Working in healthcare has never been an easy job. The years of education and training, long hours, and vicarious trauma healthcare workers are continuously exposed to, weigh heavily on the mind, body, and heart. Because of this, it should come as no surprise that healthcare workers are amongst one of the highest risk categories for mental health challenges when it comes to professions, right alongside first responders.
Working in healthcare is challenging, but working in healthcare during a pandemic? Now that’s a whole different story. The numbers of those impacted by mental health are steadily rising, exacerbated by the pandemic and political stress, that at times, feels impossible to escape. The chronicity of the exposure to trauma that healthcare workers are experiencing is incredibly concerning. Healthcare workers likely did not receive specialized training to navigate the pandemic-related changes that have become our reality for the past almost year, and despite that, they continue to work under these stressful conditions.
“I missed global crisis day in grad school,” has become my new favorite saying in response to the expectation that healthcare workers have this all figured out. Like the rest of you, we are learning and adapting on the fly, doing the best we can to do the work we are so deeply passionate about so that we can continue to provide the best care to our patients—all while living through it ourselves. A parallel process, to put it lightly.
Unlike most of my colleagues, I had a several month gap at the onset of the pandemic where I wasn’t working. In March of 2020, I had a 3rd trimester stillbirth and nearly lost my own life during the delivery. I knew that I couldn’t be a therapist under normal circumstances, let alone during a pandemic, so I took time off to focus on grieving and my own emotional and physical healing.
I returned to work in November, but the way in which therapy was being conducted had changed drastically. Everything I had come to know about therapy and mental health over the past near decade was different. All services were being rendered virtually and the need for mental health was at an all-time high. I don’t think any of us were prepared for how quickly mental health referrals would storm in, and they’ve only continued to do so as the days and weeks pass. It’s an interesting time to work in mental health. As business owners and therapists, we want and need referrals, and we also don’t want people to be suffering.
The way in which mental health and overall healthcare is now being provided is vastly different, and it got me thinking: if mental health has changed so much, how has the work of other providers changed?
Thus, on Monday night—the day before I publish new blog posts (which will make anyone who knows me laugh, because I’m annoyingly type A and usually have things planned out), this blog post idea came to be.
For this post, I’m interviewing different healthcare providers to gain unique perspectives from a nurse, physician, and therapist (me!), to have a better understanding and honest look at how our experiences within the changing healthcare system have altered our respective fields. Luckily for me, I have no shortage of healthcare worker friends and family, who were easily coerced into being part of this last-minute article, and the two individuals I interviewed are some of my closest pals (thanks, friends!).
Let’s get started!
Question #1: What field/setting do you currently work in?
Dr. Jack Bergal, DO: I’m a resident physician working in inpatient internal medicine. I work in the hospital on the general floors, as well as the ICU (Intensive Care Unit).
Karen Lemberger, BSN, MSN, RN: I work in the CT (cardiothoracic) ICU.
Tracy, M.S., LMFT, PMH-C: I have a private practice.
Question #2: How has the way in which you provide direct service to your patients changed since the pandemic?
Dr. Bergal: With the two waves, the prevalence of Covid has increased astronomically, and as a result, there’s more isolation—literal, physical isolation and emotional isolation for patients. The isolation is extremely difficult for patients to deal with, and as a provider, I find myself not only treating the disease, but their emotional states as well.
With Covid, there are so many extra precautions that can make practicing medicine feel ritualistic or robotic: gowning up, washing hands, disposing of the gown, and repeating over and over again, each time upon entering or leaving a new patient’s room. Some providers rush through these interactions—they’re scared to get infected and they’re scared to infect their families. They’ve seen firsthand the impact of this disease, so the pressure of not passing it on to others is heavy.
For treating Covid, there’s a very limited arsenal because the research is still limited and ongoing; we have streamlined protocols that we follow. When patients experience shortness of breath, it is physically and emotionally anxiety provoking and taxing. Supporting a patient through that and seeing them improve is the most rewarding thing.
On the flip side, the outcomes aren’t always positive. As physicians, we know and expect to experience death, but it’s usually more intermittent. Aside from some specialties like oncology, most physicians are seeing their patients improve. With Covid, we’re seeing death all the time and in huge numbers—there’s no reprieve, and that has caused a lot of helplessness for me as a provider. It’s interesting because one dreams about becoming a doctor, goes to school, and makes it to residency, and residency looks like it never has before, because medicine looks unlike anything we’ve ever seen.
