How Doctors and Nurses

Manage Coronavirus
Grief
In their own voices, health care workers from across the country reflect on
coping with the pandemic
Interviews by Jillian Mock and Jen Schwartz
Frontline clinicians have become the face of our pandemic.
They represent the best of humanity, rising to treat
critically ill patients, as well as the collateral damage from
America's fragile health care system and disordered
government response. Calling them "heroes" doesn't
protect them from psychological trauma, and experts warn
that a mental health crisis among health care workers
could emerge in the virus's wake. Scientific
American asked doctors, nurses and respiratory therapists
working in hospitals across the country how they were
coping with fear, processing grief and tending to their own
well-being. Interviews were conducted in late March and
early April, as COVID-19 was rapidly upending life in the
U.S. These stories reflect that period of extreme
uncertainty and may contain details (such as mask-
wearing policies) that have since changed. The essays have
been edited and condensed for clarity.
1

For providers, there's a really complex psychology to all this. Everyone realizes the
importance of what they're doing but doesn't want to be the next person felled by
COVID-19. You're grappling with fear of the unknown and your call to duty. In the early
days of this outbreak, the hospital had a policy that you couldn't wear a mask unless you
were treating a suspected or confirmed COVID-19 case, and that made the anxiety even
higher among the staff. You didn't know who could be the lurking carrier. My wife, who
is also a doctor, and I have been at this game for longer than we care to admit, and we've
never been in a situation where there was a real fear of interacting with patients like
there is now.
In mid-March I was three days into a rotation in the medical intensive care unit,
ramping up for the inevitable surge, when it was decided that those of us 60 and older
would be pulled from clinical duty because of our higher risk of dying from COVID-19
infection. Now I have younger colleagues taking on a huge amount of work, and all of
them have young families. There's a significant element of guilt in not contributing. We
ancients are currently figuring out how we can provide services to lighten their burden.
It's a nice gesture, but it's a complicated process. I'm reading the front page of
the Boston Globe today, which is trumpeting the threatened salaries and pay holdbacks
that different hospitals are proposing because their revenues have dropped like a rock.
That there's going to be pay delays and cuts for people in the emergency room and
intensive care unit who are working double time is just a little stunning.
Instead of spinning my wheels, I'm occupying myself with other issues at the medical
center. I'm responsible for ongoing research and clinical trials for a rare disease, so I'm
trying to figure out how I can protect the study coordinators and patients who are
involved and at the same time continue participation of the study patients so they don't
lose access to these disease-altering drugs.

 In late March I was running a low-grade fever and had to self-isolate at my

house for several days before my COVID test came back negative. It was so hard
to stay away from my family and even harder to stay away from my work, which
I love. It felt like punishment, like I was losing my mind. I'll admit that I was
drinking more than I ever do. In early April I decided to start staying in a hotel
so as not to accidentally bring the virus home to my husband and two kids, who
could also spread it to my immunocompromised dad, who helps with child care.
For me, the hardest part has been the isolation. I've had an eerie sense of calm
and peace about all of this up until now, but recently I've started to feel
something inside that is not me. I think it's the separation, the loneliness of
keeping everyone at arm's length. Sometimes I get in the car, blast music and
just go. I ran out of gas on a joy ride last week.

3
Audio 00:25
I honestly have no idea how I feel. I don't have time to digest any of this. I go to
work, and then I go to sleep. Training in emergency medicine in New York, with the
speed and number of patients, probably prepared me somewhat for what's happening
now. But nothing can prepare you for an event of this magnitude. Everything is in flux.
The upside is realizing the level of flexibility that's possible in a hospital. I'm seeing new
faces in the ER all the time--nurses and doctors from other departments, even surgeons,
OBs and people flying in from all over the country. In the back of my head I'm
constantly thinking, Can we manage our resources and keep our staff healthy for
however long this lasts?

