WEBVTT - COVID-19 Chapter 17: Frontline Mental Health 0:00:00.840 --> 0:00:04.160 Hi everyone. Before we begin this episode, we just wanted 0:00:04.160 --> 0:00:08.360 to issue a content warning that this episode does contain 0:00:08.520 --> 0:00:17.920 discussions surrounding depression, anxiety, substance use, self harm, and suicide. 0:00:18.560 --> 0:00:21.840 So my name is doctor Kurtica Capoli. I'm an infectious 0:00:21.840 --> 0:00:26.799 disease physician at the Medical University of South Carolina. My 0:00:26.880 --> 0:00:34.400 background is in emerging infections, biosecurity, and global health. And 0:00:34.800 --> 0:00:38.320 over the past ten years since I finished my training, 0:00:38.960 --> 0:00:42.880 I've spent half the time living internationally and the other 0:00:42.920 --> 0:00:48.040 half of the time living domestically, and the time living 0:00:48.080 --> 0:00:53.880 internationally has been spent really working on emerging infections and 0:00:54.200 --> 0:00:59.200 pandemic response. I was in West Africa during the twenty 0:00:59.240 --> 0:01:02.520 fourteen of Bowl outbreak whereas the medical director of an 0:01:02.520 --> 0:01:07.760 ebola treatment unit, and after that I was part of 0:01:08.000 --> 0:01:13.440 a US government initiative helping to develop a clinical trial 0:01:13.520 --> 0:01:21.479 capacity for therapeutics in the event of a high consequence 0:01:21.560 --> 0:01:26.399 pathogen outbreak. I've also worked in numerous disaster zones in 0:01:26.440 --> 0:01:31.679 the aftermath of natural disasters, and I feel like all 0:01:31.720 --> 0:01:38.080 of that background really has helped prepare me to work 0:01:38.200 --> 0:01:41.800 during this public health crisis for facing here in the 0:01:41.880 --> 0:01:45.360 United States and in the world because of the COVID 0:01:45.480 --> 0:01:50.040 nineteen pandemic, and this has been a really challenging year. 0:01:50.520 --> 0:01:52.800 Sometimes I forget that it's only been a year and 0:01:52.840 --> 0:01:56.560 a half because it feels like it's been ten years. 0:01:57.120 --> 0:02:01.440 And there are days when I am walking into the 0:02:01.440 --> 0:02:07.040 hospital that I'm exhausted and I feel empty, and I 0:02:07.080 --> 0:02:11.200 don't want to hear the word COVID anymore. And I 0:02:11.240 --> 0:02:16.440 think that sometimes I hear people use the word hero 0:02:16.840 --> 0:02:20.240 and it makes me cringe because I don't feel like 0:02:20.960 --> 0:02:21.799 we are heroes. 0:02:21.840 --> 0:02:25.040 I feel like we are really lucky that we are. 0:02:25.000 --> 0:02:28.200 Trained to be able to take care of patients that 0:02:28.280 --> 0:02:32.120 are sick and need our help, and that I'm just 0:02:32.160 --> 0:02:35.040 doing my job, just like anybody else would be doing 0:02:35.120 --> 0:02:38.560 if they were in this situation. And I feel like 0:02:39.400 --> 0:02:43.760 that label at times puts undue pressure on us to 0:02:44.639 --> 0:02:48.880 do some superhuman type of thing that we may not 0:02:49.000 --> 0:02:51.640 be able to do, when all we need to do 0:02:51.960 --> 0:02:55.799 is just treat our patients with the care and compassion 0:02:56.160 --> 0:03:03.800 that they need. And about how this pandemic is going 0:03:03.840 --> 0:03:07.360 to affect our healthcare workers. I feel like I have 0:03:07.440 --> 0:03:12.120 some insight because when I returned back from West Africa 0:03:12.160 --> 0:03:13.720 after the Abola outbreak. 0:03:14.080 --> 0:03:15.440 It was really difficult for me. 0:03:16.280 --> 0:03:20.400 I had visions of some of the patients I took 0:03:20.400 --> 0:03:24.040 care of. Some of the situations I had been placed 0:03:24.080 --> 0:03:28.120 in continued to run through my head and it took 0:03:28.160 --> 0:03:31.840 me a long while to work through that. And I 0:03:31.919 --> 0:03:35.400 fear that some of our healthcare workers who have been 0:03:35.440 --> 0:03:40.360 in extremely intense situations are going to have the same problem. 