‘Death is our greeter’: Doctors, nurses face trauma
There’s the COVID unit nurse whose sister got infected and became a patient. The staffer who works 12-hour shifts, only to come home to unruly and frustrated children. The nurse who felt the added pressure of supporting an unemployed brother.
Dr. Jay Kaplan listens as staffers share their fears and problems. He tells them it’s OK to get sad or angry over the coronavirus that has sickened so many and upended their lives. He reads them his poems. He shares how, early in the outbreak, he came home and cried to his wife, overwhelmed by the deluge of dying patients.
Mostly, Kaplan, 71, an emergency room physician and wellness specialist at LCMC Health system in New Orleans, wants them to know they’re not alone.
“We need to break the culture of silence and let people know it’s OK not to have it all together all the time,” he said.
The psychological risks hospital staffs face during the coronavirus pandemic came into tragic focus last week, when Lorna Breen, 49, a Manhattan emergency room doctor who treated coronavirus patients and had been infected, committed suicide.
Kaplan’s chats with medical staff in the coronavirus fight – known as “wellness visits” – are a strategy for the hospital system to prevent its workers from spiraling into depression and post-traumatic stress disorder during the pandemic.
Hospitals from Seattle to New York City have launched similar initiatives in the next phase in the war against coronavirus: protecting health care staff from serious mental fallout after weeks of fighting the relentless virus.
As of Monday, the coronavirus had infected more than 1.1 million people in the USA and led to the deaths of more than 67,000. More than 9,200 health care providers have been infected by the virus, according to the Centers for Disease Control and Prevention.
A study released last month looking at the mental health outcomes of 1,257 health care workers attending to COVID-19 patients in 34 hospitals in China, where the outbreak started and where more than 4,600 people have died, found that 50% showed signs of depression, 45% reported anxiety and 72% had
some form of psychological distress.
Even before the pandemic, about 60% of emergency physicians experienced burnout in their career, according to the American College of Emergency Physicians. About 400 physicians commit suicide each year.
Health care workers are used to dealing with death but rarely witness it in such high numbers, said Colin West, an internist who has studied physician well-being at the Mayo Clinic in Minnesota for nearly two decades. Nurses and doctors are not accustomed to putting themselves at constant risk while treating others, he said.
“Health care professionals – physicians, nurses – already had high levels of stress and high rates of burnout,” West said. “A pandemic like this is going to add strain to an already strained group of workers.”
Doctors, nurses and technicians usually absorb “secondhand trauma” from gunshot victims and other patients, said Debbie Minsky-Kelly, a social work professor at Carthage College in Wisconsin. Treating the coronavirus, they experience “firsthand trauma,” risking infection and witnessing colleagues getting sick and even dying, she said.
Unchecked, the trauma could resur
“The mental health of our
emergency physician
workforce has to be
addressed in a definitive
way.”
Dr. Aisha Terry a Washington, D.C., emergency physician
face when caseloads lighten and they have time to think about their experience, Minsky-Kelly said.
“What are going to be the triggers for doctors and nurses for future PTSD?” she said. “The person performing my surgery could suddenly be having a flashback in the middle of my procedure.”
Workers at Mount Sinai hospitals in New York City have treated more than 2,000 COVID-19 patients and seen hundreds of their colleagues infected by the virus, said Dr. Jonathan Ripp. About 20 workers died from the virus.
Starting in late March, the hospitals ramped up initiatives, such as a 24/7 mental health crisis line and one-onone counseling, Ripp said. It launched a wellness and resilience center that will track staffers’ long-term mental health.
“The number of (coronavirus) deaths we’re seeing in this country are higher than deaths we saw during the Vietnam War,” Ripp said. “There’s reason to be concerned.”
Dr. Aisha Terry, a Washington, D.C., emergency physician and board member of the American College of Emergency Physicians, said she routinely fields calls from colleagues who break down in tears.
Others have endured some of the most traumatic scenes of their career but self-isolate from family members to avoid infecting them and don’t have a support system, she said. Emergency physicians feel a sense of helplessness in facing a virus that has no known treatments or vaccines.
Her group offers free online counseling sessions to members and tries to sound the alarm that doctors and nurses in the fight against the coronavirus face serious psychological risks, she said.
“Things cannot go back to business as usual after COVID-19,” Terry said. “The mental health of our emergency physician workforce has to be addressed in a definitive way.”
Hospital staffers in Seattle are starting to see a decrease in cases, said Michele Bedard-Gilligan, a University of Washington psychiatrist who helped lead the university’s medical mental wellness efforts.
Hospital administrators plan to track and treat staffers long term, including for a potential second-wave virus outbreak, she said.
“Potentially, we’re looking at another year of tolerating increased stress,” Bedard-Gilligan said. “How that’s going to look like and how it’s going to take a toll on us remains to be seen.”
In New Orleans, Kaplan, the wellness specialist, begins each session by sharing information in printed, colorful graphs: The hospital system has enough ventilators, intensive-care beds and personal protection equipment to see them through the crisis, graphs show.
Next, he recites a poem titled, “When Corona Comes Knocking” (” Now death is our greeter as we walk in to work ... sometimes we see it walk in the door, other times it is wheeled in“). He wrote the poem in his journal as the pandemic hit New Orleans.
Kaplan often ends the 30-minute sessions by asking workers to think of the one thing they did that day that made a difference. Then he reads from Psalm 23 in the Bible: “Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me.”
“We are in the valley of the shadow of death right now,” Kaplan said. “And we will get through this if we can look into each other’s eyes and give each other hugs, even if we’re 6 feet apart.”