5_5_2020_DOCTORS_NURSES_MENTAL_HEALTH_COVID_CV_16x9 (1)
CREDIT: Images from Getty | Collage by Cathryn Virginia
Health

Panic Attacks and Sleepless Nights: Doctors Are Secretly Starting to Struggle

Doctors and nurses treating the coronavirus are increasingly worried about their deteriorating mental health and unsure who to talk to about it. "I think about COVID during sex," one doctor said.
12 May 2020, 6:38am

This article originally appeared on VICE US.

Maya woke up drenched in sweat. It was April 3, and she had just read an article that had shaken her to the core. New research indicated that blood clots could lead to potentially fatal COVID-19 complications, a scientific discovery that frightened Maya, who is genetically predisposed to blood clots herself. Now, there she was, in her home, shaking, and struggling to breathe. “I’m either having a panic attack or I have coronavirus,” Maya remembers telling her husband.

It was a panic attack—just the second of her life. And the concern was warranted. Maya is an emergency room doctor in her 30s at a New York hospital, and by then she had been treating COVID-19 patients for weeks. It had become increasingly clear just how many “young, healthy people”—around her age—“were coming in with serious disease,” she said. The prospect of contracting a virus that could kill her had already started to wear on her; the blood clots simply put her over the edge.

She didn’t hide her panic attack at work. In fact, she told everyone about it. “But I made a joke about it,” said Maya, who like most of the health care workers in this article, asked that VICE not use her real name.

“Many people here think it’s a sign of weakness to outwardly display anxiety or depression,” she explained. “We’re supposed to bottle that up and make jokes about it instead.”

"I’m either having a panic attack or I have coronavirus."

For a while now, Maya has quietly struggled with the mental effects of fighting the novel coronavirus. “You come home from work and it’s not like you can forget about everything that happened,” she said. “Sometimes, I think about COVID during sex.”

By early April, Max, an ER doctor at Elmhurst public hospital in Queens, was only able to sleep two to three hours a night because of his anxious thoughts about the virus, which had ravaged the patients in his hospital, at one point killing 13 people in one 24-hour span. When he did sleep, the coronavirus seeped into his dreams too, with patients replaced by family members and co-workers. “In one shift, I would put a dozen people on ventilators,” he recalled. “And half of them ended up dying.”

The worst part, Max said, was that the dreams might as well have been real.

Health care workers like Maya and Max may be more familiar with death than the general public, but they are far from immune to its effects. That’s especially true for those in emergency medicine. Even before the pandemic, studies found that about 18 percent of all nurses and 16 percent of emergency room physicians met the diagnostic criteria for PTSD, compared to 7 or 8 percent of the general U.S. adult population. Physicians, in particular, have long struggled with mental health issues. In fact, according to researchers at the Harlem Medical Center in New York, they have among the highest rates of suicide of any profession.

Do you have a coronavirus story you want to tell? Fill out this form or reach out on Signal at (310) 614-37552 and VICE will be in touch.

Already, signs are emerging that the coronavirus pandemic could exacerbate the problem around the world. In one early study on the coronavirus’ effects on health care workers in 34 hospitals throughout China, 34 percent reported insomnia, 45 percent reported feelings of anxiety, 50 percent of participants reported symptoms of depression, and more than 70 percent reported general distress.

Anecdotal evidence indicates the impact will be similar in the U.S. The death by suicide of Lorna Breen, an ER doctor who had been treating COVID patients at New York-Presbyterian Allen hospital in New York City, brought attention to the mental toll the virus is taking on health care workers. VICE spoke with eight medical workers on the frontlines of the COVID fight in New York—six doctors, one nurse, and one EMT—about how the pandemic is affecting their mental health. They described experiencing new levels of chaos, tragedy, and stress in a workplace where mental health challenges are stigmatized and seen as a sign of weakness.

“Health care workers already have high rates of PTSD,” said David Reiss, a psychiatrist and trauma expert. He expects these rates will dramatically increase in the wake of the pandemic. “These are extenuating circumstances, even for health care workers used to seeing trauma and tragedy,” he said.

Hospitals seem to be aware of the risk to their staff. Every hospital employee VICE spoke with said that their hospital was offering mental health support to employees and actively encouraging staff to talk to professionals. But while the offer was appreciated, not one health care worker said that they had taken the hospital up on the offer. Some worried that, because the therapists were hired by the hospital, any negative comments they made about their employer would find their way back to the administration.

