Like many people who contract COVID-19, said a New Jersey–based doctor treating people with the virus, the patient was struggling to breathe. Every day the doctor checked a list of names to see if she was still alive. Her breathing tube gradually became clogged with “thick, brown secretions.” Her body was “breaking down” with each passing day: “kidney failure, abnormal electrolytes, a pneumothorax from high peak airway pressures blowing out her lungs.” On the day she was intubated, the doctor “told her she would be okay, knowing that she had a high chance of never making it out of that 10×10 room.”
Dealing with death is customary for doctors and nurses—they are trained to handle difficult situations, in maintaining bedside manner. But for many the coronavirus pandemic is different. The sheer volume of patients, in combination with a high mortality rate and a virus that’s highly contagious, means that medical workers are often faced with multiple deaths a day while contending with the most stressful work environment of their careers.
“The hardest part has been when patients come in already in severe respiratory distress and get intubated, or are already intubated and in severe shock,” said Dr. Nicholas Caputo, the associate chief of the department of emergency medicine for NYC Health + Hospitals/Lincoln. “These patients tend to crash quickly. They are difficult to resuscitate—most you can’t. Then you have to make a call to a family that may not be expecting [it]. You inform the person on the other end. Almost as if on cue, the phone drops and you hear screams, crying, shouts of, ‘No, no, no…’ You listen to the anguish, but you don’t hang up because you still need to offer guidance on next steps. Inevitably someone picks up the phone: ‘I’m sorry, doctor, what’s next?’ A lot of phones were dropped over the last few weeks.”
As other reports have detailed, those dying of COVID-19 almost always die alone, without support from loved ones or friends. This has proven especially difficult for many doctors and nurses to cope with as they become a primary means of emotional support. “One of the first COVID patients we had did not survive,” said a Mississippi doctor treating COVID-19 patients. “It was a couple—his wife survived and he did not. They were across the hall from each other. Their families could not visit. There came a time when there was nothing left to do.”
Dr. Caputo recalled using FaceTime to communicate with a young patient’s family just before intubation: “I held my phone above the semi-recumbent patient. The family was trying to reassure the patient that they would be there when the patient was better…. The patient could only get out three words: I love you. I wasn’t able to hold my tears back. It hasn’t become any easier with time.” He added, “I’m not sure anyone could truly understand what the doctors and nurses went through…I was emotionally and physically drained. I felt like my soul was crushed.”
Dr. Michael Osterholm, regents professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told me medical professionals are “in the middle of a war zone. Their entire world is about this battle. My God, are they brave.” He added that the “problem I have had is communicating that this is a long-term encounter with this virus. We are in this for 16-18 months if we are lucky enough to get a vaccine…What’s going on is just a warm-up.”
If the timeline stretches on, the potential psychological toll of COVID-19 on the medical community could be tremendous. “We are already seeing signs that this pandemic is having a tremendously adverse psychological toll on doctors and nurses,” explained a New York–based doctor. “A study of doctors and nurses from Wuhan showed high levels of depression and anxiety among COVID-19-treating physicians. I’ve heard from my frontline colleagues that the hardest part of taking care of COVID-19 patients is watching them succumb to the disease, and [the knowledge that] they cannot help the patient no matter what they do. That helplessness can significantly contribute to moral injury and worsen the psychological burnout.”