Doctors Coping with COVID, Part 1

Season 1: Episode 63
September 8, 2020

Photo by Ralf Heß licensed under CC BY-NC-SA 2.0 

The pandemic is taking a toll on providers’ mental health. Today, the first of a two-part series that begins with an ER doctor on the frontlines in Arizona. 

Listen to the full episode below or scroll down for the transcript and more information.

Click here for more of our coronavirus coverage.

Dan Gorenstein: There’s a stat we’re going to dig into on today’s episode — actually in both shows this week.

In late June, the CDC found essential workers — including doctors and nurses — are about 50% likelier than other professionals to experience symptoms of depression, anxiety, and PTSD related to the pandemic.

How frontline providers coping with that extra stress, especially in a field where seeking help is so stigmatized.

Our two-part series begins with Mara Windsor, an ER doctor practicing outside Phoenix.

From the Annenberg Studio at the University of Pennsylvania, I’m Dan Gorenstein and this is Tradeoffs.

DG: Mara Windsor knows chaos. Actually, she embraces it.

Like when she’s at work.

Mara Windsor: We have gunshot wounds coming in, we have ambos coming in one after another, delivering patients to this room, that room. We have stroke alerts coming in. And then every once in a while, a code pops in. You’re just constantly running from one room to another.

DG: And at home everyday. With her three kids.

MW: Ella, Sawyer, Drake.

DG: And her three dogs.

MW: Bentley, Buttons, Missy.

DG: There’s hardly a moment to breathe. She’s used to coming in and saving the day. At work, it’s patients lives, and at home, it’s hugs, homework, and hot meals.

The role fits, and Mara admits she’s a bit of a perfectionist.

MW: My house is very clean. It’s very orderly. I don’t have dishes in the sink or on the counter. However, I have one room which we named the office and that’s the only room that’s allowed to have clutter in it. And it’s mainly because you can’t see it and I can shut the door and it doesn’t give me anxiety.

DG: Mara’s spent the past 15 years, practicing how to control the chaos, and she’s gotten really good at it.

But in COVID, she’s met her match.

MW: For the first time in my practice of emergency medicine, we’ve had resource issues and shortages and we’ve had diminished PPE and we don’t have enough ventilators, we don’t have enough physicians, we don’t have enough nurses, we don’t have enough ICU beds.

DG: In early June, cases climbed fast in Arizona. By the end of the month, the state hit: almost 5,500 positive cases in one day.

The surge left Mara feeling something she hadn’t felt before.

MW: It makes me feel helpless — that there’s nothing you can do to help the people. Being a person who got into medicine to help people and save lives, that’s that’s hard to to live with and accept.

DG: Doctors and nurses on the frontlines are all grappling with a sea of unknowns — as scientists scramble to learn pretty basic things about this novel virus. How infectious is it? What’s the best way to treat it? Can people get infected more than once? And that introduced another new feeling to Mara on the job: fear.

She remembers standing in the trauma bay one day in late June. Surrounded by beeping machines, under the glare of sterile white light, she looked down at a patient, gasping for air.

MW: I had to put a chest tube in a patient and a liter of pus basically came out of the patient’s chest.

DG: The pus oozed down Mara’s gown, into her shoes, between her toes.

MW: I can’t react or do anything about it because I’m doing a sterile procedure and I have to continue.

DG: One single thought gave her solace — the patient had tested negative for COVID.

She finished the procedure and did her best to clean up.

MW: I didn’t have a shower to go to an emergency department, so I had to go into the nurse’s bathroom, take off all my clothes, grab bleach wipes and pretty much take a bleach wipe bath.

DG: The nurses found her an extra pair of shoes and fresh set of scrubs. She headed back out to finish her shift.

Meanwhile, the patient was re-tested for COVID.

A few nurses approached Mara. 

MW: Oh, no, Dr. Windsor, we have horrible news to tell you. And I said, why? What’s going on? And they said the patient did test positive for COVID.

And thenI realized, wow, I have COVID all over my body. I was frightened that I’m going to get COVID.

DG: In this moment, still sticky with COVID-positive goo, Mara started to spiral.

She wondered — did she now have it? Would she bring this potentially deadly virus home to her husband and kids?

