Coronavirus Has Shined a Light on Healthcare Workers' Mental Health, but Their Struggles Aren't New

POPSUGAR: Can you describe your prepandemic work life and how it changed during the pandemic?
Dr. Sophie Shotter: Prepandemic, I worked in the private sector. I run my own skin and wellness clinic, Illuminate Skin Clinic, and also work for The Cosmetic Skin Clinic in London. A typical day involves business management meetings and a busy list of patients. When the pandemic hit, we stopped offering all nonessential medical services at Illuminate Skin Clinic, and operated as a not-for-profit private GP service. My background is as an anaesthetist and intensive care doctor, so I volunteered to return to the NHS for eight weeks. I worked at my local hospital, often doing 60 hours per week — returning to a mixture of long days and night shifts — while continuing to offer virtual skin-care consultations.

PS: Are you familiar with the concept of vicarious trauma as a health worker? And if so, do you believe vicarious trauma or PTSD is a common experience among health works?
SS: Yes, this is something I've been very conscious of in my career, and was part of the driving force behind my decision to leave the NHS in 2014. I'm an empath and struggled, at times, to disassociate from other people's pain and trauma. I knew that longterm it would have a negative psychological effect on me, so chose to remove myself from that situation.

I think it is very prevalent, but also very under recognized. We're with patients and their families at often the most traumatic times in their life. Unless you are a robot, it is impossible to switch your own feelings off completely, although we learn to cope (to varying degrees). I know many medical professionals who have chosen a different career pathway, partly because of the impact of the emotional traumas they have been involved with.

PS: How does being a health worker impact your mental health in a positive and/or negative way, and has this changed during the pandemic?
SS: Being a healthcare worker is rewarding in a way that not many careers are. In the pandemic, for me, it has been a huge positive for my mental health because I got to go out and work, be around people, and to have a purpose. That made dealing with eight weeks in lockdown immensely easier. Yes, there were some extremely tough times — things that are horrendous to see, do, and feel — but for me, the positives outweighed this.

PS: In my experience, a lot of health workers don't believe they require (or perhaps, deserve) psychological support or assistance for "simply doing their jobs." What is your experience with this, and has your perspective changed since the pandemic began?

SS: I would agree with that. If I told you the things that made up my normal life as a healthcare worker, it would be beyond most people's comprehension how I'm OK. My last weekend before I left the NHS to return to my clinic, we lost a baby in a caesarean section and a 21-year-old to a horrific drug overdose. I took that home with me, I cried, I offloaded onto my parents. But I never got proper help. We carry other people's pain, suffering, and loss home with us. Although it isn't our own, as an empath I often still felt it very acutely.

Last year I stopped at a road traffic accident, and looked after the airway of a young 22-year-old who later died. I was the first medical person on scene. I stood up afterwards, covered in blood, having lost the patient. That hit me hard and made me realize that it's normal and OK to be upset by these sorts of things, but when they're your every day rather than your "once in five years," you cannot afford to let each one affect you so heavily. The NHS has made psychological support available to healthcare workers post-pandemic, but I'm not aware of anyone who has used it.

PS: Were you offered psychological support, and is there any service you wish you had been offered to cope better during the pandemic?
SS: It was offered on posters in the coffee room, but never formally. I've never been offered psychological support from my employer. The only thing that would have made it easier was better PPE, in all honesty, and a better resourced health system. If we knew that we had access to the best quality PPE and that supply wasn't a problem, then I think we would all have felt much easier about the situation. Nothing can be done to prepare you or train you for this, so I don't feel training would have been helpful for me.

PS: Throughout the pandemic, health workers have been hailed as heroes and were compared to soldiers going to the frontline of a war. How did this make you feel?
SS: I hated that terminology. I was so proud of how the NHS pulled together: its people are its biggest strength. These are people who have essentially taken a pay cut over the last five years due to inflation, who do an incredible job in very difficult circumstances. It's OK for a hero to die; soldiers die at war, healthcare workers die in a pandemic. Cynically, I believe maybe this is why the terminology was used — to make it more acceptable when some of us died. If people want to do something positive for healthcare workers, then say thank you, and also lobby your MPs for a very well-deserved pay rise. The fact that the House of Commons had only a handful of MPs in attendance last week when a pay rise for NHS staff was debated is, to me, very telling.

