Repent for our sins. Atone through spiritual practice and action. Eventually leading us into a new way of being; relearning how to live and love again, scars and all.

May it be so. Amen.