Category Archives: Hazardous work environments

When This War Is Over, Many of Us Will Leave Medicine and the Stresses of Healthcare Workers on All Fronts

One ER physician recounts the stress of constant intubations and PPE shortages

Michele Harper reviews the stress of our frontline healthcare workers and here is a case.

I couldn’t see. My face shield was blurred by a streaky haze. I tilted my neck back and forth in an effort to peer beyond it, beneath it, through it, whatever might work. Was it condensation? I started to raise my hands to my face to wipe it away before I remembered and yanked them back down: I cannot touch my face, can’t ever touch my face — neither inside this room nor outside it.

As I stood at the head of the patient’s bed in ER Room 3, her nurse, Kate, secured a mask over the patient’s face to deliver additional oxygen. I checked to ensure the oxygen was cranked up to the maximum flow rate while we waited for the respiratory therapist. Even with that increased oxygen, the patient was saturating 85% at best, and her blood pressure was dropping.

Ninety minutes earlier, the patient — a woman of 68 years with significant impairment from a stroke — had been fine. The nurse at her nursing home called to inform us they were sending the patient to the ER for evaluation of “altered mental status” because she was less “perky” than usual. Her oxygen level on arrival was normal with no shortness of breath. Her blood pressure was a little low, but her blood glucose read high. Nothing a little IV fluid couldn’t fix, and initially, it did.

I had requested a rectal temperature; it read 103 degrees. The combination of her being a nursing home resident and running a fever was a red flag during these coronavirus times. I placed her on respiratory isolation and asked Kate to be extra vigilant for any decline. I ordered broad-spectrum antibiotics to kill any likely source of infection while I awaited her chest X-ray, urine, and blood tests. Her portable chest X-ray was done first and revealed what I had already anticipated: diffuse atypical infiltrates, a presumed telltale sign of Covid-19. Although our understanding of this viral infection is ever-evolving, it seems the only observation we can reliably conclude is that we have not yet identified anything pathognomonic about it.

Seventy-five minutes later, another nurse, Charlene, called, “They need you in Room 3.”

“Okay,” I replied as I entered orders on the next chest pain patient with shortness of breath.

“Dr. Harper, they need you in Room 3 now,” Charlene called again.

“Room 3? The nursing home patient? I’ll be right there. What happened?”

“Her oxygen is at 67%.”

I asked the clerk to call respiratory therapy for intubation. I then turned back to Charlene to ask her to help Kate prepare for the procedure.

Then the personal protective equipment (PPE) sequence. I grabbed gloves to remove my N95 mask from its paper bag and placed it over my face, checking it was snug over my nose and lower jaw. After removing those gloves, I donned my face shield, then walked to the cart for a new gown. Lastly, a fresh set of gloves before entering the patient’s room.

I was scared, and I don’t get scared. Other doctors do, but not ER doctors. We don’t scare easily.

Now I waited for the respiratory therapist. It was good that she needed extra time to get the ventilator and then don her PPE because I had to figure out why I couldn’t see without manually manipulating my face shield. My thoughts were pierced by the sound of panting. I checked the patient who was taking the oxygen quietly, rapidly, ineffectively at regular intervals that didn’t register a sound. Her eyes remained closed—no flip of an eyelash, no wince of her forehead, no twitch in a limb. Despite her instability, the patient was in no visible distress. No heaving breath there. The nurse to my left was concentrating on the patient’s oxygen. I heard only the crinkle of her gown as she adjusted her stance. The panting wasn’t hers. The nurse to my right prepared to administer the intubation medications. He read out my orders — the name and dose of the medication in each syringe and the order in which they were to be pushed. His voice was steady. It wasn’t him hyperventilating. The nurse just outside of the room kept documentation of the procedure on scrap paper she used to carefully transcribe each detail onto her laptop. She was too far away to be heard unless she yelled, so that audible breathing certainly wasn’t hers.

The panting was my own.

A hailstorm of thoughts ensued. Was my breath the fog on my face shield? If so, my N95 mask had a leak. Unsuspecting, had I already inhaled the virus? Would I be intubated next?

The respiratory therapist had arrived with the ventilator and put on her face shield. She was almost ready, so there was little time to pull myself together.

Breathe in, I commanded myself: One, two, three. Breathe out. I obeyed: One, two, three, four.

Was I already short of breath? Had I not noticed my symptoms when I drove to work this morning? Yesterday? Last night?

Breathe in. One two, three. Breathe out. One, two, three, four.

I was scared, and I don’t get scared. Other doctors do, but not ER doctors. We don’t scare easily. We’re a type of special forces who step in when everything else has failed. Typically, we do our job anonymously then leave when the mission is complete. Any injury to ourselves incurred in the line of duty is dealt with after we’re off the clock.

Once in a while, however, there are circumstances when the capacity to compartmentalize is overwhelmed, when the chronic stress breaks through so that the fear works on you. Now, as I stood at the patient’s bed with the video laryngoscope blade in one hand and the endotracheal tube in the other, panic pushed its way through me in involuntary. forceful. rapid. shallow. breaths.

Breathe in on one, two, three. Breathe out on one, two, three, four.

The respiratory therapist slapped on her gloves and in moments was at my side. It was time for intubation.

Breathe in on three and out on four.

At last, my breathing was smooth, measured, sound.

I looked through my mask again. It wasn’t condensation. It was streaks from the sanitizing wipes because we had to reuse our equipment.

I adjusted my eyes to the clear spaces. Finally, I could see. My N95 mask fit. I could breathe.

The room was relatively quiet, what I like to call “ER calm.” All was still, save for the bagging of respiratory therapy, save for the swoosh of oxygen jetting from its port aerosolizing everything.