Health care workers say that the culture in medicine—and especially among physicians—never lent itself to emotional vulnerability. Multiple people described emergency medicine as a “macho” field, regardless of gender. Reiss said the inherent stress involved requires some people to compartmentalize their feelings and strengthen their emotional defenses. But that creates an environment in which people who might be struggling with anxiety or depression don’t seek out mental health resources.

“There’s definitely an unspoken sense of shame or weakness when you admit you need help,” said Sonya, an emergency medicine resident at a hospital in New York City. “And then there’s this sort of self-loathing, like why is this affecting me more than anyone else?”

Every hospital employee said that their hospital was offering mental health support. But not one had taken the hospital up on the offer. Some worried that negative comments they made about their employer would find their way back to the administration.

Allison, an ER doctor at a hospital in New York, explained, “In residency, you learn not to complain about being sleep-deprived, or about your patient load, or feeling overwhelmed. So when you get to the point where you’re depressed, you fall into the same thing of just not talking about it.”

In a lot of ways, the specifics involved in treating coronavirus are a perfect recipe for PTSD. The virus is potentially fatal, highly transmissible, and, critically for health care workers, largely unknown and next to impossible to treat right now. Health care workers aren’t learning about this virus from a medical textbook. They’re figuring out how it kills in real time—every time one of their patients dies from it, or they do. Already, two dozen health care workers have died from the coronavirus in the U.S.

“You’re paranoid and worried all the time,” said Avir Mitra, an emergency medicine specialist at Mount Sinai in New York. “Even something as simple as eating a five-minute snack, there’s this whole process like how do I take my gown off so I can safely put it back on?”

The reality of how difficult treating a novel virus would be didn’t hit Maya all at once, but rather in drips.

Initially, Maya and other hospital staff were lax with personal protective equipment, simply because they didn’t realize they were dealing with COVID patients. “We didn’t understand enough,” Maya said. On March 11, Maya herself saw a patient who was in the ER for a kidney stone. The patient had no fever and no cough, so she went in to see her without a mask. When Maya found out that the patient had COVID, she realized that going forward, she would have to be hyper-vigilant at all times. Not every patient was presenting with the symptoms the health care workers had been told to watch out for, but many of them had contracted the virus anyway. “That started getting scary,” Maya said. “We started realizing that virtually every single patient had COVID.”

"You’re paranoid and worried all the time. Even something as simple as eating a five-minute snack, there’s this whole process like how do I take my gown off so I can safely put it back on?"

“It’s horrible,” she added, “to think of our patients as a threat.”

Other doctors and nurses have struggled to grapple with the distance they need to keep from their patients. Rather than standing by their bedside, some doctors and nurses are only able to talk to their patients on the phone from elsewhere in the hospital to minimize in-person contact.

Not being able to touch patients’ flesh or have the patient see her face is one of the hardest things for Vanessa, a critical care physician at a hospital in New York. “Call me old fashioned, but I didn't always wear gloves like I should [before COVID],” Vanessa said. “I want to make sure patients can feel me there—that they have another human being beside them. Now, I don't get to do that as much and that's tough for me.”

The lack of contact is an added stressor for the critical care physician—something that can make a terrible situation feel next to impossible. Recently, one of Vanessa’s own co-workers was admitted to the hospital with COVID-19.

“That was pretty rough,” she said. “Not only is someone I care about very sick—like, ‘Doesn’t know if there’s going to be a tomorrow’ sick—I can’t physically go comfort him and have that very human connection.”

Even if she could, there is very little that could actually be done. Doctors and nurses largely feel unable to actively help their patients get better, since there are still no drugs formally approved to treat the disease, or proven to have any success in treating it. All hospitals have is “supportive care, like ventilators,” Allison said. “And you know that 80 percent of people aren’t going to get off the ventilator. You know that most of the people are going to die on this machine that you’re putting in their throat.” Such a sense of helplessness can often be a painful catalyst for developing PTSD.

The lack of a “pandemic playbook” for hospital staff prior to the surge of coronavirus patients only added to the initial stress, the doctors said.“You really got the sense that there wasn’t a plan,” Mitra said. The hospital’s response has now improved, Mitra added, but the deluge of constantly new and changing information about the inscrutable virus has made it difficult for doctors not to second guess themselves.

