After the spring outbreak of COVID-19, nurse Jennifer Williams began taking blood pressure medication and seeing a therapist. Her stress level dropped this summer, but now, as her COVID-19 unit at Sturdy Memorial Hospital fills up again, Williams says she feels panic building. Some days after work she sits in her car and cries.
“I didn’t realize the impact it had on me in the spring because it was busy, and it was new,” she says. Now, “emotionally, I have to prepare myself. “
This time, Williams knows in advance how devastating the disease can be.
“It’s very, very scary,” Williams says as a COVID-19 nurse. “We can’t, we can’t help in a lot of ways, we can just watch. It’s just unpredictable, and it’s very, very scary. “
During ambulance races, paramedic Ben Podsiadlo says he sees the cumulative effects of the first flare on the tense faces of his colleagues. There have been so many 911 calls for COVID-19 patients who could not be saved.
“It had a big impact on our paramedics and paramedics, seeing so many deaths,” he says. “There has been a lull,” but the wait for another comeback might not be something no one looks forward to. ”
Podsiadlo, director of clinical integration at Armstrong Ambulance Service, says emergency responders are ready for anything. But there are widespread concerns about burnout among healthcare workers, depression, and increased alcohol and drug use to ease growing tensions. The stress appears to be fueled by both the lingering physical and mental impact of the spring rush, as well as looming fears about the future.
Reverend Katie Rimer has a theory about burnout that guides what she calls “this phase of the pandemic.” It is based on a quote from bestselling author Dr. Rachel Naomi Remen: “We burn out not because we don’t care, but because we don’t cry.
So when Rimer gets calls these days from distressed staff, she urges them to take a break, talk about what has been difficult, and name what they have lost. This may require some coaching for clinicians trained to keep their emotions in check.
“It’s been so tight in terms of time, where we’re already thinking about maybe having to do it again, that part of my job is to remind people to cry,” Rimer says.
North Shore Community Health Center chief medical officer Dr Damian Archer says many healthcare workers who have been asked to care for COVID-19 patients without adequate protection suffer from a loss of confidence. He calls the experience of providing care, under duress, when nurses and others do not feel safe, a moral hurt.
Archer says he’s trying to heal those wounds and restore confidence with weekly virtual meetings on the latest coronavirus developments and discussions about staff needs.
“It’s also about being open to being honest and transparent about what you have and what you don’t,” he says, “and asking people to go beyond what’s usual and normal due to lack of resources.
Staff were put to the test in health care centers and hospitals in Massachusetts this spring. In the first push, hospitals moved staff, shattering longtime shifts and sometimes called for more employees who were younger, single, or healthier than others. Fears of a repeated experience fuel part of the second anxiety flare.
“People are aware of the differences,” says Dr Paul Biddinger, medical director of emergency preparedness at Mass General Brigham. “What they want to be assured of is justice and fairness, so that in the event of a second outbreak, the way staff are asked to react, the way people intervene, is distributed as well. as uniformly as possible, as fairly as possible. possible in all our role groups. “
Biddinger and other hospital officials are investigating a “combat buddy” system that connects employees who watch over each other. Some hospitals are implementing other peer support systems, and others are employing roving and acting nurses to avoid calling tired employees for extra shifts as hospital admissions. COVID-19 are increasing.
And hospitals fixed some of the technical issues identified in the first outbreak. Fans from various sources, for example, could not be plugged into existing alarm systems. So hospital staff became human alarms, sitting outside the rooms, listening and watching for alerts that something was wrong. Biddinger says the issue has been resolved in MGB installations.
Biddinger says growing anxiety is palpable as he walks through hospital lobbies, listening to staff “who did such an incredible job” during the spring debate over the daily fall coronavirus figures and what they might mean: is this the second push? Will it be worse than the first? How long will it last?
Biddinger says no one has answers to these questions yet, and it’s difficult.
“Let’s face it,” he said. “Let’s make sure we provide services and resources to staff to help them respond, but also call this what it is – which is a fear of the unknown that we can’t completely resolve because we don’t know. not what the future holds. ”
This unpredictability can be especially difficult for physicians who are guided by numbers, protocols, and science. These elements change, sometimes daily, during the coronavirus pandemic.
“There is uncertainty in every part of our life, patient care and how to treat it and testing,” says Dr Sheena Sharma, “throughout your personal life and if you get really sick of this or God forbid, worse.
Sharma, a cardiologist in private practice, says she has come to terms with the idea that the pandemic will get worse, so she tries not to dwell on daily case updates.
“Otherwise, you adjust every day,” she said, “which I don’t find helpful. In fact, I tell my patients, “Stop, how does that help? ”
Dr. Susan Ly, meanwhile, is studying rates of positive cases and deaths, COVID-19 admissions and intensive care bed capacity at her hospital and beyond before each shift.
“For me that just builds a bit of a mindset, what kind of environment am I going to be prepared for,” says Ly, an emergency physician at Lowell General Hospital.
But Ly says it’s hard to continue at such a demanding level. Yes, she says, hospitals are better prepared for COVID-19 patients after the spring outbreak, but unlike the spring, the flu is on the rise and patients who avoided emergency rooms earlier in the day. year are back.
“We’re so beaten up with this, COVID, COVID, COVID, be prepared all the time,” she says. “But now we have all of our normal types of stressors on top of that. So for me it’s something that always hovers over it.
Paramedics and paramedics who deliver patients to emergency rooms are also worried about overloading this fall and winter.
“There’s a lot going on in America right now and in the world beyond COVID-19,” Podsiadlo says, “with the political tensions in the country, hyper-polarization.
Ly says healthcare workers need the public’s help to get through what’s happening: wear a mask, keep your distance, wash your hands.
“Be vigilant and patient,” she says, “because we are all trying to get through this together.”