Moves to reopen economy bring new fear for our weary front-line health workers
The wail was primal, an animal sound. The nurse had heard people wail before: when you tell a person someone they love has died, they can crumple, or shatter, or howl. But the woman on the phone had not seen her husband since she dropped him off at the hospital with breathing problems, and now COVID-19 had killed him, and it was the worst call of the nurse’s career. The woman kept saying, what do I do now, what do I do now? And the nurse kept saying I’m sorry, I’m sorry. What else could she do?
“You’ve got to listen,” says the nurse. “You just listen.”
Ontario’s first confirmed coronavirus case was in January. The pandemic has not crushed our hospitals the way it did in Italy and New York and elsewhere, because we stayed at home and flattened the curve.
Now Ontario is moving to reopen some businesses; people are itching to get out. It will result in new cases. Everybody knows.
Some health-care workers are doing fine, managing. But paramedics were worrying about burnout a month ago, and among health-care workers there is real strain, and cumulative weight. Some worry that the world hails them as heroes but wants to move on, and that hospitals are seen as automatic. They aren’t.
“It is out of sight, out of mind, and even more because nobody’s allowed in,” said a nurse in the Greater Toronto Area, who like other nurses in this story has been granted anonymity out of fear of workplace reprisal.
“We’re in this for the long haul, and this is not going to go away tomorrow,” says a Toronto nurse.
“And especially if Doug Ford opens more things, we’re going to see a spike and a surge. We’re already exhausted, and the marathon has just started. How are we going to be able to sustain it? I don’t quite know.”
In the intensive care unit at Credit Valley Hospital in Mississauga, they do a huddle at the nurses station every day. Not long ago, with palliative care and other support participants present, people started sharing how they really felt.
“Especially in this profession, there’s just a lot of put your head down and go, and you just sort of motor through, and push through things,” says Dr. Manisha Sharma, a palliative doctor at Credit Valley, whose colleagues were in the huddle. “And that’s unhealthy — 100 per cent, that’s unhealthy in this environment.”
“Not just the intensity of the work, but the change in everyday life, and not knowing when things would go back to normal,” says Dr. Alison Freeland, a vice-president of academic affairs and patient experience at Trillium Health Partners, which runs Credit Valley and two other hospitals.
“People move into feeling more overwhelmed, and others are experiencing more symptoms of burnout, and perhaps mental health symptoms … there is worry of acute stress disorder, or post-traumatic stress disorder, or the exacerbation of underlying stress and anxiety.”
“There are a lot of staff on the COVID unit that don’t usually experience death and dying at the rate that these nurses are dealing with right now,” says Vij Richards, an occupational health nurse and registered psychotherapist who was in a recent huddle. “I have seen that: people are getting exhausted.”
Trillium has brought in palliative care nurses to help and is trying to offer supports; many hospitals are.
But there’s only so much they can do. ICU nurses have both become the emotional conduits between families and COVID-19 patients, and are dealing with patients who are intubated and on paralytic drugs.
“It takes a toll in a way having a variety of patients doesn’t,” says another Toronto ICU nurse. “I have to remind myself that it’s a person I’m dealing with, but when they’re paralyzed and sedated and ventilated, with no family there, it’s more difficult. (Knowing the patient and family) grounds me, centres me, reminds me why I became a nurse. To treat the person, not necessarily the disease. Now every patient is the disease, and we can’t talk to their family. It’s that much harder.”
“You need to shelter yourself,” says Dr. Chris O’Connor, an ICU doctor who is also founder of Think Research, a clinical tools innovation company. “You need to put a wall between you and your patient, and you need to maintain your compassion for them at the same time.
“And you have to figure out your path and risk to being exposed to the virus. There’s a range with how people cope with that. I tend towards the controlfreak arm of it.”
It is an accumulation. Health-care workers are both grateful for personal protective equipment, or PPE, and tired of wearing it all the time: it’s claustrophobic and sweaty, and cheap surgical masks fall off while N95s give you a headache. No water bottles are allowed on wards, so your throat dries out enough to make you hoarse, and you wonder if you’re sick.
They are tired of having to focus on donning and doffing the PPE so precisely — as O’Connor puts it, “like the (climbing) movie ‘Free Solo,’ you only ever get to make one mistake” — even as Code Blue alerts blare.
Many are frustrated by shifting protocols, with little explanation. So many are tired of worrying about being infected, in a province where approximately 17 per cent of identified coronavirus cases are health-care workers.
They are tired of going home and stripping out of their clothes and throwing them in the washing machine and showering, trying to scrub clean. They are tired of worrying if they are infecting their families, or tired of living apart from them. They are tired of people who deny, or downplay, the virus.
And some are numbed by the disease, which you can’t treat so much as manage, and which can end terribly. Some are weary of death.
“A lot of us didn’t say anything for a while: we kind of kept our feelings in check, came to work, did our job, being professionals,” says a GTA nurse who works in the intensive care unit. “But as this is lasting, we’ve cried with each other. We’re all having dreams, all of us, more vivid. Every time I close my eyes, all I’m seeing is COVID.
“I’m dreaming more now than I have in a really long time. You dream you’re in the unit, or around someone who’s suddenly coughing.
“I can’t watch the news, because it really frustrates me. I understand some people are disconnected, and they don’t see, but I see a lot of self-entitled people. Where they feel it’s all about me: I don’t care about you, I don’t care about my neighbour, I’m healthy, just have the sick people wear the masks, healthy people don’t need to wear the masks.
“The hardest part is looking at a patient’s face when they know they’re deteriorating and they don’t know what’s going to happen. That’s the hardest part. It’s the fear in their eyes.”
And it’s not over. Not close. Flattening the curve means extending it. Opening up society means more cases.
“We’ve noticed coffee doesn’t do it for us anymore,” says the Toronto nurse. “There’s this emotional exhaustion, and it doesn’t go away. It’s not just COVID, it’s everything: you’re just tired all the time, and your brain can’t work the way it used to.”
They want us to remember there is a cost to all this, and there will continue to be a cost.
“You cry a whole lot more,” said the GTA nurse. “You see the faces (of the patients you lost). My husband will say, what’s wrong with you, and I say, nothing, sorry.
“But you suddenly see their face in front of your face and you’re seeing that fear again. You think, that guy was healthy, he didn’t have underlying issues, he didn’t have anything. He’s married, had a son, didn’t have any issues until this hit him.
“And you see the things people take for granted. It does take a toll. All of it takes a toll. I just want to breathe. I walk out of the hospital, I just want to breathe.”
We will lose more patience with lockdowns, and we will take more risks, and some of us will get sick. We should remember what happens, and who is there, and what they carry, when we do.