I requested that the intubation medications be administered then checked for a response. After visualizing the vocal cords easily with the video laryngoscope, I slid in the endotracheal tube, and respiratory connected it to the vent. The patient’s oxygen increased to 100% on the monitor.

Those of us who survive will return each day to battle. But when this war is over, this is why many of us will leave.

Doffing my gown and gloves, I put on new gloves to remove and sanitize my face shield. I couldn’t imagine there was a way to effectively clean the foam band across the forehead. I hoped to remove the streaks. I also hoped the impossible: to remove the virus, because it was the same shield I had to use repeatedly during my shift. I took off the N95. We’re now told that we can reuse it, too, numerous times before getting a new one due to the PPE shortages, so I put the contaminated mask back in the bag until I would need to do it again for the next patient.

This is how we get infected. This is how we die.

Those of us who survive will return each day to battle because we do not walk away from war until it’s done. But when this war is over, this is why many of us will leave.

I walked to the back of the ER to use the restroom in the seven minutes before the patient was ready for CT and saw my ER director standing in the lounge. I waved hello.

“How did it go?” she asked, her eyes gentle, her smile sympathetic.

“It went,” I replied.

“How did you feel in the PPE? Did you feel protected?”

I paused to regulate my answer. Her intentions were good. She was an ER doctor who did her best to walk the fine line between the docs on the front lines and the administrators who notified me that “doctors don’t get paid sick leave” and “thank you for your service,” which were graciously sent out in two separate emails. Just another reminder that we health care providers are regarded as more disposable than our PPE. But this wasn’t her fault, so I felt responsible, in that moment, for her feelings too.

I pulled in my tone. “No. That equipment doesn’t protect us. There’s no way that we’re not all covered in Covid, but we’re following the ‘guidelines.’”

She nodded and frowned.

“Honestly,” I continued, “and I hate to say this, but my feeling is that the majority of people will have contracted this virus. Most people will get through it, and others won’t. Many will die. I don’t want any of us to die, but many health care providers will. The thing is, it’s impossible to know which camp we’re in until it happens.”

She nodded again.

We smiled at each other, and I continued to the bathroom. I washed my hands, turning them over each other, lathering the soap along each finger, under each nail. As I dried my hands, I looked up at the mirror, noting that my breath was now imperceptible when my phone rang.

A FaceTime request from my nine-year-old nephew, Eli.

My policy used to be to not answer the phone at work unless it was critical. But this is a different era. Eli is sheltering-in-place at a military base in California while his mother, my sister, is away for deployment.

I swiped the phone to answer. “Hi, Eli!”

“Hello, Aunt,” he announced more softly than usual. His eyelids hovered low, and his eyes weren’t their typical bright.

“How are you, Eli?” I inquired, masking my concern.

“I’m good.” He smiled with sleepy eyes. “I just woke up.” He yawned; his bushy eyebrows raised high. Years ago, he said his eyebrows were the indisputable evidence that Frida Kahlo was his great, great grandmother so he had to meet her forthwith. Upon being told that she had already passed away, he cried for the woman he had decided was his long-lost ancestor. Now, as he yawned again, his thick eyelashes shut tight. His head drifted back and his mouth reeled open expelling the strongest exhale of the bravest lion cub.

Smiling to myself, I sighed easily.

He breathed.

I breathed.

Today we are OK.

Anxiety on the Frontlines of COVID-19 

It’s not just healthcare workers’ physical health but also their mental health that’s suffering

Richard van Zyl-Smit, M.D./PhD described to a friend this week the current feeling of being in the hospital with COVID-19, as like sitting under a 1,000V high-tension electricity cable: there is a constant humming above your head, which is unnerving and just does not go away.

Two years ago, he published a book called They Don’t Award Nobel Prizes to Dead People about my experience as an academic clinician with a stress-induced anxiety disorder. The context is very different now, but the lessons I learned in that time might be of help to those of you feeling this intangible “humming” — a sense of anxiety that is neither defined nor visible even with no COVID patient contact — and for those of you who are caring daily for COVID-19 patients.

The first and most important aspect of this time is to recognize that anxiety is real. This is not something you might have experienced before. For those of us who have previously or currently suffer from anxiety, it is easily recognizable for what it is, but you may never have experienced it quite like this. You are not losing your mind or losing control, you are experiencing a loss of control of your environment. In many ways, the daily changing updates, the ever-changing schedules and call rosters are unsettling at best and can be completely unnerving as we can’t be certain from one day to the next. There is not a lot you can do about it, except to acknowledge it and talk about it.

The second aspect relates directly to that gnawing “hum.”

I learned previously the benefit of and strongly believe in “downtime.” Getting away from the humming, which is not so easy anymore as we don’t have rugby or soccer scores to get excited or depressed about, we don’t have news about politics or current affairs — except COVID, COVID, COVID. I used to play Candy Crush to get my mind off work and to get away from the “hum,” but recognized that did not accomplish much — it just kept my mind going, and the anxiety was still there. I now try to be creative, to garden, draw, write, crochet (see below), paint, anything that I can do that takes the focus off my work.

Exercise is great too — but now restricted to indoors! I don’t look at the hundreds of WhatsApp group messages unless I am at work; the latest medical publication of how I should treat my ventilated COVID-19 patient on my next week on call is not important when I am at home.

I am convinced that switching off the social media, medical media, and media media when you are not working is vital for your mental health. For some, it might mean no social media, for others less, but getting out from under the electricity cable when you can, is an important way to ensure your own sustainability over the next few months.

The last aspect relates to relationships: physical distance is key — but find, and seek out the people who can support you; keep talking to each other, be kind to each other and to yourself, and talk about the anxiety, fears, worries, or stress. Professional services are available to those feeling very out of control, but simply talking with someone is a fantastic way to get the humming out of your head.

