Paula Madrid
As a clinical and forensic psychologist specializing in trauma, I have a passion for serving those in need. I must admit, I have always felt energized by the call of duty both in the midst and aftermath of disaster situations. Having spent the past 20 years answering the call to engage in what many might lightly label "tough work" — responding to the terrorist events of 9/11, working in the Houston Astrodome in the days post-Katrina and for the Gulf of Mexico over the next two years, arriving in Haiti three days after the earthquake, among many other disaster response efforts — I thought it reasonable to assume such experiences would prepare me for just about anything. I was wrong. The sheer levels of trauma, grief, helplessness, and fear for the future to which I currently bear witness are of incomprehensible magnitude, with little relief in sight.
In the interest of maintaining safe and appropriate physical distance, licensed mental health professionals can provide support over telephone or through services like Zoom. Such circumstances are unprecedented, but the precautions are sound and these tools have made our job of helping those in need somewhat easier.
In the last few days, my clinical practice has transformed into a night-shift psych-support service. I have been providing services to hospital executives and clinicians seeking support and guidance — most are eager for a chance to process the devastating reality they experience on the frontlines of the Covid-19 pandemic in NYC and Boston.
In this time I have heard regularly from hospital workers, their employers, and sometimes their families. Each night I hear stories about brave and caring professionals sent to war without armor but with their heads held high. My patients trained to administer treatment to those in need understand that "this one is on us," and remain committed to their mission.
One experienced physician sobbed while revealing that he has seen more deaths this past week than in his last 20 years of practice. He confided that the faces of deceased patients never leave his mind. A young nurse disclosed that countless patients die alone, without anyone by their side, and she has been struggling of late with unrelenting nightmares. A chief resident admitted to having frequent panic attacks, rushing to the bathroom at least twice a day in order to cope. Several medical professionals shared that they are using more alcohol than ever in order to self-soothe, fall asleep, or find "a moment's peace."
I am comfortable with tears and painful silences as well as with expressions of hopelessness. I am intent and committed as ever to working with patients on solutions to their quandaries and distressing symptoms. And yet, these are different times. The grueling 17-hour shifts, lack of adequate protective equipment, and unprecedented casualties take a severe toll on practitioners' welfare. They are overwhelmed by the abounding confusion and sense of uncertainty over what's to come.
Whereas during "normal" times physicians are able to return home to their families, to find comfort in loved ones' embraces, or even have basic access to the critical equipment they require, such luxuries are wholly absent from their new reality. Health care providers are experiencing extreme trepidation both in and out of work over fear of spreading the virus. At work, they share, they are told that by the end of the first week of April, they will have exhausted the supplies and machines necessary to manage the expected surge of patients. Upon assessment, their emotions range from flat and numb to outright hysterical — from being petrified to feeling empowered, knowing the world depends on them. Not unlike the most heroic soldiers, they are willing to march on and do their best, at whatever cost.
As mental health professionals, we know that in the wake of trauma, those directly exposed to the stressor are the ones who experience the most critical long-term impact. How then can we quantify and make sense of the experience of physicians, nurses, and their support staff in the wake of countless daily exposures?
It is not particularly helpful to pathologize these dedicated practitioners' experiences, because they are normal responses in times of utmost distress. An official diagnosis of PTSD warrants a lengthier timeline. However, I see clear signs of grief, anxiety, traumatic responses, and what, in psychology, we call compassion fatigue or secondary trauma. The latter is characterized by emotional and physical exhaustion resulting from overexposure to stressors, or what, in simpler words, is described as "the negative cost of caring." These personnel have witnessed such abundance of trauma or chaos as to render them at other times unfeeling or desensitized as a means of self preservation.
In the absence of common coping methods — spending time with friends, dining out, exercise, a weekend away, and, most importantly, up close and personal time with families — our heroes will suffer greater reliance on their own resiliency and on specialized mental health providers able to offer support and expertise. Additionally, our community's response, validation, and support play critical roles in mitigating traumatic responses.
For professionals on the frontlines of this crisis, horrors will continue to mount and exposure to the most dire of circumstances simply cannot be avoided. However, it is paramount to note that during a time of such unprecedented upheaval, we are not without a sense of hope. The force of human resiliency is unmatched, and many are able to resume healthy patterns of daily functioning, even in the face of severe trauma or adversity. It remains true that many who encounter such trauma report what is called post-traumatic growth when they receive proper support. That is experiencing greater psychological resiliency after dealing with adversity.
It is critical that our government and society at large be alerted to the new realities and made fully aware of the mental health crisis already well in progress. The gravity of this moment cannot be overstated, nor can its toll on our health care professionals be overestimated. All resources must be pooled to serve those who, in this time of unparalleled devastation, serve us so devotedly.
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