As I write this, I am acutely aware of how lucky I am to be healthy, to have a job that brings me satisfaction and meaning, and to not be personally facing the horrors being experienced by the frontline providers of critically ill COVID-19 patients. My hospital and other relief organizations have asked whether any physicians might be willing to work in a department other than the one they are trained in to help with the surge of COVID-19 patients. With this in mind, I have joined several online physician groups that share information on COVID-19—from pharmacology information to latest peer-reviewed journal articles to information on how to manage a patient on a ventilator. Although certainly overwhelming, these groups do bring a sense of solidarity with all the healthcare workers in a way that I haven’t felt perhaps since residency.
These groups also keep me informed of my colleagues on the frontlines and what they are facing medically, professionally, and emotionally. I watched with sadness and horror a video from The New York Times of a New York City doctor showing the conditions of her overwhelmed hospital. She looked exhausted and beleaguered, but also exuded the willingness to persevere. My husband noted that hospitals with limited space, providers, and resources seemed to be turning into MASH units. We providers have started to feel as if we are “in the trenches.”
I started to wonder if the COVID-19 pandemic would be referred to in the future as World War III. Instead of nations fighting each other, we were all fighting a common enemy: a pandemic. If this is the case, there is no doubt that, as a friend of mine put it, healthcare workers are the frontline infantry.
Health care professionals are no strangers to stress and tragedy on the job. We live with such perils even as we treat them. In many ways, we were drawn to and trained in a profession that allows us to feel a sense of control over chaos as we intellectualize and treat disease. What happens, however, when health care providers begin to lose the ability to control disease, or when we are faced with an unwinnable war? When healthcare professionals are not able to practice the way they feel is the best or safest way? When they are silenced by their administrators with threats of termination if they speak out against poor working conditions? These are questions being answered before our eyes since January, when the first cases of COVID-19 were discovered in the United States.
Even prior to COVID-19, post-traumatic stress disorder (PTSD) has been shown to be more prevalent in health care providers (about 15%) than in the general population (3% to 4%). Nurses and resident physicians and those in higher stress departments, such as emergency medicine, have been shown to be especially vulnerable populations in terms of developing PTSD. The higher prevalence of PTSD in these populations is likely due to multiple factors, including that they most often bear witness to patients’ suffering and dying. In addition, residents and nurses tend to have lower amounts of control over their work conditions and how they are able to practice in terms of maintaining personal safety. Indeed, one of the key factors leading to nursing burnout and possibly PTSD is feeling that work conditions are unsafe.
This feeling of lack of safety in practice is something that has also been revealed in the COVID-19 pandemic as more and more healthcare providers are reporting surging numbers of patients with COVID-19, yet at the same time reporting that their administration is sending them in to care for patients without the proper personal protective equipment (PPE) or telling them to take off PPE due to “scaring the other patients.” Healthcare workers are among those at the highest risk of acquiring COVID-19 yet providers have been admonished and fired for asking to wear PPE according to their own guidelines, and not the guidelines of the US Centers for Disease Control and Prevention (CDC), which seem to be shifting rapidly to account for the lack of PPE available to providers. This likely amplifies trauma as providers are left feeling out of control of their own safety and their ability to properly protect their patients.
Healthcare providers, physicians, and nurses are people-pleasers, yet we have little control or autonomy in the way we provide care. Under normal circumstances we simply vote with our feet and move to roles and systems that best align with our preferred way to practice. In a pandemic, this is not possible. As in residency, we are once again finding ourselves with very little personal control over how we are able to practice—but now it is impacting how we are able to keep ourselves and our patients safe.