In this week’s episode, we speak with medical journalist, Charlotte Huff, about the mental and physical hardships that nurses are facing as the coronavirus pandemic appears to be entering its deadliest phase.
Jeffrey Freedman: Hello and welcome to the RP HealthCast, by RooneyPartners. I am your host Jeffrey Freedman.
In New York City back in March and April, the pandemic was new. It was scary. It was overwhelming. Governor Cuomo ordered all non-essential businesses closed and people were afraid to leave their homes due to the severity and deadliness of this unknown illness. Our essential businesses had to remain open. Our frontline workers had to go to work every day. Those working in the healthcare ecosystem were very quickly became overwhelmed. They were overworked, they were underprepared, and they were just as afraid as the rest of us.
So as a community and as a united front, we needed to show our frontline workers how much we appreciate it them. So it is seven o’clock every night. We opened our windows. We stepped out onto our balconies or rooftops, and we made noise for two minutes. We screamed, we clapped, we bang pots and pans, and we made music, but most of all we gave thanks and we gave gratitude to all the frontline workers who are risking their lives for us every day.
That was eight months ago and thankfully due to the restrictions that were put into place and the uptake on masking and social distancing. Things in New York dramatically turned around, but unfortunately, our seven PM show of thanks, like everything else is falling off. Some instances it transformed back into five PM happy hours. Because of this, because of pandemic fatigue, it led us into a very strong second wave and this is going on across the country and in the large number of states we are back at peak hospitalizations.
In this week’s podcast, we are going to take a look at this next wave through the eyes of our frontline workers and in particular our nurses and discuss how this Deja vu is affecting them. So to help me with this, I am delighted to have Charlotte Huff. Charlotte is a medical journalist and rights for Kaiser Health News and for genome stat and people and many other news organizations.
Charlotte, thank you so much for joining us today.
Charlotte Huff: Thanks for inviting me.
Jeffrey: In my introduction, I spoke a little bit about the early days of the pandemic in New York. Our hospitals were overloaded and it was a very scary time, but there was a huge show of gratitude towards our nurses and our frontline workers. Now, can you talk a little bit about the rest of the country and what you were seeing in the early days of the pandemic in terms of our nurses and our frontline workers?
Charlotte: Well, I am based in Fort Worth, Texas. So we were kind of living and a bit of a limbo, the first few months of the pandemic. I mean, we could see what was going on in the news and the horror of the cases and New York City and also the Seattle area, but it was kind of a surreal stretch because we were unlocked down, the hospitals were warning us, the cases were coming out. We were not really going anywhere, but the really was not that much happening here, it was a sort of the sense of a come before storm, but we did not really know if the storm was ever going to happen. We waited and waited and then really the uptake here started coming off of Memorial Day weekend and then pretty much got worse into July and after July, although was not nearly the situation that we are looking at in the country right now and in Texas, too.
Jeffrey: Yes. I mean, it certainly was wave, heading across the United States, but I mean in terms of your discussion with nurses and what you said, you saw it happening in New York and you saw what was going on. Did they feel that it was going to come there or was it an isolated situation to an East Coast problem?
Charlotte: That is interesting question. In a local folks here that the clinicians here they got ready, but I think there was a sense of anticipation was going to come to Texas and then it did not happen. I think, based on talking to some of the clinicians and this area, they were– even doctors and nurses staff, well, maybe it is not going to happen here for a stretch and I am talking about the period before we hit Memorial Day weekend.
Jeffrey: Right. Wow. So it sounds like they were almost caught unaware when it finally did and it did come.
Jeffrey: Yes. With our frontline workers there, I know here we really appreciate it. They are coming into work and taking care of us every day, but I do not think we appreciated some of the conditions they were put through at the time. Now, in your reporting, can you talk a little bit about some of the issues that the healthcare workers and our nurses in particular, what they were facing at work every day?
Charlotte: Right. I mean, in the early days and actually it is still a problem even now the personal protective equipment was really short and certainly when I was reporting this article and they were reflecting back on what happened in the spring, they said they were being forced to wear a single N95 mask for much, much longer than it was safe and sometimes even as long as a week at a time. Also, we know so much more about the virus now, we have to think back to then and no one was really sure how the virus was transmitted. So the nurses would come into work and they said it seemed like almost every day there were sort of different guidance and how to protect themselves as they were learning more about whether it was on surfaces or how much it was transmitted through the air.
The other thing was just kind of keeping themselves protected and messed all that stress and there was one nurse I talked to for this story who I was not able to get into the story, but has been working at Brigham and Women’s. She said during the early days, she remember taking care of a patient and doing some really intense treatment for about an hour and then came out and then realized that she had her two masks on it incorrectly. So she basically had not been protected during that stretch. So there was the constant and there still is the push-pull between trying to protect yourself, but yet give the maximum care that you can to the patient that is in front of you.