As much as we need to care for our COVID-19 patients and protect ourselves with PPE, we also need to look after ourselves and protect our mental health. It is not a sign of weakness but requires courage and bravery to ask for help.

“Asking for help is not giving up, it is refusing to give up.” — Charlie Mackesy

We are all in this together — we need to be kind to each other and to ourselves.

India coronavirus doctors: Notes on hope, fear and longing Reporter Vikas Pandey shows us how the Corona virus is affecting doctors in India. Dr Milind Baldi was on duty in a Covid-19 ward when a 46-year-old man was wheeled in  with severe breathing difficulty.

The man was scared for his life and kept repeating one question: “Will I survive?”

The question was followed by a plea: “Please save me, I don’t want to die.” Dr Baldi assured the man that he was going to do “everything possible to save him”.

These were the last words spoken between the two men. The patient was put on a ventilator, and died two days later. The doctor, who works in a hospital in the central Indian city of Indore, vividly remembers the 30 “terrifying minutes” after the patient was brought to his hospital.

“He kept holding my hands. His eyes were full of fear and pain. I will never forget his face.”

His death deeply affected Dr Baldi. “It ate away my soul from inside and left a lacuna in my heart.” Seeing patients die in critical care wards is not uncommon for doctors like him. But, he says, nothing can compare to the psychological stress of working in a Covid-19 ward.

Most coronavirus patients are kept in isolation, which means, if they become critically ill, doctors and nurses are the only people they see in their final hours.

“No doctor ever wants to be in this scenario,” says Dr A Fathahudeen, who heads the critical care department at Ernakulam Medical College in southern India.

Doctors say they usually share the emotional burden of treating someone with that person’s family. But Covid-19 doesn’t allow that. Dr Fathahudeen says he will never forget “the blankness in the eyes” of a Covid-19 patient who died in his hospital.

“He wasn’t able to talk. But his eyes reflected the pain and the fear he was experiencing.” Dr Fathahudeen felt helpless because the patient was going to die alone. But there was a tiny sliver of hope: the man’s wife was being treated for coronavirus in the same hospital.

So, Dr Fathahudeen brought her to the ward. She stood still and kept looking at him and said her goodbye. She never thought her 40-year marriage would end so abruptly.

The experienced doctor says the incident left him “emotionally consumed”. But, he adds, there was “some satisfaction that he didn’t die without seeing his wife”. “But that won’t always happen. The harsh truth is that some patients will die without saying goodbye to their loved ones.”

The emotional toll is made much worse as many doctors are themselves in a form of isolation – most are staying away from their families to protect them. As a result, Dr Mir Shahnawaz, who works at the Government Chest Hospital in Srinagar, says it’s “not just the disease we are fighting with”.

“Imagine not knowing when you will see your family next, add that to the constant fear that you may get infected and you will begin to understand what we are going through.”

Adding to the stress, is the fact that they also have to constantly deal with the emotional outbursts of patients. “They are very scared and we have to keep them calm – be their friend and doctor at the same time.”

And doctors also have to make phone calls to the families of patients, and deal with their fears too. The whole process, Dr Shahnawaz says, is emotionally draining.

“It hits you when you go back to your room in the night. Then there is the fear of the unknown – we don’t know how bad the situation will get.”

Doctors are used to saving lives, he adds, and “we will continue to do that no matter what”. “But the truth is that we are also human beings and we are also scared.” He says that the first coronavirus death in his hospital made his colleagues break down: it was when they realized that Covid-19 doesn’t afford the family a final glimpse of their loved one.

“Family members want to remember the final moments of a patient – a faint smile, a few last words, anything really to hold on to. But they can’t even give a proper burial to the dead.”

Dr Fathahudeen says such psychological pressure needs to be addressed and each hospital needs to have a psychiatrist – both for doctors and patients. “This is something I have done in my hospital. It’s important because otherwise the emotional scars will be too deep to heal. We are staring at cases of PTSD among frontline workers.”

Doorstep doctors

It is not just those working in Covid-19 wards who are on the front line, but also the doctors, community health workers and officials who are involved in contact tracing and screening suspected patients by going door-to-door in virus hotspots.

Dr Varsha Saxena, who works in the badly affected northern city of Jaipur, says she walks into grave danger knowingly every day. Her job is to screen people for possible symptoms. “There is no other option. It’s the fight of our lifetime, but one can’t ignore the risks,” she says. “But it poses great risk because we don’t know who among the ones, we are screening is actually positive,” she adds.

She says doctors like her don’t always get proper medical-grade personal protective equipment. “The fear of getting infected is always there and we have to live with it. It does play on our mind and we have to fight hard to keep such negative thoughts away.”

But her biggest fear, she says, is getting infected and not showing any symptoms. “Then the risk is that we may end up infecting others. That is why field doctors also need PPE,” she adds. And the stress, sometimes, also comes home.

“It’s so draining. My husband is also a doctor, most nights we don’t even have energy to cook and our dinner involves just bread.”

Aqueel Khan, a bureaucrat and a colleague of Dr Saxena, acknowledges that psychological stress is a reality for all frontline workers, including officers like him who are embedded with medical teams. The fear really comes home for these workers when somebody close to them dies.

“I lost my uncle and a friend recently. It shook me, I can’t stop thinking about them. You can’t stop thinking that it can easily happen to you,” he says.

Mr. Khan is also staying away from his family: this year is the first time he will miss his daughter’s birthday. “My heart says to go home and see her from far, but the mind tells me otherwise. This constant struggle is very stressful.

