A lot of people see frontline healthcare workers as heroes in the coronavirus pandemic.
That might actually be kind of a problem.
“You hear about them being superheroes, and that’s nice, but they are people,” says Pamela Wright, an ER nurse and researcher at the University of South Carolina in Columbia. “They do need a helping hand from time to time. They do need someone not just to say, ‘You’re a superhero' and then ignore them. They do need interaction, they do need people.”
Wright is talking about the mental and emotional toll that being on the frontlines of a pandemic can take on healthcare workers; a toll that can be severe. The high-profile suicide of Dr. Lorna Breen, a New York emergency medicine doctor who died in April – reportedly because of a sense of hopelessness at the number of COVID-19 deaths she could not prevent – underscores a major issue lurking beneath the surface of legitimate medical heroics and showcases just how bad it can get for those charged with trying to save lives in a pandemic.
So here are three points of view regarding mental health among healthcare workers:
First, a perspective from the ER with Pamela Wright.
Second, April Hutto tells us what a nurse practitioner sees on the floor where COVID patients go to heal, and not.
And third, a look at the unique stressors of a neonatal intensive care unit nurse with Kayla Everhart.
There are also a few thoughts from Lamar Suber, project director for SC HOPES – a free hotline to help South Carolinians with questions about mental health or substance abuse issues that has a portion of its staff dedicated to helping healthcare workers.
To get a perspective from a different pandemic – Ebola – and how lessons learned in Sierra Leone can inform the COVID conversation, follow this link to hear from Cheedy Jaja. He worked the frontlines of the outbreak in Africa just a few years ago.
Pamela Wright: Adrenaline, Detachment, and Prayer
The first thing that surprises about Pamela Wright is how low-key she is. Her calm voice and casual demeanor belie how much she loves the high-octane work she does in emergency rooms in Richland County.
The second thing that surprises is that when she speaks of that work in the COVID-19 age, she speaks of detachment and thoughtfulness in equal measure. There is detachment from the kinds of emotions that could weigh one down in a crisis – sadness, pity, fear – and there is an embrace of the weight of what it means to, in every sense of the word, have someone’s life in your hands.
She says the key to being at your best for an environment full of moments that change at a moment’s notice is a balancing act that starts outside the ER.
“What you do outside of your shift is more important because it dictates who you will be during your shift,” Wright says.
She exercises. She embraces the solitude of life at home. She prays.
“God puts me to sleep,” she says.
And this all helps her cope with some very unpleasant things. It squares her mind and refuels her sense of humanity.
“What gets me through a shift is because I truly do care,” she says. “We may not look like we do all the time, but I do. It’s about the care that I provide my patients. It’s important that I provide the best emergency care possible. If I’ve done that, then I feel emotionally sound.”
What concerns Wright is that the way emergency care is given in this COVID era has changed. At a time when people are craving closer personal connections, emergency medicine has had to take a step back. ER workers wear goggles and face shields; they can’t touch a person in most instances; they wear PAPRs (Honeywell’s Powered Air Purifying Respirator system) that make an ER look like a moon landing and have a fan system that whirs in a healthcare worker’s ears.
Even skipping past how hard it is for an ER nurse to not try to comfort a scared COVID patient through some basic human contact, these modifications to the physical garb ER workers wear make it tough to do the job, Wright says. She worries about the mental toll this will all take on her colleagues in the long run.
“I think the big thing you’re going to see is just the absolute mental and physical exhaustion,” she says. “[It’s] going to take a huge toll on people, wondering, ‘Did I do everything? Did I hear everything?’”
Wright says she does often reflect on questions like these on the ride home. But if she’s sure she’s done her best, it’s a comfort to her.
She also says that if she gets to the point of needing to reach out for help, she will. She credits hospitals with having mental health support for caregivers and she encourages those caregivers to not try to process everything alone.
