Working in an NYC Hospital During the COVID-19 Pandemic

Most of us haven’t been inside a COVID-19 ward, and it’s hard to fathom what frontline medical workers are experiencing every day.

That’s why I want to share this video with Danielle Ofri, MD, PhD with you.

Danielle is an attending physician at Bellevue Hospital in New York, and she’s worked with COVID-19 patients at the epicenter of the crisis in the US.

We asked her what mental health professionals need to understand about what medical workers are going through right now. I’ll let you hear the answer from her.

Click here for full transcript

In thinking about the mental health needs of health care workers in the setting of this pandemic, there’s a couple of different phases. One was the run-up phase where everyone was just sort of plunging in the sprint, and I would say no one really thought about mental health then. Everyone was so driven then. There was the middle phase which you could either call the plateau or the abyss, depending on on which way you look at it because it really was both, and that was a very sort of long slog and I think that’s when many of the issues began to come up for people but there wasn’t really time to think about them or process them. The issues that came up during the most intense part was the the shock of how sick patients were and how quickly many patients died and how fast things were happening. There really wasn’t much precedent for that, I mean those of us who trained during the time of the HIV epidemic had familiarity with that sort of intense death and destruction feel. I look at our trainees now and this was completely new for them, so it was a very different sense of those who’ve never been at that before to see your patients really mowed down at rates that were staggering and in manners that were staggering. Even for those of us who experienced HIV, the pace was much more intense. I think of it as the HIV epidemic crossed with hurricane sandy and that sort of intense time pressure all together. That’s the thing that I think we need to recognize that many people in healthcare of the sort of younger generation haven’t seen this at all and so many people have seen a few patients die in their career, or over time, but not tens and dozens. That’s really quite existential, I think, for people, nurses, doctors, healthcare aides who really haven’t faced that and really thought about what death means. The first thing is just to approach the sense of what it means when you see a patient die if you haven’t been in a war before, and I think military doctors may be more prepared for this but civilian doctors really aren’t. In terms of how mental health care practitioners can assist with that, part of it is just bringing up the conversation because during the whole time, and honestly even now, there isn’t a lot of space to talk about it. People are talking in little bits and corners and hallways and offline, but there hasn’t been sort of an honest reckoning of what it is meant to be in in this sort of sea of what feels like death and destruction, particularly because the death and destruction feels divorced from what the rest of society is seeing. Everyone else may tune into their governor’s briefings and they see the charts and they see the numbers, but they haven’t really seen those patients and it’s quite a different feeling. I think a lot about the people who are protesting the lockdowns now, and I have sympathy for them, obviously being cooped up is really hard, but if you have never stepped inside the ward or the emergency room, there’s no connection to what’s there. It’s just this number or this order you can’t move out and and so the disconnect of the experience of the healthcare workers having compared with what their friends and family might be experiencing, what the general public has experienced, is quite vast. I think a starting point is to recognize that in many ways, healthcare workers feel a little bit isolated from the rest of society, that we’re seeing this but no one else is. It’s very hard to kind of jive those two experiences together, one unique part of the COVID crisis was the rapidity with which patients declined and the absence of family members to help those patients. Normally when patients are sick and ill and dying, patients have their family, they have other people at the bedside, and so the sense of loneliness was very powerful and healthcare workers were pulled into this role where they normally don’t, I mean nurses and doctors are empathetic and they step in and help, but usually they’re also assisting family members and social workers. Healthcare workers ended up being much more closer to the emotional bone, whether it was by using their phone to facetime with family members, or being the only one there. I’ll share with you during mid April when it was really the depths or the the height of it, I was helping out in the emergency room. We had one half of the ER, another ICU, so I was working there and the patients were just sort of lined up, everyone on a ventilator. Part of it was just the chaos of that we had tons of nurses and doctors from different services, different hospitals, we had ventilators donated from everywhere, so there’s a bit of a chaos feeling. There was one patient whose temperature kept rising like I’ve never seen it, 104, 105, 106, 107, 108, 108.8, which I didn’t even know was compatible with life but it was. We were racing around to get ice packs and we had to put in an arterial line in her wrist, but her wrist was really swollen, she had all these little braided bracelets on and we had to cut them off. I cut them off with suture scissors and I put them in a specimen bag, and I thought what do I want to do with these, and so I stuffed them under the bed with her stuff. I hope her family gets them and part of me thought should I keep them just in case, but it was so chaotic would I lose track of this patient? I wasn’t really on her team, so I just left them under the stretcher. A couple days later she died, and I wondered if those bracelets ever got back to her family. I remember as we were cutting them off the resident and I was looking at them, and the resident said, “This is like the last bit of what’s really her. Everything else is gone. Her clothes are gone, her personality’s gone.” She’s at this point intubated and paralyzed and sedated and this is a set of about eight different bracelets, different colors, braided friendship bracelets and I regret that I didn’t keep them. I wasn’t supposed to do that, but I should have broken the rules, kept them, kept her name, and then I could have put them in an envelope and mailed them to her family. I think everyone has those sort of regrets of those little things you could have done, tiny things, but too much was happening and and I think those small things become places where we put all of our anxiety. Everything that I regret about what I could have done better, or more for my patients, or work longer hours, or whatever we could have done, come into that, I think everyone had a sense of we weren’t doing enough. It took many different roles to make this work, I mean lots of people had to stay home in their houses and call the thousands of patients who couldn’t come to keep them out of the hospital and keep them healthy, but those doctors and nurses felt really guilty they weren’t in the hospital helping the patients. Those in the hospital felt that they weren’t in the ICU and those in the ICU felt they weren’t working overnights and 24 hours a day, and so everyone had sort of sense of guilt they weren’t doing enough. Even when you were doing the most, but you got your day off you’re like I need to go in and I need to check the medical records from home and see what I can, and all of us felt sort of consecutive levels of guilt of not doing enough. I think we need people to speak openly from the top. I noticed a resident posted on twitter about the stress she was having, and then she said but I spoke with my psychiatrist and I’m feeling better now. I was so impressed that she came forward and said that, and that’s really destigmatizing. We need the chairs and the medical directors and the hospital talking about speaking with a therapist or a social worker or a psychologist or a psychiatrist, it’s really helpful. We’d be harming our patients if we didn’t care to this part of ourselves, just like we all get our flu shots and we get them because we don’t want to spread flu to our patients, and so tending to our emotional needs so that we can take better care of our patients. We don’t want to harm our patients by bringing in poorly adapted mechanisms from some other stressful period that we didn’t ever handle, so I think that walking the walk beyond just talking the talk from the top down would really help to destigmatize this. It’s hard to predict what the long-term mental health consequences will be. I remember after 9/11 we thought about how this would be really a permanent scarring on patients, on staff, on the community, and it seemed we would never heal from that. It was amazing to look back and see that people somehow managed to do that and I think they will again from this. The same with HIV, the thing with hurricane sandy, and all the various calamities and tragedies that we’ve faced. I think the recognition that it is a marathon and that COVID will certainly be there, even as we release from the lockdowns, and get past this peak it’s not going away, it’s not going to disappear, and so it’ll be there in the fall when people’s attention are on something else. I think maybe health care workers will start to feel a little bit ignored then, like oh everyone is on to something else, like we’re on to the elections, and but we’re still battling COVID here. Maybe setting systems in place to be there in the future, recognizing that there will be effects. What those effects are are hard to say but certainly many trainees and younger healthcare workers were very frightened by this and maybe don’t have a language to articulate that and how that might affect their choice of career, the choice of how they practice, what they ultimately choose to do. You may be influenced by this. We’ll need people there to just help guide that anxiety and distress that’s come from this. We may not yet know where it lands. The other thing I’ll put a plug for is the role of humanities and the arts in dealing with all of the emotions and in helping us smooth the edges of our practice. I’m slightly biased because I’m going to bring up the Bellevue Literary Review, this is our literary journal we publish from Bellevue and it’s fiction poetry and creative nonfiction about health and healing, open to the general public and we publish twice a year. We try to find things that people would find helpful to think about, things you might not have thought about, like the first patient who died on you, the first time you were afraid, and using creative ways. I think that music, arts, art literature really play a role, so much of medicine presented in the textbooks feels very straightforward, but the practice of medicine is filled with ambiguity in shades of gray and we have such discomfort and ambiguity in medicine. We want evidence-based medicine, but real people and real conditions are very ambiguous and so it’s profoundly unsettling and we don’t get much training in how to deal with ambiguity, but great works of art and literature and music specialize in ambiguity and shades of gray. That’s what makes them so fascinating, interesting in dissecting metaphors. Poetry is a way of looking at the complex things that don’t fit into easy boxes, so I would certainly encourage all of our mental health efforts, wellness efforts to incorporate the arts, music, literature, and the humanities because they treat a part of the issues we’re facing that don’t come in through the journals and textbooks.