“But we can’t turn our backs on the job. We just have to just keep at it, hoping that we come out alive on the other side of this fight.” ‘The risk is always there’

There is no respite for doctors and nurses even when they are not directly involved in the fight against coronavirus. People with other ailments are continuing to come to hospitals. And there has also been a surge in the number of people who are turning up at hospitals with coronavirus-like symptoms.

Dr Mohsin Bin Mushtaq, who works at the GMC Hospital in Indian-administered Kashmir, says coronavirus has “fundamentally changed our lives”. “We are seeing patients every day for other ailments. But the risk is always there that some of them could be infected,” he said.

And it worries him even more when he reads about doctors getting infected despite wearing PPE and dying. A number of doctors have died in India and dozens have tested positive. There is nothing we can do about it, he says, adding that “we just have to be mentally strong and do our jobs”.

Dr Mehnaz Bhat and Dr Sartaz Bhat also work in the same hospital, and they say that the “fear among patients is too much”. Dr Sartaz says people with a slight cold end up thinking they have coronavirus, and rush to the hospital. “So apart from treating them, we also have to deal with their fear,” Dr Sartaz adds.

He recently diagnosed Covid-19 symptoms in a patient and advised him to go for testing. But his family refused and took him away. The patient was brought back to the hospital after Dr Sartaz called the police. He says he had never imagined doing something like this in his medical career. “This is the new normal.”

The way patients are examined has also changed for some doctors. “We really have to try and limit close interactions with patients,” Dr Mehnaz Bhat says. “But it’s not what we have been trained for. So much has changed so quickly, it’s stressful,” she says.

And several attacks on doctors and nurses across the country have made them even more worried. She says it’s difficult to understand why anybody would attack doctors. “We are saving lives, risking our lives every day. We need love, not fear.” she adds.

And even worse:

E.R. doc on COVID-19 ‘front lines’ died by suicide                             To show how serious the stress is seen in this report by Cory Siemaszko reported that a New York City emergency room doctor who was on the “front lines” of the fight against the coronavirus has died by suicide, police said Monday. Dr. Lorna Breen, 49, who worked at New York-Presbyterian Allen Hospital, was in Virginia when she died on Sunday, said Tyler Hawn, a spokesman for the Charlottesville Police Department.

“The victim was taken to U.V.A. Hospital for treatment, but later succumbed to self-inflicted injuries,” Hawn said.

It was her father, Dr. Phillip Breen, who revealed the first details about his daughter’s tragic death. “She tried to do her job, and it killed her,” he told The New York Times. “She was truly in the trenches of the front line.”

He said his daughter seemed very detached of late and that she had described some of the horrors she had witnessed at the hospital while battling the virus. “Make sure she’s praised as a hero, because she was,” Phillip Breen said. “She’s a casualty just as much as anybody else who has died.”

The hospital confirmed Lorna Breen’s death in a statement released by chief spokesperson Lucky Tran, but gave few other details. “Words cannot convey the sense of loss we feel today,” the statement said. “Dr. Breen is a hero who brought the highest ideals of medicine to the challenging front lines of the emergency department. Our focus today is to provide support to her family, friends, and colleagues as they cope with this news during what is already an extraordinarily difficult time.”

NewYork-Presbyterian Allen Hospital has 200 beds, is in northern Manhattan and is one of the seven hospitals that make up NewYork-Presbyterian Hospital.

Infectious Disease Expert Makes Chilling Prediction for States Reopening Amid Pandemic                                                                 Reporter Lee Moran noted that infectious disease expert Michael Osterholm warned that the states starting to reopen amid the coronavirus pandemic “will pay a big price later on.”

Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told CNN’s Jake Tapper on Thursday that states like Georgia, Colorado and others that are easing social distancing restrictions were “putting gasoline on fire.”

“I think right now, this is one of the things we’ve learned, if we’re going to learn to live with this, then you just don’t walk in the face of it and spit in its eye, because it will hit you,” said Osterholm. “And I think that that’s a really important issue right now,” he continued. “When we have transmission increasing, when our hospitals are not able to take care of it and we don’t have enough testing to even know what’s going on, then that’s not the time to loosen up.”

Osterholm suggested it was “the worst example of how to start this discussion” about the “loosening” of society. “I wouldn’t do it,” he added. “I fear that these states will have to pay a big price later on because of what they’re doing.”

COVID-19: National Psychiatrist-Run Hotline Offers Docs Emotional PPE                                                                                              Emily Sohn reported that Mona Masood, DO, a Philadelphia-area psychiatrist and moderator of a Facebook forum called the COVID-19 Physicians Group, reviewed post after post about her colleagues’ fears, anxieties, and the crushing pressure to act like a hero, inspiration struck. Would it be possible, she wondered, to create a resource through which psychiatrists would be available to provide frontline physicians with some emotional personal protective equipment (PPE)?

She floated the idea in the Facebook forum, which has more than 30,000 members. The response was immediate. “All these psychiatrists just started contacting me, saying, ‘Please let me be a part of this. I want to volunteer,’ ” she told Medscape Medical News.

On March 30, Masood launched the Physician Support Line, a free mental health hotline exclusively for doctors. Within the first 3 weeks, the hotline logged more than 3000 minutes of call time. Some physicians have called repeatedly, and early feedback suggests the resource is meeting a vast need.

“Most of the cases have a lot of emotion from both sides. There are a lot of tears, a lot of relief,” said Masood.

“If Not Me, Then Who?”

Physicians have been facing mental health challenges long before the pandemic, and doctors have long struggled with stigma in seeking psychological help, says Katherine Gold, MD, a family medicine physician at the University of Michigan, Ann Arbor, who studies physician well-being, suicide, and mental health.

