Medical staff fight against a virus and feelings of abandonment; Part 3 of Edify's series on mental health
By Cory Schachtel | January 10, 2022
When emergency medicine doctor Jessie Breton thinks back to the beginning of COVID, she remembers fear. Limited information. Foreboding images. Emergency departments collapsing in China, Italy and New York. She updated her will, and moved to a different part of the house to spare her husband, assuming she’d eventually get sick. But for all the unknowns back then, Breton says one thing was certain: “The enemy was clearly COVID.”
Today, that enemy remains a “formidable clinical foe,” but it’s compounded by the climate outside the hospital walls. “It was difficult to imagine then that we would get to now, where what we’re really up against is misinformation, a lack of decision-making and policies that have failed to keep people safe,” says Breton, a Top 40 Under 40 alumna. “And so, in many ways, that fear and uncertainty at the very beginning — at least we had a clear sense of what we were up against, and how to get out. I think this is a lot more difficult today. At well over 18 months into this, we’re exhausted.”
So far, doctors and nurses haven’t quit in large numbers — though, like long COVID, the long-term impact on their collective mental health is unknown. Health-care workers don’t do it for thanks and praise, but Breton worries that people will forget about them once the pandemic is relatively out of mind. And she doesn’t have hope for how the provincial government will handle the aftereffects, given its track record on this crisis, its attitude towards those on the front lines — and even its healthcare philosophy.
Physician and nurse support programs exist. There is a phone line and access to counsellors, and Breton is part of an organic, voluntary peer support team of physicians who assist each other, whether it’s helping find formal support or to simply ensure they don’t feel alone. “But the wounding is ongoing,” Breton says. “And so to me, that’s all more first aid, because you have to go right back into the fight. Once the crisis is passed, I think that’s when most of will finally be able to take a breath and sort of take stock what’s happening in our heads and hearts right now.”
Despite describing the virus as an enemy and foe, Breton bristles at my description of frontline healthcare workers as modern-day soldiers fighting a world war that’s killed millions. She says they’re just doing their jobs, and she doesn’t want to be called a hero. But, like many modern wars, this battle is being fought by a minority and monitored by the majority with minimal day-to-day sacrifice. During the Second World War, people bought war bonds and held scrap metal drives. Women entered the workforce en masse. The entire economy changed to support those risking their lives. Today’s soldiers are pleading with the populous to “sacrifice” a few minutes of up to two days to take a safe, painless prick in the arm, or wear a mask in public — a minute fraction of the effort people eagerly made in the ’40s — but many refuse, in some cases because they simply don’t want to. The potential to infect others doesn’t even seem to cross their minds.
But Breton has empathy for these individuals — she doesn’t even like the word “blame.”
“I think most people are intrinsically good, trying to do the best they can. But there’s very good evidence that you can’t convince the undecided or hesitant by printing a stat sheet with numbers showing how safe and effective the vaccines are. Humans operate on intuition and emotion. That’s why you hear them rely on anecdotal evidence like ‘My dad’s uncle got it and it wasn’t so bad,’ even though [relying on anecdotal evidence] is the opposite of how science works.”
Breton does hold two groups responsible: those spreading misinformation on TV and social media, and a provincial government that reinforces it in the way it reports COVID statistics. When we talk, the Restriction Exemption Program has been in place for a few weeks, but Breton says it would’ve been nice to have it earlier, back when Alberta was “open for summer.”
In Provincial Chief Medical Officer of Health Dr. Deena Hinshaw’s regular updates on COVID, there are referrals to the ages and pre-existing conditions of pre-vaccine patients. In September, both Premier Jason Kenney and former Alberta minister of health Tyler Shandro referred to COVID’s fourth wave as the “pandemic of the un-vaccinated.”
Breton believes that the government messaging has been not just callous and inaccurate, it’s also led people to believe they are immune even if they haven’t “researched” Facebook or read some misinformation website. “That’s what happens when you have messaging from a government that calls expert physicians alarmists or dismisses them as ‘Twitter doctors.’ I end up talking to these 40-year-old unvaccinated patients who are gasping for air, telling them I’m going to put them on life support, and that they should FaceTime a loved one first. I really get the sense that most of them thought this was over, that it wasn’t going to affect them.”
When nurses — like the one we spoke to from a local emergency room, who wishes to stay anonymous — deal with patients, they are professional to the point of seeming stoic. But each patient, certainly each death, leaves an emotional mark.
“It feels like I don’t even remember what nursing was like before this.”
