Sirens, Deaths and Grief Fray the Mental Health of Virus Doctors
(Bloomberg) -- At Lincoln Hospital in the Bronx, emergency calls were a soundtrack of suffering for physician Haydee Brown.
They came over the loudspeakers several times an hour to summon help for severely ill Covid-19 patients, some of whom she might have admitted hours earlier. Each one tore at her. Then, two weeks ago, her own brother-in-law became one of the more than 17,500 people to die from the disease in New York City. Brown helped her sister arrange a memorial service and navigate backed-up funeral homes and crematoriums -- all while grieving herself.
“Sitting at home and thinking about it is intolerable for anyone,” Brown said. “We’re in such a state. We’re like, alive-dead.”
Officials are frantic to keep health-care workers on the right side of that divide. On Sunday, the director of emergency medicine at NewYork-Presbyterian Allen Hospital died by suicide after treating virus patients and falling ill herself. She and Brown belong to a legion of health-care workers trying to save people in a pandemic unprecedented in our lifetimes -- and the consequences for those workers may be unprecedented as well.
With no proven cures, they witness patients die at rates rarely seen in civilian medicine. They deliver the news to grieving families who are not permitted inside for fear of spreading the virus. They watch colleagues succumb to the illness, and wonder if they might be next.
“There’s going to be people that this really leaves a scar on in some way,” said Jonathan Ripp, chief wellness officer at Mount Sinai Health System in New York, which is setting up a center to screen, treat, and study health workers’ own mental trauma.
The pandemic descended on a workforce that already had been stressed for years. Long hours, emotional exhaustion and paperwork burdens contributed to burnout that studies suggest affects more than half of physicians and a third of nurses. Doctors attempt suicide at more than double the rate of the general population, according to one review of the research.
This weekend, Lorna M. Breen of NewYork-Presbyterian Allen Hospital was among them. The doctor died in Charlottesville, Virginia, where she was with relatives, said her father, Philip Breen, himself a physician.
“I’m a trauma surgeon. I have had people die with my hands inside them,” he said Tuesday. “I can assure you, you don’t go through that type of thing unscathed and unharmed.”
Lorna Breen, 49, fell ill with Covid-19 a few weeks ago but stayed home for a little over a week before going back to the hospital, her father said. She was later hospitalized with severe depression and left the hospital to stay with a sister in Charlottesville.
Philip Breen said his daughter had never had mental-health problems, but struggled with the sheer volume of severely ill patients for whom she and her colleagues cared. “They couldn’t even get people out of the ambulance,” and bodybags lined the halls, he said.
“She was a hero in every sense of the word,” he said. “She loved New York and she loved her work and it killed her.”
Hospitals are trying all manner of things to keep the healers healthy. In addition to setting up crisis lines and offering practical help with childcare and other necessities, the Mount Sinai health system created respite stations with snacks and information about mental-health support. A therapy dog, Moby, is particularly popular.
At Northwestern Memorial Hospital in Chicago, officials brought in chaplains, social workers, and psychiatry staff. Alan “Tony” Amberg, a psychiatric nurse practitioner, was reassigned from treating patients to supporting colleagues with “emotional crisis first aid.”
Amberg goes floor to floor to remind nurses to breathe, stretch and eat. “Some of these patients, when they crash, they crash hard, and it is very hard for these nurses to watch,” he said.
The sessions are rejuvenating, said Karena Brown, a nurse manager on a Covid-19 surge floor. “As nurses, we are go-go-go. We forget to go to the bathroom. This is to remind us: You are a person,” she said. “You have needs, too.”
Even as new cases ebb in some areas, the work inside many hospitals remains grim.
With visitors barred to avoid spreading the virus, doctors and nurses become intermediaries between dying patients and their families.
Relaying the news, and knowing that patients are “going to die by themselves is by far the hardest part,” said Damian Carabello, an emergency doctor at a hospital in Tampa, Florida. “But it really is part of our jobs. No matter how bad things get, you just keep moving on and take care of the next patient.”
Julie Bevers, a trauma and crisis chaplain, traveled from her home in Sacramento, California, to New York City to counsel health-care workers. She said the deaths inflict a spiritual toll.
“How do you prepare for that?” Bevers said. “When you arrive on shift, you’re going to be assigned eight patients, and when you leave in the morning, all eight are no longer with us.”
Many health-care workers feel helpless as their efforts fail.
“That’s why we all chose this profession,” said Arghavan Salles, a surgeon and scholar in residence at the Stanford School of Medicine who traveled to volunteer at a New York City hospital using vacation days. “If you have someone who is sick and no matter what you do, they don’t get better, they get worse -- you feel like a failure.”
Jessi Gold, an assistant professor of psychiatry at Washington University in St. Louis, helped set up programs for employees of its health system: a hotline, groups for mindfulness and anxiety on Zoom, and clinic appointments. The demand has been less than she expected, which makes her worry about a future crash.
“Mental health, in all honesty, tends to be something people recognize in a crisis, or often a little bit late,” Gold said. “And as a result we get really depressed people, or people who almost need to be hospitalized, or are really sick.”
Brown, the doctor at Lincoln Hospital, has found purpose in work, but the coronavirus is present even when she returns home to her Harlem apartment. Her fiancee, a firefighter, has been working 24-hour shifts for weeks. Her 9-year-old son’s father, meanwhile, is an emergency medical technician, so “my son is surrounded by Covid,” she said. Her son recently said he didn’t want to go outside because he was afraid of the virus.
At the hospital, emergency calls still ring out, but the facility now plays applause over the loudspeakers when patients get off ventilators or are discharged.
“You feel like you’re winning part of a war,” Brown said. “And that it’s not futile.”
Longer battles may lie ahead.
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