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A Career No Physician Ever Expected To Die For

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Coronavirus. Doctors. Nurses. PPE. Social distancing.

Sound familiar? Our entire conversation about the COVID-19 pandemic surrounds those words and phrases. We see celebrities, companies, coworkers, family members, and friends donating PPE and money to organizations and local hospitals, trying to do some good. No one wants our front-line health care workers to get sick. If that happens, the public will be at even greater risk.

For the past several weeks, all that media outlets and pundits have been discussing is: how to get PPE to our health care heroes, how practicing social distancing is a must, and how we have to urge our elected officials to act.

But what happens when our nurses and doctors come home from the hospital? Many must take extreme precautions to keep their loved ones safe; some have resorted to intense garment routines, changing out soiled scrubs and shoes in their garages, while others have resorted to sleeping alone in isolated rooms. This is what the pundits are talking less about: the sheer amount of stress, anxiety, and insomnia doctors face every single day in the hospital. The public seems to believe, collectively, that our doctors can face any threat without irreparable harm to themselves. Wrong.

At some point, this cycle of diagnosing, treating, and caring for COVID-19 patients will wear down our physicians. For many, the sheer chaos in ERs and ICUs will erase the compassion and empathy they once mustered for patients. How long that wearing down process takes will vary person to person, but eventually time plus reckless attrition will prevail. Eventually, there will be a breakdown of physicians’ mental barriers and defense mechanisms. Even when you see death every day, this pandemic isn’t something our doctors were taught how to deal with in medical school or residency — it’s new. 

In New York, patients are dying at an alarming rate, and ventilators are available on a first-come, first-serve basis. In some places, doctors have been instructed to put their N95s in brown paper bags to be used the next day … and maybe the day after. Hospitals provide assurances that they are supporting the mental health of their staff and faculty — but are they really?

I’ve spoken to several nurses who adamantly say that their hospitals do not recognize their wellbeing as a priority. Some are quitting their jobs. A dear friend of mine even told me, “This crisis makes me consider why I even thought of becoming a nurse in the first place.” She said that patients are dying and she and her colleagues are forced to trudge on — without protection or recognition. 

This is sustained blunt force trauma. As a society, we are not accounting for the extreme anxiety, sadness, anger, and guilt clinicians are living with. Anxiety about becoming ill themselves, and about furthering the spread. Sadness that their patients are suffering with no vaccine in sight and far from full-proof treatment options. Anger that health care administrators are not caring for their wellbeing and continue to put them in harm’s way. Guilt when patients die.

In the United States, no study has assessed reported rates of mental health disorders in hospital workers. A recently published article in JAMA supports my hypothesis that the mental health of nurses and physicians during this pandemic is at risk. In the study, nurses and doctors working in COVID-19 wards in China reported alarming signs and symptoms of depression, anxiety, insomnia, and distress. The same will soon happen on our own soil.

About 95% of Americans are under stay-at-home orders, which don’t apply to our first-line responders, our nurses, our surgeons, our critical care doctors. They can’t be heroes if their mental health is not intact. We need to do more than provide PPE. We need a nationwide call to action to support the mental health of every nurse and physician who is fighting for us as we stay at home and pray for them. This is an opportunity to de-stigmatize mental health issues. So let’s stop pretending and push our pundits to open the discussion up. We need to talk about mental health resources. We need to support the bodies and minds of every nurse and doctor in this country.

Ton La, Jr. is a MD/JD/LLM candidate at Baylor College of Medicine and the University of Houston Law Center applying to internal medicine residency programs. He sits on the American Medical Student Association Board of Trustees as the Vice President for Membership and previously served as the Student Editor of The New Physician. He is a 2019–2020 Doximity Op-Med Fellow.

Illustration by April Brust

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