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Last January cardiac critical care physician Umesh Gidwani, M.D., attended a retirement celebration for a colleague at Mount Sinai Hospital in New York City. The retiree was a 62-year-old intensive care unit nurse who had been with the hospital for 35 years.
"We did a beautiful party for her at a waterfront restaurant,” Gidwani recalls. “There were speeches and gifts, and her family was there. We thought she rode off into the sunset.”
In March, however, his colleague was back in the ICU — this time as a COVID-19 patient, intubated, on a respirator and fighting for her life. Weeks later, she was one of the lucky ones, extubated and sent home. But health care workers in COVID-19 hot spots across America are caring for, and often losing, not just patients they had never met before but also friends, family and, in some cases, colleagues with whom they have been fighting medical battles side by side. And that can be both physically and emotionally exhausting.
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Jodie Freid, a licensed mental health counselor in Natick, Massachusetts, says that while it may be too early to diagnose PTSD in her clients who are frontline workers, she is seeing plenty of fatigue and mental health conditions, including depression, generalized anxiety disorder, panic disorder and insomnia.
Unprecedented caseloads, anxiety and grief
Little could have prepared health care workers in hot spots around the country for the kind of adrenaline rush that would accompany the surge of patients in ICUs last March, according to Keith Rose, M.D., director of the critical care division in the department of medicine at Hackensack University Medical Center in Hackensack, New Jersey. “Everyone was working double time to try to care for really sick people,” he says. “It was early and it was new, and everyone was getting it done. Our team did an amazing job, and so did the hospital. It was really impressive.”
But as time wears on and the number of deaths rises, Rose says he's seen staff members becoming overwhelmed, taking breathers in the stairwell or walking outside to collect themselves on a difficult day. “Most are very stoic and say they're fine, but underneath it all you never really know. You can be stoic, but if you're a human being and you've seen a lot, you definitely have to have some feelings about that.”
The National Suicide Prevention Lifeline offers free and confidential support 24/7 at 800-273-8255.
Beyond the strain of trying to keep an influx of very sick people alive and losing so many of them, there are other stressors: economic concerns, additional home-life responsibilities, such as child care, as well as the sadness that comes with being unable to perform the usual rituals for the dead, like gathering at the bedside for a moment of silence and then doing a mental health check on those involved in the patient's care. “It's so sad to see the absence of these rituals, because they have meaning,” Gidwani says. “They are a process of closure, but there is not time and no practical way to do them now.”