Jeffrey: Right. That is a scary story from nurses and it is not isolated, I have heard that as well from others. You are talking that that was the early days of the epidemic and as the saying goes that was then, this is now, and hospitals now again are filling up again all over the country. I guess, from a from a nurses point of view, they have to be in disbelief that they have to go through this all over again. You talked about your article and it was a very moving piece you did for Kaiser Health News and it was also recently published in People Magazine. It was entitled “Nurses Feeling the Strain of the Covid Pandemic, Say the Resurgence is Paralyzing.” Now, can you talk a little bit more about this article and the some of the other stories you were told by these nurses?
Charlotte: Yes, I cover a lot of other medical stories besides Covid related, but whenever I spoke with nurses for any reason, they would quickly come back to the fact that the cases had dipped for the time being, that they were waiting and thinking that they were going to come back because everyone was so afraid of some kind of surge happening in the fall or the winter time. So that constant kind of fear in that it was a temporary situation. I mean, when it started, the case of started going up, I thought about this nurses who really had not had much of a break of a longer than say a few months. Sometimes in the summertime in some parts of the country they had a break and it was not terribly long.
Even before, this latest search they have witnessed so much death and they have to turn around and do it all over again. There is a nurse that I focused on quite a bit in the article or her name is Christina. She was typically a post-surgery nurse and in the spring in Massachusetts in Worcester and her unit was suddenly she walked in one day and her unit was converted into a Covid unit and suddenly she was only taking care of Covid patients. She described how she had one woman who early on who is in her 80s, who she said when she came to her unit. She did not even know why she was there. She did not even seem like she was sick, she was very energetic and she deteriorated very quickly. Less than a week later, she died and Christina not only spent all that time with her, but then she actually was one of the people who carried this woman’s body down to the morgue. It was clear that this was just imprinted on her memory and when I got on the phone with her, almost immediately she said, I said, “How you doing? Are you worried about the case is starting to go up?” She said, “They are walking in and now suddenly under unit again, they do not just have surgery patients, they have Covid patients all over again. It is paralyzing.” She just said that straight out and just the thought of facing it all over again.
I mean, one thing that people also do not realize is it is not just nurses in the hospital they are impacted, nurses who work in all kinds of areas of healthcare who are trying to both take care of patients and keep themselves safe as well. Another nurse I interviewed, Giuliano. He was treating patients in a psychiatric hospital and also he is a traveling nurse. He moves around, so he was also at an outpatient dialysis clinic. He said that it was a constant worry as we were trying to figure out how the virus transmitted and he had inadequate personal protective equipment. He was also trying to keep the potentially Covid patients separate from the ones who did not have Covid, say in dialysis area. He said it was very stressful and he felt no constantly like he was either putting himself at risk or potentially putting the patients at risk as well.
Jeffrey: My bad. I mean, one of the things that I love about your pieces it was the fact that was told from a nurse’s perspective, right? I do not think we see this very much. Before we get further into some of the reporting, let me ask you, why do you think nurses do not appear more frequently in pandemic coverage or even much reporting on the health care system over all?
Charlotte: Right. Yes. I am a long time medical reporter and I done a lot of reporting for daily newspapers before I started having family members land in the hospital. It is really illuminating to be in a hospital room day in and day out and see how it is, of course, it is at the doctors who are making the treatment decisions, but it is really the nurses who spend so much time with the patients and that mean, we as family members get to know them and even after hopefully our loved ones go home, it is often the nurses names remember the most. I find from a reporting perspective that it is really difficult to get their voices into articles and stories about healthcare. It is really in large part because they are employees and they are saying the hospital or hospital employees and if they talked to me as a reporter, without getting the hospital’s permission, the risk getting fired. Often hospitals even when nurses asked, would rather not have them not talk to the media because they want to stay out of the press in anyway. So for this particular article, I talk to, I would say four or five nurses who wanted to be interviewed in either were afraid to talk to me or when they went to their hospital press staff were basically barred from talking to me, even though they were not saying anything directly critical about the hospital but more talking about just the strain and stress of treating Covid patients. I mean, one of the things I have noticed recently and I wonder if there is going to be a shift here but I have seen more nurses speaking out on Twitter and kind of other social media outlets. Doctors for sure but also nurses and in maybe they will start becoming more public and expressing what is going on healthcare moving forward.
Jeffrey: Well, I hope so. I think you did a great job in chronicling some of these heroic stories. In your article, you mentioned, I am going to quote this, “Researchers are concerned that nurses working in a rapidly changing crisis like pandemic, can develop a psychological response called moral injury.” Now, I have never heard of that before. What do you mean? What is moral injury?