PS: Do you think the work you have done during the pandemic will affect you long-term, psychologically, or in a different way than your pre-COVID workload did?
SS: It will be something I always remember and never regret doing. There will be images in my head that I will probably never see in front of me again, and the memories of it will always be emotive. Probably, for me, the most difficult part was actually before I went back. I was under no obligation to return to help, I had friends in the NHS telling me not to do it as it was too dangerous. I spent two weeks seriously afraid, having dreams that I was going to die of COVID and feeling like I was voluntarily putting myself forward as a lamb to the slaughter. That feeling will never leave me, but I'm very proud of what I did.

POPSUGAR: Can you describe your prepandemic work life and how it changed during the pandemic?
"Nurse Patti" Lafontant: Prepandemic, work was very busy, but despite being in an emergency room, there was nothing we saw that we weren't prepared for. Work was business as usual . . . more patients than beds, being short-staffed, and the same hospital politics.

A lot changed during the pandemic; things changed by the hour. Hospital leaders and administrators were very lost and confused, so naturally, the clinicians and essential workers were, too. A lot of the staff were scared. A lot of nurses have small children at home, were pregnant, or were already elderly and had chronic illnesses themselves. That made things more complicated, because we would witness people suffer and/or die and understood that it could also be us or our families. On top of the anxiety of getting sick, dying, or causing someone else to, we were hearing about the PPE shortage and how nurses in other states were working without any at all. The work environment was very tense and sometimes even hostile. We were all overwhelmed.

PS: Are you familiar with the concept of vicarious trauma as a health worker? And if so, do you believe vicarious trauma or PTSD is a common experience among health works?
PL: Yes, I believe both vicarious trauma and PTSD exist amongst MOST healthcare workers, but I also believe that most of us experienced PTSD long before COVID-19. Those of us who work in hospitals — especially in acute care settings such as the emergency room, trauma center, and ICU — had many traumatic experiences after taking care of critically sick or severely injured patients and their families.

PS: How does being a health worker impact your mental health in a positive and/or negative way, and has this changed during the pandemic?
PL: My mental health has been impacted in a positive way by my profession because I get to see, on a regular basis, that no matter how bad or difficult you think your situation is, someone else's is even harder. The way my profession has impacted my mental health negatively is that I will never understand why people have to suffer the way that they do, and I have witnessed a lot of human suffering. The pandemic didn't really change anything — it highlighted it.

PS: In my experience, a lot of health workers don't believe they require (or perhaps, deserve) psychological support or assistance for "simply doing their jobs." What is your experience with this, and has your perspective changed since the pandemic began?
PL: Prior to the pandemic, many of us felt like we could handle the demands of our jobs by just having good support from family and friends. I think, after experiencing this pandemic, we now know that professional assistance is probably best.

PS: Were you offered psychological support, and is there any service you wish you had been offered to cope better during the pandemic?
PL: I was not offered "real" support, but I was offered a 1-800 number assistance from the employment assistance program through my employer. This was the same assistance they provided prior to COVID-19, and it wasn't much. I wish nurses were offered real psychological support early on, including taking time off to reset. Having PPE readily available would've also saved a lot of lives and a lot of us from anxiety and depression.

PS: Throughout the pandemic, health workers have been hailed as heroes and were compared to soldiers going to the frontline of a war. How did this make you feel?
PL: I wasn't comfortable being called a hero or being compared to a soldier at war. Being called a hero put false expectations and pressure on us. Nurses are superhuman, but not superheroes — because as much as we wish we did, we do not have superpowers, and we can become a patient at any time. As far as being compared to soldiers, I would never want to diminish the danger soldiers face fighting for a country on a battlefield with real weapons. I was a nurse following the earthquake in Haiti, and that felt more like a war zone to me than COVID. COVID was (and is) bad, but I wouldn't compare it to an actual battle field with bullets flying and bombs going off.

PS: Do you think the work you have done during the pandemic will affect you long-term, psychologically, or in a different way than your pre-COVID workload did?
PL: I believe the work that I did during this pandemic will never be forgotten. I'm not sure if I can predict what long-term affects it will have on me.

PS: Is there anything else you would like people to know?
PL: I'd also like to add that COVID-19 disproportionately affects African-Americans more than almost any of our counterparts, and COVID-19 shone a bright light on how broken our healthcare system really is.

