As the one-year mark since the declaration of the global coronavirus pandemic arrives, the continuing health crisis is taking a toll on the mental health of those on the front lines.
It is a busy afternoon in the ICU at Scarborough General Hospital. There are 37 beds, with nine COVID-19 patients to care for. These are the most critical of the COVID-19 patients in the hospital.
The team is accustomed to a high-stress environment, but working through this pandemic is unlike any experience these front-line health-care workers have had in the past.
“We’re right there at the greatest risks … what the public sees through the camera is not necessarily what goes on here,” explained respiratory therapist Kelly Cray.
“It’s tiring, frustrating not being able to succeed in getting your patient past their illness.”
Cray was pulled to the front lines at the start of the pandemic a year ago.
“It’s been up and down … when COVID started, my outpatient clinic was shut down so I was brought back into critical care — it was a change in my home life and at work,” she said.
Dr. Ilan Fischler, chief of psychiatry for Scarborough Health Network, pointed to research suggesting, “about 75 to 80 percent of physicians in North America are experiencing burnout. The vaccine is giving everyone hope that there is a light at the end of the tunnel but there’s still the fear about the third wave.”
For Dr. Martin Betts, chief of critical care, there is a constant worry about his team’s mental health.
“The last year has been a really challenging year for myself and our all health-care providers,” Betts said. “Challenging because of the duration of the pandemic, challenging because when we go home like for everyone else life is not normal … but mostly because of the needs of our patients and how sick patients are.”
Betts is aware burnout could be an issue as the pandemic rolls into a second year, and so he encourages his staff to talk about it and to look out for one another.
“The challenge with burnout is that it’s often under the covers and not really apparent. So we really have to rely on each other to recognize the signs in one another and help support each other that way,” he said.
It doesn’t help that the usual means of support are lost to COVID-19 safety protocols — a simple gesture, like a hug from a colleague, is not possible.
“We are not hugging each other anymore and we always have to have a mask … we are trying our very best to just support each other verbally, at least, if not by hugging,” said patient care coordinator Ann Li.
Dr. Julie Ann Irving, a Toronto clinical psychologist who specializes in physician wellness, explained “Burnout is thought to be a precursor in some cases for depression or generalized anxiety that shares some of the features and so if we leave it unaddressed it can get worse and it can be harder to treat.”
At this stage, Dr. Irving said physicians may not have Post Traumatic Stress Disorder, but that does not mean they aren’t experiencing some of the symptoms.
“Not sleeping as well, feeling chronically anxious, having difficulty turning their flight or fight system off,” she said.
Social worker Hayley Harlock is the founder of “The Flipside Life” — an online support group for physician families.
“There’s statistics that talk about how over 85 per cent of physicians may know that supports exist for them but less than 15 per cent are actually seeking out the support,” she said.
Harlock, whose husband is a surgeon in Hamilton, Ont., is advocating to include families in the conversation surrounding mental health.
“If we included physician families as a partner and as part of the team, then there’s a lot of room to educate families about what to look at … if your spouse is telling you ‘I’m fine’ you might not know what the next step might be,” she said.
Back in the ICU at Scarborough General Hospital, amid a flurry of physicians and nurses, a woman is pushing a cart filled with treats and chatting animatedly with the staff.
“Are you ready? Are you ready?” asks wellness coordinator Philippa Dawood, adding enthusiastically, “We’re going to get going!”
Then suddenly, she turns on music. It is loud and everyone quickly gathers, giggling and shouting.
For about ten minutes, the whole team is following Dawood’s choreography and the mood has shifted. There is joy and laughter, in stark contrast to the pain and suffering that surrounds them.
“We work under a lot of stress in here so when Philippa comes and helps us de-stress … that little moment where we’re not thinking about the patient helps us get through the day,” said Li.
“From the very beginning when the pandemic hit, our senior leadership recognized the importance of wellness in this organization,” explained Dawood. “Staff are not alone and it’s OK to not be OK. To have that communication and to have the ability to provide staff a break has really had a very positive impact on the team for the past year.”
Dawood visits all three sites, bringing her cart, music and positive attitude.
“Mental health is not a bad word. We want people to open up and to share and to feel comfortable asking for help. And I will give physical activity. I will give peer support. I’m not a therapist or counselor, but my role is to share information, to listen, to provide them the tools and resources that they need,” she said.
It is clear the team appreciates her efforts.
“Resilience is a challenge. Burnout is real. And what I’d like to offer in wellness is a chance to take a break and reflect, to laugh.”