‘Crying Out for Help’: Harvard Affiliates on Pandemic Front Line Describe Mental Health Toll

During the first surge of the Covid-19 pandemic in March 2020, David F. M. Brown — chief of the Department of Emergency Medicine at Massachusetts General Hospital – moved out of his home for more than three months in fear of transmitting the virus to his family.

“At that time, my daughter — who was in our Covid pod — was pregnant, and I was convinced that I was going to get infected, and I didn’t want to infect her or my wife,” Brown said.

Though moving out “seemed like the right thing to do,” Brown said his isolation came with personal challenges.

“I didn’t move back in until sometime in June — that was kind of a tough time for me to stay upbeat,” Brown said. “I remember that weekend moving out of the house and feeling kind of down and then there was that 15 weeks of isolation.”

Similar to Brown, second-year infectious disease fellow at MGH Kathryn A. “Katy” Bowman found herself facing the unprecedented threat and onslaught of work last spring — all without the support of her family or time off to rest.

Bowman said she did not see her family in Texas for a year following the first wave. In fact, she gave up her one week of vacation last year to volunteer in the Covid-19 intensive care unit.

“I felt like even if I took time while in Boston, I couldn’t leave here, I’m not from here, I couldn’t see my family — I would just be wondering what I could be doing here instead,” she said.

More than 10 medical professionals who have been on the front lines of the Covid-19 battle at two Harvard-affiliated teaching hospitals — MGH and Beth Israel Deaconess Medical Center — told The Crimson in interviews that they had faced similar impacts on their emotional well-being over the past 14 months while they put their lives on the line to save others.

In response, the hospitals have implemented programs to support their staff, drawing on the expertise of Harvard’s own faculty specializing in mental health. The frontline workers also said they relied heavily on one another through the darkest periods of the pandemic.

Even with vaccinations on the rise and cases falling across the nation, several of the employees said these mental health impacts would persist.

“This problem doesn’t end when the surge ends,” said Medical School professor Kerri Palamara McGrath, who leads the Center for Physician Well-being at MGH. “This is a problem that is going to be with us for a while.”

‘Operating in Emergency Mode’

According to a national survey conducted by Mental Health America from June to September of 2020, 93 percent of health care workers reported experiencing stress, 86 percent reported anxiety, and 76 percent reported exhaustion and burnout.

McGrath said these wider trends are consistent with the pandemic’s toll on MGH hospital staff, including increased rates of depression and anxiety, loneliness, and burnout.

HMS psychiatry professor Christopher M. Palmer said health care workers have faced overwhelming stress that has led to these mental health problems.

“Their providers have been overwhelmed, crying out for help, begging for help, saying, ‘We can’t take this. We can’t do this. I can’t sleep, I’m having ruminations, I don’t know how to deal with all of the guilt. I don’t know how to deal with all of the grief. People are dying,’” he said.

The first phase of the pandemic, in particular, came with great uncertainty for health care workers, according to BIDMC Senior Director of Social Work Barbara S. Lee.

“The first surge was really challenging because none of us knew much about Covid,” Lee said. “We were operating in emergency mode without really understanding the illness and what we were up against.”

John Herman, associate chief of MGH’s Department of Psychiatry, similarly noted that the surge of Covid cases at “unprecedented levels” early in the pandemic, coupled with the novelty of the virus, placed an immense burden on clinicians.

“We didn’t know how, at first, to take care of these patients, and so the clinicians were feeling desperate to deliver the very best care,” Herman said. “We were learning.”

‘A Huge Roller Coaster Ride’

Another major stressor for health care workers has been the fear of bringing the virus home and infecting family members, according to MGH intensive care unit nurse Brittany Sheehan, who characterized the pandemic’s mental health impacts as a “huge roller coaster ride.”

“I cared for critically ill patients for years, but never at the threat of bringing something home that could kill my parents,” Sheehan said.

Health care workers also took on the additional responsibility of facilitating interactions between patients and family members when social distancing restrictions limited hospital visitations, according to Pamela N. Peck, clinical director of BIDMC’s Department of Psychiatry. She noted that this task put an “unusual strain” on the hospital staff.

Brown said he distinctly remembered one interaction with a patient who was very sick and required intubation.

“We helped him FaceTime with his wife before we intubated him and put him on a respirator because we knew there was a pretty good chance that he was not going to survive to talk to her again,” Brown said.

“That experience happened again and again and again, especially during the first surge,” he added.

Despite more than a year of trying to cope with the tremendous emotional distress, medical professionals have largely not been able to take time off. When the first surge of the pandemic hit, non-Covid-related surgeries and care had to be postponed, creating a “backlog of care,” according to MGH Chief of Emergency Preparedness Paul D. Biddinger.

MGH Associate Chief Nurse Suzanne Algeri compared the current situation for health care workers with soldiers coming home from war.

“When you think about soldiers going off to war and then returning, they’re given some time off for a very good reason, they need that time to take that pause to restore their mental health and well-being,” she said. “In similar ways, staff here have been through a really tough year with this pandemic, and there’s been an enormous amount of stress on them.”

An unending cycle of intense, toiling work since last year has resulted in “cumulative fatigue,” according to Bowman.

