Emergency doctor: We need help before it’s too late

Editor’s Note: Dr. Tsion Firew is an emergency medicine doctor based in New York. She is an ardent advocate for the advancement of high-quality global emergency medicine, an adviser to the Ethiopian Ministry of Health and a member of its Covid-19 Response Team. The opinions expressed here are her own. Read more opinion at CNN.

Last weekend, I was on CNN discussing the importance of supporting the mental and emotional health of medical professionals. I likened this pandemic to an invisible bomb going off in our emergency departments.

Tsion Firew

Twenty-four hours later, I learned about the death of my colleague, Dr. Lorna Breen. A day later, I learned from media reports that she had died by suicide. It was a one-two punch, like she died twice.

Lorna had survived Covid-19 earlier this month. As her physical symptoms got better, the mental toll of the pandemic continued to get worse. And so I spent Tuesday, my birthday, mourning the most recent devastating loss of a colleague, a friend. And as I mourned, I reflected.

The world is hailing medical professionals as heroes, and don’t get me wrong: The public praise has been a welcome shift. Our jobs were harrowing long before this crisis and will remain so long after we return to some semblance of normalcy. I am grateful for the acknowledgment.

But Lorna’s untimely death is painful evidence of the hidden battle that so many doctors, nurses and frontline workers are fighting right now. A battle that words of praise, welcome though they may be, simply cannot overcome.

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I see it unfold in front of me every day in my emergency department here in New York City. It’s not the first time I’ve worked in challenging circumstances. I saw many tragedies working as a volunteer medic in Iraq over my four weeks on the front line with US-backed Iraqi soldiers. But I never imagined a future where I would care for so many colleagues unable to breathe, presumably due to coronavirus infection.

We treat everyone as if they have it – that’s what risk mitigation calls for. I treated a friend’s critically ill father and, atop an already-terrifying situation, initiated difficult end-of-life-care conversations. He survived, but the discussions of whether to intervene and how far under such duress leave scars.

I hadn’t conceived of counseling a nurse I know in my department through despair and helplessness after she infected her mother with the virus. Her mother also survived and left the hospital after several days of oxygen therapy, but the trauma of her guilt will endure and take much, much longer to heal.

I never thought I’d become infected myself. To make matters worse, I didn’t have access to testing when I fell ill. Fortunately, my symptoms were such that I could convalesce at home – chills, body aches that turned to an unrelenting headache and then exhaustion – and return to work a week later. No shortness of breath, no ventilator. Lucky.

I couldn’t imagine that I’d see such an alarming number of elderly and nursing home patients dying at rates that none of us had ever experienced. I never thought that patients’ families would be barred from visiting their dying loved ones; that I would give them updates over the phone and offer up last-minute video calls to say goodbye. How does one prepare to facilitate a FaceTime goodbye?

We are facing death at such an accelerated rate that the word unprecedented isn’t adequate, isn’t enough. It is like nothing any of us could have prepared for.

To deepen the trauma, many health care workers were promised personal protective equipment that never arrived. My ED has been very well-stocked, but other hospitals in New York City and across New York City continue to experience shortages. We put ourselves and our loved ones at risk every time we go to work and we rely on PPE to keep us safe, to reduce our families’ risk.

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We stretch to physical and mental limits beyond imagination. The next day, we surpass those limits. And we need help.

In Iraq, we provided trauma care under immense levels of stress, often with limited access to regular resources. Prior to our deployment, we received training on what to expect and how to manage the mental and emotional strain of health care in a warzone.

Warzone medics return home likely to develop post-traumatic stress disorder (PTSD) and related physical ailments. The long-term risks are real and well-documented. They are at much higher risk of self-harm and are more prone to substance abuse and depression.

Now, amid the Covid-19 pandemic, health care professionals across the globe are faced with extraordinary levels of pressure not so different from a war zone. The trauma of this crisis is creating a new generation of veterans of a war at home, each of whom is serving our country and needs our support. But with the current capacities of our institutions, and the cultural stigmatization of mental and emotional health issues, we as a country are not prepared to support them.

The unfortunate truth is that the United States has never adequately provided treatment for mental and emotional health challenges, such as PTSD, for brave citizens who put their country before themselves. As we begin to imagine a post-Covid-19 America, we must do better by all of our veterans, including the hundreds of thousands of health care workers who have borne the trauma of this pandemic. That starts by destigmatizing mental health issues and making it easier for physicians, nurses and others to seek out the resources they need.

As I grieve the loss of Lorna and so many patients, I recognize how fortunate I am to have been trained in conflict medicine, to have received the guidance I did when so many have not. I am keeping my head down, but my eyes are wide open. Medical professionals are indeed heroes, but we are also human. Many of us are suffering beyond anything we are able to articulate and the weight of this moment is heavy upon our shoulders.

Heed our call. The front line of this pandemic needs mental health resources and emotional support to process the destruction we cannot prevent, we cannot fix. The next wave is coming. We need help before it’s too late for more of us.