0:03:40.840 --> 0:03:43.280 On top of the fact that this pandemic has been 0:03:43.360 --> 0:03:47.280 drawn out for so long, and I feel like every 0:03:47.320 --> 0:03:50.840 time we see another surge, it's just another layer of 0:03:50.880 --> 0:03:56.600 exhaustion that people feel, and I hear it from my colleagues. 0:03:56.640 --> 0:04:00.000 I hear it from my friends who are just really tired, 0:04:00.920 --> 0:04:04.720 and I'm starting to see it as well. I see 0:04:05.360 --> 0:04:10.600 personality changes in people that I never even used to 0:04:10.680 --> 0:04:15.600 hear a crossword from. I've seen people who are older 0:04:16.560 --> 0:04:22.080 thinking about retiring or stepping back, and this will affect 0:04:22.160 --> 0:04:26.880 our entire profession. I think for myself, some of the 0:04:26.920 --> 0:04:32.160 things that I worry about is when I came back 0:04:32.160 --> 0:04:37.920 from West Africa, I noticed that I had somewhat of 0:04:37.960 --> 0:04:45.520 a more disconnected feeling, and I noticed that I have 0:04:45.680 --> 0:04:49.760 that now. It's not so much that I don't care 0:04:49.800 --> 0:04:52.800 about my patients or I don't care about people, but 0:04:52.880 --> 0:04:59.520 there's definitely some sort of detachment, and I think that 0:04:59.680 --> 0:05:04.719 part of that is to protect myself, and I think 0:05:04.800 --> 0:05:07.720 other people do that too, as a way to protect themselves. 0:05:08.600 --> 0:05:11.800 And I think we should all be cognizant of that 0:05:11.960 --> 0:05:15.200 because this has been a very difficult time for all 0:05:15.279 --> 0:05:18.800 of us in the healthcare field. We don't just have 0:05:18.920 --> 0:05:22.160 the same structures as everybody else, but then we also 0:05:22.240 --> 0:05:25.880 have the increased demands of trying to care for our patients. 0:05:26.680 --> 0:05:29.640 And since this has been going on for over a 0:05:29.720 --> 0:05:34.360 year now, it's felt like a marathon, and it's a 0:05:34.400 --> 0:05:37.880 marathon that for some of us we don't see ending 0:05:37.960 --> 0:05:43.400 anytime soon. We need support just like everybody else. And 0:05:43.480 --> 0:05:47.240 I hope that people who are out there listening to 0:05:48.839 --> 0:05:55.040 my story and everybody else's story remembers that, and hopefully 0:05:55.720 --> 0:05:58.039 as we see this small light at the end of 0:05:58.080 --> 0:06:02.880 the tunnel with our vaccines, which are wonderful, we can 0:06:02.920 --> 0:06:05.280 all remember that and remember that we need to come 0:06:05.320 --> 0:06:12.120 together as we try to end the coronavirus pandemic. Thank you. 0:06:15.520 --> 0:06:18.040 I work as an ear nurse in a regional hospital 0:06:18.080 --> 0:06:21.600 in Montana. The second wave of COVID was really our 0:06:21.640 --> 0:06:24.240 first and while we were not nearly as devastated as 0:06:24.279 --> 0:06:27.680 places like New York or Houston, we were pretty battered. 0:06:28.640 --> 0:06:28.880 You know. 0:06:29.040 --> 0:06:31.880 It was a series of crises of you know, short 0:06:31.880 --> 0:06:35.360 staffing because coworkers were getting really sick, a huge surge 0:06:35.400 --> 0:06:38.760 of patients from all around the region that needed hospitalization, 0:06:39.400 --> 0:06:42.000 with our capacity well above one hundred and twenty five 0:06:42.160 --> 0:06:44.200 one hundred and fifty percent. I mean, it was wild 0:06:45.080 --> 0:06:48.640 holding vented ICU patients in the er, dealing with the 0:06:48.760 --> 0:06:53.080 just rampant misinformation, but you know, just worst of all, 0:06:53.520 --> 0:06:56.320 it is just you know, dealing with how sick these 0:06:56.320 --> 0:07:00.400 patients could get. I wanted to share specifically Mikes experience 0:07:00.440 --> 0:07:04.840 with two patients. I think they're both good representations of 0:07:05.320 --> 0:07:09.240 what COVID can do to people and what we've been 0:07:09.240 --> 0:07:13.080 seeing at the bedside. You know, patient number one. She 0:07:13.280 --> 