As a whole, physicians tend to be perfectionists and have high expectations of themselves. That combination can set them up for mental distress, Gold notes. Studies that have focused mainly on medical students and residents show that nearly 30% have experienced depression. Physicians are also at significant risk of dying by suicide.

Compounding the issue is the fact that physicians are also often reluctant to seek help, and institutional stigma is one persistent reason, Gold says. Many states require annual license renewal applications in which physicians are asked questions about mental health. Doctors fear they’ll lose their licenses if they seek psychological help, so they don’t pursue it.

A study conducted by Gold and colleagues that analyzed data from 2003 to 2008 showed that compared to the general public, physicians who died by suicide were less likely to have consulted mental health experts, less likely to have been diagnosed with mental health problems, and less likely to have antidepressants in their system at the time of death.

The COVID-19 pandemic may exacerbate these trends, suggests a recent study from China in which investigators surveyed 1257 healthcare workers in January and February.

Results revealed that a significant proportion of respondents had symptoms of depression, anxiety, insomnia, and distress. This was especially true among women, nurses, those in Wuhan, and frontline healthcare workers who were directly engaged in diagnosing, treating, or caring for patients with suspected or confirmed cases of COVID-19.

As Masood watched similar concerns accumulate on the COVID-19 Physicians Group Facebook forum, she decided to take action. She says her mentality was, “If not me, then who?”

Assisted by a team of experts, she created the hotline without any funding but with pro bono contributions of legal and ethical work, and she received a heavy discount from a company called Telzio, which developed the hotline app.

The hotline is open daily from 8:00 AM to midnight Eastern Time, and calls are free. Services are available only to physicians, in part because as a group, doctors tend to harbor guilt about asking for help that someone else might need more, Masood says.

When other types of healthcare workers call in, volunteers redirect them to hotlines set up for first responders and other healthcare providers.

So far, more than 600 psychiatrists have volunteered. They sign up for hour-long shifts, which they fit in between their own patients. Two or three psychiatrists are available each hour. Calls come directly through the app to their phones. There is no time limit on calls. If calls run long, psychiatrists either stay on past their shifts or pass the call to another volunteer.

Since its launch, the number of calls has steadily increased, Masood says. Callers include ICU doctors, anesthesiologists, surgeons, emergency department doctors, and some physicians in private practice who, Masood says, often express guilt for not being on the front lines.

Some physicians call in every week at a certain time as part of their self-care routine. Others call late at night after their families are in bed. If indicated, psychiatrists refer callers for follow-up care to a website that has compiled a list of psychiatrists across the United States who offer telehealth services.

There are no rules about what physicians can discuss when they call the hotline, and popular topics have evolved over time, says Masood. In the first week after the hotline’s launch, many callers were anxious about what the future held, and they saw other hospitals becoming overwhelmed. They worried about how they could prepare themselves and protect their families.

By the second week, when more doctors were in the thick of the pandemic and were working long hours, sometimes alone or covering shifts for infected colleagues, there were concerns about coworkers. Some were grieving the loss of patients and family members. The lack of personal protective equipment (PPE), says Masood, has been a common topic of conversation from the beginning.

Given the many unknowns about the virus, physicians have also grappled with the uncertainty around safety protocols for patients and for themselves.

On a deeper level, physicians have expressed a desire to run away, to stop going to work, or to quit medicine altogether. These escape fantasies are a normal part of the fight-or-flight response to stress, Masood says.

Doctors often feel they can’t share their fears, even with family members, in part because of societal pressures to act like heroes on the front lines of what has been framed as a war, she adds.

Heroes aren’t supposed to complain or show vulnerability, Masood says, and this can make it hard for physicians to get the support they need. Through the hotline, psychiatrists give doctors permission to feel what they are feeling, and that can help motivate them to go back to work.

“They don’t want to look like cowards, because that’s the opposite of a hero,” she said. “Saying it to another doctor feels much better because we get it, and we normalize that for them. It’s normal to feel that way.”

Each week, Masood conducts debriefing sessions with volunteers, who talk about conversations filled with raw emotion. When conversations wind down, most physicians express gratitude.

They tell volunteers that just knowing the hotline is there provides them with an emotional safety net. Masood says many physicians tell volunteers, “I know that if anything’s going wrong, I can just call and somebody will be there.” Volunteers, too, say they are benefiting from being involved.

“We are all really having this desperate need to be there for one another right now. We truly feel like no one gets it as much as we get one another,” said Masood.

Long-term Fallout

The need for psychiatric care is unlikely to end after the pandemic retreats, and Masood’s plan is to keep the hotline running as long as it’s needed. Like the rest of the world, physicians are in survival mode, but she expects a wave of grief to hit when the immediate danger ends. Some might blame themselves for patient deaths or question what they could have done differently. The long-term impact of trauma is definitely a concern, Gold says. Physicians in the ER and ICU are seeing many patients who decline quickly and die alone, and they witness young, previously healthy people succumb to the virus.

They’re seeing these kinds of cases over and over, and they’re often doing it in an environment where they don’t feel safe or supported while people in many places stage protests against the measures they feel are helping protect them.

Like veterans returning from war, they will need to reflect on what they’ve experienced after the adrenaline is gone and there is time to think.

“Even when things calm down, it will be great to have resources like this still functioning that can help folks think back through what they’ve been through and how to process that,” Gold said. “Things are going to remind them of experiences they had during COVID, and they can’t predict that right now. There will be a need for the support to go on.”

Masood is optimistic that the pandemic will bring the issue of physicians’ mental health out of the shadows.

“We have a really deep feeling of hope that that there’s going to be a lot more empathy for one another after this,” she said. “There’s going to be a willingness to not take mental health for granted. Doctors are people, too.”