April Hutto: The Floor, the Families, and the Fear
April Hutto’s new office in Columbia barely had the moving boxes stashed away the day we met. After a dozen years as a family nurse practitioner, and five months contending with COVID as as a hospitalist for Prisma Health Richland Hospital, she is starting a new career in psychiatric mental health with Lake Psychological Services.
Her quiet office on Atrium Way has a colorful personal touch on the wall behind her – a painting she did herself; one of the ways Hutto processes and copes with what can be the horrors of the job.
COVID work drained her of some of her creative energy, she says. But she is about ready to tap back into it. She’s even started writing, just to get the feelings out.
What drained her in the first place had a lot to do with the weight of her work. She provided care on the floors where COVID patients get sent for treatment. From the early days of the pandemic, this meant a tireless stream of patients terrified by their diagnoses.
It also meant a nagging sense of fear in herself.
“It was really scary at first,” she says. “And very overwhelming. There was just nothing that could have prepared me for this.”
The “this” was wave after wave of unknowns about what this strain of coronavirus is, worries that she might contract a disease she saw ravaging people to death, fears that a panicked patient might claw away at her protective gear looking for some kind of comfort.
That lessened as more became known about COVID-19. But that brand of angst shifted into what it means to care for people Hutto knew would not survive.
The separation in particular haunted her.
“This isn’t how any of us want to practice medicine or to be nurses,” she says. “We weren’t trained for these conditions. So it hurts us as much as it hurts the patients and the families to have the separations; to have [it] be so difficult to develop that nurse-patient relationship.”
Having to tell families that their loved one was isolated and will die here was bad enough. Having to tell them they couldn’t come in to say good-bye was worse. Hutto was often the last conversation a person would have, and it drove home the isolation and loneliness that COVID care has brought.
To survive in this environment, healthcare workers need emotional support, she says. They need self-care, which she finds in books, painting, and television.
Ironic as it might sound, she also finds it in separation on the job too.
“I think one of the unique qualities of people in healthcare is, they have to have the ability to separate,” Hutto says. “You kind of just go to a different place. You have to remove the emotions you’re feeling right then and there and be able to objectively provide whatever care that patient needs.”
But that’s on the job. One thing healthcare workers will say a lot these days is that they’re human beings, not machines and not superheroes. So while Hutto finds a kind of Zen in the solitude of her home, where she knows she’ll at least not have to tell anyone that someone is going to die alone, she also lets her emotions happen.
“You have to allow yourself to feel,” she says.
You also shouldn’t try to be a tough guy.
“You talk to somebody yourself,” she says. “You see a therapist yourself to help you work through your feelings.”
She still feels for the families who have to let their loved ones go from a distance, she says. She worries about those trapped in abusive homes. And it’s the kind of thing she says she hears a lot of COVID’s frontline workers coping with.
Kayla Everhart: The NICU, Parental Stress, and Being Open
Kayla Everhart is quite familiar with the dynamics of a neonatal intensive care unit. Long before COVID, she needed to reconcile with the fact that “not all the outcomes are good” in a ward where newborns enter with health problems.
With COVID here, things might seem to be more dire on the NICU for one overarching reason:
“Newborn babies have no immune system,” Everhart says.
Drop that fact in the middle of a pandemic in which the illness exploits weaknesses in immune systems and that could be a big problem.
Yes and no. On the upside, Everhart says that protocols established long before COVID – ones requiring special visitation measures and protective clothing – have continued. Extra care always had to be taken around the newborns, so in that sense, this virus doesn’t offer much new.
But COVID has altered a few things for sure – chiefly that the mothers of these newborns at the onset of the pandemic were not allowed to visit with their babies. Vital beginning-of-life contact between mother and child morphed into anxiety for the patients and empathetic pain for NICU caregivers.
“I’m a mom,” Everhart says. “I can’t imagine being by myself [with a newborn in intensive care].”