0:07:15.560 was my mother's age, in her fifties, and I had 0:07:15.560 --> 0:07:18.200 started my shift with her on two leaders nasal canula, 0:07:18.240 --> 0:07:23.160 which is basically just bare minimum boxygen requirement. And I 0:07:23.280 --> 0:07:25.920 ended my shift calling your family to let them know 0:07:26.040 --> 0:07:29.520 it did not look good. She had progressively worsened throughout 0:07:29.560 --> 0:07:31.920 the day with her work of breathing getting worse and worse, 0:07:32.080 --> 0:07:35.560 and she was she entered that third stage of COVID 0:07:36.040 --> 0:07:38.640 that we all so dread, and she went in to 0:07:38.680 --> 0:07:42.760 car to pulmonary arrest four times after we had intibated her, 0:07:43.520 --> 0:07:48.440 and then she arrested four more times in the ICU. 0:07:47.680 --> 0:07:50.080 Before they finally called time of death that night. 0:07:51.320 --> 0:07:54.000 Patient two was a thirty something year old that you know, 0:07:54.360 --> 0:07:57.680 had started again with just bare minimum oxygen requirements just 0:07:57.720 --> 0:08:00.520 three days prior. I mean, she was borderline and home, 0:08:00.720 --> 0:08:04.080 you know, when she'd come to the hospital and I 0:08:04.120 --> 0:08:07.960 assumed care of her as an er impatient a few 0:08:08.000 --> 0:08:10.320 days later, and I just I knew in my heart 0:08:10.360 --> 0:08:11.680 when I walked in her room, I was going to 0:08:11.680 --> 0:08:13.320 interbate her by the end of my shift. 0:08:14.160 --> 0:08:16.600 Within four hours of that shift. 0:08:16.680 --> 0:08:19.120 No matter how much proning we did, how much oxygen 0:08:19.120 --> 0:08:21.640 we gave her, you know, how much support there was, 0:08:22.160 --> 0:08:24.320 I could never get her above about seventy eight percent 0:08:24.360 --> 0:08:28.000 saturation normal, being of course ninety five to ninety eight. 0:08:28.960 --> 0:08:31.760 At one point she dropped to thirty percent, a true 0:08:31.920 --> 0:08:32.480 real life. 0:08:32.400 --> 0:08:34.360 Thirty percent of the monitor. And I have only seen 0:08:34.400 --> 0:08:38.319 that a few times in my career pre COVID. Within 0:08:38.360 --> 0:08:40.240 that time, the hospitalist had transferred her care to the 0:08:40.440 --> 0:08:44.760 ICU doctor, whom I called down saying, you know, it's 0:08:44.800 --> 0:08:49.440 it's time, she's were it's this or nothing. 0:08:49.600 --> 0:08:50.600 You know, it's this or. 0:08:50.520 --> 0:08:54.560 She dies, and we intibated her and then eventually I 0:08:54.559 --> 0:08:57.760 got her transferred upstairs for a time I'd heard that 0:08:57.800 --> 0:09:00.400 she was making some recovery. I do not know, though, 0:09:00.400 --> 0:09:06.360 how things have turned out. And you know, sorry, these 0:09:06.640 --> 0:09:10.520 guys really they tellget my hearts because they just there's 0:09:10.559 --> 0:09:15.240 particular things with these patients that you know, I got 0:09:15.280 --> 0:09:17.760 kind of close to them, and you it's a sense 0:09:17.800 --> 0:09:20.880 of failure in a way once you get to that point, 0:09:20.920 --> 0:09:26.240 once you know, you start intubating because we just we know, 0:09:26.520 --> 0:09:29.720 we know that there's nothing more we can do. And 0:09:30.040 --> 0:09:33.560 I'm really tired. I'm so tired of COVID. I have 0:09:33.679 --> 0:09:38.360 spent time as an ICR nurse. I'm no stranger to death. 0:09:39.960 --> 0:09:42.520 Bad bad flu seasons in the past have of course 0:09:42.559 --> 0:09:46.560 been devastating, but you get used to saving thirty, forty, fifty, 0:09:46.640 --> 0:09:49.160 even sixteen seventy year olds. You know, it's a It 0:09:49.200 --> 0:09:52.640 was a well established expectation that for that age group, 0:09:52.720 --> 0:09:56.840 that for the most part, barring complications, patients with respiratory 0:09:56.840 --> 0:10:02.040 illnesses have a good chance of making recovery with you know, careful, 0:10:02.360 --> 0:10:05.680 with the right care and you know ventilator management. 