We understand about those on the frontline of this pandemic. But do you all realize that many physicians and nurses are being furloughed during this pandemic due to elimination of elective surgery, many of which are necessary such as transplants and cancer treatments and surgery as well as limitation of their practice during this pandemic.

How do physicians pay their malpractice insurance and pay their staff and overhead and their huge education loans?

I fear that we may see a mass quitting/retirement of many nurses and physicians in our country and maybe world wide or many suffering from PTSD (Post Traumatic Stress Syndrome).

What then happens to our healthcare system? Will this pandemic force Congress to finally get serious regarding improving our healthcare system for All?

Why We Celebrate Labor Day, a Holiday that had a Violent Start and What About Our Health Care Workers?

40305161_1691609390968713_2600545733576753152_nTomorrow is Labor Day, a day to relax, enjoy and get ready for children of all ages to return to school. Susan Miller a writer for USA Today reviewed why we celebrate Labor Day. We are waving so long to the summer of 2018.

You sizzled us, you soaked us, and you satiated us. And like every other summer season, your sprint to Monday – Labor Day – seemed a blur.

For many, Labor Day is all about capturing that last blast at the beach, backyard barbecues, school retail bonanzas and the grudging realization that sun-soaked play days are no more.

But the day has a deeper meaning and marks a pivotal moment in U.S. labor history — and it had a pretty violent start.

In the late 1800s, the state of labor was grim as U.S. workers toiled under bleak conditions: 12 or more hour workdays; hazardous work environments; meager pay. Children, some as young as 5, were often fixtures at plants and factories.

The dismal livelihoods fueled the formation of the country’s first labor unions, which began to organize strikes and protests and pushed employers for better hours and pay. Many of the rallies turned violent.

On Sept. 5, 1882 — a Tuesday — 10,000 workers took unpaid time off to march in a parade from City Hall to Union Square in New York City as a tribute to American workers. Organized by New York’s Central Labor Union, It was the country’s first unofficial Labor Day parade. Three years later, some city ordinances marked the first government recognition, and legislation soon followed in a number of states.

Then came May 11, 1894, and a strike that shook an Illinois town founded by George Pullman, an engineer, and industrialist who created the railroad sleeping car. The community, located on the Southside of Chicago, was designed as a “company town” in which most of the factory workers who built Pullman cars lived.

When wage cuts hit, 4,000 workers staged a strike that pitted the American Railway Union vs. the Pullman Company and the federal government. The strike and boycott against trains triggered a nationwide transportation nightmare for freight and passenger traffic.

At its peak, the strike involved about 250,000 workers in more than 25 states. Riots broke out in many cities; President Grover Cleveland called in Army troops to break the strikers; more than a dozen people were killed in the unrest.

After the turbulence, Congress, at the urging of Cleveland in an overture to the labor movement, passed an act on June 28, 1894, making the first Monday in September “Labor Day.” It was now a legal holiday.

In the coming decades, the day took root in American culture as the “unofficial end of summer” and is marked by parades, picnics and family/friend time. Post offices, banks, courts, and federal and state offices are shuttered.

My questions are:

Why was Labor Day invented and Have we Lost the Real Spirit of the Holiday?

Labor Day came about because workers felt they were spending too many hours and days on the job.

More history, as you remember in the 1830s, manufacturing workers were putting in 70-hour weeks on average. Sixty years later, in 1890, hours of work had dropped, although the average manufacturing worker still toiled in a factory 60 hours a week.

These long working hours caused many union organizers to focus on winning a shorter eight-hour workday. They also focused on getting workers more days off, such as the Labor Day holiday, and reducing the workweek to just six days.

These early organizers clearly won since the most recent data show that the average person working in manufacturing is employed for a bit over 40 hours a week and most people work only five days a week.

Surprisingly, many politicians and business owners were actually in favor of giving workers more time off. That’s because workers who had no free time were not able to spend their wages on traveling, entertainment or dining out.

As the U.S. economy expanded beyond farming and basic manufacturing in the late 1800s and early 1900s, it became important for businesses to find consumers interested in buying the products and services being produced in ever greater amounts. Shortening the workweek was one way of turning the working class into the consuming class.

Some Common misconceptions

The common misconception is that since Labor Day is a national holiday, everyone gets the day off. Nothing could be further from the truth.

While the first Labor Day was created by striking, the idea of a special holiday for workers was easy for politicians to support. It was easy because proclaiming a holiday, like Mother’s Day, costs legislators nothing and benefits them by currying favor with voters. In 1887, Oregon, Colorado, Massachusetts, New York and New Jersey all declared a special legal holiday in September to celebrate workers.

Within 12 years, half the states in the country recognized Labor Day as a holiday. It became a national holiday in June 1894 when President Grover Cleveland signed the Labor Day bill into law. While most people interpreted this as recognizing the day as a national vacation, Congress’ proclamation covers only federal employees. It is up to each state to declare its own legal holidays.

Moreover, proclaiming any day an official holiday means little, as an official holiday does not require private employers and even some government agencies to give their workers the day off. Many stores are open on Labor Day. Essential government services in protection and transportation continue to function, and even less essential programs like national parks are open. Because not everyone is given time off on Labor Day, union workers as recently as the 1930s were being urged to stage one-day strikes if their employer refused to give them the day off.

In the president’s annual Labor Day declaration in 2015, Obama encouraged Americans “to observe this day with appropriate programs, ceremonies, and activities that honor the contributions and resilience of working Americans.”

The proclamation, however, does not officially declare that anyone gets time off.

Controversy: Militants and founders

Today most people in the U.S. think of Labor Day as a noncontroversial holiday. There is no family drama like at Thanksgiving, no religious issues like at Christmas. However, 100 years ago there was controversy.