POPSUGAR: Can you describe your prepandemic work life and how it changed during the pandemic?
Aimee C: Prepandemic work life was busy, but nothing like when COVID-19 hit. Respiratory therapists (RTs) are often stretched thin because people within our own hospital don't always understand our role and skills, but we are trained to do so much more than many realize. On a regular basis, RTs intubate (or assist), breathe for patients who cannot do it themselves, ECMO [Extracorporeal membrane oxygenation], titrate pulmonary vasodilators, manage invasive and noninvasive mechanical ventilators better than anyone else, and work with every age group — from neonatal, to geriatric, to trauma patients — sometimes all in the same shift.

When the pandemic started, things became more hectic and we were stretched even thinner. I was placed in the COVID intensive care unit (ICU) at the beginning of the pandemic and spent over three months assigned only to this unit, throughout the peak in my city. Everyone wanted RT, and many of the physicians sought us out to listen to what we had to say because we were all still trying to understand this new illness and how to treat it. Procedures we used to perform every few months were now daily occurrences, or multiple times a day, in emergent and fragile situations.

PS: Are you familiar with the concept of vicarious trauma as a health worker? And if so, do you believe vicarious trauma or PTSD is a common experience among health works?
AC: I have heard of this before, but I am more familiar with the term PTSD. I feel it is quite common among healthcare workers due to the nature of what we see and do on a regular basis. Regardless of whether people in healthcare admit it or not, many of us have various coping mechanisms and self-care routines that we use to process the things we see and do at work. Even when practicing proper self-care, some days can be extremely physically and mentally exhausting. I can definitely feel it in my mood in the few days after an especially hard week.

PS: In my experience, a lot of health workers don't believe they require (or perhaps, deserve) psychological support or assistance for "simply doing their jobs." What is your experience with this, and has your perspective changed since the pandemic began?
AC: I have heard many healthcare professionals share similar sentiments, but I am not one of them. Coming from a family with a healthcare background, I went into this profession knowing it would be extremely stressful, and that it's important to take care of yourself and ask for help when you need it. I truly wish this topic was not so taboo within healthcare still. Any of us would recommend help to one of our patients, but also look down on other healthcare professionals (or themselves) if they voice the need for mental health support. Some even fear repercussions from management, which is truly a shame and only leads to more psychological damage.

PS: Were you offered psychological support, and is there any service you wish you had been offered to cope better during the pandemic?
AC: My employer has offered mental health support throughout the pandemic, and has a general mental health support service. More security and better preparation for a pandemic would have saved many healthcare professionals from some of these stresses.

PS: Throughout the pandemic, health workers have been hailed as heroes and were compared to soldiers going to the frontline of a war. How did this make you feel?
AC: As an RT, my profession has always been in the shadow of nurses and doctors, but because this pandemic was caused by a virus that attacks the respiratory system, RTs started to get a small amount of recognition. It saddened me that it took a pandemic for people to start mentioning RTs.

I have always been proud of my profession, but I didn't feel like a hero. In fact, there were many times in the beginning of the pandemic I was left in rooms alone, because many of the things RTs do directly expose anyone in the room to the virus. So we would be left alone to cover ourselves in viral particles while everyone else watched from the other side of the glass, so it was a strange feeling to have RTs barely being recognized for the work we do, while other professions were praised and awarded. Every profession plays an integral role in the process, but we were often left out when it came time for recognition.

One day in particular after a long week, my husband told me "Go save some lives!" trying to be sweet and cheer me on as I was leaving for work, and I cried. I didn't feel like a hero. I didn't feel like I was saving anyone; I was tired, frustrated, and emotionally exhausted. We did not sign up to potentially infect our loved ones with an unknown disease because of mass shortages of protective equipment. So the idea of "soldiers going to war" or being used as a martyr never sat well with me. Soldiers are not sent to war without weapons or armor, but that is exactly what it felt like many of us were doing.

POPSUGAR: Can you describe your prepandemic work life and how it changed during the pandemic?
Julia Eze: Prior to the pandemic. I worked on an inpatient bone-marrow transplant unit. Because the oncology and bone-marrow transplant patient populations are extremely vulnerable, when the pandemic began, the goal was to keep them out of the hospital, so transplants and some chemotherapies were postponed. As a result, the census on the unit dropped drastically from an average of greater than 50 patients to less than 20. This decline in patients on my unit is what led me to go and help out in the epicenter of the COVID crisis in New York. I mostly worked seven days a week in a high COVID-impacted area.

