Being a hospital medicine physician and leader, I am accustomed to chaos and working through daily challenges in a hospital environment. As stressful as it is, I thrive on solving and troubleshooting issues. The COVID-19 pandemic has brought a whole new level of challenges  and stress, and it initially was exhilarating.

Dr. Dhaval Desai is a practicing hospitalist and medical director of hospital medicine at Emory Saint Joseph’s Hospital. He is on Twitter as @DrDesaiMDx.

At the beginning, information was constantly changing as we were learning and adapting to this new disease process. It brought the worst of fears to most of us. But, at the same time, it felt thrilling as I was part of a historic pandemic by leading and caring for patients. The excitement was fueled by the constant change of information. During those first few weeks, it was truly mind-blowing seeing how fast the daily number of COVID cases were increasing. As a clinician directly caring for patients, I felt constantly stimulated from the latest clinical guideline or development on how to best care for a COVID-19 patient.

During that first phase, I did not feel that there was an “off button” to escape the pandemic. Once home, I would be glued to my phone or computer, addressing the latest challenge, communicating with colleagues, and handling acute situations that arose. On top of that, I had a  newborn and 4-year-old at home. My wife and I constantly questioned if we were doing the best to protect our children, and each other. I felt tired, but reassured myself that we were part of history in the making. Being a front-line physician and leader during a pandemic felt like a once-in-a-career opportunity. In a way, it felt like a privilege.

Weeks into the pandemic, across the country, there were celebrations and constant inspiration for healthcare workers. There were meals delivered to the hospital, letters and posters sent showing support. We were deemed heroes, and it was flattering and inspiring. The community and country were constantly cheering for healthcare workers on the front lines. This support was palpable, and lifted us through the darker days of the pandemic through two major surges. It continued to fuel our adrenaline to fight this disease.

Months passed in the pandemic, and after getting through a second surge, it felt like the worst was over. While there was constant advocacy to protect ourselves and each other, life was  trying to get back to normal (a new normal). The chaos was starting to subside, and maybe we  had just adapted to functioning in a pandemic. For a few weeks, it felt as if it were the end of the  commotion caused by COVID-19. But, the harsh reality was that it was the end of the beginning.

As we enter the fall season, we are projected to have a grim few months with COVID-19 cases surging on top of the already high number of patients we see in the winter yearly. It’s true that we are better at treating COVID-19, and are much more organized to navigate another surge during this pandemic. But the difference now is it does not feel exhilarating or exciting. Instead, it’s a challenge and a strenuous uphill battle.

Members of the healthcare teams, including physicians, nurses, respiratory therapists and others are exhausted. The duties of caring for non-COVID patients has returned back to baseline, which already is busy and chaotic. But these duties are further challenged with an entirely changed hospital environment, and having to consider all aspects of care in relation to COVID. It has completely misshapen the human and patient experience in medicine. There is nostalgia thinking back eight months ago to the “pre-COVID” days when caring for a hospitalized patient was much more open and welcoming. Now, it’s a closed, isolated, and a more demanding environment.

On top of the internal challenges, the politics and divide in the country cause more unrest. We are constantly seeing controversy on masking, and how some are being dismissive towards small behaviors to protect themselves and each other. Fundamentally, masking is the only major  strategy we have to mitigate the spread of COVID-19. And ultimately, the healthcare system is  going to be plagued with COVID-19 if cases keep rising, which is so maddening and frustrating, as we have a degree of control on this.

It’s clear to me now that the first six months of the pandemic were adrenaline-fueled. And while the support for healthcare workers is largely still present, the adrenaline that was first felt has waned. The same feelings of fatigue and frustration experienced by most during the pandemic  are shared by healthcare workers. Outside of the medical environment, healthcare workers face  the same challenges on the social and psycho-social front in their home lives, including virtual  learning for children, social isolation, and staying well during a pandemic. They are no different.  And, while I continue to strive to give each patient the best care I can while partnering with a  multidisciplinary team and other physicians, I also recognize that it’s more challenging than ever.

With the projected increase in cases of COVID-19 during the upcoming months, there has to  fundamentally be a message to protect ourselves and each other by masking, socially distancing  and following community guidelines. We still have time to make the reality far better than the  grim projections. And, if we do that, we are not only helping ourselves, but also will relieve a huge impending burden on the healthcare system and its workers.