The first controversy that people fought over was how militant workers should act on a day designed to honor workers. Communist, Marxist and socialist members of the trade union movement supported May 1 as an international day of demonstrations, street protests and even violence, which continues even today.

More moderate trade union members, however, advocated for a September Labor Day of parades and picnics. In the U.S., picnics, instead of street protests, won the day.  There is also the dispute over who suggested the idea. The earliest history from the mid-1930s credits Peter J. McGuire, who founded the New York City Brotherhood of Carpenters and Joiners, in 1881 with suggesting a date that would fall “nearly midway between the Fourth of July and Thanksgiving” that “would publicly show the strength and esprit de corps of the trade and labor organizations.”

Later scholarship from the early 1970s makes an excellent case that Matthew Maguire, a representative from the Machinists Union, actually was the founder of Labor Day. However, because Matthew Maguire was seen as too radical, the more moderate Peter McGuire was given the credit.

Have we lost the spirit of Labor Day?

Today Labor Day is no longer about trade unionists marching down the street with banners and their tools of the trade. Instead, it is a confused holiday with no associated rituals.

The original holiday was meant to handle a problem of long working hours and no time off. Although the battle over these issues would seem to have been won long ago, this issue is starting to come back with a vengeance, not for manufacturing workers but for highly skilled white-collar workers, many of who are constantly connected to work.

How About Considering the Health Care of our Workers?

But maybe we should consider the health care of our workers on this day. According to Gallup, as I already mentioned, the average adult works more than 40 hours per week. Long workweeks without adequate rest can damage Americans’ health. For example, the European Heart Journal published a study in 2010 showing that people who reported working more than 10 hours a day had the highest risk of coronary heart disease. Long work hours also may lead to stress, which can cause health issues like obesity, depression and high blood pressure, among others.

Along with harming individual’s personal health, these chronic health conditions can lead to high costs for the U.S. health care system. According to the National Research Council and Institute of Medicine, Americans spend almost twice as much on health care than people in other advanced countries, yet we still have more injuries and illnesses.

And whether it is a complication of a chronic condition or a seasonal cold, Americans continue to show up sick to work. This is known as “presenteeism,” a term used to describe employees with health conditions who are at work but unable to perform at full capacity. Health-related presenteeism has a larger impact on lost productivity than absenteeism, according to peer-reviewed research sponsored by the National Pharmaceutical Council (NPC) and published in the Journal of Occupational and Environmental Medicine in 2009.

“The study found that when considering medical and drug costs alone, the top five conditions driving costs are cancer (other than skin cancer), back/neck pain, coronary heart disease, chronic pain, and high cholesterol,” as NPC explained when the research was published. “But when health-related productivity costs are measured along with medical and pharmacy costs, the top five chronic health conditions driving these overall health costs shift significantly, to depression, obesity, arthritis, back/neck pain, and anxiety.” As a result, when employers focus on medical and pharmacy costs alone, they may miss an opportunity to address these potentially much more impactful conditions.

Also, remember those who don’t get to take a vacation day on Labor Day one group is the healthcare worker.

Jim Mangia, President, and CEO of St. John’s Well Child and Family Center notes that as a child of the labor movement in New York City, Labor Day holds special meaning for me. I grew up walking picket lines to help serve food to strikers and was able to attend college and graduate school because of a union college fund. From an early age, I understood that the fight for decent pay, benefits, and working conditions was a noble one— but not one without consequences. For every memory I have of victories for the labor movement, I’ll never forget seeing police on horseback beating labor activists that gathered to protest jobs from being moved to “right-to-work” states. I learned it takes courage to stand up for worker’s rights and solidarity among workers is key to shaping a healthy and productive workforce.

At John’s Well Child and Family Center, we know that empowered health care employees are essential to society as a whole. Studies show that fair wages are inextricably linked to better service because the reality is that people are motivated to work harder when they’re paid a fair wage. Investing in higher pay for employees has also been proven to reduce illness and increase stamina— two benefits that are absolutely critical for workers in the healthcare industry. Higher paid healthcare workers are less likely to miss work or get sick than their underpaid counterparts, which means that organizations like ours can be fully staffed with healthy people, translating to benefits as concrete as shorter wait times for the patients we serve.

John’s mission for social justice is rooted in a strong relationship with the labor movement because standing up for our employees makes us stronger as a whole. The truth is, we would not be the successful organization we are today without the help of worker’s rights activists. Almost ten years ago, we invited SEIU Local 721 to organize our staff, and in 2015, they helped us become one of the first nonprofit organizations in the United States to implement a $15 minimum wage for our workers. Our workforce makes it possible for St. John’s to operate fourteen different clinic sites and two mobile clinics. As we’ve grown, we’ve been able to employ hundreds of employees who provide high-quality health care to hundreds of thousands of marginalized and low-income patients in South Los Angeles, adding up to an impressive 350,000 annual patient visits.

In addition to celebrating the lifesaving care our workers provide, St. John’s is also celebrating our contributions to one of the most critical fights of this decade: protecting the Affordable Care Act. This summer alone, St. John’s staff, patients, and allies have made nearly a thousand calls to legislators who were set to vote on an act that would have destroyed our life-saving health care system. We are proud to have been part of the resistance effort that saved health care access for millions of Americans. However, our work here isn’t done. We won’t stop working until health care is respected as a fundamental human right.

Alongside our local labor unions, we will continue to push ourselves to improve our benefits, pay, and working conditions— all the while maintaining our commitment to elevating the voices of our staff. The partnership and trust between St. John’s and the labor movement has helped build the political muscle necessary to advocate for increased funding, improved quality of care, and greater access to health care services for our community members. The work of American labor activists is a labor of love for our fellow man— and we’re grateful for their unwavering commitment to justice.