PS: How does being a health worker impact your mental health in a positive and/or negative way, and has this changed during the pandemic?

JE: When caring for patients, I've always taken the approach of gratitude, often reminding myself that no matter what I may be experiencing in my personal circumstances, things could be much worse. This has always kept me grounded in my work life. But in all fairness, this mindset was much easier to maintain prior to the pandemic. Once the pandemic began, the constant fear that the very lifesaving care I was providing my patients may compromise my own (or my family's) health was daunting. This was the game changer that began to play on my psyche.

PS: In my experience, a lot of health workers don't believe they require (or perhaps, deserve) psychological support or assistance for "simply doing their jobs." What is your experience with this, and has your perspective changed since the pandemic began?
JE: I agree. Psychological support hasn't been a mainstay in healthcare. Even the longstanding history of burnout in healthcare hasn't prompted the creation of a universal resource. While working during the crisis, I definitely saw various members of the healthcare team fold due to the pressure and trauma caused by the pandemic.

PS: Were you offered psychological support, and is there any service you wish you had been offered to cope better during the pandemic?
JE: At the hospital I worked, there was a wellness room that served to provide a safe space of respite and relaxation while on the job. I thought this was extremely cool, but sadly didn't exist prior to the pandemic. The pandemic shed light on how ill-prepared and fragile the healthcare system was and is regarding pandemic response. Nursing is the largest sector of the healthcare field and should have had more training in this area, as well as mental health and wellness.

PS: Throughout the pandemic, health workers have been hailed as heroes and were compared to soldiers going to the frontline of a war. How did this make you feel?
JE: While it felt good to be acknowledged, nurses were being praised for doing the job we'd always done, so it was disheartening that it took a pandemic to reveal our contributions. Ironically, the pandemic also shed a light on how little the general public knows about the role of nurses. Additionally, it was also hard to see so many people praise nurses, yet claim the pandemic is a hoax or behave in ways that further spread the virus.

PS: Do you think the work you have done during the pandemic will affect you long-term, psychologically, or in a different way than your pre-COVID workload did?
JE: I'll never forget my pandemic experience. I do believe not only the workload, but the crisis hours and the physical and mental exhaustion will stay with me.

POPSUGAR: Can you describe your prepandemic work life and how it changed during the pandemic?
Kelly Leonard: I was a clinical lead pediatric physiotherapists working with children of various ages and disabilities. I was due to start a new job on 1 April, but as we went into lockdown, the new team would have been without a team leader for two weeks, so I stepped up early.

The whole team's life changed because of the pandemic. We had to segment our caseloads and step up our virtual contacts with patients. There was such a feeling of uncertainty about what was happening and some of the team were redeployed to other teams to help. It was a very high-stress situation and hard to navigate as a new team leader; I didn't really know the team members before the pandemic, so being responsible for their mental health needs and ensuring the pediatric physiotherapy service was able to provide what it needed to, was a huge challenge.

PS: How does being a health worker impact your mental health in a positive and/or negative way, and has this changed during the pandemic?
KL: Being a health care professional and a pediatric physiotherapist gives you a sense of purpose. We help children to try to fulfill the best functional ability that they can, provide support to the families, and are the gateway to other services. We are the advocates for these children and their families. This is empowering to us and we facilitate empowerment.

This pandemic has made that job harder. We are not face to face and hands on with most of the children as we would usually be. We like to get a rapport with children so they trust us to be able to assess them and this is very difficult over the virtual world. It is frustrating. We know the power of touch and movement, and how it can ground our patients and ourselves; it is a reinforcement of safety. I have been struggling. I find working from home isolating. Thankfully, I have my family with me, but there is a lot of pressure to ensure they are okay, too.

PS: In my experience, a lot of health workers don't believe they require (or perhaps, deserve) psychological support or assistance for "simply doing their jobs." What is your experience with this, and has your perspective changed since the pandemic began?

KL: I was in the military before becoming a physio. I have had to overcome major life changes and it has highlighted to me that psychological assistance is invaluable. Yes, we are all simply doing our jobs, but, like in the military, when you sign on the dotted line, you sign up to the ideology that you are ready for anything. There is nothing "simple" about our jobs. I have not been on the frontline of the NHS . . . (but) those who were there, those that had to make those life and death decisions, had to watch scared people come in, comforted them and even held their hand as they passed away — they were doing more than simply a job, and our jobs are never just that; healthcare professionals take pride in giving more.

