Sustained and stressful work during the coronavirus pandemic is taking a stiff, but so far manageable, psychological toll on Long Island’s health care workers, said hospital officials charged with maintaining morale and readiness.
To keep a vital workforce performing at a high level, many hospital officials said they focused on coping strategies, not long-term therapy. Stony Brook University Hospital, Mount Sinai South Nassau and Northwell Health officials said they had created or expanded employee assistance programs to link workers by phone or internet to therapists, chaplains and social workers.
Stony Brook established a help line specifically for COVID-19 response and has opened it to all health care workers, not just those from the hospital. About 200 health care workers have used the hospital's telecounseling, said Adam Gonzalez, a psychologist in charge of the service. Thousands have visited "respite spaces" in a converted psychiatric unit there and in tents outside Northwell facilities to decompress before heading home or back to work.
Anxiety is common, officials said, as health care workers accustomed to routines learned in medical school have had to adapt to a lethal virus whose workings are not fully understood.
A March study of health care workers treating COVID patients in China found symptoms of “depression, anxiety, insomnia and distress," and Sunday Dr. Lorna M. Breen, a Manhattan doctor who ran an emergency room swamped with COVID patients, killed herself. "She tried to do her job, and it killed her," the doctor's father told The New York Times.
Breen's suicide is a "brutal reminder that coronavirus can affect more than your health," said Mount Sinai South Nassau chief medical officer Dr. Adhi Sharma. High mortality, risk to self and family and the pandemic's length take an emotional toll on health care workers, Sharma said. "We need to try harder to keep our staff engaged in wellness, monitor for burnout, exhaustion, and PTSD, and to take care of each other."
Gonzalez said the work his co-workers are doing can be "exhausting and overwhelming" but there is "help and support available." In addition to Stony Brook's existing resources, he said the hospital would be holding a question-and-answer session for staffers about suicide.
While few of Long Island's health care workers will develop post-traumatic stress disorder, some are showing symptoms of a precursor, subacute stress disorder: “sleeplessness, your heart is racing, fingers are tingling, your head is pounding,” said Janet Kahn-Scolaro, a psychotherapist who is Mount Sinai South Nassau's administrative director. Another common reaction, based on her work and about 100 calls to her hospital’s staff hotline over the past week: “Sadness. A lot of sadness.”
Some workers, pulling long shifts in an adrenalized state that Gonzalez called “hyper-vigilance,” have trouble transitioning to home life. Some have seen more patients die in weeks than they have over careers, said Joe Calderone, a Mount Sinai South Nassau spokesman.
Curtis Reisinger, a psychologist who heads Northwell’s employee assistance program, said he and his colleagues were providing "psychological first aid” similar to what the Red Cross, FEMA and the American Psychological Association advise for catastrophic circumstances. The aim is to “enforce and support natural resilience and natural strengths,” not talk about emotions and relive the sometimes disturbing sights and sounds of the hospital.
Gonzalez, who researches the intersection of mental and physiological health, described a pervasive communications effort to instill good habits. Posters dot the hospital, reminding workers to relax, eat, sleep and talk. Daily emails assure staffers that personal protective equipment, worn properly, will do its job.
Occupational, physical and recreational therapists visit to guide three-minute stretching or controlled breathing sessions. “The hope is that some of the work we’re putting into practice now, in terms of helping people cope with stress, will help offset the development of more severe problems post-disaster,” he said.
Clergy make their own rounds. Northwell chaplain Hillel Fox, a rabbi who used to counsel primarily patients and their families, said some days his team counsels as many as 75 workers. Many are consoling both patients and their families, because the hospital cannot allow most visits, and come to him “physically, emotionally and spiritually drained." The counsel he gives his co-workers is short: “I care about you ... Don’t let fear dispel hope and faith.”
Stony Brook's respite space has drawn more than 3,655 visits. Two visitors, nurses Denise Garcia and Nanci Zichittella, said it had snacks and bottled water, comfortable chairs, showers, aromatherapy and music that sounded like James Taylor. It may sound New Age, but there is “rich literature” on the efficacy of music and aromas for stress management, Gonzalez said.
Zichittella, a nurse supervisor who works the hospital’s overnight shift, put a few drops of jasmine scent on a gauze pad and kept it in her lab coat. “You don’t get a lot of nice smells when you work in a hospital,” she said. “The emotional toll this is taking on nurses is the part that worries me. You can only do this for so long.”
Denise Garcia, a nurse practitioner on Stony Brook's rapid response team, spends most of her 12-hour shifts on the move, without set break times. Once she spotted a co-worker in intensive care; on one shift her team intubated 15 patients. “You feel their fear,” she said.
Endurance is “part of being a health care worker,” she said, adding that she was neither traumatized nor exhausted.
Simply stepping off the unit and sitting with a bottle of water for a few minutes in the respite room is like a “reset,” she said. “It brings you back to, ‘OK, we can do this.' ”
Stony Brook University help line for health care workers: 631-632-CHAT
Family and Children's Association essential worker support line: 516-281-0202
National Suicide Prevention Lifeline: 800-273-8255