During a time of increased income inequality and toxic political divisions, it’s important now more than ever to take a stand for the folks on the ground who provide high-quality, loving care to the most vulnerable among us. The wealthy few will continue their attempts to threaten our progress, but we will not back down. We will continue fighting to ensure that the Affordable Care Act remains the law of the land, celebrating the hard work of health care workers, and paving the way for healthier communities everywhere.

So as we enjoy Labor Day, let’s remember to take a deep breath, relax and to take care of our own health. It’s not only good for us, but it’s good for all of us. Yet another reason to celebrate the American worker. So if you work all the time and never really take a vacation, start a new ritual that honors the original spirit of Labor Day. Give yourself the day off. Don’t go into work. Shut off your phone, computer and other electronic devices connecting you to your daily grind. Then go to a barbecue, like the original participants did over a century ago, and celebrate having at least one day off from work during the year.

And then How do You Get the Most Out of a Day Off?

Elizabeth Grace Saunders reviewed some suggestions regarding your day off. The idea of “vacation” often conjures up thoughts of trips to faraway lands. While it’s true that big trips can be fun and even refreshing, they can also take a lot of time, energy, and money. A lot of people feel exhausted just thinking about planning a vacation—not just navigating personal commitments and school breaks, but deciding how to delegate major projects or put work on hold just so they can have a stress-free holiday. Because of this, some might put off their time away, figuring they’ll get to it when their schedule isn’t so demanding, only to discover at the end of the year that they haven’t used up their paid time off.

In my experience as a time management coach and as a business owner, I’ve found that vacations don’t have to be big to be significant to your health and happiness. In fact, I’ve been experimenting with the idea of taking “micro-vacations” on a frequent basis, usually every other week. These small bits of time off can increase my sense of happiness and the feeling of having “room to breathe.”

From my point of view, micro-vacations are times off that require you to use a day or less of vacation time. Because of their shorter duration, they typically require less effort to plan. And micro-vacations usually don’t require you to coordinate others taking care of your work while you’re gone. Because of these benefits, micro-vacations can happen more frequently throughout the year, which allows you to recharge before you’re feeling burnt out.

If you’re feeling like you need a break from the day-to-day but can’t find the time for an extended vacation, here are four ways to add micro-vacations to your life.

Weekend trips. Instead of limiting vacations to week-long adventures, consider a two- to a three-day trip to someplace local. I’m blessed to live in Michigan, and one of my favorite weekend trips is to drive to Lake Michigan for some time in a little-rented cottage on the shore or to drive up north to a state park. Especially if you live in an urban area, traveling even a few hours can make you feel like you’re in a different world.

To make the trip as refreshing as possible, consider taking time off on Friday so you can wrap up packing, get to your destination, and do a few things before calling it a night. That still leaves you with two days to explore the area. If you get home by dinner time on Sunday, you can unpack and get the house in order before your workweek starts again.

There may be a few more e-mails than normal to process on Monday, but other than that, your micro-vacation shouldn’t create any big work pileups.

The margin for personal to-do items. Sometimes getting the smallest things done can make you feel fantastic. Consider taking an afternoon—or even a full day—to take an unrushed approach to all of the nonwork tasks that you really want to do but struggle to find time to do. For example, think of those appointments like getting your haircut, nails did, oil changed, or doctor visits. You know that you should get these taken care of but finding the time is difficult with your normal schedule.

Or perhaps you want to take the time to do items that you never seem to get to, like picking out the patio furniture, unpacking the remaining boxes in the guest room, or setting up your retirement account. You technically could get these kinds of items done on a weeknight or over the weekend. But if you’re consistently finding that you’re not and you have the vacation time, use it to lift some of the weight from the nagging undone items list.

Shorter days for socialization. As individuals get older and particularly after they get married, there tends to be a reduction in how much time they spend with friends. One way to find time for friends without feeling like you’re sacrificing your family time is to take an hour or two off in a day to meet a friend for lunch or to get together with friends before heading home. If you’re allowed to split up your vacation time in these small increments, a single vacation day could easily give you four opportunities to connect with friends who you otherwise might not see at all.

If you struggle to have an uninterrupted conversation with your spouse because your kids are always around, a similar strategy can be helpful. Find days when one or both of you can take a little time off to be together. An extra hour or two will barely make a difference at work but could make a massive impact on the quality of your relationship.

Remote days for decompression. Many offices offer remote working options for some or all of the week. If that’s offered and working remotely is conducive to your work style and your tasks, take advantage of that option.

Working remotely is not technically a micro-vacation, but it can often feel like one. (Please still do your work—I don’t want to get in trouble here!) If you have a commute of an hour or more each way, not having to commute can add back in two or more hours to your life that can be used for those personal tasks or social times mentioned above.

Also, individuals who work in offices that are loud, lack windows, or where drive-by meetings are common, working remotely can feel like a welcome respite. Plus, you’re likely to get more done. A picturesque location can also give you a new sense of calm as you approach stressful projects. I find that if I’m working in a beautiful setting, like by a lake, it almost feels as good as a vacation. My surroundings have a massive impact on how I feel.

Instead of seeing “vacation” as a large event once or twice a year, consider integrating into micro-vacations into your life on a regular basis. By giving yourself permission to take time for yourself, you can increase your sense of ease with your time.

Some herald the new beginnings that dot the post-Labor Day months – the NFL in full swing, election season in high gear, the first frost, fall’s colors and remember the Mid-term elections and possible transfer of power as the Democrats try to impeach the President. Oh, the surprises ahead beyond who is going to make it to the Super Bowl and which college team will make it to which Bowl game?

But for those mourning another summer that slipped from sight, starts the countdown clock, remember that Memorial Day 2019 is only 267 days away.