In the military, you know you will have to go away, you know your life could be on the line, but as a healthcare worker it is unusual to go to work and think that you could get sick and never see your family again. Sometimes people can be too proud or feel that it is a sign of weakness to show you are struggling. It can be lonely and it's not healthy. Healthcare workers have been through the mill recently, and it is important for family and friends to look past the "I'm fine" exterior and ask how they are again. My advice to those workers is to talk, to take the courageous step and talk about what you have seen, experienced, and feared.

PS: Do you think the work you have done during pandemic will affect you long-term, psychologically, or in a different way than your pre-covid workload did?
KL: I have struggled with being isolated from work and training but other than that I don't necessarily feel that I will be affected long term by this. I have already been receiving help through Help For Heroes, so I have coping mechanisms and am working on continuing to try to implement those. I have also passed many mental health support links on to my team, and the Field Guide to Self-Care resources from Help For Heroes, which is created by veterans who've been through trauma and has been packaged up to help NHS and frontline workers.

PS: Can you describe your prepandemic work life and how it changed during the pandemic?
Dr. Annie Park: Prepandemic work life was likely very similar to many anaesthesiologists: I took care of patients in both the perioperative and intraoperative environments, and also performed interventional pain procedures for chronic pain patients. During the pandemic, the process of going to work is much the same, but my institution started the use of screening questions and temperature checks upon arrival to work, and a specialized "intubation team" of anaesthesiologists was created specifically for the emergent management of COVID-19 patients and their airways. We engaged in a significant amount of training in order to become comfortable with donning and doffing of our protective equipment.

PS: Are you familiar with the concept of vicarious trauma as a health worker? And if so, do you believe vicarious trauma or PTSD is a common experience among health works?
AP: Yes, this is a concept I am familiar with, but my awareness of this concept has not prevented me from having a continued desire to make an effort to engage empathetically with all my patients. The relationships I build with my patients are some of the most rewarding elements of my career as a physician. Due to our roles as caregivers and a tendency to try our best to empathize with our patients, I personally do think healthcare workers have increased likelihood to experience vicarious trauma in comparison to a person who does not work in healthcare.

PS: How does being a health worker impact your mental health in a positive and/or negative way, and has this changed during the pandemic?

AP: I think being a healthcare worker and working as a physician have had a tremendously positive impact on my mental health. Being a physician uniquely melds a mandate for a mastery of the sciences with the human condition. I have always been enormously grateful for the incredible trust my patients place in me to provide their care. That feeling of gratitude keeps me feeling joyful, no matter what. This pandemic adds stress and anxiety to our lives, and the future is unknown to all of us — but I've never been happier and prouder to be a physician.

PS: In my experience, a lot of health workers don't believe they require (or perhaps, deserve) psychological support or assistance for "simply doing their jobs." What is your experience with this, and has your perspective changed since the pandemic began?
AP: I do not think my perspective on this issue has changed since the pandemic began. I personally believe that if healthcare workers need psychological support or assistance, they ought to be able to obtain the support they need.

PS: Were you offered psychological support, and is there any service you wish you had been offered to cope better during the pandemic?
AP: Even prior to the pandemic, our institution had great access to psychological support for workers. We were reminded by our leadership during the pandemic that this resource was available to us should any of us need it.

PS: Through the pandemic, health workers were hailed as heroes working the frontlines — the mainstream conversation was reminiscent of soldiers going to war. How did this hero status make you feel?
AP: I don't feel particularly heroic for simply going to work every day, so perhaps I feel a little embarrassed by the applause. I am glad that many more people are aware of the role that anaesthesiologists play in the hospital setting as a result of the pandemic. Our specialty, in particular, and our role as "airway experts" has been thrown into the spotlight.

PS: Do you think the work you have done during the pandemic will affect you long-term, psychologically, or in a different way than your pre-COVID workload did?
AP: No, I don't think that my work during the pandemic will affect me long-term psychologically, but I do think I will never forget the connections made and relationships forged during this time. Since this pandemic is unprecedented during my lifetime, I think I will always remember this period of my life.