For the last month or perhaps even longer, I have been rising each morning with a tightness in my chest. This intensified in December and has progressively worsened in the new year. Initially, I attributed it to anxiety, but it felt different from my typical anxiety. This sensation was more tormented.

In the first week of January, I volunteered at a clinic where I interacted with patients, evaluated, and managed psychiatric disorders. My primary role involves inpatient psychiatry, and I take pleasure in providing care to outpatients in this clinic for uninsured individuals at the start of each month. That particular week, all of my patients were Venezuelan immigrants. The pressure continued to increase in the days that followed.

Then, Renee Good was shot dead by an ICE agent in Minnesota, which heightened the pressure. It dawned on me that what I was feeling was moral injury, rather than anxiety. It required several incidents and extensive introspection to recognize my true feelings.

**Understanding moral injury**

The psychiatrist Jonathan Shay first articulated the concept of moral injury, which he introduced to capture the experiences of veterans. It aims to describe an injury that can happen if someone participates in, is unable to stop, or observes an event that contradicts their values. It has been acknowledged as prevalent in the field of medicine.

The Pitt, a TV series currently airing, serves as a poignant illustration of this kind of workplace trauma. In The Pitt, physicians, nurses, and hospital personnel seem to accumulate a lifetime of moral injury over a 15-hour shift. A casual viewer might not perceive this while watching, but as a doctor viewing the show, I found myself feeling uneasy and emotionally affected, realizing that it was depicting reality accurately, moment by moment, as the series progresses.

I am quite familiar with the moral injury I have accumulated throughout my medical career. I have experienced it in emergency departments, my office, and in restrooms, fervently wishing no one would enter and hear me sobbing. It begins with a knot in my stomach, a surge in my heart rate, and an urge to flee. It’s a sensation I can best describe as utterly drained exhaustion, while I attempt to hold back tears and my heart races at what seems like an alarming speed. Following the initial realization, the repercussions can span months or even a lifetime to confront, and they build up with each injury, accumulating over the years.

I had always correlated moral injury with my professional life. I had never truly connected it to other aspects of my existence, and perhaps, aside from during COVID-19, there has yet to be a time in my life that encapsulated it as effectively as the present moment.

**The ethical warning sign**

After delving a bit deeper into the topic, I discovered that in 2000, it was further examined as an “ethical canary,” indicating that moral injury on a larger scale serves as a warning sign about the need for systemic changes. I appreciate that metaphor, being from West Virginia. It implies that the notion of moral injury and distress can highlight moments when systemic modifications are essential. I believe we are undeniably on the brink of something significant in this nation, and I suspect many others are waking up with the same heaviness in their chest as I am.

The issue is that I think so many of us, including myself, are trapped in a state of learned helplessness, convinced that our actions cannot bring about change. For me, this is entangled with my privilege and a lifelong tendency to rely on it, using it as a justification for allowing others to handle the work. Naturally, I vote, but that alone isn’t sufficient.

**Systemic violence and silence**

Renee Good was shot in the head in front of her spouse, just a few miles from where George Floyd was also murdered in plain sight five years prior. Black and brown individuals have always recognized that a simple traffic stop could result in their death, but for many of us in this country, that’s not our reality.

Violence against women, particularly white women, has always existed, but it often occurs behind closed doors and family secrets. This violence was witnessed in full view of the public, and the officer compounded it by referring to her as a “fucking bitch.” As a woman and a female physician, I have faced this insult thrown at me countless times. It is a grim rite of passage for women.

The rapid response of some media figures to undermine her and tarnish her reputation was another layer of injury. This is familiar territory for all of us: If a Black or brown individual is deemed discreditable by the media, they dredge up their past names and traits to damage their reputation. More injury. One might argue that I, as a white woman with wealth and all the privileges that accompany it, am late to these realizations, and you would be accurate. All the