“There’s a cumulative grind to being constantly at work, constantly thinking about work, constantly wondering how to get on top of upcoming literature and know as much as you possibly can because it’s all new,” she said.

Narsis Attar, an internal medicine resident at MGH, said these pressures have manifested in different ways for each frontline worker.

“I can say that I really don’t think I had experienced burnout until this,” she said.

Resources To ‘Break the Cycle’

In response to the pandemic’s impact on clinicians’ mental health, Harvard-affiliated hospitals have not only bolstered established programs, but also created new wellness resources for their workers.

During the pandemic’s first wave, existing groups at MGH promoting staff wellness — including the Employee Assistance Program, which offers free, confidential counseling — came together to form a group called the Wellness Collaborative in order to help address the challenges staff were facing.

Not a single person showed up to the first listening session that the Collaborative scheduled, according to McGrath, the Center for Physician Well-being director.

“What we realized was people didn’t want extra — people had no time,” she said. “So we had to start meeting people where they already were.”

Throughout the summer and early fall of 2020, employees who were part of the Collaborative instead conducted 130 to 150 listening rounds within Patient Care Services where they sat in on departmental meetings and gathered employee feedback on how to best implement mental health resources, according to Algeri.

One initiative that developed out of those listening rounds was a going-home checklist — a list of questions for staff asking how their day went, what things they felt good about, what challenges they had to overcome, and whether they or their colleagues needed any support.

“People were waking up stressed out about the day ahead, going into their day bringing those stressors with them,” McGrath said. “And then bringing that stress home with them, and then having terrible experiences at home, and then going to bed even more stressed than when they woke up.”

“This intervention was one way to break that cycle,” she noted.

The Wellness Collaborative expanded the hospital’s existing peer support network, most notably by launching a Buddy Program for staff to check in with one another.

Some volunteers at MGH facilitated by Elyse R. Park — a professor of psychiatry at the Medical School — formed a peer support hotline from March to July 2020 that offered real-time assistance to MGH frontline workers in need of mental health support.

In addition to numerous peer-support programs, Park also created resiliency training programs for employees to develop coping skills.

According to Park, those that participated saw a decrease in depression and anxiety, as well as an improvement in stress management and resilience.

“People said the most helpful thing was just actually being in a group with other clinicians, and being able to have a space to talk,” she said.

MGB has also begun to offer virtual yoga, spin, cycling, meditation, and cooking classes, among other wellness resources. To help staff navigate the plethora of offerings, the Collaborative curated a resource guide, an internal website listing resources by need, and a weekly newsletter, according to McGrath.

Beyond established wellness initiatives, frontline workers said they relied most heavily on their colleagues, with whom they could have open conversations about their mental health.

“Everyone’s been really aware of the impact of the pandemic on each individual,” Attar added. “People checking in on each other and and really being thoughtful and watching out for one another — I think that really has been incredible.”

Bowman added that the most resilience-building aspect of the pandemic has been how “close knit” everyone in and beyond her division have become.

“There’s been a surfacing of humanity within our healthcare system that’s between health care providers that’s been really refreshing and I think really wonderful,” Bowman said.

“I hope that that continues,” she added.

An Ongoing Challenge

Many of the clinicians said they believe their hospitals should continue providing easily accessible wellness resources for health care workers.

“Leadership saying that, ‘How are you doing?’ — I think that’s for peers to ask each other,” Herman said. “But for leadership to say, ‘What can we do for you?’ — those are critically different questions.”

Attar added that simply making resources available is “not enough.”

“It has to be advertised, it has to be accessible,” she said. “Just because they exist, that doesn’t mean people are able to use it.”

Offering mental health services “in the moment” is essential for clinicians who often are limited in their time to access more external resources, according to Sheehan, the ICU nurse.

“Everyone doesn’t always have the time to kind of outsource when you’re not at work,” Sheehan said. “I think that’s been the most helpful thing and would continue to be really helpful for services to come in to us at work and say, ‘We’re here.’”

Attar also said she believes institutions should aid in preventing clinicians from overworking, or providing care to others “at the cost of caring for themselves.”

“I think just reinforcing that being able to take care of yourself and taking time away from caring for others is actually important,” Attar said. “In a practical sense, being able to give employees that specific devoted, dedicated time to be able to actually step back and take care of their mental health, take care of their physical health even.”

Burnout among physicians and nurses has been an issue within the healthcare system long before the pandemic, according to McGrath.

With the increased awareness regarding the importance of maintaining mental health and well-being, though, McGrath said hospitals should now consider how to not just correct the negative impacts of the pandemic, but also think about ways to improve the system that existed before.

Despite the vaccine rollout and optimism around the state of the pandemic, Biddinger said he believes health care workers will need considerable time to recover from its impacts.

“The psychological wounds of the pandemic will likely linger for a while,” Biddinger said. “I think the people should be aware of what the wounds and needs are of medical providers going forward, as they will need time to process and heal themselves.”

—Staff writer Ariel H. Kim can be reached at ariel.kim@thecrimson.com.

—Staff writer Anjeli R. Macaranas can be reached at anjeli.macaranas@thecrimson.com.