A couple of weeks ago, when all of this was ramping up and we were seeing
floods of patients at other places in the country, I had to ask myself, Can you do this?
When I was a resident in the cardiac ICU, I had terrible shifts: getting slammed, people
dying left and right, four codes at once. I feel like my training has prepared me for
having to make decisions on the fly and having to be OK with those decisions. But when
you get into the main event, who knows?
We currently have a dozen COVID-positive patients and many pending, but it's actually
been really slow at the hospital. When I was a medical resident in Florida and Hurricane
Irma came through, I remember seeing pictures of Tampa's beaches, and the ocean, like,
retreated. Everything left. It was so eerie. We're lucky in that we've been able to prepare
for getting destroyed.

What has changed is morale and the atmosphere of the hospital. The nursing staff are
really the ones that are the most affected because they are in these patients' rooms the
most and get the brunt of the exposure. There was a situation the other day where a
respiratory therapist was wearing an N95 mask, and they were saying to one of the
nurses, "Why aren't you wearing an N95?" The nurse said, "Oh, we're not recommended
to wear an N95 unless we're in the presence of an aerosolized maneuver." And the RT
responded, "Oh, no, you should wear one all the time." And it just created all this
commotion on that floor for two hours: Who should be wearing N95s? Are we safe? Is
anyone looking out for us? As the leader of the team, I'm trying to keep everyone calm.

Our workflow has changed a lot, too. I'm a big communicator; that's how care moves
along. On rounds we're talking to patients on the phone now to avoid frequent exposure,
then calling family separately. It's this whole disjointed process. But I've also been trying
to call in to their rooms just to say, "Hey, what's going on, how was lunch?" It takes only
a minute, but I think it signals to the patient, "The doctor is checking in on me." Imagine
being an old person diagnosed with COVID, being left alone; you're kind of a leper.
Being so isolated has got to make struggling with this disease even tougher.

It sucks dying alone in the hospital, whether you're a COVID patient or not. I had a guy
the other day who has cancer and has been going downhill. He's not imminently dying,
but he'll probably die in the next month or so. Now his wife can't come to the hospital to
spend time with him, and it's heartbreaking. I tried to push our administration for an
end-of-life exception, but our policy is to not have a lot of exceptions because that's how
these rules break down, is what I'm hearing.

I try to separate myself from my emotions when I'm at work. I try not to think about
things too deeply. Every day I get a list of patients, and my focus is, I want to take care of
those patients. At home I do what I always do to totally zone out: play music. I've
bought, like, 15 guitar pedals in the past few months, though, so I guess that's how I'm
coping, by playing so much guitar. If I let all this stress and anxiety of the pandemic get
to me--if I think about what's going on outside my house, what's going on outside the
hospital doors--I'm not going to be able to function. It's an outlook that I didn't choose,
but it is what it is.

We had a code the other night on a COVID-positive patient where we had to rush in, and
people weren't properly putting on their PPE. Obviously the patient comes first, but I
said to them, "Stop, we have to protect ourselves." The patient ended up doing fine. But
those sorts of calls are going to be tough. If someone's coding and that extra minute of
putting on PPE means they might die, should we risk ourselves? The answer is not clear.

You can never really be fully prepared for a pandemic. Thankfully, nursing is never
routine, so we adapt quickly. I'm a float pool nurse, which means I work on almost every unit in
my hospital. I rarely feel intimidated by something new. But many of my co-workers have been
displaced and are now working in unfamiliar areas or jobs, creating chaos and stress. I've
noticed the most tension on the new COVID rule-out floors. Many staff members are scared to
even enter the unit and act like anyone working there is dirty. Patients have commented on how
they feel like a burden. Nurses working on these floors are teaching everyone who enters a
patient's room how to properly put on and take off our protective wear, and I have been on the
receiving end of many eye rolls and rude body language when all I was doing was trying to help.
Fear of the unknown is certainly putting people on edge. I'm coping by just allowing myself to
leave work at work. My dog has gotten more walks in the past few weeks than the whole year
combined.

…………..

 On just gettin
each

Ma
day

ew
Bai P

Emergency R
PhysicianLOC
York City