We are coming up on the one-year anniversary of the COVID-19 pandemic in this country, and there are stories throughout the media looking back on the past year. To be honest, it is a traumatizing to many of us to recollect what we have gone through, the highs and lows, and yesterday’s noon conference presentation really brought it all home.
At our noon conference at National Jewish Health yesterday, Dr. Marc Moss and colleagues presented the topic, “The Growing Epidemic of Psychological Distress in Healthcare Professionals.” While I cannot do the presentation justice in this Medium blog post, I would like to share some of the key concepts I took away from one of the most impactful hours of the year.
The problem of burnout is far from new, and it is not unique do healthcare workers, but Dr. Moss explained that the unique stresses in healthcare create a profession where burnout syndrome is an occupational medicine issue. These stresses, magnified over the past year with surges in critically ill patients in our ICUs, center around taking care of extremely sick patients, and as seen in stories and throughout the media, the challenges of COVID-19 pneumonia and ARDS included caring for extremely sick patients who often declined despite the best efforts put in at the bedside, seeing the look of fear in the patient’s eyes as they realize they are needing more and more oxygen, taking care of dying patients unable to see their loved ones due to isolation rules of the pandemic, often sitting at the bedside with them as they passed away, with family members on an iPad, or — worse yet — when things happen suddenly or when people don’t have family to contact, being a substitute for them without loved ones present. Nobody should die alone. After people die in the hospital, the nurses are the ones who take care of the body so it can go to the morgue. This is called post-mortem care, and in the era of COVID-19 this happened all too frequently. During the pandemic, healthcare workers also lost loved ones, and lived with the fear of bringing home this disease to people with whom they lived. During the peaks of COVID-19, these stressors were literally the same, day-after-day, with a high volume of incredibly ill patients flooding the ICUs, asking an incredible amount of our nation’s frontline healthcare workers. if you have not seen the New York Times short film, Death, through a nurse’s eyes, I highly recommend it to be able to grasp even a little bit of what we’re talking about here. So with this context, it was perhaps of no surprise when Dr. Moss presented data from a survey of critical care nurses in which the majority of respondents reported symptoms of psychological distress.
I’ve written previously on burnout, or moral injury, and to give a definition, burnout is a long term stress response, characterized by emotional exhaustion, depersonalization, and reduced sense of effectiveness and personal accomplishment. It leads to many downstream issues, from depression to increased medical errors, to physician turnover at medical practices, and, as noted above, even suicide. Another term for burnout that has taken hold lately is that of “moral injury”, which Dr. Wendy Dean, psychiatrist and co-founder of the organization, Moral injury of Healthcare, reframes as “the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control.”
In his lecture, Dr. Moss brought this concept of phases of the disaster response, and this brought a new clarity, I think to what many of us have experienced over the past year. This figure comes from the samhsa.gov website, and is adapted from the Training Manual for Mental Health and Human Service Workers in Major Disasters, by DJ DeWolfe. Dr. Moss described how over a year ago it started with us seeing the rising cases in China, then the spread to other countries, the declaration of the pandemic, then the pandemic entering our country and how this initial disaster was met with a truly heroic effort, as healthcare workers responded to the call with all hands on deck, and thousands of healthcare workers traveling to New York City, retired physicians and nurses returning to work, all to help on the front lines. Early in this period our government imposed brief recommendations to close down and stop the spread. We brought the cases down from that initial peak. However, with the politicization of the pandemic and mask wearing, and muzzling of the CDC, those recommendations were soon neglected, and our with the de-unification of our national response, we left healthcare workers on the front lines dealing with repeated surges and peaks in this illness over a sustained period of time, and honestly with little hope in sight in many parts of the country. This was the period of disillusionment, and it hit many of us hard, with moral injury/burnout as I described above. I definitly experienced my period of disillusionment, and still feel at times this doom when I see images of fellow Americans not responding to the call to come together and defeat this virus. Fortunately, I think that we are now working toward the reconstruction phase of living with COVID-19. We have effective vaccines that are rolling out at faster rates, we now have healthcare workers volunteering on the front lines to give shots to the public, which gives this surge of hope. Many of us are recognizing and working through our grief and moral injury in our own ways, and for me, it has been a journey back to my bike to get out of my darkest places.
After Dr. Moss spoke, several of my incredible colleagues shared their personal stories and struggles in medicine during the pandemic, as well as how they found their resilience to work toward a new beginning. They dared bravely, in the words of Brene Brown, and allowed themselves to be boldly vulnerable in order to help normalize the struggles that each of us have had to face. In so doing, I am certain they helped save others in the audience, as we all realize our experiences are not isolated but in fact shared, the collective experience as we continue to move through this disaster of the COVID-19 pandemic. Most of all, I recognize now even more than before how much my colleagues, those who spoke yesterday and also the many more who have selflessly served and have fought or are still fighting through the moral injury, truly are heroes. I held my colleagues and friends here in extremely high regard long before the pandemic, but my sincere respect and love for my colleagues has only grown deeper. I am grateful to know so many incredible people here at my institution and in the healthcare community.
In this one year anniversary of the COVID-19 pandemic, please be kind to yourself. If you know someone in healthcare, please give a shout to those who have served. Words of support or thanks right now matter just as much as they did in the beginning of the pandemic. And please join us in this race to the finish line. We are making progress, but our current levels are just now getting below the number of cases at the summer peak and still above the number of deaths at the summer peak, so we need everyone to do all they can to keep up the fight. Please wear a mask, continue to be safe with social distancing, avoid large gatherings, and when you get your chance, get the COVID-19 vaccine, whichever one you are offered. Please don’t stop running this race before we reach the finish line. Doing that will not only help protect you, but help protect your loved ones and our community and society, so we can all return to a better quality of life.