In addition to her work as an internist, Danielle is also author of several books, including When We Do Harm: A Doctor Confronts Medical Error and What Doctors Feel: How Emotions Affect the Practice of Medicine. If you’d like to find out more, go to danielleofri.com.

Now we’d like to hear from you. Please tell us your biggest takeaways from the video below.

If you found this helpful, here are a few more resources you might be interested in:

When the COVID-19 Pandemic Leaves Us Feeling Helpless, with Bessel van der Kolk, MD

COVID-19 Frontliners and Moral Injury

What Can Help COVID-19 Frontliners Who Are Exhausted and Overwhelmed?

53 Comments

David Glover, Nursing, CA says

Thanks Dr. Olfi, I am an RN redeployed to Front Line. It has been extremely stressful not only on me but also my family. Your video was very validating. Thank you.

Kat Vikingson, Social Work, Silver Spring, MD, USA says

This was very compassionately spoken. As a case worker during the AIDS epidemic and the COVID pandemic the suffering of healthcare workers is something you cant go home and talk to with your family and friends. I’ve struggled with getting back to the marathon ..after this very long hard dash. Intrusive thoughts and sensations prevail. Who am I as a result of this?? Who will I become as a result of my experiences? Your clarity was very helpful!

« Older Comments

Please Leave A Comment Cancel reply

53 Comments