The Despair of Physicians/Nurses in the Face of COVID-19
A Virus That Is Defeating Even the Most Dedicated Medical Professionals
Fresh from the rigors of medical school and their clinical training, they came with the belief that they would adhere to the oath of “first do no harm.” Never did they suspect that harm or death awaited them, not only their patients.
Medical residents and attending physicians, as well as nurses, both recent graduates and highly experienced, are now among the numbers who have been victims of COVID-19. Some have been cut down even before they set out on their healthcare careers.
Schools dispensed with graduation for them to put these fresh troops on the deadly line. They were the canaries in the mine that should have warned us how lethal and unforgiving this virus can be for anyone. COVID-19 stops for no one, no matter their age, sex, or status in the medical community. And it is tearing at the very heart of that community with staggering results.
The Statistics of Death and Dispair
Medicine has always been a demanding and rewarding career at the same time, but with this virus, the rewards can be too few and the death too many to endure. The situation related to physician burnout and suicide has been well-documented, but now the situation is worse.
“We are already seeing large numbers of health care workers having to self-isolate or otherwise withdraw from the front line through illness or sheer exhaustion, and this is no doubt exacerbating the already critical workforce shortages…Burnout, however, is likely to become even more of an issue unless we take remedial action and we need to do this with speed, as otherwise the diminished ranks of people in the front line will be denuded further which of course will lead to further exacerbation of an already critical situation.”
When a situation such as the COVID-19 pandemic is present, and medical personnel has inadequate PPE (personal protection equipment) at a time when there is an inundation of seriously ill patients, a situation of moral distress is created. As explained in the literature, this is “when a nurse knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” But it’s not limited to nurses. Any healthcare professional can suffer from moral distress.
Even chiefs of emergency rooms are prone to the despair, depression and suicidal thinking COVID-19 brings. The recent deaths of a woman ER chief and a new EMT are evidence of how the mental stress’ toll spreads a wide swatch in the medical field. No one can consider themself above it because stress is the thief in the night who strikes without notice.
Moral distress can lead to a sense of despair, depression, and guilt with feelings that they should have been able to save a patient. It is a war of a different type, and not all of the medical care should be patient-directed.
The increase in burnout is multi-factorial. “Given the scope of the pandemic and all of the factors surrounding it, the hard truth is that it may be impossible to avoid some level of burnout or long-term trauma…The overwhelming number of patients and the severity of their needs are requiring palliative care teams to deliver care outside of their established patterns.”
Staff is regularly called on to tell loved ones that a patient died, and they have to do it over a phone. In this highly impersonal setting, they tell the relatives that they cannot see dying patients because of the high rate of viral infection. The relatives then direct their pain at the staff member on whom they lay blame for the death. Even years in medicine cannot prepare someone for this day in and day out when hundreds die each day.
Physician Suicide Not During a Pandemic
“Current literature suggests mental illness and burnout are epidemic in physicians and medical trainees. One study found 20% of medical residents met criteria for depression, while 74% met criteria for burnout. Burnout — different from but correlated with depression — refers to the triad of emotional exhaustion, depersonalization, and feelings of inefficacy resulting from chronic work-related stress. Yet even with high rates of illness and knowledge of mental illness gleaned from their own coursework, physicians and trainees rarely seek treatment. The trend starts early: per Rotenstein et al., while 27.2% of medical students exhibited depressive symptoms, only 15.7% percent sought treatment.”
How could the COVID-19 pandemic not put our cadre of healers at greater risk of suicide and burnout? It would appear it’s a given, and the wave of destruction may not come until after we see the light at the end of the pandemic tunnel.
Pamela Wible, a physician who specializes in helping suicidal physicians, has offered her thoughts on physician suicide. “Suicide is an occupational hazard in medicine. Doctors develop on-the-job PTSD, especially in emergency medicine. Patient deaths — even with no medical error — may lead to self-loathing. Suicide is the ultimate self-punishment.” The ER during the current pandemic is more active than ever. What might be the result?
We must protect our protectors. But who will do it? How can we create an environment of acceptance that the pandemic caused thoughts of suicide, depression, and burnout to flourish?
There is no question that we must succeed in this because we need them now and we’ll need them in the future. Reports are that this virus will NOT go away, but may come in waves and will not be seasonal. Singapore has a temperature in the 90s, and it is experiencing its third wave of COVID-19.
