On days when his emotions seem like too much to bear, Dr. Zaher Sahloul takes the scenic route to and from work.
“I look at the trees and the lake, and that gives me some relaxation and helps me unwind,” he said.
He’s unwinding from a day at Saint Anthony Hospital, on Chicago’s West Side where he works in the COVID intensive care unit as a pulmonologist. There, he has faced days of losing patients, days when his years of training and experiences don’t seem enough to change that.
“Basic health principles are different [right now],” Sahloul said. “Your main concern is ‘Which patient I should direct my attention to because they are more likely to live?’ instead of giving all the energy to every patient. We can’t afford to do that when you have a pandemic like this.”
Experts point to those feelings of helplessness, of being demoralized, as signs of potentially increased levels of anxiety, depression, or even lasting post-traumatic stress disorder among physicians and other frontline workers who are working through the unpredictability of the pandemic.
“It’s a war zone”
Some physicians say the anxiety they feel started in part because of a shortage of personal protective equipment, or PPE, as the crisis first unfolded. Sahloul compares working in the pandemic to his time on medical missions during war in Syria.
“Many of the doctors that I worked with in Syria ended up killed while they’re on duty because they weren’t protected from bombs,” he said. “[Now] we have physicians and nurses dying in the United States … because of lack of protection. When you go to the COVID unit, it’s a war zone.”
The lack of protection can play a role in how traumatic the work feels for physicians and nurses, according to Alexa James, the executive director at the National Alliance on Mental Illness, Chicago.
“One of the ways to mitigate trauma is to make sure that people are really well prepared, and particularly in the workforce, to make sure that they have all the tools that they need to do their job,” James said. “Powerlessness is the baseline for trauma, so when you don’t feel protected, we can be more prone to a negative experience that feels like trauma because we feel so powerless.”
But while the lack of PPE might be unique to COVID, the high-intensity environment is not new. And it’s creating an age-old response that’s perhaps keeping doctors and nurses going during this time.
“I call them the fire alarms in your brain,” said Dr. Joan Anzia, a psychiatrist who’s treating health care workers at Northwestern Medicine. “The two organs called the amygdala — those are there to alert us to threats or danger” and your body then releases adrenaline “so that you’re ready to move into the fight or flight mode.”
That adrenaline rush, Sahoul and others say, will keep doctors and nurses fighting through everyday challenges of the pandemic. But Anzia says it can only last so long.
“This is not a one-hit disaster”
On top of being on the front lines of the crisis, health care workers are dealing with personal stress: not enough toilet paper, distance from friends and family, homeschooling kids and uncertainty about when it will all end.
“The load of the stress is really going to reach that person’s breaking point no matter how resilient folks are, and physicians are some of the most resilient people on the planet,” Anzia said. “They are going to start to experience burnout, fatigue, feel depressed, wake up not wanting to go to work and then feeling guilty about it.”
She expects the immediate fallout to be significant, pointing to a study in China that found “a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing.”
Among 1,257 people surveyed in China, 50% reported symptoms of depression, 34% reported insomnia, 45% reported anxiety and 72% reported general distress.
“So we anticipate that the rates [here] are going to be high,” Anzia said. Still, she added, the majority of nurses and physicians will likely overcome those challenges in the months following the pandemic.
But health care workers, hospitals and mental health experts across the city are trying to find ways to manage the stress and anxiety that, if left unaddressed, could be long-lasting for some.
At Northwestern Memorial Hospital, where Anzia works, it’s now a nurse practitioner’s full-time job to help health care workers breathe, stretch and meditate throughout the day. The hospital has started daily stretch, meditation and even essential oil sessions for COVID-unit teams.
Northwestern is one of several hospitals that have ramped up mental health services to their staff amid the pandemic. Rush University Medical Center has implemented “reverse rounding,” where psychiatrists make rounds to COVID-unit health care teams each day to check in on their mental health and take appropriate steps if someone is in or anticipating a mental health crisis.
But experts say stress, anxiety and trauma might be felt the greatest at under-resourced hospitals that are short-staffed, short on equipment or can’t implement new robust mental health services in response to the pandemic.
And outside of that, those trying to help have to contend with a profession that for decades did not make mental health a priority.
“We have this mindset of like: Gather yourself, keep going. And that is the culture of medicine,” said Dr. Meeta Shah, who works in the emergency department at Rush. “It’s this concept of: I don’t want to look weak. I just think that, unfortunately, it is the culture we’ve created.”
Shah said she and her team go against the grain — she’s relied on close workplace relationships for support, along with daily exercise and breathing breaks to alleviate stress and anxiety brought on by the pandemic.
And experts say small efforts — such as taking the scenic route to and from work —will go a long way in helping prevent long-term effects of trauma.
But at the end of the day, Anzia says one of the biggest barriers is that frontline health workers are used to putting others’ well being first.
When a health care worker Anzia talks to is reluctant to get help, she offers them this:
“I say to them, … ‘Listen, you are terrific. You are doing an amazing job,’” she said. “‘And you deserve the very best care. You deserve it. You are providing and giving so much to other people, but you need to put on your own oxygen mask first.
“‘Let’s see what we can do to help you take care of you and help you feel better.’”
Mariah Woelfel is a reporter at WBEZ. You can follow her @MariahWoelfel.