Front-line workers: Mental health concerns rise as cases surge.
Mental health concerns rise with latest wave
YONKERS, N.Y. – It doesn’t take much to put Cathy Hopkins right back into the worst of the first coronavirus wave.
Just a mention and she’s back behind layers of protective gear in the standingroom-only intake tent outside St. Joseph’s Medical Center.
She’s navigating a bumper-to-bumper ambulance bay, walking emergency department halls clogged with gurneys of the sick and dying, while monitors signal the last heartbeats of 11 patients on her first Saturday shift.
Hopkins shivers at the memory, and her eyes brim with tears.
“Ooh, it comes all back, doesn’t it?” she says, taking a deep breath. “I lost a part of my life in there. I think we all did. It was just a blur. It was going home, getting up and going back to work again.”
For months last spring, on that workhome-work-home treadmill, work meant encountering death on a scale she’d never seen; home meant not having the energy to talk to her family about what she was going through.
Like other first-wave first responders – EMTs, police and fire, doctors and nurses – Hopkins, a nurse practitioner who is director of employee and community health at St. Joseph’s, ran on adrenaline for months.
Then Sharee Skalsky and the Westchester County Behavioral Health Response Team began to see their first wave: COVID-19 first responders seeking help.
“May was a rough month because that’s when everything started, it seemed, to catch up to people, their feelings, what they’ve experienced,” Skalsky says. “Numbers were kind of coming down at that time, so they actually had time to sit and think about what had just happened.”
Those thoughts brought them to Skalsky, program director at the St. Vincent’s Behavioral Health Center, in White Plains.
Skalsky says there are warning signs of stress that first responders and their families should look out for:
• Irritability.
• Anxiety.
• An inability to sit still.
• An inability to even move. “We’re seeing nurses, doctors, police officers, firemen and EMTs, the whole full gamut of first responders,” Skalsky says. “We’re seeing mental health professionals, as well.”
Early in the first wave, Skalsky says, the ground was constantly shifting.
“Especially March, April, May, it was so much unknown. It was just heightened anxiety constantly because of constantly changing regulations,” she says. “They’d walk in every day, and (the state Department of Health) had new stuff. They never knew what they were walking into, just with laws and regulations, not
“I really have to be honest with myself: Do I have the stamina to do that all again?” Cathy Hopkins Nurse practitioner who is director of employee and community health at St. Joseph’s Medical Center in Yonkers, N.Y.
even patient care, dwindling supplies of PPE (personal protective equipment), as staff got sick, having to work longer hours, cover shifts. All of those things really wore people down.”
First responders have untold reservoirs of resilience, she says, but COVID-19 put that to a test.
“EMTs, police, firemen, my worst day is their every day, that’s what they see,” Skalsky says. “They’re seeing a tremendous amount of grief, loss, pain.”
Skalsky knew the virus had the potential to do a number on stoic police and firefighters, whose culture tends to shy away from sharing feelings. In March, she set up presentations at police and fire companies to put them on alert for warning signs within their units.
“More firemen die by suicide every year than by fire,” she says. “Thirty percent of first responders have PTSD (post-traumatic stress disorder) once in their lifetime; 37% have contemplated suicide. The pandemic just pushed it to another level.”
Since May, Skalsky says, “we’re hearing a lot of guilt and self-doubt, balancing the personal responsibility to the patient but at the same time trying to protect themselves and families.”
Unpacking those complicated emotions is best left to professionals, she says.
“I don’t think people should be doing this on their own if they have anything more than just post-trauma reactions,” she says. “If you’re starting to get into nightmares and sleep disturbances and stuff like that, that’s not a do-it-yourself kind of situation. You can exacerbate your symptoms.”
Unwritten memories
For Hopkins, who was pulled into allhands-on-deck COVID-19 duty at St. Joseph’s from her normal assignment running Yonkers’ in-school clinics, the memories have started to dim.
“Part of me, in looking back, thought, ‘Maybe I should have done a journal,’ because you can’t remember what you’ve been through,” she says. “I think part of it can be protective.”
