NEW ORLEANS (AP) — Sonia Malhotra is intimately familiar with death. As a doctor who treats seriously ill patients, she's comforted countless people and their families through their final moments. But this coronavirus pandemic is affecting her and her team in ways no health care worker was prepared for.
“The amount of death and dying that we’ve seen in such a short period of time is surreal to me, and this is my line of work,” said Malhotra, the director of palliative medicine and supportive care at University Medical Center New Orleans.
“It’s exhausting — mentally, physically, emotionally — to tell another family that their loved one is dying," Malhotra said.
The medical staff at UMC, a leading hospital in Orleans Parish where the coronavirus death toll reached 546 this week, has had to do this again and again and again, speaking through masks or phones, with none of the hugs or hand-holding that can make such awful experiences more humane.
The mental health toll on health care workers is intensifying as the pandemic stretches on, with U.S. deaths totaling 140,000 people and Louisiana particularly hard-hit at 3,558 deaths. The American Medical Association has sounded an alarm and the U.S. Centers for Disease Control and Prevention has offered a to-do list for health care workers under stress. Among the suggestions: Accept that some outcomes are beyond their control. This can be hard for people trained to save lives.
Doctors have in fact learned how to keep many more COVID-19 patients alive, flattening the death spike they faced in April in New Orleans. But with caseloads soaring again and death counts creeping up with no end in sight, they've got more time to reflect. The adrenaline they once felt inside intensive care units has dissipated. Depression is more of a threat.
“Coronavirus is not going away anytime soon, so we need to treat this as a marathon and not a sprint,” Malhotra said. “We have to learn the strategies of how to keep coming back every day to work and how to live through that.”
They're showing significant rates of post-traumatic stress, anxiety, insomnia and depression, according to a review of studies involving 33,000 health care workers that was published by the National Institutes of Health in May. The NORC's COVID Response Tracking Study, meanwhile, found that people risking exposure at work are more than twice as likely to feel that difficulties are piling up, so high they can’t overcome them.
“Over time, we all are vulnerable, and we’ll start to break down, no matter how good we are,” said Patrick Bordnick, dean of the School of Social Work at Tulane University, which is affiliated with UMC.
Self-care is vital so that workers can have stamina and resilience in the months to come. Bordnick said this should include a complete mental, physical and emotional break from the job for several minutes each day, and regular days off, since the stress doesn't go away once workers get home.
Bordnick and a team at Tulane created a “one-stop” for self-care to encourage relaxation and mindfulness whenever health care workers need it, even for just a few minutes between patients. The website features positive messages from New Orleans artists, and resources for guided meditation.
Attending physicians also hold daily check-ins with residents, trainees and others to intercept workers who may be struggling, and UMC has encouraged staffers to share their thoughts in virtual therapy sessions. At the workers’ request, the hospital also launched a program that helps them stay in touch with grieving families for a full year after a patient dies.
“We’re are already seeing the bereavement program working,” Malhotra said. “When we go back to the floor the patient died on, and we tell the nurses that the family is doing okay, that the family expressed pride and appreciation for the nurses who stepped in and were there when they couldn’t be — that lifts our nurses more than anything else. The nurses have said they feel better knowing the families are okay.”
A previous version of this report incorrectly said the number of people who have died from the pandemic in Louisiana is 9,451. The correct number at publication was 3,558.
Warren reported from Decatur, Georgia.