Coronavirus Diaries is a series of dispatches exploring how the coronavirus is affecting people’s lives. This as-told-to essay is based on a conversation with psychiatrist Nicole Christian Brathwaite, who treats health care workers in Boston. It has been transcribed, condensed, and edited for clarity by Julia Craven.
I didn’t have as many physician patients prior to COVID. That number has increased. I’ve been practicing psychiatry since 2008. I’m board certified to treat both children and adults so I see the lifespan. I’ve always had a large number of calls, both from adults seeking care and adults seeking care for their children, but that number has increased exponentially since the start of the pandemic—along with the number of healthcare workers looking for care for both themselves and their family members.
At the start of the pandemic, there was significant dismay from healthcare workers around the lack of PPE, having to take pay cuts while having your hours increased, running out of ICU beds, running out of ventilators, and just a general sense of helplessness. I remember talking to a lot of my patients and they were basically dealing with their own mortality. They were creating a will and talking to their families about what to do if they die. That was heartbreaking. And to think that everyday that someone went to work, there was a real fear that this could be the day that their life ends simply because of a lack of PPE, constant exposure, or the onslaught of very, very ill patients.
That was initially one of the most heartbreaking things. Being in Massachusetts, we have a higher rate of vaccination, so then there was a lull. We had a number of months where we even had a day of no deaths from COVID and certainly a much smaller number of people hospitalized. It’s scary that many of those fears are returning.
I practice tele-psychiatry, so I see patients in various states throughout the country. There certainly is a difference between the physicians I work with in Massachusetts and the physicians I work with in Illinois or Idaho. The numbers of hospitalizations are much higher in those Midwestern states, and those physicians are now literally experiencing trauma-like symptoms. They’re beginning to suffer from sleep deprivation, they’re noticing increased irritability. They’re beginning to be more reactive at work because they’re starting to see a lot of the same things that they were dealing with in January. It’s starting to come back to them now.
Right now, I am concerned about the sustainability of healthcare workers and their ability to withstand another surge. There’s always been high burnout among nurses and physicians. The rates of suicide has always been twice the rate of the general population. My concern is that those numbers are going to drastically increase.
Many physicians and healthcare workers tend to be type A personalities. We work very hard. We want to do things well, and we set a standard for ourselves. We go into medicine because we believe in it. We believe in the ability to treat people and hear people. So to turn around and be in a situation where, day after day, you’re faced with patients who, despite every effort, despite being up all night, despite using every resource available, still end up passing away? That’s completely demoralizing, and a part of trauma is the sense of helplessness and powerlessness. People should recognize these experiences are absolutely traumatic, and many of my physician patients are meeting the criteria for PTSD—and that number has gone up.
I am not clear that anything was learned [from the last wave]. Physicians are still being overworked, still feel helpless, and there hasn’t necessarily been an increase in mental health support on the ground at hospitals to address it. For some physicians, burnout has taught them that they don’t feel as valued in the healthcare system, that their lives aren’t as important. Hospitals need to ensure that there is immediate and sustained access to mental health support for all healthcare workers and destigmatize mental health treatment. Often physicians or healthcare workers are afraid to admit feeling depressed or afraid to seek treatment because they fear that it will impact their job. We really need to normalize healthcare workers seeking and receiving mental healthcare treatment and that not impacting their career.
I currently have multiple jobs. I am the medical director of a tele-psychiatry company, and I also have a small private practice and consulting company. Prior to that, I was a medical director in a community mental health clinic, and I absolutely experienced burnout. I was exhausted. I was working all the time. I wasn’t able to devote the time and attention my family needed. The line between work and my personal life was very blurred. There wasn’t even a line. I ended up transitioning into tele-psychiatry because I felt completely burned out and I began to lose my excitement and passion for mental health and for psychiatry.
In terms of what I’m doing now, I mean, I’m trying to honestly practice the same thing that I recommend to my patients—and even the physicians that I supervise. Part of burnout is individual, but also a large part of burnout is institutional. I’m careful to not just recommend individual changes, because if you’re working in a toxic institution, you can get as much sleep as you need, but you’re still going to experience burnout because you’re not in a place that supports you.