0:10:06.840 --> 0:10:08.359 Just now, there's no such expectation. 0:10:09.280 --> 0:10:11.559 And if we have to put a patient on BiPAP 0:10:11.679 --> 0:10:14.520 or god forbid yet the incubatum, it's like a sinking 0:10:14.640 --> 0:10:18.520 feeling of loss. And in all my years of nursing 0:10:18.559 --> 0:10:22.599 and nursing education, I've just I've never seen anything like it. 0:10:25.120 --> 0:10:25.440 Hello. 0:10:25.800 --> 0:10:27.839 My name is Christy and I'm a registered nurse in 0:10:27.880 --> 0:10:31.160 New York City. I graduated in May twenty nineteen, and 0:10:31.160 --> 0:10:33.440 when the pandemic hit, I was still in a fellowship 0:10:33.480 --> 0:10:36.440 training to become an er nurse. I remember the panic 0:10:36.480 --> 0:10:38.480 that started hitting all of us as we saw more 0:10:38.480 --> 0:10:41.199 and more patients show up to the er with COVID symptoms, 0:10:41.800 --> 0:10:43.800 And what really shocked us was how young they were, 0:10:44.000 --> 0:10:47.320 how unpredictable this thing seemed to be. In April, I 0:10:47.320 --> 0:10:49.280 got a phone call that I was being reassigned to 0:10:49.360 --> 0:10:51.960 a makeshift COVID floor that had been refashioned from an 0:10:51.960 --> 0:10:55.640 outpatient surgical center. The first thing I arrived to start 0:10:55.679 --> 0:10:58.440 my shift, I saw a giant truck outside the building. 0:10:59.000 --> 0:11:00.840 It reminded me of the truck to see around New 0:11:00.920 --> 0:11:03.520 York when they were filming a movie. I was later 0:11:03.559 --> 0:11:05.600 told that this was the refrigerated truck to hold the 0:11:05.600 --> 0:11:09.160 dead bodies that were outpacing the hospital morgue. Every shift 0:11:09.200 --> 0:11:12.360 began that way, walking past that truck like a symbol 0:11:12.360 --> 0:11:14.440 of what felt like the futility of trying to save 0:11:14.480 --> 0:11:17.640 the people who were dying. Working on the floor was 0:11:17.640 --> 0:11:19.760 a type of nursing that I hadn't trained for and 0:11:19.800 --> 0:11:22.600 that I never planned on doing. Most of the patients 0:11:22.600 --> 0:11:24.800 where I worked had do not resuscitate and do not 0:11:24.880 --> 0:11:27.720 intobate orders, so I was there to provide them comfort 0:11:27.720 --> 0:11:31.120 care as they died. The image of these people gasping 0:11:31.160 --> 0:11:33.800 for air as I slowly slipped away, as an image 0:11:33.800 --> 0:11:36.000 I can't erase from my mind, and I think it 0:11:36.040 --> 0:11:39.320 will hold onto my whole life. I spent twelve hour 0:11:39.360 --> 0:11:42.240 shifts in this windowless floor and layer upon layer of 0:11:42.360 --> 0:11:45.640 protective gear. I saw patients die, and I saw other 0:11:45.720 --> 0:11:49.280 patients have emotional breakdowns from being sequestered from their families. 0:11:50.040 --> 0:11:52.439 I think most people that become a nurse do so 0:11:52.440 --> 0:11:54.960 so they can help comfort and heal people, and for 0:11:55.040 --> 0:11:57.000 so many of us, we didn't feel like we were 0:11:57.040 --> 0:11:59.040 able to do either for our patients, and that, more 0:11:59.040 --> 0:12:02.600 than anything, has broken in our spirits. Eventually, when the 0:12:02.600 --> 0:12:04.480 surge lifted, I got to go back to the er, 0:12:04.640 --> 0:12:07.239 where a new normal has set in of wearing protective 0:12:07.280 --> 0:12:10.800 gear for entire shifts, always concerned that any patient could 0:12:10.840 --> 0:12:13.800 be carrying this virus. I'd say at least half the 0:12:13.840 --> 0:12:16.400 staff has gotten COVID and many are dealing with long 0:12:16.440 --> 0:12:19.160 haul symptoms such as brain fog and shortness of breath. 