Karen: At the most basic level, we’ve had to put up physical barriers; we wear masks and have protective gear. The patients can’t see our faces so the non-verbal ways of communicating, which is often how we connect to patients, is gone.
From a practical standpoint, we’ve been exposed to different specialties. We have taken patients on units that we wouldn’t normally take, due to hospital overflow. Every unit is so overloaded and we’re pulling staff from different departments, to meet the insatiable need. It’s a strain on the individual provider and a strain on the system. There are not enough providers for all the patients because the demand is too high, and that also impacts the amount of time we can spend with each patient, which impacts the overall patient experience.
Tracy: The biggest change is that most therapists are not providing in-person services. We are providing video services through telehealth, or what I commonly refer to as, “telehell”. Prior to the pandemic, I had never done therapy via a video platform, and if you had asked me if I had planned to, I would have said, “no—never”.
There are so many challenges with telehealth: technology failing, which can lead to interruptions in service, freezing, and poor connections. There’s nothing more awful than having to tell someone who is crying or has just revealed something so important, to repeat what was said, because the system has glitched, (eyeroll).
We’re getting creative—doing video sessions on our phones when we have to, muting the video screen on the computer while simultaneously calling on our phones for audio. In my experience, the individuals I work with, are more understanding, patient, and flexible when it comes to technological difficulties than I am. I, on the other hand, cannot escape the guilt I feel for not being able to practice the way I’d like to.
Video sessions are better than phone sessions, and effective treatment can be provided virtually—it’s just not quite the same as sitting face-to-face with someone. With telehealth, so much is missed. We get the upper half of someone’s body, but we miss a lot of the metacommunication (how we communicate without verbally communicating). It’s hard to see complete body language, which can often relay a person’s underlying emotional experience (for example, if someone is feeling anxious, their leg may fidget).
There are some therapists who are providing in-person services. Some patients need face-to-face services, especially those who are high acuity, and I’m thankful there are therapists who are willing and able to do so. To provide in-person services means everyone would have to wear a mask, and for me, personally, so much of therapy is in the affect. I need to be able to see people’s faces, so if the choice is virtual care without a mask, or in-person care with a mask, my choice is telehell—I mean telehealth!
While there are many pitfalls to telehealth, there are many positive aspects that are important to mention. For one, there is a wider net to cast. I’m licensed to practice anywhere in CA, and working virtually, has allowed me to meet with individuals across the state. It’s been pretty cool to provide care to those outside of the city where I reside. I have the opportunity to meet and work with individuals I normally wouldn’t get to work with, and that has been extremely meaningful. Additionally, there is more flexibility with telehealth, for both the provider and consumer. There is less time spent driving to and from an appointment, and it is easier for individuals to schedule daytime appointments, especially now that a lot of people are working remotely.
Question #3: How do you think your field has specifically changed?
Dr. Bergal: A lot of healthcare has leaned towards telemedicine. The interesting thing about the pandemic is the volume, it’s exhausting, and has been especially so during the two surges. The volume is testing not only the entire healthcare system, but hospital systems, clinic systems, and additionally at the individual provider level. On the department level, every specialty is strained. The outpatient providers are overwhelmed because they’re seeing so many more patients. The inpatient providers are burnt out because of the surges in the hospital. Critical care is overburdened because every ICU throughout the country is packed.
The other major strain is death. The death toll is insane, frequent—saturated; it’s something that doctors prepare for but now it’s becoming the norm. People are putting up barriers and defense mechanisms to be able to survive this and go back the next day. At times, it is code, after code, after code—and those outcomes aren’t great. Doctors get into medicine to help and sometimes despite our best efforts, we’re not able to. This has been magnified by the pandemic.
Karen: We’re not doing scheduled procedures or surgeries; we’re constantly triaging and treating emergencies. There are important, scheduled procedures which are still considered needed, and they’re now being pushed because of the overflow from the pandemic. Patients are having to delay these surgeries and procedures, so that the hospital staff can deal with more imminent health risks.
