Lately, as Erica White, RN, drives to the hospital in Buffalo, NY where she’s a nurse, she’s met with a wave of anxiety as soon as the facility comes into view.
Anyone would understand. White has spent the last 23 months working as a nurse in a dedicated COVID-19 ICU. She’s stood with the sickest patients during their most terrifying hours. “We hold their hand and try to make them comfortable as they’re getting ready to be intubated.,” White says. “We try to get them to calm down enough so they can say goodbye and call their families.”
But the punch of anxiety White began feeling as she drove into work every day didn’t start until sometime within the last year.
In early 2020, when COVID-19 was new to the U.S., White was often running on adrenaline. It was a worse point in the pandemic in some ways. At times, more than a thousand people were dying per day. There were no vaccines, and medical experts knew less than they do now about treatment. But while in 2022, effective vaccines and therapeutics are more available, and we know more about the virus and how it's spread, to many on the front lines, each passing month of the COVID-19 crisis has only added to their strain.
“As [the pandemic] wore on, it was like there was no more gas in the tank anymore,” White tells Refinery29. “With the surge of patients we’re seeing due to Omicron, I feel numb to the sense of dread that I had with previous waves. I’m too tired, too disheartened, to be scared anymore.”
Workers at healthcare facilities all over the country are reporting similar emotions. Sixty-one percent of physicians said they often experienced feelings of burnout, a significant increase from 40% in 2018; more than half of physicians reported feeling “inappropriate feelings of anger, tearfulness, or anxiety because of COVID-19,” according to a Physician’s Foundation Survey of 2,504 healthcare workers conducted from May to June 2021.
Since that survey was taken, another surge in COVID-19 cases in the U.S., caused by the Omicron variant, has made the situation for healthcare workers even more difficult. “I care so much about my patients and I want them to get better, but the amount of emotional energy I have to give patients just keeps depleting a little more with each passing wave,” White says.
While she’s been doing similar work throughout the past two years, it “takes a bigger toll than it used to,” White says. “All of the COVID deaths I’ve witnessed, I’m just kind of putting in a little box and I can’t even really think about it too much,” she adds. “I still think about the first patients I had who passed from COVID back in March 2020, and all the countless patients who I have lost since then. But I haven't been able to mourn, to reflect, to heal, because, for those of us working in dedicated COVID units, the weight of this pandemic hasn’t yet lifted.”
Some healthcare workers are likely dealing with what is known as “secondary trauma” or secondary traumatic stress disorder, says Charles Figley, PhD, a professor at Tulane University who developed an early measure of PTSD and whose research has focused on compassion fatigue and secondary trauma. Synonymous with “compassion fatigue” and similar to burnout, secondary trauma occurs when you are helping or attempting to help someone going through first-hand trauma, according to Dr. Figley’s research. Secondary trauma can cause people to feel tense, emotional, angry, worn down, dissociative, or stressed, he says.
For those of us working in dedicated COVID units, the weight of this pandemic hasn’t yet lifted.”
Erica White, Rn
Not all frontline workers identify with the “secondary trauma” label. But it's clear that, at this point in the pandemic, many are struggling with their mental health in some way. “The real challenge right now, I think, with medical practitioners is the days are often the same, and there’s nothing for them to look forward to, only death and illness and trying to help. It feels like you’re trying to plug up the dam with your thumb when it’s breaking,” Dr. Figley says.
“There’s a certain distancing that anyone in healthcare does, when you deal with awful things on a daily basis,” says Gary Price, MD, president of the Physicians Foundation. “But when things get really overwhelming, like they have, you begin to feel powerless and like there is nothing you can do to change things. That leads to what’s been described as burnout. You feel like you’re not able to make a difference, you’re withdrawing, and you’re being socially isolated.” Dr. Price says that this can lead to poor mental health outcomes, including suicide, and to worse care for patients.
The amount of misinformation around COVID-19 has become an additional source of stress for healthcare workers. “It makes the job that much more challenging,” says Bayo Curry-Winchell, MD, the regional clinical and medical director of Carbon Health and Saint Mary’s Hospital, who also serves on Nevada’s Governor's COVID Medical Advisory Team. “When you think of other diagnoses, like cancer, for example, you don’t have patients telling you, ‘No, cancer doesn’t really exist.’”
While many people in the healthcare industry have taken it upon themselves to advocate against misinformation in the pandemic, by now, many are too worn down by their work and the abuse they’ve received from online trolls to continue to do so. “I think in the beginning, I engaged more with those types of attacks and tried to explain things because I thought there was a way to get through to people,” says Shikha Jain, MD, FACP, an assistant professor at the University of Illinois Chicago, oncologist, and the president of Women In Medicine. “Now between patients and work and family, I don’t have the time or energy to engage with people who are attacking me. I’m just tired.” The other day, she posted a factually accurate tweet about vaccines, but got such negative feedback online that she deleted it, she says.
The enormous and unique demands that the pandemic has placed on healthcare institutions are partially responsible for the industry’s burnout problem. But many workers are also saying that COVID-19 has exacerbated issues that had already been at a simmer for years. Burnout was rampant even before the virus, Dr. Price says. These workers often hear a collective urging to “take care of their mental health” and “practice self-care.” This puts the onus on the workers, not their bosses, institutions, and government. It implies people who are unable to buck up and deal with the pandemic are simply not resilient enough for their field. But as Dr. Price says, “It's like saying, ‘If the canaries are dying in the coal mine, you should send out for tougher canaries.’ It’s systemic.”
“The saddest thing I’ve heard from colleagues is that we need help and no help is coming,” Dr. Jain says. “We need better public health messaging, we need more hazard pay, better safety procedures, childcare subsidies, loan repayment or repayment for the amount of money people paid to go to school, and to show healthcare workers that we actually care about the sacrifices they make,” including the mental health tolls, as well as the increased risk to their own and their families’ health they’ve taken on.
This problem may seem large and complex, but it deserves an urgent solution. More and more frontline workers are leaving medicine altogether — nearly one in five healthcare workers have quit their jobs since the pandemic began, according to a Morning Consult survey from October 2021. More still have been laid off. And yet, we need healthcare workers now more than ever.
White says that despite all her work-related anxieties, she still loves helping people and believes that healthcare is her calling. But with everything she’s seen in the past two years, she may someday reconsider whether she can work in this field — especially if things continue the way they are.
For now, she thinks she has another “pandemic year” in her, and then she says she may have to reassess. As she puts it: “It’s difficult to grapple with the fact that the job has always given me so much satisfaction, but it’s probably not the best thing for my mental health.”
If you are thinking about suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the Suicide Crisis Line at 1-800-784-2433.
Editor's note: White is a relative of a Refinery29 staff member.