The hidden wounds of COVID-19

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By the time we started to have a significant number of COVID-19 patients in our hospital, I was working as the attending on the inpatient infectious disease service.  Along with the rest of my infectious disease colleagues, we had all been tracking the evolving COVID-19 statistics and mounting predictions that we would eventually become inundated with COVID-19 cases.  We were in that “waiting for it” phase.  Although it gave us time to continue to prepare, I had this ominous feeling of an imminent threat developing.

One day after I finished rounding, I was driving home from work and stopped at a red traffic signal.  Staring out at that red light, I suddenly heard the rattling of a metal door handle and a low rumbling.  It was the sound of the metal door and window handles shaking in my apartment when I lived in Kathmandu, Nepal.  The local time was 11:56 a.m. on April 25, 2015.  On that day, a 7.8 magnitude earthquake was felt throughout Nepal, Northern India, and Bangladesh.   I was suddenly there again. I took shelter under my dining room table, holding on for what seemed like forever.  I always thought that I would be anxious or scared when I was faced with death, but instead, I felt a strange peace wash over me and a calm and matter-of-fact thought that I might die here underneath this table. Then, when it stopped and I realized that I had survived, I rushed out of the house, fearing it would collapse.

At the time, I was working in Kathmandu as an infectious disease consultant at a tertiary university hospital, and suddenly I was once again looking out across the courtyard of the hospital taking in the scene when I first arrived there after the earthquake.   The courtyard and entire campus of the hospital were filled with a sea of injured people with broken bones.  Some were clearly dead already.   I remembered the middle-aged woman who sustained an almost complete scalp avulsion (also known as “scalping injury”) when a building collapsed on her, the young boy struggling to breathe after being buried in debris and the screams of pain as people with crush injuries cried out for help.  I remembered the following exhausting days of endless patients – triage, stabilize, die, or survive, repeat.

Then I was back in my car.  The traffic signal turned green, and I drove the rest of the way home.  At first, I thought it was just a passing memory.  However, over the next few days, I realized I was more anxious than normal.  I began waking up at 4 a.m. on the dot and couldn’t get back to sleep.  I realized that the feeling of “impending doom” of the oncoming COVID-19 tidal wave had triggered my memories of being overwhelmed in my hospital in Nepal.  Although the infectious disease specialist in me was interested in the multiple COVID-19 updates each day, another part of me was just trying to shut it out.

Months after the earthquake, I came to realize that I was wounded from the experience.  It was a hidden wound that no one could see, but it was there. In the first 12 hours, I witnessed many people die of traumatic injuries despite trying everything possible to save them.  For some, all I could do was to control their pain as they died.  Others gave me hope that they had survived the initial trauma to only die days later of some other complication or infection.  It was traumatic.  Trauma – a word that I had only thought applied to my patients now seemed to apply to me.

For the rest of my time on the inpatient infectious disease service in March, I made a point to ask my colleagues and residents how they were doing, and how they were feeling.  I made an active effort to do this because I knew how poorly we make space for such discussions in clinical medicine.  As health care workers we were facing many challenges with COVID-19 – the severity of illness and mortality, the frustration over the lack of an effective treatment, the anxiety of their own potential exposure to COVID-19 and the risk to our families and the general uncertainty of how severe the pandemic will be.   I tried to invite people to simply express how they are feeling and help people see that it was ok to feel.  Even if it was just to say, “I am nervous” or “I don’t know what to think.” I felt compelled to do this because I knew how easy it was just to bury yourself in work, and how important it was to engage with those feelings and experiences.   I knew that some of them were carrying hidden wounds from their experiences.

We have to recognize that COVID-19 is causing tens of thousands of health care workers to face trauma every day.  Being educated and trained to recognize trauma in our patients, we need to acknowledge that trauma is being experienced by us as health care workers.  We are carrying hidden wounds, which each of ourselves may not fully understand yet, others may not recognize, but are clearly affecting us.

We think we are immune to this trauma. We think that we need to “just focus on doing our job,” or we think that we “should” be able to “handle it.”   We need to be mindful that some of us will benefit from professional help.  It is also important for all of us to have safe spaces with our colleagues and teams to think, talk, and express how we are feeling and reacting to the COVID-19 pandemic and how it is shaping our world.  COVID-19 is creating a shared trauma, and by opening up this dialogue, it can help us support each other and engage with how we are coping (or not) with the situation. Just as taking part in this dialogue helped me in my experience in the earthquake, I hope this can help us recognize the hidden wounds of health care workers in the COVID-19 pandemic.

Andrew Trotter is an infectious disease physician and can be reached on Twitter @Andrew_Trotter1.

Image credit: Shutterstock.com

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