It wasn’t how the emergency doctors ranked each statement — from “never” to “every day” — in the burnout inventory that alarmed Dr. Kerstin de Wit and her research team.

It was the doctors’ responses, in a final, optional, open-ended question: “Is there anything you would like to tell us about your experiences?”

“This is awful. Worst in 20 years. With no light; just darkness,” one remarked.