0:12:19.960 --> 0:12:21.880 I was able to get my vaccine on the second 0:12:21.920 --> 0:12:24.560 day it was available in the United States, and although 0:12:24.600 --> 0:12:27.200 I was nervous and had my concerns, I had seen 0:12:27.200 --> 0:12:29.840 the devastation and the long term effects of COVID enough 0:12:29.880 --> 0:12:32.319 that I was willing to take the chance. I thought 0:12:32.320 --> 0:12:33.960 it would give me some sort of peace of mind 0:12:33.960 --> 0:12:36.479 to be vaccinated. But work is still full of anxiety 0:12:36.520 --> 0:12:39.840 and fear due to the variants. So many patients who 0:12:39.880 --> 0:12:42.840 are now testing positive admidst taking vacations or going to 0:12:42.920 --> 0:12:45.720 large underground parties in New York. And there's nothing that 0:12:45.760 --> 0:12:49.560 frustrates us of healthcare workers more. For a brief time, 0:12:49.600 --> 0:12:52.200 the world was clapping for us, and everyone seemed to 0:12:52.200 --> 0:12:54.280 tire of that and tire of trying to stop this 0:12:54.320 --> 0:12:57.840 thing from spreading and mutating. I've started attending therapy for 0:12:57.920 --> 0:12:59.960 my sleep issues and have been told I have pta 0:13:00.160 --> 0:13:03.120 SD From the last year of work, I'm haunted by 0:13:03.120 --> 0:13:05.680 the faces of people I watched die, but I also 0:13:05.720 --> 0:13:08.280 try to remember the rare, beautiful moments of the last year. 0:13:08.920 --> 0:13:11.600 I had one patient who wanted to watch baseball last spring, 0:13:11.679 --> 0:13:13.160 and I had to explain to him that the sport 0:13:13.200 --> 0:13:16.160 had been canceled for the season, so instead I pulled 0:13:16.200 --> 0:13:18.080 up an old Mets game on the iPad and sat 0:13:18.120 --> 0:13:20.079 with him for a couple of minutes to watch it. 0:13:20.880 --> 0:13:22.520 He told me he wished he could buy me a 0:13:22.520 --> 0:13:25.760 hot dog. A year later and baseball is happening again, 0:13:25.800 --> 0:13:29.360 but he is dead. I, like so many people, desperately 0:13:29.400 --> 0:13:31.600 want this thing to be over, but part of me 0:13:31.640 --> 0:13:33.680 doesn't know if I see an end date anytime in 0:13:33.720 --> 0:14:09.760 the future. 0:14:19.960 --> 0:14:23.280 Thank you again to everyone who provided a first hand account. 0:14:23.400 --> 0:14:26.880 Those were incredibly powerful, and we really appreciate you taking 0:14:26.920 --> 0:14:29.480 the time to share your story with us, and for 0:14:29.600 --> 0:14:32.120 also everything that you're doing to fight this pandemic. 0:14:32.680 --> 0:14:37.960 Yeah, definitely. Hi, I'm erin Welsh and I'm erin Alman Updike. 0:14:37.920 --> 0:14:40.160 And this is this podcast will kill you. 0:14:40.520 --> 0:14:47.160 It sure is. Welcome to the seventeenth episode. What it's 0:14:47.200 --> 0:14:50.040 a lot of episodes, it's a lot of our Anatomy 0:14:50.080 --> 0:14:53.400 of a Pandemic series. In each episode of this series, 0:14:53.520 --> 0:14:56.160 we've been taking a closer look at a certain aspect 0:14:56.240 --> 0:15:00.400 of this pandemic, from virology to economics, from spillover events 0:15:00.400 --> 0:15:03.280 to schools. And in one of our earlier episodes, we 0:15:03.360 --> 0:15:06.200 discussed some of the mental health impacts that this pandemic 0:15:06.240 --> 0:15:08.440 has been having on the general public, as well as 0:15:08.480 --> 0:15:11.000 some coping strategies for how to deal with the stress 0:15:11.040 --> 0:15:13.720 and anxiety that a lot of us are feeling. With 0:15:13.800 --> 0:15:17.120 this episode, we wanted to revisit the mental health impacts 0:15:17.160 --> 0:15:19.800 that this pandemic is having, but on a very specific 0:15:19.840 --> 0:15:22.600 group of people, frontline healthcare workers. 0:15:23.080 --> 0:15:23.440 Yeah. 0:15:24.040 --> 0:15:27.720 But before we get into that, it's quarantiny time, It's 0:15:27.800 --> 0:15:31.280 quarantin any time. What are we drinking this week? 0:15:31.680 --> 0:15:36.280 Well, Aaron quarantiny seventeen, yeap quarantiny seventeen. 0:15:36.320 --> 0:15:43.600 Ey oh, I like that the quarantine seventeen or seventeeny 0:15:43.840 --> 0:15:46.960 is essentially a clover club, which if you don't know 0:15:46.960 --> 0:15:51.240 what that is, it is basically gin grenadine or raspberry syrup, 0:15:51.680 --> 0:15:54.440 lemon juice and egg white and you kind of shake 0:15:54.520 --> 0:15:56.840 it up and it looks quite beautiful. 