“I get a reoccurring nightmare. Every time I close my eyes, I see my patient’s face, his mouth slightly open, gasping for air. The sounds of the medical machines around us seem heightened in my head. My heart seems to pound, and I feel like it is about to explode in my chest. I, too, feel like I cannot breathe. I wake up in cold sweats with my T-shirt drenched on nights like these,” said *Dr Rahul, a junior pulmonologist at a private hospital in Mumbai.
A year of treating COVID-19 positive has taken a toll on his physical health, sleep cycle and relationships. However, it is his mental health issues that have aggravated to the point of grave concern.
“These days, I feel overwhelmed with the smallest of things that seem to be happening in my life. I cannot seem to focus or concentrate. Recently, I found my hands to be trembling whilst conducting a small procedure for another patient. I feel I have emotionally shut down and cannot talk to anyone,” added Dr Rahul.
In the past year, Dr Rahul has also started drinking heavily in a futile effort to block out these repetitive thoughts and images of his patients dying, struggling for few last breaths, after being afflicted by COVID-19. “The worst feeling, however, is that of guilt. It eats me up inside. I feel responsible for his death. I feel that I could have done much more or done something differently, perhaps to save him. I will never forget the expression on his wife and son’s face when I had to share with them that there was nothing else that we could do in the emergency room. This is the eighth time I have felt like this. This is the eighth patient that has died under my care in the last six months,” he added sombrely.
Like Rahul, there are thousands of frontline medical practitioners and health workers who experience symptoms of anxiety, stress, burnout, PTSD and even depression. However, they still do not have the luxury to process their thoughts or seek out help. As beds fill out rapidly in the second covid-19 peak, the healthcare workers are again burdened with the responsibility of fighting death, keeping people alive. Of course, this fight is being fought at the high cost of growing mental health issues among healthcare workers.
High Levels of PTSD
Canadian research on PTSD among nurses estimated a prevalence of as high as 40 per cent in this current pandemic. Whether one’s a nurse, surgeon, paramedical, physician or psychiatrist – the responsibility, duty, and liabilities always remain the same. Thus, the risk of experiencing trauma and stress is very high for such professionals.
Long working hours, fatigue, lack of rest and sleep, dealing with complications, the uncertainties of an ongoing pandemic, difficult caregivers or relatives and unrealistic expectations have also contributed to burnouts and drained emotions. Often, doctors or emergency care workers have also been beaten, threatened, abused or mobbed by family members or relatives who’ve lost their loved ones under their professional’s care. This has also led to apprehension and anxieties amongst professionals who deal with such critical COVID cases.
The exposure to high levels of the COVID-19 virus, as well as other contagious diseases during this time, has only added to their existing stress. It often happens that professionals who work with the paediatric population, terminal cases like HIV /AIDS, cancer or other chronic health conditions, find the emotional trauma very difficult to deal with, as in most cases, death is prolonged, yet inevitable. Many mental health professionals and psychiatrists too, who have lost clients to suicide, have silently suffered the loss and experience symptoms of grief and bereavement. Many have felt responsible and wondered if they could have done more to prevent suicide. However, until COVID-19 arrived, rarely had so many physical health practitioners experienced such extreme mental stress and anxiety.
What Are The Symptoms?
Physicians, doctors, nurses, paramedics — they all need to realise that they are human beings too. They mustn’t ignore their feelings and emotions because they are not super-humans or Gods and cannot be in control of every given situation or predict how things may turn out. They have worked tirelessly for a year, despite many logistical issues and personal difficulties and also taken the significant risk of repeated COVID-19 exposure.
They have done it because they are dedicated, and they care and have a duty to uphold. They have done this because they’ve taken an oath to treat, heal and care for anyone that comes to them for treatment. However, they must not do it at the cost of their mental health.
A person, even if he/she is a doctor, cannot take care of anyone if he/she is not in the suitable mental space and framework, or processing excessively drained emotions, or PTSD or burnout. Therefore, they should identify the challenges they face and try to address them as soon as possible.
If any Medical practitioner or health care worker is experiencing any of the symptoms of stress or trauma, it is essential to reach out and speak to a Support group, Counsellor or Mental health professional.
The symptoms include vivid memories or flashbacks, feeling like the incident has happened now, intrusive, repetitive thoughts or images, disturbed sleep or nightmares, intense distress at real or symbolic reminders of the trauma- like sounds, voices, specific images, people or even smells. They should also pay attention to physical sensations such as pain, sweating, nausea or trembling, getting easily irritable, emotional, upset or angry, extreme alertness or ‘hypervigilance’ which are our bodies way of telling us that the minds need to be taken care of.
Some of the other symptoms include being jumpy or getting easily startled, self-destructive behaviour or recklessness, being unable to remember details of what happened, feeling blank or having memory lapses, feeling emotionally numb or cut off from feelings, being unable to express affection and feeling that nobody understand them, using alcohol or drugs to avoid memories, blaming themselves for what happened with tremendous guilt, shame and low self-confidence and esteem.
How to Cope and heal
Frontline healthcare workers need to find healthy ways and coping mechanisms during these distressful times. Staying away from alcohol, drugs, and negative people or situations is imperative. They need to ‘talk and share’ their feelings with someone they trust. Consulting a health professional may be the best option.
They also need to create boundaries and put into place a work-family-self- life balance, and even though this is perhaps not the best time, they should consider taking short breaks, and going on holidays and being with nature, which really helps to unwind and disconnect from work. They also need to find time for themselves, despite their hectic work hours, to pursue hobbies, exercise, socialise, wind down or create ‘me-time’
And finally, They need to have realistic expectations and accept how much they can do and things that they will not be able to control. They need to find ways of ‘letting go’ and ways to practice Mindfulness, Gratitude or meditation. Deep breathing exercises, progressive muscle relaxation, self-monitoring, expressive writing and journaling can also be beneficial.
*The junior pulmonologist’s name has been changed to protect his identity.
The author Dr Zirak Marker is a Senior Psychiatrist & Adviser – Mpower The Centre. The views expressed in this article are personal.
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