Charlotte: Yes. Moral injury is traditionally been discussed more in a military context with combat veterans essentially. It is the trauma that they experienced when they are forced to participate or witness a horrible situation which conflicts with their own personal values and beliefs that they carry with them sort of in a non wartime situation. We often hear of post-traumatic stress disorder and there is some overlap between moral injury and post-traumatic stress disorder. Really in the last few years, it is very, very recent. Health care workers have begun to discuss how they also can develop moral injury related to their work and it probably for similar reasons when there is a conflict between what they think should be done for their patient in terms of treatment or care and what they are able to do based on maybe constraints or strictures of some kind that is put on them by either their job description or other forces with my healthcare system. For a doctor that could mean it is something as simple as just messing with all the documentation and insurance authorizations prevents them from kind of getting the treatment that they want to to the patient because say they are denied by the insurance company.
For nurse, it could be things like just. I mean particularly in this context currently with the surgery going through right now where they have more patience than they really feel like they can provide the best care for. I mean, either just the Sheer Medical Care or certainly the emotional support for these patients, who often need understandably so hand holding and emotional help. Because their family members frequently are not left in the hospital. The idea is over time as they have these interaction, there is almost like many kind of micro assaults that overtime kind of develops into something called moral injury.
Jeffrey: Yes. Even being turn between wanting to do more and just not being able to do any number of issues. I mean, that is…
Charlotte: Yes, exactly. You know, in reality and I actually had not about this too much until I started pouring the piece. I mean, nurses are really caught in the middle. I mean, they are implementing the treatment decisions of the physicians and or they are following say policies that the hospital has laid down. For example, how many are whether family members can come into the hospital itself and so they are kind of caught kind of betwixt and between. So they are often the ones who are having to implement decisions that they do not really have any control over and then keep in mind. They are the ones who spending the most sustained time with the patient as a patient is going through all this and they are kind of– it is not quite the right term but they are serving as a bit of a go between almost I think someone described it to me as the center of the spokes in the wheel the healthcare system a lot of them connect back to the nurse at the bedside.
Jeffrey: From this then, this is the second way of some place it is third wave. I mean, what are some lessons learned that these nurses can use to help themselves from a mental health point of view? What resources, you know, if any of these nurses are available to help those that are helping us?
Charlotte: Well, I mean, a lot of these nursing groups like the American Nurses Association, they compiled various online resources, and they have recommendations, meditation, talking to someone, taking time out. When I talk to people for the article, there is a registered nurse and bioethicists and rushed in at Johns Hopkins and she is done a lot of work in moral resilience. She said that nurses and hospitals need to do a kind of more rituals to wrap up each day when the nice ones that she kind of describe was. When a nurse is leaving, a chef and they are kind of doing that last– excuse me, they are doing that last hand washing as they leave the shift at the end of the day to take that time to really reflect on what they have done the best that they could that day and kind of focus on the good and not just the bad. This might be a little bit of a corny image, but it kind of resonated with me kind of focus on that, the bad of the day kind of going down the drain as they are washing their hands. So they are not carrying it at home with them at the end of the day.
Another nurse I talked to described how that they are trying to do more regular huddles, I mean, obviously with the virus you cannot hold too close and in fact this is one of the constraints right now for nurses in generals, they cannot literally hug each other or lean on each other as it coping with these awful days, but gather together the nurses and the other clinicians and kind of debrief and what was difficult and frustrating but then have, you know, every person talk about a couple of good things that they had been able to achieve during that shift before they wrap up. Stepping back, it is some of it is just the big picture stuff. I mean, there is going to have to be a real attention paid to staffing and nurses around the country. We hear it in the news everyday now or just stretched to the limit and if we do not want to burn them out, wipe them out, they are going to– administrators are going to have to find ways to give them breaks and not stretch them to then. Help them with basic stuff like back them up on child care or help them with groceries or food when they get home at the end of the day.
Jeffrey: That is great. That is great stuff and that is certainly from a hospital point of view. Let me flip it around, lastly. What can you recommend? What can we do to help? In all your discussions with nurses and frontline workers, what are a couple things that we as patients as people that appreciate, everything that they are doing for us? What can we do on a daily or weekly basis that could have a positive impact for them?
Charlotte: Right. I heard a lot of kind of griping and wariness about being called Heroes, that is the jargon that is thrown around a lot. They say they are just doing their job, they do not want to be called Heroes but that they get really– you know, I do not know frustrated is the word or really they say angry when they talk about working these horrible long shifts and then going about on their errands and seeing people out about maybe in groups, maybe not wearing mask. Yes, it almost makes them feel like it is, all this effort and all this risk that they are taking is for not. I know, I mean, they send an interviews to me. I mean, do not call me a hero, just take better care of yourself and then that way, I will not see you in the Intensive Care Unit at my hospital.
Jeffrey: Right. So just follow the guidelines and they do not want to see us at their office.
Charlotte: Exactly, exactly.
Jeffrey: Charlotte, thank you so much. Thank you for telling these stories and getting their voices heard. People that we do not hear from and their stories are so important. So thank you and thank you for being here with us today.
Charlotte: Thank you. I really appreciate the opportunity. They are amazing people. They really are.
Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP HealthCast.