Skalsky is wary of journals, in some cases.
“I always suggest do not do any kind of narrative writing or journaling if you’re having extreme reactions while you’re doing it, unless you’re under the care of a professional,” she says. “We help reconstruct that narrative so that it lessens the intensity of the memories and the reminders, or triggers. While you’re doing that, you’re doing relaxation skills.”
Hopkins’ better memories are those involving personal connections with the sick, including a colleague, a nursing supervisor whom she did not know well.
“The nurse stepped out, and I went in,” she says. “There was nothing I could do for her, but I held her hand. And she said to me months later, ‘You don’t know how often I tell my family members that you just held my hand.’ Here I felt inadequate, and the only thing I could do was hold her hand. And that was what she needed at the time.
“I touch people. If I can’t go in and hold the colleague’s hand who’s so sick, then what’s it all about?”
A rising second wave
As first responders process the first wave, a second wave appears to be rising.
“We have about eight or nine patients now in the hospital who are COVID-positive,” Hopkins says. “There was a time we didn’t have any patients there. Could we be back where we were a few months ago? Absolutely. That’s what all the literature, all the experts are saying.”
The latest patients aren’t as critically ill as those in the first wave, when St. Joseph’s opened a second intensive care unit for critically ill, intubated patients.
“The patients we’re seeing now don’t seem to be as critical. Maybe that’s because of the mutation, the changes that have gone on with the virus,” Hopkins says. “We don’t know.”
What she does know is that the wave is rising as flu season arrives.
“You come in with the flu, well, that sounds very much like COVID. So now we are mandated to not just do a COVID test, but we have to test people for flu,” she says. “So instead of two swabs in each nostril, we’re doing four now.”
Smiling, she says, “I bring grown men to tears, let me tell you. They start sneezing and tearing and everything.”
In touch with emotions
Knowing what to expect doesn’t make it easier emotionally.
As hospitals across the region begin what’s called “surge prep,” looking at best practices and reviewing procedures in anticipation of that expected wave, those discussions could trigger issues lying dormant.
“It’s not fear so much” that she’s feeling, Hopkins says. “It’s the anxiety of it all.”
She’s anxious for her family, including her daughter, Megan, expecting the family’s first grandchild.
“It should be a wonderful, happy, joyful time,” she says, “and I’m like, ‘Whoa! What does this mean? What does it mean for my daughter and my son-inlaw?’ ”
Skalsky listens to Hopkins, nodding. “She should react the way she’s reacting,” Skalsky says. “That means you’re in touch with your emotions about it. You’re not avoiding them because avoiding them is what leads to acute stress disorder, which is a precursor to PTSD. The more you avoid, the worse it’s going to be.”
Being in touch with emotions, she says, means recognizing when they change, which is not easy.
“Trauma progresses very gradually,” she says. “Most people don’t notice it, especially when you’re in the grind, when you’re on the ground and in the trenches like that and it’s just ‘Go, go, go. Get the job done. Get the job done, get the job done.’ You don’t notice these little things creeping in.”
Skalsky’s clinic does consultations, face-to-face evaluations to assess first responders, hoping to identify “posttrauma effects” before they worsen into clinical symptoms.
If done early, she says, the treatment can be much shorter, sometimes four or five sessions “to untangle the memories and put it into context that’s healthier or more constructive and positive and realistic.”
A second coronavirus wave could easily bring a return of those old feelings and a need for a refresher wave of support, Skalsky says.
“We’ve even had some that have come back because, although they were doing extremely well, now they’ve been triggered again, and there’s this anxiety hanging over their head,” she says. “They come back just to make sure that they have the appropriate skills to be able to deal with whatever is thrown in their laps.”
Hopkins appears to have those skills, but those searing memories are there at a mere mention. She wonders whether she can do what she might be called on to do again.
“I really have to be honest with myself: Do I have the stamina to do that all again?” she says.
Then she answers her own question: “I mean, if it needs to be done, it gets done.”