After his roughest days in a New York City emergency room, physician Matthew Bai feels his whole body relax when he sees his wife and 17-month-old daughter. “My light at the end of the tunnel is going home to family,” Bai says. When Manhattan’s Mount Sinai Hospital started to overflow with COVID-19 patients in late March, however, Bai and his wife decided she should take their toddler and stay with her parents in New Jersey. The risk of spreading the virus to his family was too great. Now Bai confronts a daily cascade of patients who are struggling to breathe, in an ER busier than he has ever witnessed it. On his mind, always, is whether he will be able to keep his staff safe. All doctors have bad shifts, but now those days repeat, piling up. At night, virtual story time with his daughter is nowhere as soothing as the real thing. “I honestly have no idea how I feel,” Bai says. “I go to work, and at the end of the day, I go to sleep. I have no time to digest any of this.”
Medicine is a stressful profession under normal circumstances. The physical demands, psychological strain and ineffective work processes can lead to burnout, a condition that affects up to 50 percent of physicians in the U.S., says Colin West, an internist who has studied physician well-being at the Mayo Clinic for more than 15 years. A 2018 review in the journal Cureus described it as “a combination of exhaustion, cynicism, and perceived inefficacy.” Burned-out clinicians are more likely to quit their jobs. Their patients may have worse outcomes. Yet burnout cannot capture what doctors, nurses, paramedics and others are experiencing as coronavirus overwhelms the health care system. “Burnout is a chronic response to health care conditions,” West says. “This is an unprecedented acute crisis.”
As the pandemic upends much of society, frontline health care workers are shouldering the burden of a systemic lack of preparation. In the U.S., a sluggish government response, along with the bungled rollout of testing, allowed the virus to spread widely. Years of running lean operations left many hospitals without the resources to quickly expand care. Global demand for personal protective equipment (PPE) and ventilators made these crucial supplies scarce. Backup stockpiles proved too small, and efforts to bolster supplies were uncoordinated or, worse, forced hospitals and jurisdictions to compete with one another. Now ERs in hard-hit areas struggle to keep up with a flood of critically ill patients. Staff in eerily quiet hospitals elsewhere look on, wondering if the virus will overwhelm them next. Nurses facilitate final phone calls between the dying and their loved ones who are barred from entry. As morgues overflow, refrigerated trucks arrive to house the bodies.
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