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Emotional Health of Front Line Workers

May is Mental Health Awareness month. The current pandemic provides an opportunity to investigate some of the resulting tolls on mental health this virus has taken.

As this article began there was a striking news story, that emphasizes the importance of mental health awareness

On Sunday April 26, 2020, according to Zachary Dowdy of Newsday:  “Doctor Lorna Breen, medical director of the emergency department at New York-Presbyterian Allen Hospital in the northern tip of Manhattan, died in Charlotte, Va., where she was staying with family.”

Dr. Breen who was 49, received both her undergraduate and graduate degrees from Cornell University, and completed her residency at Long Island Jewish Medical Center. Dr. Breen doubled in Emergency Medicine and Internal Medicine.

It was while at New York-Presbyterian Hospital that Dr. Breen became infected herself with the coronavirus. After recuperating, she returned to work. Following a week and a half back at work, she was sent home. Concerned, her family brought her back home to Charlotte. It was there, Dowdy writes: “Police officers responded to a call seeking medical assistance on Sunday.” Dowdy continues: “the victim was taken to the U.Va. Hospital for treatment but later succumbed to self-inflicted injuries.”

Dr. Lorna Breen’s father, Dr. Philip C. Breen said in an interview with the Times, as Dowdy recounts: “That his daughter had no mental illness that he was aware of. But he said she did recently seemed  ‘detached,’ making him suspect she was having problems coping with the fact the virus had so ravaged the city that patients were dying before they could be removed from the ambulances arriving to the emergency room.”  Dr. Breen went on to say: “She tried to do her job, and it killed her.”

Finally, Breen told newspaper reporters: “She was truly in the trenches of the front line,” and then went on to say: “Make sure she’s praised as a hero because she was.” He’s right.

There are so many concerns with the Covid-19 pandemic and with the complexities and diversity of our population that it is far from a simple task to arrive at solutions which are all encompassing. The chances of neglecting one group or another is a certainty. The passing of Dr. Breen brings to light one of the groups which are not so much neglected as they are taken for granted. Often expected to just be there, it may be incorrectly assumed there is no need to worry about a highly educated doctor, they know how to care for themselves.

In a blog, Sigal Samuel reminds us: “If you’re finding it hard to stay home right now, imagine how it would feel to be a doctor or nurse. Health care workers don’t have the luxury of holing up in their homes to shield themselves from the coronavirus.” For us, the current isolation is challenging, but for those dedicated to saving lives, separation from families for long periods of time is necessary rather than taking the risk of transmitting the virus to their love ones.

It has been reported that physicians have a higher suicide rate than those who are in the military which is considered a career that is very stressful. In this research reported by Pauline Anderson, she writes that the: “rate exceeds that of the general population by 2.5 to 4 times.” It seems while trying to understand the reasons for the high rates, that the most common diagnoses is attributed to mood disorders, alcoholism and substance abuse.

As this pandemic spread across the world and the anxiety which correspondingly accompanies the illness, consider the impact on our first responders and healthcare workers. As emergency rooms became overwhelmed with cases of the Coronavirus, a shortage of supplies and the seemly endless rising number of people requiring medical attention the call went out for more help. Doctors, Nurses, EMTs and other health care workers and responders were forced to face mounting cases of the infection.

When discussing the mental health toll on health care staff, Sigal refers to Italy as an example: “Doctors there had to choose which patients got put on a ventilator, a heartbreaking decision that may cause lasting psychological distress.” In the United States, shortages in ventilators loomed over most hospitals and in particular in New York City. Fortunately, medical personal here were not forced to make the choice of who lives and who dies.

In the U.S., emergency room staffs soon became inundated. Samuel, using Italy as a comparison, details: “Because there aren’t enough infectious specialists to tend to all the Covid-19 patients, other doctors like ophthalmologists and dermatologists are being trained to care for them, for example by providing supplemental oxygen.” Most have no experience watching a patient intubated or die in front of them, being forced to hide or delay their grief, and unable to share their emotions, some of them may end up with post-traumatic stress disorder or other mental health problems down the line.” In America, doctors with varying specialties stepped up to help, wherever they could.

While first hand witnessing the increasing death toll, combined with little break from the epidemic and long hours, many hospitals quickly resembled something like a wartime MASH unit. Stress, anxiety and weariness, for some, provides the potential for Post-traumatic stress disorder (PTSD) is a reality.

In her article for Psychologytoday.com, Shaili Jain M.D. has found: “the intensity of exposure to disaster plays a big role in determining who will develop PTSD in the aftermath.” Being isolated from family or being fearful of subjecting family to the disease, while attempting to maintain their chosen career mission of preserving life, mixed with concerns for the wellbeing of fellow workers and the frustrations of patients needing treatment with little options available the exhausting, frustration easily leads to helplessness and depression. The results are that they are reminded of their own vulnerabilities.  As doctor Jain wrote: “the high stakes demands that force them to ‘carry on and defer’ grieving and the processing of emotions and subsequent self-quarantine mandates which left them isolated from their traditional support systems.”

Finally, doctor Jain finds: “the collective lessons we have learned from prior disasters tell us what needs to be done to prevent an epidemic of PTSD among COVID-19 essential workers: in the immediate term, fundamental resources to help secure their personal safety and in the mid to longer-term a systematic, coordinated response that provides active outreach, identify vulnerable subgroups and if necessary, offer psychological treatment. Fortunately, the mental health community has developed effective therapies specifically tailored to treat and manage PTSD. There is no reason for this side effect of the COVID-10 pandemic to persist.”

Frontline healthcare workers require systematic action to fight the mental health effects from the high pressure of the reality of treating those people who have contracted the virus. To be successful at defending against the deteriorating mental health of caregivers requires more than lip-service, or sympathy and rhetoric. What is required is a long-term commitment of funds, resources, and societal support and understanding.

If you would like to help provide mental health support to health care providers visit: https://www.drlornabreen.com/

Are You In Crisis? Call the American Foundation for Suicide Prevention at 800-273-8255

Works Cited:

Anderson, Pauline. (2020) Doctors’ Suicide Rate Highest of Any Profession. Retrieve From: https://www.webmd.com/mental-health/news/20180508/doctors-suicide-rate-highest-of-any-profession#1

Dowdy, Zachary, R. (2020) Top Manhattan ER doctor dies by suicide, cops and report say.
retrieved From: https://www.newsday.com/news/health/coronavirus/manhattan-emergency-doctor-suicide-1.44212330

Jain, Shaili, M.D. (2020) Bracing for an Epidemic of PTSD Among COVID-19 Workers. Retrieved From: https://www.psychologytoday.com/us/blog/the-aftermath-trauma/202004/bracing-epidemic-ptsd-among-covid-19-workers

Samuel, Sigal. (2020) Doctors and nurses are risking their mental health for us.https://www.vox.com/future-perfect/2020/3/26/21193122/coronavirus-mental-health-doctors-nurses-covid-19

Image Cited:

Dr. Lorna Breen Retrieved From: https://heavy.com/news/2020/04/lorna-m-breen-dead/

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