MW: It sat with me for a week at least, any time I coughed or had a chill, I thought, oh, no, here it comes.

DG: The fear of getting sick, the stress of work, the energy of running a big household. Mara was burnt out.

MW: Every shift I don’t want to go to. And every time that I’m there, I don’t want to be there.

DG: Mara is not alone.

Small studies from China, Italy in the early days of the pandemic showed doctors and nurses were at high risk of developing symptoms of depression, anxiety, and insomnia — findings consistent with the CDC’s own report from this June.

DG: Mara ended up testing negative for the virus.

But she still has to keep showing up in the ER — the stress right in front of her.

MW: We’ve had some doctors take a leave of absence. We’ve had some retire early. But I have bills to pay. I have three children. I have to go. We rely on my income. And so it’s hard when you don’t want to go to work every day, but you still have to.

DG: Part of Mara’s job actually is helping colleagues cope with their stress and anxiety.

Before the pandemic, she designed programs to arm physicians and nurses with strategies to ease stress.

After COVID hit Arizona, Mara set up a room in the hospital where people can shut the door and scream.

She’s always understood she’s the least popular person in the room when she’s playing her chief wellness officer role. 

Mara gets it. Most doctors and nurses keep their heads down, and try to white knuckle their way through. It’s what she’s done.

MW: Because I’m a physician, I’m not going to go see a psychiatrist and get a diagnosis. That’s the problem. I mean, a lot of us, unfortunately, don’t reach out for help and care. I’ve always been more on the anxious side of things and tried to always deal with that on my own.

DG: That’s meant a lot of long, hot decontamination showers.

It’s where she tries to shake off the day.

MW: It helps me to just kind of let go of whatever case stressed me out or whatever horrible trauma I saw.

DG: An ER doc who thrives when she can create order out of the swirl around her, Mara admits it’s hard to let that control go. But that’s what it’s taken to cope these days.

There are mornings when she feels the impulse to be up, getting everybody squared away.

But instead she sleeps, leaving the hugs, the housework and the homework to her husband.

A rare indulgence has become a necessity over the past 90 days.

To do right by her patients, her family and herself, Dr. Mara Windsor has learned she must ask for help.

DG: In part two of our series on Thursday:

Mona Masood: I started seeing a lot of personal posts come up about how people were not coping so well.

DG: We look at the research on physician mental health and some of the solutions cropping up to meet this moment.

MM: Someone who was seeing 20 deaths a day, feeling that they don’t even have time to process that grief.

DG: I’m Dan Gorenstein, and this is Tradeoffs.

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Episode Resources

Select Research and Reports on Provider Mental Health:

Mental Health of Young Physicians in China During the Novel Coronavirus Disease 2019 Outbreak (Weidong Li, Elena Frank, Zhuo Zhao, et al; JAMA Network Open; 06/01/2020)

Mental Health Outcomes Among Frontline and Second-Line Health Care Workers During the Coronavirus Disease 2019 (COVID-19) Pandemic in Italy (Rodolfo Rossi, Valentina Socci, Francesca Pacitti, et al; JAMA Network Open; 05/28/2020)

Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019 (Jianbo Lai, Simeng Ma, Ying Wang, et al; JAMA Network Open; 03/23/2020)

Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020 (Mark É. Czeisler, Rashon I. Lane, Emiko Petrosky, et al; CDC MMWR; 08/14/2020)

An ER doctor who continued to treat patients after she recovered from Covid-19 has died by suicide (Taylor Romine; CNN; 04/28/2020)

Covid-19 Might Lead To A ‘Mental Health Pandemic’ (Jessica Gold; Forbes; 08/06/2020)

After the surge, the psychological impact of Covid-19 is hitting home (Sabrina Weiss; WIRED; 07/30/2020)

L.I.F.E. (Mara Windsor’s wellness nonprofit) 

Episode Credits

Guests:

Mara Windsor, an emergency medicine doctor practicing in Arizona.

The Tradeoffs theme song was composed by Ty Citerman, with additional music from Xavier Rudd and Blue Dot Sessions.

Additional thanks to:

Steven Arnoff, Mona Masood, Rashon Lane, the Tradeoffs Advisory Board…

…and our stellar staff!