Tracy: The biggest thing with mental health is that while we’re dealing with a pandemic related to a physical disease, we’re also dealing with a mental health pandemic. Therapists are inundated with mental health referrals, because what’s happening in the world is taking a toll on everyone’s mental health, and how could it not? It’s great to see so many people who have never received therapy access services, and that demand can lead and has led to exhaustion. The unique thing about providing therapy during a pandemic, is that much of what our patients are experiencing, we are also experiencing simultaneously.
Question #4: How do you manage your own physical and mental health, while working as a healthcare provider during a pandemic?
Dr. Bergal: Honestly, it kind of depends on the month. I’m a resident, so I’m rotating through departments. Rotations outside of the ICU are less intensive. If I’m in the ICU, unfortunately, there isn’t much time to process or cope with much of anything. I am in moment-to-moment survival. The schedule is work 16 hours, sleep, and do it all over again for the next 6 days or so in a row. So that’s not very healthy, as one can imagine. And because of the pandemic and the nature of my job, I probably isolate more than the average person, because I’m scared to unknowingly infect someone. I try to get outside and exercise as often as I can. I could probably benefit from some therapy, but for now I lean on my wife, who is an emergency room physician.
Karen: Debriefing with coworkers is huge. My coworkers are living through it at the same time as I, so having that camaraderie has been helpful. When I’m not working, I try to make room for down time and find ways to disconnect. With an infant, that’s been especially challenging, but it’s something I really strive for. Being in nature and moving my body is essential.
Tracy: The biggest thing for me is taking care of my own mental health. I hold the belief that everyone could benefit from therapy, and therapists are no exception. If anything, they’re the rule—therapists need therapy to be able to hold space for others. I go to individual therapy and couples therapy with my husband, which helps me to nurture my own needs. I also try to maintain a good sleep schedule, disconnect from technology, read, spend time with my dogs, and I try to go to the beach at least 1 time a week.
Question #5: How do you think your field will look post-pandemic?
Dr. Bergal: There will be a massive amount of relief amongst the entire healthcare system and across all providers, because the system won’t be as overwhelmed. There has been a massive, forced movement to embrace telemedicine, so I think there will be a lot more telemedicine incorporated into healthcare in the future.
Karen: I think it will change how nurses are regarded in the public eye—at least that’s the hope. Some nurses might leave clinical work and transition to more administrative roles. I expect to see massive burnout and I wonder if people will be less likely to go into nursing.
Tracy: I think telehealth is likely here to stay, and for good reason. While most therapists (myself included), long for the day they can see people in person, most will likely continue doing some telehealth beyond the pandemic. In addition to this, I think what we’re realizing is that the current system doesn’t work. We need more therapists and we need people to have better access to mental health services. Even individuals who have insurance have a difficult time getting mental health services because of the way the system is set up. The hope is that as the need for mental health is realized and becomes more accepted by our culture, the barriers to accessing services are broken down. Mental healthcare is healthcare.
Question #6: What’s the biggest thing you wish patients and the community could understand about being a healthcare worker right now?
Dr. Bergal: To put simply, we’re doing our best. We are stretched thin. We took an oath to treat patients to the best of our ability and that’s exactly what we are currently doing, and will continue to do.
Karen: If a patient feels there is something that is not being tended to (for example, they’re clicking the call button because they want their phone passed to them and they’re upset that we don’t respond fast enough), I would like them to know it’s because something more critical is being tended to; not because we don’t care. We care, and we care deeply.
To the larger community: there’s a lot of talk about how bad it is in the hospitals and the reality is that it’s far worse than anyone could imagine. We need to band together because we need the greater community to get through this.
Tracy: The biggest thing I want people to know is that we’re doing the best we can and we’re here to help. Yes, being a healthcare worker is hard, and for most of us, it’s the sort of job that goes far beyond a paycheck—it is the sort of work that feeds our souls.
To every single healthcare worker, whether you’re providing direct care, support services, administrative work, and anything in between—thank you! Your work matters and you are a true hero!
Click here for general mental health resources, including a free virtual group for healthcare workers.
Dr. Jack Bergal and Karen Lemberger were interviewed for this article. This article was written and edited by Tracy, with approval from Dr. Bergal and Karen.