The coronavirus patient, a 75-year-old man, was dying. No family member was allowed in the room with him, only a young nurse.

In full protective gear, she dimmed the lights and put on quiet music. She freshened his pillows, dabbed his lips with moistened swabs, held his hand, spoke softly to him. He wasn’t even her patient, but everyone else was slammed.

Finally, she held an iPad close to him, so he could see the face and hear the voice of a grief-stricken relative Skyping from the hospital corridor.

After the man died, the nurse found a secluded hallway, and wept.

A few days later, she shared her anguish in a private Facebook message to Dr. Heather Farley, who directs a comprehensive staff-support program at Christiana Hospital in Newark, Del. “I’m not the kind of nurse that can act like I’m fine and that something sad didn’t just happen,” she wrote.

Medical workers like the young nurse have been celebrated as heroes for their commitment to treating desperately ill coronavirus patients. But the heroes are hurting, badly. Even as applause to honor them swells nightly from city windows, and cookies and thank-you notes arrive at hospitals, the doctors, nurses and emergency responders on the front lines of a pandemic they cannot control are battling a crushing sense of inadequacy and anxiety.

Every day they become more susceptible to post-traumatic stress, mental health experts say. And their psychological struggles could impede their ability to keep working with the intensity and focus their jobs require.

Although the causes for the suicides last month of Dr. Lorna M. Breen, the medical director of the emergency department at NewYork-Presbyterian Allen Hospital, and John Mondello, a rookie New York emergency medical technician, are unknown, the tragedies served as a devastating wake-up call about the mental health of medical workers. Even before the coronavirus pandemic, their professions were pockmarked with burnout and even suicide.

On Wednesday, the World Health Organization issued a report about the pandemic’s impact on mental health, highlighting health care workers as vulnerable. Recent studies of medical workers in China, Canada and Italy who treated Covid-19 patients found soaring rates of anxiety, depression and insomnia.

To address the ballooning problem, therapists who specialize in treating trauma are offering free sessions to medical workers and emergency responders nationwide. New York City has joined with the Defense Department to train 1,000 counselors to address the combat-like stress. Rutgers Health/RWJ Barnabas Health, a New Jersey system, just adopted a “Check You, Check Two” initiative, urging staff to attend to their own needs and touch base with two colleagues daily.

“Physicians are often very self-reliant and may not easily ask for help. In this time of crisis, with high workload and many uncertainties, this trait can add to the load that they carry internally,” said Dr. Chantal Brazeau, a psychiatrist at the Rutgers New Jersey Medical School.

Even when new Covid-19 cases and deaths begin to ebb, as they have in some places, mental health experts say the psychological pain of medical workers is likely to continue and even worsen.

“As the pandemic intensity seems to fade, so does the adrenaline. What’s left are the emotions of dealing with the trauma and stress of the many patients we cared for,” said Dr. Mark Rosenberg, the chairman of the emergency department at St. Joseph’s Health in Paterson, N.J. “There is a wave of depression, letdown, true PTSD and a feeling of not caring anymore that is coming.”

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Screw all of you now I see exactly why the only thing left to do is suicide. — a Facebook post by a St. Louis paramedic in April

After Kurt Becker, a paramedic firefighter in St. Louis County, saw that post, which included a profanity-laced screed of frustration and despair over the job, he sent a copy to the man’s therapist with a note saying, “You need to check this out.”

“I’m reading this, and I’m ticking off each comment with, ‘stress marker,’ ‘stress marker,’ ‘stress marker,’ ” said Mr. Becker, who manages a 300-person union district. (The writer is in treatment and gave permission for the post to be quoted.)

The paramedics are part of a “warrior culture,” Mr. Becker said, which sees itself as a tough, invulnerable caste. Asking for help, admitting fear, is not part of their self-image.

Mr. Becker, 48, is himself the grandson of a bomber pilot and son of a Vietnam veteran. But his local has been hit by a dozen suicides since 2004, and he has become an advocate for the mental health of its members. To maintain his equilibrium, he works out and sees a therapist.

Recently, he has been getting more requests than usual for the union’s peer-support team and its roster of clinicians who understand the singular experiences of emergency medical workers.

“The virus scares the hell out of our guys,” he said. “And now, when they go home to decompress, instead, they and their spouses are home schooling. The spouse has lost a job, and is at wit’s end. The kids are screaming. Let me tell you: The tension level in the crews is through the roof.”

Many besieged health care workers are exhibiting what Alynn Schmitt McManus, a St. Louis-based clinical social worker, calls “betrayal trauma.”

“They feel overwhelmed and abandoned” by fire chiefs who, she said, rarely acknowledge the newly relentless demands of the job.

Many paramedics, she added, are “aggressive and depressed. They are so committed to the work, they are such good human beings, but they feel so compromised now.”

Brendan, who asked for his last name to be withheld to protect his privacy, is a 24-year-old paramedic firefighter who works 48-hour shifts on the tough north side of St. Louis. His unit has been so busy running calls that he goes for long stretches without showering, eating or sleeping. He is terrified he might infect his fiancée and their daughter.

“We got a letter from our chief saying that there’s a national shortage of gloves, gowns, masks and goggles because the public is taking them,” he said. “Then we walk into Walmart and see that 90 percent of the people have better masks than we do.”

With no end in sight to the crisis, Brendan sought out a therapist.

“We are a lot quicker to be angry with each other,” he said. “Any little thing sends us over the edge. But among the older guys in their late 30s and 40s, it’s not OK to talk about things. So all anyone talks about is alcohol.”

 

Read more: https://www.nytimes.com/2020/05/16/health/coronavirus-ptsd-medical-workers.html