0:15:56.960 --> 0:16:00.200 I must say, it's so gorgeous. I think it's one 0:16:00.200 --> 0:16:02.400 of the prettiest quarantinies ever. 0:16:02.560 --> 0:16:05.560 I think so too. Yeah, we will post the full 0:16:05.640 --> 0:16:08.880 recipe for our Quarantine seventeen as well as the non 0:16:08.920 --> 0:16:12.000 alcoholic place rita on our website this podcast will Kill 0:16:12.040 --> 0:16:13.880 You dot com as well as on all of our 0:16:13.920 --> 0:16:15.280 social media channels. 0:16:15.680 --> 0:16:20.280 Yeah, any other business, Aaron, our usual suspects? 0:16:20.480 --> 0:16:21.760 Yeah, why don't you take us through it? 0:16:21.800 --> 0:16:24.720 Aerin all right, we have a website. You can find 0:16:24.760 --> 0:16:26.000 everything there. 0:16:26.480 --> 0:16:28.200 Yeah, basically, we have a website. 0:16:28.480 --> 0:16:30.440 We have a website. It's this podcast will Kill You 0:16:30.520 --> 0:16:30.840 dot Com. 0:16:30.920 --> 0:16:32.800 Check it out. There's a bunch of fun stuff there. 0:16:32.920 --> 0:16:34.800 Okay, moving on, moving on. 0:16:35.320 --> 0:16:38.760 So let's get into the actual meat of this episode. 0:16:39.240 --> 0:16:44.520 Let us frontline healthcare workers, doctors, nurses, respiratory therapists, nps, 0:16:44.640 --> 0:16:49.360 pas mas. So many people have been involved since day 0:16:49.480 --> 0:16:52.560 one in the direct care of people sickening and dying 0:16:52.600 --> 0:16:56.600 from COVID nineteen, and since so much about this virus 0:16:56.600 --> 0:17:00.600 and disease, especially in the early months, was unknown, it's 0:17:00.640 --> 0:17:04.480 been a really difficult road to say the least. Providers 0:17:04.480 --> 0:17:07.840 have been dealing with overloaded hospitals, a lack of adequate 0:17:07.880 --> 0:17:13.119 personal protective equipment, in watching patients die alone without family 0:17:13.200 --> 0:17:16.600 or friends there for comfort. And we've heard a lot 0:17:16.800 --> 0:17:21.440 of this healthcare heroes narrative in the media, but healthcare 0:17:21.480 --> 0:17:25.840 workers are human beings, not superheroes. And this year has 0:17:25.880 --> 0:17:29.159 put an incredible amount of stress on the healthcare system 0:17:29.600 --> 0:17:32.040 and on our providers as individuals. 0:17:32.480 --> 0:17:36.119 Yeah, and that is on top of a system that 0:17:36.240 --> 0:17:41.000 is already stretched, where healthcare providers are already suffering from 0:17:41.040 --> 0:17:44.520 things like burnout and depression at higher rates than the 0:17:44.560 --> 0:17:48.199 general public, and often with little or no support for 0:17:48.280 --> 0:17:51.880 their mental health from the healthcare system in which they work. 0:17:52.640 --> 0:17:55.320 So we wanted to focus today on the impact that 0:17:55.359 --> 0:17:58.639 this pandemic is likely having in the immediate and the 0:17:58.720 --> 0:18:02.280 long term the mental health of frontline healthcare workers. But 0:18:02.400 --> 0:18:05.639 also we wanted to take a broader view to examine 0:18:05.640 --> 0:18:09.399 what kinds of structural issues in the healthcare system contribute 0:18:09.440 --> 0:18:10.640 to the problem to begin with. 0:18:11.000 --> 0:18:14.960 Yeah, and we were fortunate enough to interview an expert 0:18:15.000 --> 0:18:19.760 on this topic, doctor Michael Myers, a psychiatrist who specializes 0:18:19.800 --> 0:18:23.159 in treating other physicians and healthcare workers, and who is 0:18:23.200 --> 0:18:26.760 also a professor of clinical psychiatry at Sunny Downstate Health 0:18:26.760 --> 0:18:31.080 Sciences University in Brooklyn, New York. His newest book, titled 0:18:31.119 --> 0:18:34.320 Becoming a Doctor's Doctor, is a memoir of his journey, 0:18:34.440 --> 0:18:36.960 and he joins us in this episode to answer so 0:18:37.200 --> 0:18:40.640 many of our