Exhaustion and trauma take toll on Georgia’s front-line medical workers

033021 Jackson: Administrator Jennifer Vasil, RN, looks over a bed in an empty room on the hallway where residents with Covid used to be and have since died at Westbury Medical Care and Rehab on Tuesday, March 30, 2021, in Jackson.  “Curtis Compton / Curtis.Compton@ajc.com”

Credit: Curtis Compton / Curtis.Compton@ajc.com

Credit: Curtis Compton / Curtis.Compton@ajc.com

033021 Jackson: Administrator Jennifer Vasil, RN, looks over a bed in an empty room on the hallway where residents with Covid used to be and have since died at Westbury Medical Care and Rehab on Tuesday, March 30, 2021, in Jackson. “Curtis Compton / Curtis.Compton@ajc.com”

It’s been more than three months since the coronavirus last infiltrated Westbury Medical Care and Rehab in Jackson. The section reserved for COVID-19 patients sits empty. But, when registered nurse Jennifer Vasil walks down the unit’s quiet hallway, she can still see the faces of the sick, still feel the fear.

Her heart starts to pound and tears well up as her thoughts race back to last spring, when, one after another, Westbury’s occupants fell ill. “I can vividly remember looking into residents’ eyes and knowing they had COVID,” Vasil said.

In a matter of weeks, the virus swept through the corridors, infecting 69% of the residents and claiming 34 lives.

With the number of new infections falling and number of people getting vaccinated rising, the worst of the pandemic may be over in Georgia. But, for front-line health workers like Vasil, the psychological trauma of a year of chaos, uncertainty and heavy loss could take much longer to heal.

Vasil started experiencing the symptoms of post-traumatic stress disorder — severe anxiety, nightmares and overwhelming sadness — after several months of dealing with the coronavirus outbreak at her facility. It comes and goes, often without any warning.

Jennifer Vasil, a registered nurse and administrator, stands in the doorway of an empty room on the hallway where residents with COVID-19 were treated at Westbury Medical Care and Rehab in Jackson.  “Curtis Compton / Curtis.Compton@ajc.com”

Credit: Curtis Compton / Curtis.Compton@ajc.com

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Credit: Curtis Compton / Curtis.Compton@ajc.com

“We have psychological scars, and I don’t think we’ll ever be the same,” Vasil said of the staff at Westbury, where she serves as the administrator.

Psychologists who specialize in trauma-related mental health conditions say they are seeing a sharp increase in the number of health professionals with PTSD, depression, anxiety, extreme exhaustion and burnout. And they expect to see more in the months ahead.

In a recent Yale School of Public Health survey of 1,132 health care workers, almost a quarter reported signs of PTSD and nearly 43% reported “probable alcohol-use disorder.”

“It’s been nonstop every day for 13, 14 months, and it feels like it’s never going to end,” said Margaret Apara, a nurse practitioner who works at Northside Gwinnett Hospital. “And even when we are home, there’s the emotional and mental fatigue that accompanies the pandemic. We still have not been able to grieve and deal with this pain.”

Margaret Apara is a nurse practitioner at Northside Gwinnett Hospital. 
This photo is contributed by Walden University, where Apara received a Master of Science in Nursing degree. She has since obtained a Doctor of Nursing degree.

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There’s an emotional toll that comes with caring for severely ill patients shift after shift and trying feverishly to save them, medical professionals say. Apara, who manages a large team of nurses, has been struggling with insomnia and restlessness. She thinks often of patients in respiratory distress, flipping them to try to help them breathe, giving some of them supplemental oxygen just so they could have the breath to say goodbye to loved ones on video chats.

“I have a tough exterior, but this has chipped away at me,” she said.

Amanda Chenault, a critical care nurse at Emory Saint Joseph’s Hospital, understands.

It’s been particularly hard for her to cope with the rollercoaster of emotions that COVID-19 has brought. Sometimes, she said, patients are admitted into the intensive care unit, improve enough to be moved to a regular floor, then take a sharp turn for the worse.

Amanda Chenault is a critical care nurse at Emory Saint Joseph’s Hospital. A German artist saw this photograph of Chenault on Facebook and painted this picture of her with the caption. "with respect to front-line healthcare workers, not only in times of corona."

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“All of a sudden, they are back, and they are not able to breathe,” she said. “They are intubated, and there are a bazillion drips. ... You are watching them slowly die.”

And, during the pandemic with access restricted, they are dying without family members by their side, just medical workers to hold their hand. “The hardest part for me as a nurse is to know I am the one that holds that memory for the family,” Chenault said, “so I have to step up. I have to do my best.”

A battlefield

What medical professionals are experiencing is similar to what soldiers experience on a battlefield, the product of witnessing relentless suffering, said Jordan Cattie, a clinical psychologist and assistant professor at Emory University School of Medicine.

“I think the war analogy is very apt because these health care professionals are being called on to perform and perform, and to serve and to serve, when their humanity is hurting so much,” said Cattie.

It’s not just that the patients die. It’s the way that they die. “When it is difficult for patients to breathe, these patients are uncomfortable and afraid,” she said. “And these health care professionals really want to care for that person as an individual. Even while they are springing around the unit, checking alarm after alarm, and even while their bodies are pushed to the limit, they feel a need to keep that human connection. That makes it all the more painful when there is a loss.”

Dr. Jeffrey Siegelman

Credit: Handout

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Credit: Handout

It’s also similar to a battlefield in that health care workers, too, are in harm’s way.

