1. ‘You don’t feel alone’: How medical workers help each other cope
Dr. Hala Sabry tried to stay composed as she looked down at the woman lying in the bed beside her. The patient was a mother in her early 40s. “The same as me,” Dr. Sabry thought.
An emergency medicine physician, she has learned to bridle her emotions when death draws near. This time, as her patient slipped away, the tears fell.
Dr. Sabry grieved for the woman and her loved ones, none of whom were allowed in the hospital room to comfort her. In an almost unconscious act, the doctor and her medical team gathered around her, joining gloved hands in silent prayer.
Before this year, before the onset of COVID-19, Dr. Sabry felt prepared for the intense vagaries of her work. She seldom considered her job a threat to her life or her family. Now, splitting time between two hospitals outside Los Angeles, she traverses the uncharted extremes of the pandemic.
“There’s still so much we don’t know about what we’re up against,” says Dr. Sabry, who lives with her husband and their five children. The questions extend from the medical to the familial. When she leaves home for her next shift, she wonders, “What if I die? What will my kids do?”
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She has countered the uncertainty, in part, with a private Facebook group she started for health care providers to support each other and share information as they confront an unrelenting fight to save lives.
An offshoot of the Physician Moms Group, an online community Dr. Sabry founded in 2014 for women juggling medical careers and family duties, the COVID-19 subgroup has attracted more than 37,000 members around the world. She gains strength from the solidarity as much as the exchange of details on treatments, scientific articles, and initial studies.
“We run toward patients with the disease, and when you see other people doing the same, it’s invigorating,” Dr. Sabry says. “The sense of community reminds us continually about our purpose. You don’t feel alone.”
The demands of responding to the crisis consumed Dr. Lorna Breen, an emergency room physician in New York who treated coronavirus patients and contracted the illness. Her suicide last month brought into focus the mental and emotional toll of the pandemic on doctors, nurses, and other practitioners amid the rising number of deaths, shortages of protective equipment, and lack of proven remedies.
The collective strain has moved health care workers to launch social media efforts to reassure and inform their own and magnified the importance of peer support programs that can alleviate their internal burdens. In illuminating that hidden struggle, wellness experts explain, the outbreak presents a chance to address the mental health needs of providers – needs neglected long before COVID-19 – and fortify their resilience to persevere in the moment and beyond.
“This is an opening to try new things,” says Dr. Anne Browning, who helps manage the peer support program for University of Washington Medicine, a health care network in Seattle. “It’s an opening to ask, ‘How can we support our people in managing this hardship and not have them go back to just white-knuckling it?’”
A different approach
Health care workers tend to adhere to a code of silence about their mental health for fear of ostracism by colleagues and the potential impact on their medical licensure and careers. Research has found that an aversion to self-care contributes to high levels of burnout and post-traumatic stress disorder among doctors and nurses, whose suicide rates run well above national averages.
Studies in Canada, China, and other countries show escalating rates of anxiety and depression among front-line responders treating coronavirus patients. In the United States, where almost 9,300 providers were diagnosed with COVID-19 through mid-April, health care networks have turned to various strategies to aid them, including meditation and sleep apps, crisis lines, and online counseling. Some hospitals have set up “recharge rooms” with soothing lights and music.
The American Medical Association lists peer support among the resources and recommendations for assisting providers. In a quirk of timing, UW Medicine established its program in January, only days before the country’s first coronavirus case surfaced in a Seattle suburb.
The peer model emphasizes informal, confidential conversations to reduce the reticence of caregivers and the pervasive stigma against seeking help. Providers who volunteer as peer specialists receive training to recognize signs of stress, emotional fatigue, and burnout. They learn to point colleagues toward methods for coping that range from exercise, cooking, and gardening to self-help books and clinical counseling.
“The program allows people to decide if they want to talk and also to be more supportive of one another,” Dr. Browning says. “It creates openness.” Most health care systems have yet to embrace peer support. She expects that to change as medical workers contend with a deepening sense of helplessness.