questions about the underlying issues that contribute 0:18:40.680 --> 0:18:43.840 to mental health struggles and healthcare providers, as well as 0:18:43.880 --> 0:18:48.720 how the COVID nineteen pandemic has exacerbated these This interview 0:18:49.040 --> 0:18:51.920 was recorded on March twenty ninth, twenty twenty one, and 0:18:52.119 --> 0:18:54.439 we also wanted to mention that there were some sirens 0:18:54.480 --> 0:18:56.520 that went off a few times while we recorded, so 0:18:56.760 --> 0:18:59.240 you may hear those in the background, so just keep 0:18:59.240 --> 0:19:02.400 that in mind, and we will let him introduce himself 0:19:02.520 --> 0:19:03.720 right after this break. 0:19:25.760 --> 0:19:29.199 My name is Michael Myers. I'm a psychiatrist. I'm a 0:19:29.200 --> 0:19:33.720 professor of clinical psychiatry actually at Sunny Downstate Health Sciences 0:19:33.880 --> 0:19:37.879 University in Brooklyn, New York. I'm a former Training Director 0:19:37.880 --> 0:19:41.919 in psychiatry. But since I've semi retired, what I do 0:19:42.080 --> 0:19:45.639 now is that i'm the ombits person for our medical school, 0:19:46.119 --> 0:19:48.720 meaning that I investigate any complaints that our students have 0:19:48.800 --> 0:19:52.200 about miss treatment, and I also serve on the medical 0:19:52.200 --> 0:19:55.919 Student Missions Committee. So I'm a specialist in physician health. 0:19:56.119 --> 0:20:00.040 I've written extensively on that, and I'm excited about my 0:20:00.119 --> 0:20:04.280 most recent book, which is called Becoming a Doctor's Doctor. 0:20:04.680 --> 0:20:06.680 Mmoir excellent. 0:20:06.880 --> 0:20:09.320 Thank you so much for taking the time to chat 0:20:09.359 --> 0:20:12.000 with us today. We're really excited to speak with you. 0:20:12.800 --> 0:20:14.840 So our first question is just if you could tell 0:20:14.920 --> 0:20:17.480 us a bit about how you became interested in the 0:20:17.520 --> 0:20:20.919 field of physician mental health and what made you choose 0:20:20.960 --> 0:20:22.800 to pursue that as a kind of career. 0:20:23.480 --> 0:20:29.720 Well, this started with a tragedy. Actually, in nineteen sixty two, 0:20:30.400 --> 0:20:34.200 I lost one of my roommates, his name as a pseudonym, 0:20:34.240 --> 0:20:38.320 Bill this is his first name, to suicide. And that 0:20:38.440 --> 0:20:41.840 was over the Thanksgiving weekend. We were both first dramatical students. 0:20:41.880 --> 0:20:44.920 IR was the last person to see him alive, and 0:20:45.280 --> 0:20:48.000 it was awful. I was young, I mean I was 0:20:48.040 --> 0:20:52.000 only nineteen. I had never been exposed to suicide before. 0:20:52.080 --> 0:20:55.199 But I think what really struck me the most was 0:20:55.240 --> 0:20:57.920 how much his death was I don't know what I 0:20:57.960 --> 0:21:02.399 would say, perhaps covered up. The stigma associated with any 0:21:02.520 --> 0:21:06.520 kind of perceived flaw or whatever you might call that 0:21:06.960 --> 0:21:10.239 in medicine back in those days was so profound. So 0:21:10.280 --> 0:21:12.480 we didn't hear anything from the dean's office. I'm the 0:21:12.480 --> 0:21:15.880 one who made the announcement to my classmates. We didn't 0:21:15.880 --> 0:21:19.560 attend his funeral, we didn't send flowers, And I thought 0:21:19.560 --> 0:21:21.640 over the years, how different this would be a Bill 0:21:22.000 --> 0:21:25.639 were killed in a motivatal accident night of cancer or something. 0:21:26.480 --> 0:21:28.679 And I think that that got me thinking about the 0:21:28.720 --> 0:21:34.120 stigma associated with psychiatric illness and medical students and physicians. 