Stress, isolation, and grief have become accepted realities for health-care workers treating COVID-19 patients. But that doesn’t mean these front-line workers have gotten used to the new, grim rhythms of their jobs.
“The human condition can only handle so much pain and suffering and stress,” said Troy Brindle, a licensed clinical social worker and founder of outpatient services provider Springfield Psychological’s behavioral health integration services division, “and everything that’s occurring around us right now is just unprecedented.”
The coronavirus pandemic is burdening doctors, nurses, and first responders with feelings of helplessness, anxiety, loss, and even hopelessness, Brindle said. Those feelings have intensified as plans move forward to relax stay-at-home orders designed to restrict spread of the virus, potentially putting the health-care system — now calmed after passing the peak of cases — in a renewed state of emergency. The people tasked with saving others from the coronavirus are themselves struggling.
“They’re having a hard time caring for their patients,” Brindle said. “They’re having a hard time caring for their own family, and then they’re having a hard time with their own self-care because everything is out of whack. Everything.”
The extreme circumstances the pandemic has created at times force health-care workers to act against their core training and values, something that mental-health experts described as “moral injury.” These moments of trauma arise from pressures that health-care workers never anticipated: battling with their employers over necessary safety equipment; failing to save sick patients; and contending with the reality that their work puts themselves and their families in danger.
“Typically, people who go into medicine are quite idealistic. If you don’t do something right, it can be quite devastating,” said Rita Brock, director of the Shay Moral Injury Center at Volunteers of America. “They’re currently stuck in a situation where they cannot do what they aspire for themselves, their team, their profession. This is a crisis where so much has gone wrong.”
Brindle said health-care workers are increasingly talking about sleepless nights, anticipatory thoughts (imagining future anxieties), and excessive drinking to cope with stress. He also knows that doctors, in particular, are less likely to express their emotions in front of coworkers and patients, and may not want to share their fears with their families.
“If I have to cry in front of a patient, I’ll cry in front of a patient, but I’ll usually try not to because it’s their moment,” said Megan Stobart-Gallagher, an emergency medicine physician at Thomas Jefferson University Hospital. “It’s what they’re going through, and what I’m going through usually has very little to do with what they are experiencing.”
These accounts led Brindle to collaborate with the medical societies in Philadelphia, Chester, and Delaware Counties to create Helping the Helpers, a group support program specifically for health-care workers. Every Thursday at 7 p.m., doctors and nurses from around the region log into a Zoom video call to share stories, exchange advice, and, often, just listen.
“For every one person talking, there’s 20 or 30 other people benefiting from that,” Brindle said.
Each week is centered on a different topic. One session explored beliefs that health-care workers aren’t doing enough. Participants who need additional support can connect with Brindle to set up a private conversation.
“That stress is just amazing,” said Steve Permut, a family practitioner with the Temple University Health System who has participated in the support sessions. “The social isolation is depressing, as well.”
The most recent session centered on talk of societal reopening that has caused significant dismay among health-care workers, Brindle said.
“When they hear about we’re reopening, they feel devalued,” Brindle said, “almost like they’re pawns in a game and that they’re dispensable.”
Doctors are used to being listened to, Brindle said, and the indifference to medical opinion from those who insist the coronavirus is not a significant threat, or that economic matters trump health concerns, leaves them feeling unexpectedly powerless. They are also experiencing feelings of futility that their efforts to mitigate the toll of the virus will be undone.
“I just diagnosed someone this week who was at a large Mother’s Day gathering, so for the next two weeks, I’m going to be very concerned about all of those people who were at that gathering,” Stobart-Gallagher said. “It’s going to be up and down for a long time.”
Hospital workers also fear a return to shortages of the protective equipment they need.
“As we reopen hospitals and start doing more business-as-usual activities, it will lead to much higher consumption of PPE [personal protective equipment],” said Matthew Behme, chair of general internal medicine and geriatrics at Einstein Medical Center Philadelphia. “That’s going to drive back a lot of anxiety among physicians.”
Compounding the issue is the struggle for health-care workers to obtain appropriate protective equipment from hospital administrators or the government.
“That can cause a kind of anger that can become really toxic, can really start to go into cynicism, outrage that is really hard to control,” said Brock of the Moral Injury Center. “All of those things interfere with capacity to function, maintain career, and relationships with those close to you.”
Other concerns expressed in support sessions have been weighing on hospital workers since the outset of the pandemic, such as potentially exposing their families to the virus.
“I have a 6-year-old little girl with asthma, and the thought of making her sick keeps me up at night. My parents are older, and I worry so much about them,” Behme said. “I never even conceived the idea that I might make my family sick.”
This is one of the most painful moral quandaries, Brindle said.
“What if you were a nurse and a doctor who had it, and you went home and you had an immunocompromised parent living with you,” he said. “What are you left with the rest of your life? You’re left with the fact of, ‘I killed my mom.’ ”
And then there is the work itself. Hospital workers are seeing patients die daily, sometimes one after the other. Physicians who are used to expecting perfection of themselves are struggling daily to treat a deadly virus they know very little about.
“It’s normal for physicians to give bad news,” Brindle said, “but they’re giving bad news many times a day.”
Some doctors in Brindle’s support group have said they felt like failures.
“When those kinds of things happen to people, it affects their capacity to feel like decent human beings, and compromises their sense of humanity,” Brock said.
Permut, who is practicing by telemedicine, has lost patients he’s known for years to the virus.
“We’re all like in the wilderness trying to figure out what’s the right thing to do,” he said.
He has found comfort in humility, a lesson he learned in medical school half a century ago, he said. During his orientation, an acclaimed Temple physician, Thomas Durant, gave students perspective on their careers ahead.
“If you came to medicine to save lives, you came for the wrong reason,” Permut recalled Durant saying. “You don’t get to save any lives. If you’re lucky, and you do a good job, you get to prolong lives.”