At Northside Hospital’s emergency department last weekend, Dr. Kathleen Funk was caring for ailing patients as usual while she also focused on how she could help take care of Northside’s entire medical team in the days and weeks to come.
With Georgia’s confirmed coronavirus cases rising daily and the hospital beginning to see patients in critical condition, Funk listened carefully as colleagues shared personal stories of stress and sacrifice.
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One nurse struggled with not being able to see her elderly parents or young niece and nephew for the foreseeable future. Another nurse talked about her husband’s anxieties. They have two small children, and watching the pandemic escalate he couldn’t help but worry about how exposed she was, how one of their kids could become infected, and how his wife could possibly even die. “He just broke down and cried,” Funk said.
These intense, fearful moments are playing out across Georgia, as everyone has taken in the alarming scenes of sick and stressed hospital workers in China, Italy and now New York. “Everybody wants all their families to be well,” Funk said. “We can’t focus on patients if we don’t make sure our families are well. And that’s a lot of the conversations my nurses were having with me.”
Those conversations are part of a broader effort Northside has initiated to help workers deal with the emotional toll of being on the front lines of the pandemic as it confronts them with personal risks and disturbing choices.
Well before the pandemic, front line doctors and nurses were already suffering from widespread stress and burnout working in a complex and often frustrating healthcare system. Funk and her husband, Joe Funk, who is also an emergency department physician and is Northside Hospital's chief of staff, were in an academic program looking at long-term solutions. Kathleen Funk was also working with Dr. Toral Fadia, a top Northside psychiatrist, on wellness issues among providers.
Now, the pandemic’s realities have shifted their focus to immediately finding ways to support colleagues who are desperately needed to deal with the inevitable onslaught of patients.
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With stress already high, Funk’s taking every opportunity during shifts to talk about how colleagues can support one another, help keep each other well and even be more forgiving when needed. To keep everyone as mentally strong as possible, she is preaching the need for sleep, hydration and exercise.
She and Fadia have also switched gears to get professionals lined up to provide therapy to rattled and exhausted workers who may reach a crisis point while battling the pandemic.
It’s not just physicians Funk is thinking about as the unknown approaches. “It’s our nurses, it’s our techs, it’s our radiology techs, it’s our support staff, it’s our environmental services, it’s our registration folks,” she said.
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“I mean, we’ve got registration folks with no medical knowledge now being told this can kill them and they need to go in and register the patient. I mean, that’s terrifying. And they’re stepping up to it. They’re following our lead, and they’re just as critical to the team operation.”
Workers are also having to deal with dramatic restrictions on who can visit the hospitals. Nurses, already being stretched, may try to compensate as patients are often alone, without family members to support them.
Hospitals everywhere are also dealing with the desperately short supply of masks and gowns needed to keep the staff safe, which is a terrible stresser for the healthcare workers who are like firefighters running into the fire. Even with the right protective equipment, Funk said, there are worries and risks. “It is constantly on our minds,” she said.
While Atlanta is not yet dealing with what has arrived in New York, where hospitals are way over capacity and a significant chunk of the healthcare workforce has been sidelined because they got sick, too, Funk sees that day coming.
“We maybe have just a tiny bit more time to prepare, but I don’t think it’s going to change the sense of being overwhelmed,” she said. “There are only so many ventilators, there’s only so much PPE (personal protective equipment), there are only so many hospital beds. I think we can expect to see our systems overwhelmed.”
Hospitals across the state are making plans for when the demands for care exceed the current capacity. Tents are going up at hospitals. New ICU rooms are being created. Doctors and nurses who aren’t as busy because elective procedures and routine appointments have been cancelled are being prepared to do critical care. Anyone who has the skills is being called to step up.
What Funk doesn’t want to face are the kind of scenarios she’s heard about coming from Italy. “There was a colleague there who had to make the decision, based on resources, which patient was going to die. That was really crushing to have to make that decision, and that’s a decision she’s going to have to live with the rest of her life. “
Facing the test
Even for physicians like Funk and her husband, veterans for years of the life-and-death events that are part of emergency medicine, what’s coming is filled with new challenges — especially the idea they likely won’t have the supplies and beds and personnel to do what they can to heal patients infected with a disease for which there is currently no easy cure or vaccine.
Funk and her colleagues are accustomed to being able to tap into resources that are expensive but available when they’re needed to save their patients. “That may not be the situation we find ourselves in in a couple of weeks,” she said.
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As the couple works to help Northside prepare, Kathleen Funk said she thinks about the test she faced in 2016 when she and Amanda Tubbs, a registered nurse, went to Haiti to care for victims of Hurricane Matthew. They were the first medical workers to arrive in an isolated region and had to make do with whatever they had to treat people with serious injuries.
Tubbs and Funk still work alongside one another at Northside, and they know they may once again have to work together to find the kind of work-arounds and creative solutions that they resorted to in Haiti.
But Funk knows that Tubbs has more on her plate now than she did in 2016, with a 2-year-old at home and another baby on the way. But she’s on the job, where she’s needed.
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Other pregnant nurses and doctor also keep showing up for work every day even though no one knows for sure about the risks.
“All of our clinicians realize they could be taking the coronavirus home,” Funk said
Funk said she’s encouraged that so many people in Atlanta are getting the message about social distancing and staying at home, and listening to the pleas from hospitals and doctors to isolate if they have mild symptoms and not overwhelm emergency rooms out of worry instead of need.
She was also touched by reports that people living in high-rise apartments near an Atlanta hospital have been coming out on balconies to applaud healthcare workers during their shift change.
That support in the days to come will be meaningful, she said.
“We don’t get thanked that often,” she said. “And so I think now is a time when the risk is so much greater that small acts of kindness could really, really go a long ways towards encouraging us as we have tough days.”
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