0:21:34.160 --> 0:21:36.679 And then fast forward a few years when I was 0:21:36.720 --> 0:21:40.159 in training that in psychiatry in the early seventies, I 0:21:40.200 --> 0:21:44.040 saw my first physician patient on Christmas Day, nineteen seventy, 0:21:45.480 --> 0:21:48.680 the pseudonymus for doctor Monroe. And that's how I started 0:21:48.840 --> 0:21:51.200 my book. I actually about my memoir because I really 0:21:51.200 --> 0:21:54.959 wanted to capture how captivated I was really by his 0:21:55.080 --> 0:21:59.639 story looking after him and his family, And through the 0:21:59.640 --> 0:22:02.240 rest of my training, which is four years, I got 0:22:02.280 --> 0:22:06.480 to actually look after some other members of doctors' families, 0:22:07.000 --> 0:22:09.879 so that by the time I graduated and opened up 0:22:09.920 --> 0:22:13.080 my halftime private practice, I felt I had a little 0:22:13.080 --> 0:22:15.640 bit of a leg up. I wasn't quite as intimidated 0:22:15.680 --> 0:22:19.600 about looking after my peers or whatever as maybe some 0:22:19.680 --> 0:22:22.760 of my colleagues were. So that's kind of how it 0:22:22.800 --> 0:22:23.720 all got started. 0:22:25.040 --> 0:22:29.600 So, even in non pandemic times, physicians and other healthcare 0:22:29.640 --> 0:22:34.000 workers experience a multitude of challenges, such as burnout or 0:22:34.000 --> 0:22:37.720 isolation that can have a substantial impact on their mental health. 0:22:38.200 --> 0:22:40.760 So can you talk us through what some of these 0:22:40.840 --> 0:22:43.959 challenges are and what impact they have on the mental 0:22:43.960 --> 0:22:48.280 health of healthcare professionals? You know, does this field experience 0:22:48.359 --> 0:22:53.119 things like depression, anxiety, substance abuse, and suicide at higher 0:22:53.200 --> 0:22:54.560 rates than the general public. 0:22:55.200 --> 0:22:57.439 I'm going to do this in two ways because I 0:22:57.640 --> 0:23:01.040 like to think of like the big factors, that what 0:23:01.080 --> 0:23:05.680 we call the systemic factors of the situation in medicine 0:23:05.680 --> 0:23:09.520 today here in the United States, because that seems to 0:23:09.560 --> 0:23:13.639 be driving a lot of the concern that so many 0:23:13.680 --> 0:23:18.639 of our physicians today described as burnout. Some are unhappy 0:23:18.720 --> 0:23:22.160 with that term, and it's now being called moral injury. 0:23:22.680 --> 0:23:25.560 But then it can get worse though too, and you 0:23:25.680 --> 0:23:29.560 touched on that aeron that sometimes individuals then wonder is 0:23:29.600 --> 0:23:32.760 this burnout or perhaps have I fallen into a depression 0:23:33.400 --> 0:23:35.760 something like that. Now there is the illness of depression, 0:23:36.640 --> 0:23:39.320 things like that. So the systemic factors are felt to 0:23:39.400 --> 0:23:44.440 be the things that are really driving this, and physicians themselves. 0:23:44.440 --> 0:23:47.360 So in other words, you could take the healthiest doctor 0:23:48.080 --> 0:23:50.480 and he or she is going to succumb at some 0:23:50.600 --> 0:23:55.639 point with a system that is so demanding of them. 0:23:55.960 --> 0:23:58.080 And some of the things that you hear about so 0:23:58.200 --> 0:24:04.240 much of the electronic health records, for instance, or the 0:24:04.320 --> 0:24:09.160 increasing corporatization of medicine so that there's less less time 0:24:09.200 --> 0:24:11.840 with the patient having gathered so many things on the 0:24:11.880 --> 0:24:17.760 computer and having to do so much work that feels 0:24:17.920 --> 0:24:23.720 like deureaucracy. And there are a number of other factors 0:24:23.720 --> 0:24:26.000 that doctors describe. It varies a little bit on the 0:24:26.000 --> 0:24:31.560 branch of medicine, and so that can really make doctors 0:24:31.560 --> 0:24:34.639 feel demoralized. And you know, when we look at the 0:24:34.680 --> 0:24:37.560 definition of burnout, it really it's got to do with 0:24:37.640 --> 0:24:41.080 a loss of agency and control over your life. Or 0:24:41.160 --> 0:24:46.200 doctors on a treadmill and they describe this kind of exhaustion, 0:24:47.680 --> 0:24:51.480 an erosion of their spirit. Those are the terms that 0:24:51.520 --> 0:24:55.159 they'll often use. They'll talk about depersonalization, for instance, that 0:24:55.560 --> 0:25:00.920