“This unprecedented event has shown folks that they have to pay attention to well-being in a way they haven’t previously,” she says. “A different approach is way overdue.”
The safety concerns and social restrictions that await providers outside the hospital erase the line between work and home, compounding their distress. Many worry about exposing family members to illness or live apart from them to avoid the risk.
Talking with colleagues can act as a release valve for practitioners and recalibrate their emotional balance. “When people experience hard events and don’t get enough support, it leads to burnout,” says Dr. Kiran Gupta, medical director of the peer support program at University of California, San Francisco Health. “That’s what we want to prevent.”
The hospital system formed its program three years ago and has shifted individual and group sessions to Zoom during the pandemic. Volunteers from the network’s pool of behavioral health clinicians have joined the effort as demand rises for peer services.
The program’s webinar series on mental health has proven useful for Dr. Rima Bouajram, a critical care pharmacist. As hospitals prohibit families from visiting loved ones dying from the virus, providers fill the void, comforting patients in their last moments. Dr. Bouajram’s training as a peer supporter has made her more inclined to ask co-workers about their mood, to take time to listen to their frustrations and console them in their despair.
“We don’t usually talk about our feelings in the intensive care unit,” she says. “But we need to be there for each other. Everybody is affected.”
The people behind the masks
The Instagram page Frontline COVID-19 shares the stories of practitioners from inside the pandemic. Drs. Jessica Lu and Sandra Truong, colleagues at UW Medicine, created the project to unite providers across the country and enlighten the public about their daily reality.
A recent post from an ICU nurse in Atlanta captured her mix of emotions after a 12-hour shift. “I do have a sense of pride knowing that I am actually able to make a positive impact in someone’s life in a time of crisis – that’s a huge reason why I became a nurse,” Gabi Naumann wrote. “But also I am tired, and sad, and angry, and anxious about what the future holds.”
The anecdotes reveal the people behind the masks and the invisible weight they carry. Dr. Lu recalls losing one of her patients, a nursing home resident she saw for regular checkups and who remained in good health until she contracted the coronavirus.
“She was such a bright light in my patient experience. I think of her blue sweater, her pink nail polish,” says Dr. Lu, a second-year family medicine resident. She received the news of the woman’s death in a phone alert. “Not being able to be by her side, not seeing her again – that was really difficult in a different way.”
Behavioral health researchers warn that the emotional fallout from the outbreak’s first wave could reverberate for months and even years for front-line responders. The potential fallout concerns Dr. Wendy Dean, a psychiatrist and co-founder of the nonprofit group Moral Injury of Healthcare, who advocates for protecting providers.
Staving off burnout among them will require hospital networks to devote greater resources to preserving their mental and physical health, including psychological first aid and adequate personal protective equipment.
“Health care organizations need to listen to their workers,” Dr. Dean says. “They will need a chance to process what they’ve been through, to get right with what they’ve seen and had to do. You can’t heal the health care system without healing them.”
The pandemic has laid bare that system’s numerous deficiencies. At the same time, the ordeal has strengthened providers’ camaraderie, seeding hope among them that a spirit of shared empathy will outlast the coronavirus.
“This is a chance to change the culture of health care,” says Dr. Jina Sinskey, a UCSF Health anesthesiologist and trained peer supporter. “It’s a chance to show compassion for others and for yourself, and to recognize we’re in this together.”
The bond with colleagues – along with frequent walks with her dog – sustains Dr. Lu as the outbreak stretches from weeks to months. She weathers the loss of patients by cherishing the triumphs of others.
She recounts the first meal request of a man after he moved out of the ICU while recovering from the coronavirus. He mentioned a craving for chicken tostadas from his favorite restaurant. “Your wish is our command,” Dr. Lu told him. She laughs at the memory.
“It’s important for all of us to remember that people do get better. It’s not all death and despair,” she says. “There is still joy and gratification.”
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