“We have decades and decades of treating the flu, appendicitis, heart attacks. And now all of a sudden, you’ve taken our expertise and thrown it out the window,” Max said. “Every week we learn something new and have to modify how we’re treating it.”

“I had one day that was just absolutely awful,” said Sonya, the emergency medicine resident. The onslaught of patients left Sonya no time to call three to four patients’ families to tell them that “not only was their loved one in the hospital, but they’d had to have a tube down their throat.” By the time she did have a minute to call at the end of her shift, every single one of the patients had died. “I think that’s the part that I regret the most,” she said. “We just didn’t have time.”

Sonya said she’s still struggling with the guilt and frustration of what she wasn’t able to do. “Sometimes, patients would lose pulses just after I intubated them. It essentially felt like I killed them,” she said. “It’s frustrating because all of these patients deserved more time, attention, and treatment than we could possibly give them.”

For Amanda, an EMT who transports COVID patients in New York, it’s the nights that get her. In an attempt to keep her family safe, she has moved into a hotel room where she spends what’s left of her free time.

“Once the day is over and you’re back at your hotel room, alone with your own thoughts, you just feel sad,” Amanda said. “You wish there was more you could do or could have done. There’s a feeling of helplessness.”

Many others are doing the same, renting apartments or staying in hotels that are sometimes made available by the hotel at no cost to the health care worker. Not having the ability to be comforted by loved ones at night can exacerbate the trauma they endure during the day. In one study of health care workers in Toronto during the SARS pandemic of 2002-04, “personal isolation” was among the factors listed as sources of “extreme emotional distress.”

“My off days are the worst,” Max said. “I’m just alone in my apartment trying to process everything I’ve seen and figure out how this happened.”

Those who do head home have to live with a fear that they might infect their families. Even though she takes every precaution she can, it’s hard for Maya to know that because she’s around COVID patients all day, “I’m a threat to my family and friends.” She has a cardboard box at the front entrance of her apartment and every day after work gets completely naked immediately after entering her front door.

“I’m a threat to my family and friends.”

“[The box] is where all my COVID-covered clothes stay for a few days until we do the laundry,” Maya said. “Then I immediately run into the shower and use surgical grade scrub on all the skin that was exposed.”

The SARS pandemic gives us a small window into the mental health challenges health care workers are likely to develop before the end of the pandemic. A study published in 2009 in the Canadian Journal of Psychiatry surveyed hospital employees who worked at a Beijing hospital during the outbreak. It found that 10 percent of respondents experienced high levels of post-traumatic stress (PTS). Those who “had been quarantined or worked in high-risk locations such as SARS wards, or had family or friends who contracted SARS were two to three times more likely to have PTS symptoms than those without these exposures.” A different study, published in General Hospital Psychiatry, found that 41 percent of health care workers and SARS survivors have PTSD.

The study’s authors concluded that SARS was “a mental health catastrophe.”

Such a catastrophe can have a lasting impact on health care workers’ personal and professional lives. The Toronto study compared the mental health outcomes of health care workers who treated SARS patients against those who didn’t. Researchers found that those who worked in hospitals that treated SARS patients had “significantly higher levels of burnout, psychological distress, and posttraumatic stress.” Further, they were more likely than their counterparts to report “behavioral consequences of stress,” which can include developing a substance use disorder, changes in appetite or sleeping patterns, and avoiding responsibilities.

“When you’re in survival mode, you’re not really ready to process it.”

At least in New York, it appears that COVID hospitalizations are declining. On May 2, Governor Andrew Cuomo announced that COVID-19 hospitalizations had hit the lowest number since March 29, when 9,517 people were hospitalized. At its peak on April 12, the number of new COVID-19 hospitalizations in New York was 18,825.

“When this started, it felt like the virus was always two steps ahead of us,” Mitra said. “Now, it finally feels like we’re winning.” But as the deaths fall, some health care workers are left with the lingering trauma of what they went through.

“Right now, most of those health care workers are in survival mode,” Reiss said. “When you’re in survival mode, you’re not really ready to process it.”

Reiss said there is no substitute for professional help. But for now, emergency medicine providers are coping the best way they know how—with more gallows humor. “My friend at work made a meme in which the punchline was ‘funeral expenses for health care workers,’ and we cracked up over that,” Maya said.

“When I posted it on Instagram, all my health care worker friends laughed at it,” she added, “and all my non-health care worker friends sent the sad emoji.”