On the 100th anniversary of WWI’s end, lessons on life in health care’s trenches

It is common these days to hear physicians, nurses and other health professionals refer to their daily work as “life in the trenches.” The phrase usually contrasts the experiences of patient-facing professionals with those of administrators and others who labor “behind the lines.” (In many medical practices and hospitals, non-clinical staff outnumber health professionals by 5 to 1 or more.)

Nov. 11 marks the 100th anniversary of the end of World War I, the first large-scale military conflict in which trench warfare – combat between opposing troops hunkered down in ditches – played a major role, making this an opportune time to explore the similarities between the lives of contemporary health professionals and those once literally in the trenches.

Historically speaking, the introduction of trench warfare can be traced to advances in military armaments, especially small arms and artillery. Such weapons proved effective against exposed enemies, such as troops advancing in formation, but they offered limited advantage against an enemy out of the line of sight or sheltered by large amounts of earth. In other words, firepower leapt forward, while mobility advanced relatively little, an imbalance that led later to the development of tanks and air power.

The height of trench warfare was reached on the Western front in France, where well-protected troops were separated by “no man’s land,” resulting in long stalemates for which trench warfare became a byword.

For soldiers, life in the trenches tended to be highly monotonous. Both sides were so deeply entrenched that most attempts to advance were doomed to failure. Soldiers devoted most of their time to constructing and repairing the trenches, cleaning their weapons, transferring food and supplies, and attempting to mitigate rats, lice and ailments such as cholera and trench foot. By contrast, they spent very little time engaged in combat, a role that was soon largely reserved for elite units. Simply put, soldiers in trench warfare endured many miseries, but almost none stemmed from their defining purpose – fighting.

As a practicing physician, I believe that many contemporary health professionals can relate to this experience. Though trained to focus on direct patient care, many find that they spend a remarkably high proportion of their time on activities that draw them away from patients – activities such as filling out electronic forms, wrangling with coding and billing requirements, and demonstrating compliance with rules and regulations. One study showed that nurses spend less than a third of their time actually caring for patients. This gives rise to a number of professional afflictions – among them depersonalization, inefficacy, and loss of purpose, which take their own toll on “battle readiness.”

Flooding, heat and terror

U.S. soldiers in a trench in France during World War I. Susan Law Cain/Shutterstock.com
During WWI, conditions in the trenches were typically terrible. For example, soldiers remained entrenched in all seasons and weather conditions. In heavy rains, the trenches flooded. In winter, a flooded trench would often freeze. Under the hot sun, by contrast, heatstroke and dehydration became the principal threats. Furniture was scarce, and many soldiers slept on the damp earth. The typical trench diet offered little in the way of wholesome nutrition or relief from the monotony. In the case of British soldiers, it often consisted of tea, biscuits and tinned beef – a regimen that, over prolonged periods of time, resulted in malnutrition.