When COVID-patients started streaming into Grady Memorial hospital last spring, Dr. Jeffrey Siegelman, an emergency room physician, saw a staggering number of extremely sick people, more than he had ever seen before.

“I think this was the first time as a physician I had to worry about my own safety and about bringing illness home,” he said.

Then, on August 3, Siegelman woke up with a headache and a low-grade fever. Coronavirus had overtaken him, too, as it has at least 38,000 other Georgia health care workers, according to the latest data from the Georgia Department of Public Health. Among those with confirmed cases, 360 have died.

Siegelman developed chills, muscle aches, headaches, insomnia and a loss of taste and smell. “My battery drained quickly,” he said, “even with minimal exertion.”

He’s been struggling to recover since.

As a long-hauler, someone who experiences continuous symptoms for weeks or months, he has, at times, worried that he’ll never have the energy to practice emergency medicine again. Also, he said, he’s felt guilt, about not being there for his colleagues or his wife. Though he’s back at Grady, he’s working part-time.

“I felt bad knowing they were already stretched so thin,” he said of his co-workers. “It was internal — they were very gracious and kind and so was my wife at home. But my wife was leading a single-parent family household, and I couldn’t be the dad I wanted to be.”

Early in the pandemic, hospitals began offering emergency mental health services. At Emory University hospitals, more than 75 volunteers from the psychiatry department staffed a virtual clinic every day, from 6 a.m. to midnight. It was recently replaced with a new program that provides employees with confidential online counseling and support 24 hours a day, seven days a week.

Cattie said sometimes it’s a panic attack or an inability to sleep that prompts a health care worker to reach out for help.

“For others, it’s more burnout. They woke up for their shift and reached for the reserves, and there’s nothing there,” she said.

EMS crew bring a patient in the Emergency and Trauma Center at Northeast Georgia Medical Center (NGMC) in Gainesville on Jan. 20, 2021.  A January survey by Morning Consult found that 26% of U.S. health care workers have considered leaving their job since the pandemic. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: Hyosub Shin / Hyosub.Shin@ajc.com

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Credit: Hyosub Shin / Hyosub.Shin@ajc.com

In Georgia, there are 141,000 nurses, 22,000 doctors and tens of thousands of respiratory therapists, EMTs and other health care workers.

Though not broken down by state, a January survey by Morning Consult found that 26% of U.S. health care workers have considered leaving their job since the pandemic, including 14% who say that COVID-19 has left them thinking that they might leave the health care profession altogether.

Many are troubled by what the pandemic revealed. Early on, there were concerns about taking care of patients “when the tools and weapons weren’t there,” such as personal protective equipment and ventilators, said Dr. Gary Price, president of the Physicians Foundation. Then, he said, there’s been the refusal of many Americans to adhere to safety precautions, such as avoiding crowds and wearing masks, to help slow the spread of the virus.

It’s discouraging for health care professionals to toil all day and, perhaps on their way home from work, drive past a crowded bar or restaurant. It feeds a sense of hopelessness, that this will never be over. “There’s been this feeling of being on edge,” said Cattie.

‘Helps keep you going’

Medical professionals are trained to be resilient and self-reliant and can be reluctant to seek mental health help. But, without intervention, their conditions often worsen.

Apara, the Northside nurse, has tapped into services provided by the hospital, which includes meeting a social worker over Zoom. It helps “to talk to a life coach who is non-judgmental and to talk and vent,” said Apara, who is married and has an 11-year-old daughter. “It helps you keep going.”

One reason doctors and other health care workers are afraid to ask for emotional support is they worry they could face professional consequences. In many states, including Georgia, licensing and credentialing applications include questions about past mental or behavioral health conditions.

Many experts believe more mental health resources should be available for health care workers in a way that does not put their jobs in jeopardy. Already, they say, the pandemic is changing the conversation about wellness and the need to seek help.

Some say they are seeing a shift in the attitudes of colleagues, many of whom are now more open about what they are feeling, realizing it’s OK to acknowledge they are struggling.

Co-workers are paying more attention to each other, pushing colleagues to take breaks during their shifts and to schedule more time off from the job. Employee assistance programs are being greatly expanded to provide emergency child care, elder care assistance and substance abuse counseling.

“I think the whole country has a lot to process and deal with, and we have to take a long hard look at how we could have been better prepared,” said Price.

Administrator Jennifer Vasil looks at a blooming cherry blossom tree that will be part of a memorial for residents and staff member who died of COVID-19. Vasil is ordering a granite bench to be placed there. “Curtis Compton / Curtis.Compton@ajc.com”

Credit: Curtis Compton / Curtis.Compton@ajc.com

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Credit: Curtis Compton / Curtis.Compton@ajc.com

Meanwhile, Vasil, a 36-year-old mother of two, has been turning to prayer, meditation and yoga to help cope with lingering emotional pain. But the horror stays with her.

Westbury has returned to more of a normal environment. Residents can see their loved ones once again. The hair salon has reopened and group activities – dining, playing games, exercise programs – have resumed.

“That gives us hope the end is in sight,” Vasil said, “because we never, ever, ever want to have to go through this again.”

The personal toll on health care workers

  • 62% say worry or stress related to COVID-19 has had a negative effect on their mental health.
  • 55% feel “burned out” going to work.
  • 21% say the fear that they will get infected or infect their family members or patients is the hardest part of working during the pandemic.
  • 16% say wearing personal protective equipment is the hardest part of working during the pandemic — citing discomfort, overheating and the added difficulty of making personal connections with patients.

SOURCE: The Washington Post-Kaiser Family Foundation Survey Project