Washington Post today
I have never felt so helpless’: Front-line workers confront loss
Doctors, nurses and first responders grapple with the enormity of what they’ve witnessed during the pandemic’s first wave
Marc Ayoub remembers the woman in her 50s who came alone to the emergency room. She went into cardiac arrest and was hooked up to a ventilator. Ayoub, a resident at hard-hit Elmhurst Hospital in Queens, tried to reach her family all night, and when he finally connected with her daughter, he had only bad news.
As he stood in his spacesuit of protective gear, holding his phone in front of the woman’s face so her daughter might see her one last time, Ayoub was indignant that this is what death had become during the
coronavirus pandemic.
He looked away, trying to be respectful of the sacred moment. But he could not help but overhear as the daughter connected family member after family member, until there were more than a dozen people weeping on the chat. “Mommy, please come back,” the daughter begged.
“Please.”
“I am a doctor. I spent years training to help people, but I have never felt so helpless in my life,” recalled Ayoub, 31. “There was nothing I could do for the patient or the family.”
Doctors, nurses and emergency medical technicians are supposed to be the superheroes of the pandemic. They are immortalized in graffiti, songs belted out from balcony windows and tributes erected from Times Square to the Eiffel Tower. But despite the accolades, many confide that the past months have left them feeling lost, alone, unable to sleep. They second-guess their decisions, experience panic attacks, worry constantly about their patients, their families and themselves, and feel tremendous anxiety about how and when this might end.
The unfathomable loss of more than 100,000 Americans within a matter of weeks — many in isolation, without family or friends — has inflicted a level of trauma few anticipated when they signed up for these jobs. At least 592 of those deaths were of health-care workers, according to a list compiled from news reports, social media and other sources by the National Nurses United union.
As the first wave of patients subsides, many are struggling with the death and devastation they saw close up and — perhaps most difficult — with their own inability to do more, to save more people’s lives.
A few became casualties themselves: Two health-care workers in New York City took their own lives within two days of each other in late April. John Mondello, 23, was an E.M.T. working in the Bronx. Lorna Breen, 49, was an emergency department physician at New York-Presbyterian Allen Hospital. Breen’s sister said she had been tormented by what she experienced. She quoted her as describing a scene “like Armageddon” and saying, “We can’t keep up.”
Ayoub said he was not surprised when a quarter of his classmates in the residency program at the Icahn School of Medicine at Mount Sinai revealed in a survey they had thought about suicide. “We know exactly how she felt,” he said of Breen. “We understood what she was going through. That could have been any one of us.”
“A lot of people were angry at the whole situation and the system,” he added. “How it all happened. How we weren’t prepared. The lack of support.”
Worried that the coronavirus might leave a whole generation of health-care workers with post-traumatic stress disorder, many hospitals and ambulance companies have brought in grief counselors via Zoom and started weekly mediation sessions, prayer circles and other support services. Mental health apps such as Headspace and Fitness Blender are offering free access for health-care workers. Online therapy company Talkspace donated more than 2,100 months of counseling to medical workers, and more than half of that time has been used.
Counselors seeing health-care workers describe symptoms of burnout, PTSD and “moral injury” — the effect of hundreds of decisions made each day on the fly and amid the chaos, creating conflict between deeply held beliefs and options considered inadequate or downright wrong.
Brittani Holsbeke, 31, emergency department nurse in a Detroit suburb, described sending home patients with blood oxygen levels lower than normal because of triage policies in place during the peak that raised the threshold for those who would get treated. “It got gray,” she said, especially when some of those people would show up even sicker a few days later.
Audrey Chun, 48, a New York City doctor, struggled with helping her elderly patients sick with covid-19 decide whether to stay home and die surrounded by family — or go to the hospital where they would get treatment but still possibly die, in that case, almost certainly alone. There was “no clear answer to give them,” she said.
Matt Kaufman, 51, a physician at Jersey City Medical Center, remembers the guy who came in at the peak of the crisis with minor chest pain. In normal times, it would have been “a no-brainer” to admit the man, if only for observation. But Kaufman was torn. “The concern was if he sticks around, he could get infected and be in an even worse situation.”
Images of health-care workers during the pandemic often show them cheering as a patient is wheeled out of the hospital, arms pumping, with the theme from “Rocky” or “Don’t Stop Believin’” playing in the background. The daily reality has been grimmer. In some medical centers, the ratio of deaths to discharges was as high as 9 to 1 among the critically ill on ventilators.
Signs of burnout, anxiety and frustration are widespread, especially as colleagues, friends and family members have gotten sick or died. That has provoked quiet despair in some medical workers and angry confrontations from others.