Before Covid-19, health care workers were already vulnerable to depression and suicide. Mental health experts now fear even more will be prone to trauma-related disorders. The coronavirus patient, a 75-year-old man, was dying. No family member was allowed in the room with him, only a young nurse.
In full protective gear, she dimmed the lights and put on quiet music. She freshened his pillows, dabbed his lips with moistened swabs, held his hand, spoke softly to him. He wasn’t even her patient, but everyone else was slammed.
Finally, she held an iPad close to him, so he could see the face and hear the voice of a grief-stricken relative Skyping from the hospital corridor.
After the man died, the nurse found a secluded hallway, and wept.
A few days later, she shared her anguish in a private Facebook message to Dr. Heather Farley, who directs a comprehensive staff-support program at Christiana Hospital in Newark, Del. “I’m not the kind of nurse that can act like I’m fine and that something sad didn’t just happen,” she wrote.
Medical workers like the young nurse have been celebrated as heroes for their commitment to treating desperately ill coronavirus patients. But the heroes are hurting, badly. Even as applause to honor them swells nightly from city windows, and cookies and thank-you notes arrive at hospitals, the doctors, nurses and emergency responders on the front lines of a pandemic they cannot control are battling a crushing sense of inadequacy and anxiety.
Every day they become more susceptible to post-traumatic stress, mental health experts say. And their psychological struggles could impede their ability to keep working with the intensity and focus their jobs require.
Although the causes for the suicides last month of Dr. Lorna M. Breen, the medical director of the emergency department at NewYork-Presbyterian Allen Hospital, and John Mondello, a rookie New York emergency medical technician, are unknown, the tragedies served as a devastating wake-up call about the mental health of medical workers. Even before the coronavirus pandemic, their professions were pockmarked with burnout and even suicide.
On Wednesday, the World Health Organization issued a report about the pandemic’s impact on mental health, highlighting health care workers as vulnerable. Recent studies of medical workers in China, Canada and Italy who treated Covid-19 patients found soaring rates of anxiety, depression and insomnia.
To address the ballooning problem, therapists who specialize in treating trauma are offering free sessions to medical workers and emergency responders nationwide. New York City has joined with the Defense Department to train 1,000 counselors to address the combat-like stress. Rutgers Health/RWJ Barnabas Health, a New Jersey system, just adopted a “Check You, Check Two” initiative, urging staff to attend to their own needs and touch base with two colleagues daily.
“Physicians are often very self-reliant and may not easily ask for help. In this time of crisis, with high workload and many uncertainties, this trait can add to the load that they carry internally,” said Dr. Chantal Brazeau, a psychiatrist at the Rutgers New Jersey Medical School.
Even when new Covid-19 cases and deaths begin to ebb, as they have in some places, mental health experts say the psychological pain of medical workers is likely to continue and even worsen.
“As the pandemic intensity seems to fade, so does the adrenaline. What’s left are the emotions of dealing with the trauma and stress of the many patients we cared for,” said Dr. Mark Rosenberg, the chairman of the emergency department at St. Joseph’s Health in Paterson, N.J. “There is a wave of depression, letdown, true PTSD and a feeling of not caring anymore that is coming.”
I have nightmares that I won’t have my P.P.E. I worry about my patients, my co-workers, my family, myself. I can’t turn my brain off. — Christina Burke, an I.C.U. nurse at Christiana Hospital, Newark, Del.
A nagging detail sticks in Christina Burke’s mind like a burr. Not only is hers the last face that patients see before they die, but because of her mandatory mask, all they glimpse are her eyes.
Her identity as a compassionate nurse feels diminished. She longs to lift up her mask and reveal her full self to patients.
At 24, Ms. Burke has already worked in an intensive care unit for three years. She has loved the connections she made with patients and their families, but those experiences are now largely gone.
“I can’t imagine one of my relatives on their last breath with a stranger,” said Ms. Burke, who is close to her own family but hasn’t been able to visit them for two months.
One recent day, overcome with sleeplessness and despondency, she contacted Bridget Ryan, a member of the hospital’s peer support program. In Ms. Ryan’s office, she tearfully unloaded.
A March study in JAMA Psychiatry looked at the psychological impact of the epidemic on health care workers in 34 Chinese hospitals, reporting that nurses, especially women, carried the heaviest burdens. They had elevated rates of anxiety, depression and insomnia.
The prevalence of burnout and suicide among medical professionals has been widely studied. As the pandemic invaded the West Coast earlier this year, Stanford psychologists gathered focus groups in their medical system to explore how to shore up mental health.
Researchers flagged workers’ limited capacity to manage Covid-19; their fears of contaminating family members; the moral code-bending decisions about when to use limited, life-saving resources. But much distress could be headed off if hospital leadership created a proactive, supportive culture that included ways for workers to express concerns and feel heard, the researchers wrote in JAMA.
ChristianaCare, a four-state health system, began assembling such a protocol five years ago. The program provides group support and daily inspirational texts. Twice a week, doctors and staff meet senior leaders. It set up designated “oasis” rooms, outfitted with low lights, massage chairs and meditation materials, where stressed workers take a breather.
“We’re trying to provide them with psychological first aid,” said Dr. Farley, an emergency medicine physician who directs ChristianaCare’s Center for WorkLife Wellbeing.
Peer counselors are quickly available. “No one else understands what we’re going through,” Ms. Burke, the I.C.U. nurse, said. “It doesn’t sound like much, but that program has changed the world for us.”
At the end of her meeting with Ms. Ryan, the two women, both in surgical masks, shared a social-distance-defying hug. Ms. Burke said she emerged refreshed. For the first time in two months, she slept through the night.
To address safety fears, ChristianaCare offers disposable scrubs, which workers tear off at the end of a shift. It also has a gratitude program, in which former patients return to thank their healers. At a time when so many Covid-19 patients are dying, such exchanges, said Dr. Farley, reconnect demoralized staff to “why we do what we do.”
Dr. Farley and her team check on hospital crews, pushing carts loaded with hand lotion, anti-fog lens cleaner, protein bars, chocolate and solace.
Every time, Dr. Farley said, “There is someone crying with me, and it’s 3 a.m. They’re exhausted. They need this.”
Culled from the NEWYORK TIMES
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