NICU policies have softened. Mothers can now visit with their newborns in many instances, though fathers are still not allowed. That’s because the mother, in the hospital, is in a controlled environment; the father is not.
What’s causing Everhart more stress is that she’s been partially reassigned as a “floater,” someone who covers shifts in other areas of the hospital to help meet the number of COVID patients coming in.
“It’s terrifying,” she says. “As a NICU nurse, you’re a specialist. Worse, we’re always worried about did we bring something back? The last thing we want is to feel responsible for a sick baby.”
Going from the cloister of the NICU to the less-predictable hospital at large is a major stressor for neonatal caregivers, she says. Remember, Everhart’s patients are already among the most vulnerable. Take away the controlled environment, and the stress adds up fast.
To cope, Everhart and her colleagues go a little old school.
“We chat. We vent,” she says.
She and her colleagues follow the protocol of blowing out the lines before any pressure builds up.
“You leave it at the door,” she says. You can’t dwell on [tragedy] or it will eat you alive.”
That familiar refrain of needing to compartmentalize and let yourself feel in measured doses is part of Everhart’s conversation too. So is focusing on her family. She has a 7-year-old son who could not wait to go back to school and “get out of this house,” she says. It’s given her something else to devote her time and energies to when she’s not pulling a 12-hour shift at the hospital.
And it’s in her son’s craving to be out in the world like a person in normal times that she also finds remedy for that other familiar refrain wrought by the coronavirus pandemic – loneliness. It’s not an easy road to drive – “Do I put him in a bubble or send him to school?” – but all considered, Everhart says the social aspect of school (and life) will go a long way towards reducing some of the stress.
Just as long as everyone is smart about it.
Lamar Suber: Help, Hope, and … Hello?
SC HOPES, 844-724-6737, launched on June 1, thanks to a grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA). It’s a 16-month project that offers free help for South Carolinians struggling with emotional or mental health issues and substance abuse, but it also helps point residents to services to help them get by in their daily lives.
That’s the first thing Lamar Suber, the project director for SC HOPES, wants you to know. The second thing he wants you to know is that if you’re a healthcare worker dealing with issues brought on by the coronavirus pandemic, there is a team of mental health and substance abuse counselors waiting for you on the other end of this line as well.
The HOT, or Healthcare Outreach Team, specializes in getting medical workers through tough times, Suber says. HOT can offer telehealth services, provide mental health counseling, and even help healthcare workers to secure finances if they’re in trouble.
“We were trying to encompass who were the people on the frontlines of this pandemic,” Suber says of the creation of the outreach team. “To make sure that those who were impacted by COVID were being helped and healed.”
It’s an objectively good idea. The trouble is, not a lot of healthcare workers have called.
“We have received very little outreach from healthcare workers,” he says. “We haven’t actually had as many as we would have hoped to come and seek help from our support line.”
Suber suspects that this is due to a combination of lack of awareness about the program – something he is trying to remedy – and the uncomfortable truth that healthcare workers really do make for bad patients.
“In the healthcare field there is a stigma around receiving help when it comes to mental health or when it comes to addictions,” he says.
The short version is, healthcare workers don’t want to be seen as in-need, he says. It tends to make them feel as if they’re admitting they can’t do their jobs.
A physician friend explained the dynamic to him like this: “It’s interesting that we treat people for all of these different ailments, but it’s hard for us to treat ourselves.”
Suber says that healthcare workers, whether frontline nurses or lab techs or even project directors, do tend to sweep problems under the proverbial rug and do their best to ignore them. What he wants is for those healthcare workers to know that they have a place to turn, and to not take the macho route to dealing with the lingering, frustrating weight of the COVID crisis.
“[A problem] gets to the point where it becomes unignorable,” Suber says. “At that point it could be at its worst.”
His Rx? Don’t let it get unignorable.
Anyone in need of an ear can call SC HOPES at 1-844-SC-HOPES or visit the project’s website at the South Carolina Department of Mental Health.