Our source always planned to work in the ER, but admits that after only three orientation shifts, she wasn’t ready, because the hospital was “so strapped for people they just weren’t able to fully prepare us.”
Nurses tend to have dark senses of humour. It’s their way of dealing with what they see every day, even pre-COVID. So is crying in their cars before driving home after 12-hour shifts. But as nurse-to-patient ratios increase to unmanageable levels, they find time when they can. “I don’t think I’ve ever cried in the bathroom so many times as I have in the last six months. And we kind of just laugh it off like, yeah, I just fucking cried in the bathroom. But it’s not funny.”
But even nurses have their breaking points. When a COVID patient from the Remand Centre needed hospitalization, that person was accompanied by a guard who was unvaccinated and apparently unable, or unwilling, to read the hospital room. “She was saying she doesn’t need to get vaccinated and that doctors and nurses ‘signed up for this,’ while we could all hear her. I kind of flipped out on her, because I wouldn’t go to her workplace and start talking about guards in front of them.”
She took a mental health day off the next day, and has since gotten a doctor’s note to get more consecutive days off between shifts. She’s also curbed her online time and left certain Facebook groups because coming home from COVID patients and dealing with conspiracy theorists and deniers is just too much. “I feel that I’m not being the best nurse I can be, because I’m just so tired and burned out.”
Even in normal times, emergency room doctors and nurses see people at their worst. And Breton says part of her and her coworkers’ job description is to be “ambassadors of death.” But they’ve been trained to do it in a different, more humane way than this virus affords. Translating peoples’ last words through iPads, yelling, “He says he loves you!” over noisy machines, is an amputated form of grieving and dehumanizing for everyone involved. During the fourth wave, this happened many times per day.
“It’s horrible to witness. And this is not an isolated thing. I took care of someone who had decided he didn’t want to call anybody. But I was quite worried that he was going to die, so I insisted. He wanted to reconnect with a family member he hadn’t spoken to in a very long time, but couldn’t bring himself to do it. So I started the call and then put the iPad up to him, and the two of them didn’t say anything. They just looked at each other. And at the end of it, he tried to say ‘I love you.’ And she said it back. And that was it. I was trying not to cry because I had to put this gentleman on a ventilator.”
While Breton has seen workers attempt to ease their stress by shifting departments or switching to part-time hours, there hasn’t been an exodus of medical staff so far — though that could just be delayed out of a sense of duty to see this battle to its end.
But will it ever really end? Researchers are only starting to understand long COVID’s effects, and the early results aren’t good. Cancelled cancer surgeries need re-scheduling, assuming the patients are still alive and well enough to receive them, all while the province deals with opioid and suicide crises as well. All those people, and many of their loved ones, need mental and physical help from a medical community that just went through the two worst professional years in living memory.
The province plans to clear that backlog by the end of 2021, in part through private facilities. In July the province announced plans to move many orthopedic surgeries to private clinics — and fund them — in order to ease waiting lists that had grown unmanageable due to COVID. But the thought of using private facilities for public health stresses Breton out even more.
“This crisis won’t be over when the last COVID patient is discharged. And right now, there’s no election. But the leaders we choose, more than anything else, have an impact. I’m quite worried… we’re going to get down a path of two-tier healthcare. And I worry that that is part of the intention of this government, unfortunately. Because… they had every opportunity to turn the direction of the ship and they just kept going forward.”
In the pre-election meantime, disinformation abounds. And Breton believes COVID has brought to the surface an individual-as-paramount, no-government’s-gonna-tell-me-what-to-do attitude that’s been building for years, which is hard to argue.
But even then, the ever-introspective doctor identifies a communication failure on her profession’s part: to make people understand the literal meaning of pandemic. “The root words ‘pán’ and ‘demos’ mean ‘all people,’ so when we overly focus on the individual, we miss what’s especially true right now, which is that there is no individual in a pandemic. Everything that happens to somebody impacts somebody else.”
Even before COVID-19 changed the way we live, a mental-health crisis was already here, along with a massive increase in opioid overdoses. More and more young people are taking their own lives.
Those troubling trends have only grown through the COVID pandemic. Add to that the strain the virus has placed on our health-care professionals, and we’re heading to a great reckoning. What happens when the people who are charged with taking care of us are also asking for help?
We take a closer look at how the mental-health crisis drives us to extremes. If you are feeling the strain, it’s important to know you are not alone. Help is out there. Alberta Health Services’ mental-help line is available 24/7, at 1-877-303-2642. The addiction help line number is 1-866-332-2322. When it all becomes too much, the bravest thing you can do is ask for help. Please, do not suffer in silence.