During coronavirus, doctors need emotional support, too

Dr. Guy Topaz, a senior physician who works in the COVID-19 ward at Meir Medical Center in Kfar Saba, has found himself having to cope with unusual situations that he never encountered in the past, despite his many years of experience.

“As doctors, we are used to handling difficult situations, including high mortality rates,” Topaz explains, “but in recent months, we have been experiencing much higher mortality rates than ever before and many patients are severely sick, including young people we’ve had to put on ventilators to help them breathe. It’s absolutely heartbreaking that so many people have had to die this way.

“We have never had to deal with such intensity and with such a large number of extremely sick patients, day after day.”

Up until now, there has been lots of discussion about people who have contracted COVID-19 and their families, as the entire community has experienced lockdown, during which we were required to stay indoors and suffer the difficulties that arise from long periods of isolation. But not much has been said about the hardships suffered by the nurses and doctors who work day and night inside COVID-19 wards, and the fact that they, too, are in desperate need of TLC.

“In the COVID-19 wards, everything is very dynamic, and a patient’s situation can deteriorate quite quickly,” continues Topaz. “Add to that the fact that we need to suit up with all the PPE every single time we go into a COVID-19 patient’s room, which adds a few minutes each time. We are still dealing with a new phenomenon and learning lessons as we go along. Each time a person crashes quickly or, God forbid, dies, we mourn together with the patients and their families. It’s really hard for our staff when so many of our patients are not surviving or are suffering from so many life-threatening conditions. It puts a real strain on us emotionally to deal with this every single day, all day long. You just have to take a deep breath, close your eyes for a moment and then keep chugging along.”

How has this affected you personally?

“Unfortunately, these difficult images stay with me when I go home, and it’s hard for me to stop thinking about them even days after the event. It’s very hard not to be sad that all these people have lost their lives.

“On the other hand, this intensely difficult work has really helped our medical staff coalesce as a team, and we really support each other. We share our sadness and feelings with each other, and all of us are mandated to meet with the hospital psychologist or social worker once a week. We’re encouraged to talk about everything and not hold back, so that we can remain healthy emotionally and be strong enough to suit up and go right back into the COVID-19 unit each day.”

“We take care of the most seriously ill patients and we feel their suffering,” says Dr. Ali Abdallah, a senior internal medicine physician who works in the COVID-19 ward at Kaplan Medical Center in Rehovot. “We see our patients suffering and struggling to breathe. They are all alone, since their family members are not allowed into the ward. We are their only contact with the outside world. I try to help our patients as much as possible. It’s extremely hard for me to speak with their family members, but I do it anyway because it’s so important. It’s also hard to communicate with the patients, since we can’t touch them and they can barely see our faces since we’re all covered up with gear. It’s especially hard knowing that it’s impossible for them to feel my compassion, since they don’t see my facial expressions.”

How does all that affect your mental state?

“I’m absolutely exhausted and empty by the time I get home from one of my shifts. During the first wave, I was very worried that I might infect one of my family members. My son is two and my wife is pregnant. This fear was constantly in the back of my mind.” Describe a particularly difficult situation you’ve experienced.

“Some patients make such a deep imprint on your psyche,” continues Abdallah. “There was one older gentleman – we would speak with his wife on the phone all the time. I watched as he deteriorated day after day. I tried to offer him reasons to remain optimistic, but his situation was really declining. He was so dependent on me, and I wanted so badly to have some good news to give him. I’d become very connected with him, and when he died I took it really hard.

“It’s just so awful when you lose a patient. We did absolutely everything we could to save him, but this virus is nefarious.”

“Well, luckily, my wife is a pediatrician, so the last few times that I’ve arrived home overwhelmed by a feeling of helplessness, I was able to tell her everything because she really gets it. She’s really helped me release all the tension I hold inside.” The hospitals are actually the main providers of emotional and psychological help for their medical staff that work in the COVID-19 wards.

“We created, together with the hospital management, a support network for our nurses and doctors who work in the COVID-19 wards,” explains Mazi Bilu, director of social services at Meir Medical Center. “Of course, we don’t force any of our employees to go to these sessions with our social workers and psychologists if they choose not to. We meet one-on-one with each staff member, and also hold group counseling sessions. We try to hold the sessions before a shift starts, since by the time the doctors’ and nurses’ shifts end, they’re exhausted and usually have no energy to talk about what they’re experiencing.”

