A nurse examines a patient who was admitted to the Regional Medical Center emergency room in San Jose, California on May 21, 2020. Frontline workers continue to care for coronavirus COVID-19 patients across the San Francisco Bay Area.
Justin Sullivan | Getty Images
DETROIT – Intensive care nurse Kelsey Ryan wakes up suffocated at night and experiences the trauma of treating – and losing – patients during the peak of the Michigan pandemic in the spring of Covid-19.
In her dreams, she is lying in a hospital bed and cannot breathe while her colleagues from Beaumont Health on the Detroit Metro press a breathing tube down her throat.
"I still have nightmares every night. My manager and my best friend at work put a tube down my throat while I cry and beg them not to do it, just like all my patients. I wake up suffocated," said the 28-year-old nurse in Michigan.
Ryan was also a Covid-19 patient after she tested positive in late March, but she was able to recover at home without being hospitalized.
She lost more patients in March and April than in the past six years. For nurses like Ryan, the climax of the coronavirus pandemic felt like war, she said. And similar to a soldier with post-traumatic stress disorder or PTSD, she had a scarred psyche and nightmares.
"It was a little shock. Everything happened so quickly. We just didn't have time to deal with everything that was going on," said the mother of two. Life and death decisions about who would get a ventilator were made in seconds and several times a day. "It literally felt like we were at war."
She and her colleagues "need a lot of mental health support," but until recently she had no time or energy to deal with it. Since then, cases across the state have decreased and the hospital system has been less overwhelmed with Covid 19 patients.
Kelsey Ryan, a nurse at Beaumont Health Systems in Michigan.
"I know it changed me and it will change forever," she said. "I coded and intubated more patients in three weeks than in intensive care for six years."
Ryan is not alone. Healthcare workers are fighting a new battle against the corona virus as many struggle with PTSD, which can include flashbacks, nightmares, and extreme anxiety. Many have experienced more deaths than soldiers during the war, with the corona virus killing more than 120,000 lives in the United States alone.
Anyone suffering from severe depression or thoughts of suicide should seek help. The National Suicide Prevention Lifeline is open 24 hours a day, 7 days a week at 1-800-273-8255 or by text "HELLO" at 741741.
Many doctors and nurses with less severe symptoms are anxious and stressed, and are still afraid to spread the disease to family members. They are also concerned about a resurgence in cases where states are allowing more and more companies to reopen, and the financial burden on the economy, the health authorities say.
"The pandemic and its impact on healthcare workers and the general population were significant," said Dr. Lisa MacLean, director of wellness at Henry Ford Health System in Michigan. "In this recovery phase, we now notice a lot of exhaustion, guilt, anger and these PTSD-like symptoms – nightmares, a look back, a feeling of reliving the events."
At the height of the pandemic on April 7, Henry Ford treated 863 Covid-19 patients. That number had dropped to 13 to start this week.
The corona virus has emotionally strained the country, but according to a Kaiser Family Foundation survey, no one was affected more than front workers and their families. About two thirds of those living in a household with health workers said they had at least one adverse effect on their mental health or well-being. That is almost half of all Americans.
In Covid-19 hotspots such as Detroit and New York, where patient health systems have been overcrowded, hospitals offer contact programs, interventions, and support groups for workers. They started peer-to-peer groups and online programs with access to personal support from mental health experts and psychologists.
Mental health crisis
But not everyone could be helped in time. After the suicides of two New York health workers in April, Mayor Bill de Blasio said US military trauma specialists would support the city's frontline workers. In recent months, the city has expanded its efforts to help citizens, many of whom could not afford advice. De Blasio called it a "mental health crisis within the crisis".
Dr.'s father Lorna M. Breen, a Manhattan doctor who committed suicide, told the New York Times that she "described devastating scenes of the toll the coronavirus took on patients."
"She tried to do her job and it killed her," said Dr. Philip C. Breen, her father, to the newspaper.
The hospital system in which Breen worked, the New York Presbyterian Allen Hospital, began offering support programs for employees in March, according to a spokeswoman for the hospital. This includes team-based crisis support, urgent counseling services and a "Psychiatric Symptom Tracker and Treatment Resources (START)" that employees can use to monitor their symptoms of depression or anxiety and whether they are developing over time.
According to the NewYork-Presbyterian Allen Hospital, more than 1,800 sessions were held with more than 10,000 of the 47,000 participating hospitals. The system declined to comment on whether Breen was looking for help.
"Acknowledging that our colleagues were under constant stress and anxiety, NewYork-Presbyterian began offering robust front-line psychosocial services, including an urgent counseling service, to all frontline workers," Williams said in an emailed statement. "While we hope to face the worst of this pandemic, it is important that our frontline colleagues continue to have access to emotional support and practical strategies to help them deal with their experiences."
Dr. Anne Browning, vice dean of wellbeing at the University of Washington Medical School, said it would take about one to three years for healthcare workers to emotionally recover from Covid-19.
"Some relive the hardest moments of their days and months in their dreams," she said. "It can be incredibly annoying."
On May 12, 2020, medical personnel at the Scripps Mercy Hospital intensive care unit in Chula Vista, California, USA, looked after a patient with Coronavirus disease (COVID-19).
Lucy Nicholson | Reuters
In Washington State, the first hotspot for Covid-19 in the United States, hospital systems such as UW Medicine and EvergreenHealth were quickly mobilized to help their workers who were struggling with stress and anxiety. They launched peer-to-peer support systems, coping resources and other online tools, and personal advice.
According to Dr. Joy Hampton, director of care management at EvergreenHealth, aims to use various communication and contact methods to reach as many employees as possible in their preferred manner.
"The teams are suffering from critical illness and death that most of them have never seen before," she said. "In general, people are a little bit different."
EvergreenHealth, which handled the nation's first Covid 19 outbreak, offered online resources to deal with stress and other issues in March, followed by team leaders and live webinars. The online conferences made it possible for those who wanted individual help to get in touch.
The hospital system has also launched a website called "55 Word Stories" where employees can submit their thoughts anonymously. The page contains comments and issues related to Covid-19, including some poems.
Dr. Anne Browning, Deputy Dean of Wellbeing, UW School of Medicine
UW School of Medicine
Browning and her team at UW Medicine have focused on helping employees cope with anxiety, stress, and insecurity of the disease for which there is no cure and where a vaccine is months, if not a year or more, away .
Fortunately, in January – weeks before Covid-19 – UW Medicine set up a peer-to-peer counseling program to help with regular burnout. This helped workers cope with the pandemic stress, Browning said. The system also launched group and online counseling, including zoom sessions for family members.
"We have recognized that people's anticipated fear definitely spills over to their families and affects the well-being of their family members," she said.
According to Henry Ford's MacLean in Michigan, one of the hardest things to do is to reach people who bottle their feelings or pretend they're okay when they're not. This can lead to depersonalization, in which the person feels detached from their body or tries to numb the pain through self-medication.
Henry Ford has launched a new mental health program that focuses on six goals: process feelings related to the pandemic; Alleviate suffering; Confirm feelings; teach about post-traumatic growth; Avoid getting stressed out. Reduce future traumatic reactions and learn new coping strategies.
"Our employees are currently experiencing enormous mental stress and it is our responsibility to help them," said Dr. Betty Chu, Associate Chief Clinical Officer and Chief Quality Officer at Henry Ford.
Ryan is the same with her patients at Beaumont Hospital in Michigan. When she discusses what happened and why she will continue to work despite the potential of a second wave, she says, "It's my job."