How do these counseling sessions help?

“First of all, it helps them figure out the best ways to interact with the families of their patients, to deal with the relatives’ fears and feelings of helplessness and frustration, especially in cases where a patient has died.

“We work closely with the COVID-19 staff members to help them process their feelings, become resilient and learn coping skills.

“Some people claim that exercise has helped them, whereas others say walking on the beach or talking with a good friend is the most helpful. In our experience, just keeping them talking and expressing themselves is the key to helping them process what they’re experiencing and thereby keeping them healthy. Not everyone has someone he can vent to on a daily basis, and so we make sure to jump in and fill that hole.

“By the way, many times the doctors and nurses themselves don’t even realize at the time that they’re suffering psychologically, and as a result they can develop PTSD at a later date.”

“Since the beginning of the COVID-19 outbreak, we’ve been taking steps to increase the mental and psychological resilience of the staff working in our COVID-19 units,” says Sigal Alon-Sidlik, a psychologist who works for Clalit Health Services, and who has been an active member of the team that’s creating a program to increase mental resilience of the medical staff working in COVID-19 wards in all Clalit hospitals. “At the beginning of the epidemic, we began offering video counseling sessions for all our medical staff. And we hold brainstorming sessions in all of our hospitals between the medical staff and management so that we can adjust our protocols, work more effectively and provide our staff members with the support they need to function well.” According to Alon-Sidlik, there is a tremendous need for this type of support.

“Working in a COVID-19 ward can be extremely challenging, even for staff members who have lots of experience working in a stressful environment. For example, families of severely sick COVID-19 patients cannot visit their loved ones, and we are experiencing higher mortality rates than ever.

“In the past, doctors and nurses would be able to share with co-workers during coffee breaks or in staff meetings, but these aren’t taking place these days, due to social distancing restrictions.

“In addition, our staff members are constantly worried that they themselves will become infected with COVID-19 and then spread it to their families.

“So, our goal is to reduce the stress levels, acknowledge their feelings and offer them tools to help one another, since we are all in this together.”

Dr. Tatiana Michaelov, who was appointed head of the COVID-19 department at the Hillel Yaffe Medical Center in Hadera, has also faced many challenges since taking on her new role.

“I’d already been working as a doctor for 20 years when the epidemic broke out, but I’ve had to deal with circumstances that are completely new to me.

“It’s been difficult and challenging trying to save the old and young people who are getting critically sick from COVID-19. Sometimes, a young patient’s condition can deteriorate quickly right in front of our eyes, and we have to put them on ventilators. We fight hard for each and every patient who comes through our doors, but unfortunately we are not able to save everyone.

“It’s so difficult to go through the mourning process with each family as they say goodbye to their loved one.

“For example, this past Rosh Hashanah, I had a 50-year-old patient with no background illnesses who quickly began experiencing respiratory distress. We put him on a ventilator and his prognosis wasn’t looking too good. I spoke on the phone with his wife and kids and tried to offer them as much support as I could. He died after just two weeks. The entire staff here was absolutely devastated.”

What’s it like when you get home every night?

“I continue thinking about my day even after I get home. My 18-year-old daughter is worried about me and is always asking me if I’m okay. Since I took on the role of head of the COVID-19 ward, I really take each case to heart.

“My daughter has had to grow up quickly – she suddenly began to cook for us and clean up the house without me asking her to. She sees how mentally and physically drained I am.

“I’ve always been a very hardworking person and worked 24/7, but I’ve never experienced anything like this.

“One of the hardest parts is that patients’ families cannot come visit them, and so their only way to feel connected and get updates is to speak with our staff. They’re constantly calling me, asking me, ‘Dr. Tatiana, how is my mother?’ ‘How is my father?’ Before, I would never give out my personal cellphone number to patients, but now I give it to everyone. Family member calls me directly 24/7, and I always answer my phone.

“The hospital suggested that I sit down for a talk with one of their psychologists, but I haven’t taken advantage of this service yet. I guess I’m getting by somehow.

“I love my profession, and every morning when I wake up, I look forward to going to the hospital and working together with my amazing team.”