Healthcare workers are a gritty and resilient lot. But in the face of COVID-19, many are now struggling with PTSD. Mark Goulston, MD, and Diana Hendel, PharmD, explain why—and explore some of the “storm factors” that have come together in such a devastating way.
Healthcare professionals are no strangers to stress. They must regularly field huge challenges, rapid changes, and the unpredictability that comes with caring for human beings—and many thrive in this demanding environment. But COVID-19 is a new ball game. The deadly virus, currently in full surge mode, has healthcare workers struggling like never before—and many are showing signs of post-traumatic stress disorder.
Psychiatrist Mark Goulston is not surprised. He says for almost a year now, workers have battled a “perfect storm” of factors that have overwhelmed them to an unprecedented degree.
“Fear, grief, and exhaustion are only part of it,” says Dr. Goulston, coauthor along with Diana Hendel, PharmD, of Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD (Harper Horizon, December 2020, ISBN: 978-0-7852-4462-2, $17.99). “COVID-19 has unfolded amid a backdrop of devastating political and cultural reactions as well as other factors that have coalesced in a way that’s deeply traumatizing.”
History has shown us that frontline workers may suffer from post-traumatic stress following a deadly outbreak. It happened following the SARS and Ebola epidemics, and early research shows it is happening with COVID-19 as well. Why Cope When You Can Heal? takes an empathetic, informed approach that helps people navigate traumatic stress and PTSD, process their experiences, and heal from the inside out.
“Traumatic stress is different from routine stress,” notes Dr. Hendel. “Stress is temporary. We can build the resilience to endure it. But trauma threatens our sense of safety and changes how we see the world. It can create long-lasting harm—and it must be approached in a different way from stress.”
The first step is understanding why this pandemic and the conditions surrounding it have proven to be so devastating. Drs. Goulston and Hendel list some of the factors that add up to a perfect storm for trauma and PTSD:
STORM FACTOR 1: It all happened so quickly. Reports of a pneumonia-like virus in Wuhan, China, began circulating in December 2019. The virus spread across the globe like wildfire, and by March 26, the U.S. had the highest number of COVID-19 cases in the world, with at least 81,321 infections and over 1,000 deaths.1 This was just the beginning of the surge in the U.S. A massive nationwide effort to “flatten the curve” went into effect. Nonessential businesses closed, and office workers set up shop at home. Education went online. Churches closed. Every aspect of normal life changed drastically…and it happened shockingly fast.
STORM FACTOR 2: Healthcare workers have faced (and continue to brace for) wartime conditions. Many have seen and done things that have scarred them for life. At the beginning, doctors, nurses, paramedics, and other healthcare workers braced for a massive influx of sick patients. Hospital leaders launched government-recommended, stringent infection control protocols as they went into “surge” mode, setting up triage tents and dedicating floors and wings for coronavirus patients. And they prepared for the grim likelihood that a shortage of beds and ICU equipment would force them to make impossible life-and-death decisions. Surge mode continues in current hot spots today, and healthcare workers everywhere are either bracing for either a resurgence or anticipating that they will become the next hot spot.
STORM FACTOR 3: Workday realities are harsh and upsetting. Healthcare workers experience intense, overwhelming, and unforgettable moments on the job. They face moral injury when having to make impossible life-or-death decisions. They grieve for patients who die alone with no soothing human touch, and comfort family members who must say goodbye via video screen (if at all). Plus, many healthcare workers must isolate from families, or if they must continue living at home, they must go to extreme measures to stop the spread of the virus and constantly worry that exposure could happen at any moment.
STORM FACTOR 4: Their own lives are at risk. While healthcare workers have been busy caring for their patients, they have been getting infected themselves. As of June 2020, nearly 600 healthcare workers had died.2 By September 2020, the latest report by one of the largest nurses unions, National Nurses United (NNU), has that number at more than 1,700.3
STORM FACTOR 5: They are running on fumes. Healthcare professionals work long shifts that they compare to living nightmares. They post photos of their exhausted faces marked by red and purple bruises caused by their PPE. Many have been working 24-hour shifts so they can make fewer trips home and lower the risk of passing the virus on to family members and other citizens. But what’s more, they don’t have time to hit pause—the need for healthcare workers is too great—and the shortage of available healthcare workers continues to grow. This means they don’t have the time or ability to pause, reflect, and process the crisis that continues grinding away at them.
STORM FACTOR 6: They have received a distressing lack of national and united support. From supply-chain issues, to clear and concise guidelines, to messaging and instructions to the public, there has been a lack of a cohesive plan for the country. Unfortunately, healthcare leaders and workers must do their incredibly difficult jobs inside a healthcare system that is often disjointed and fragmented and part of a deeply divided nation wracked by strife. And in the early days of the pandemic, America’s lack of readiness equated to equipment shortages of virus tests, ventilators, and PPE.
STORM FACTOR 7: The just-get-over-it culture in America AND in healthcare make matters worse. America’s just-get-over-it culture has created a double whammy for healthcare providers in terms of trauma. Exhibit A: the big push to quickly reopen the country and the divisiveness that has only intensified over the course of 2020. As more and more businesses reopened (too soon, in the eyes of many experts), the virus surged in many places. As a result, healthcare workers have gotten little relief from their workload and its heavy psychological toll.
Meanwhile, healthcare has its own version of the just-get-over-it culture. In some settings, workers are expected to buck up, figure it out, get it done with the equipment they have, and move on to the next patient. Trying to navigate a pandemic in such a culture (where burnout is already rife) is pushing workers to the breaking point.
It’s clear health workers need help. And while there are no clear or easy solutions, providing healing tools and plenty of empathetic support can go a long way, says Dr. Goulston.
“It’s imperative that symptoms that arise in the face of this trauma are not ignored, downplayed, or dismissed and that the stigma of PTSD is not perpetuated because of lack of knowledge or unwillingness to learn,” he says.
“With good leadership in healthcare, PTSD can be treated and managed,” adds Dr. Hendel. “We owe it to healthcare professionals to give them the tools and support they need to heal from the trauma they have faced and continue to face every day. We owe it to the patients they serve. And we owe it to the future of the healthcare industry, our nation, and our world.”
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1. Donald G. McNeil Jr., “The U.S. Now Leads the World in Confirmed Coronavirus Cases,” New York Times, updated March 28, 2020, https://www.nytimes.com/2020/03/26/health/usa-coronavirus-cases.html.
2. Christina Jewett, Melissa Bailey, and Danielle Renwick, “Exclusive: Nearly 600 US Health Care Workers Have Died of COVID-19,” Kaiser Health News, June 8, 2020, https://khn.org/news/exclusive-investigation-nearly-600-and-counting-us-health-workers-have-died-of-covid-19/.
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About the Authors:
Mark Goulston, MD, FAPA
Dr. Mark Goulston is the coauthor of Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD (Harper Horizon, December 2020) and Trauma to Triumph: A Roadmap for Leading Through Disruption and Thriving on the Other Side (HarperCollins Leadership, Spring 2021). He is a board-certified psychiatrist, fellow of the American Psychiatric Association, former assistant clinical professor of psychiatry at UCLA NPI, and a former FBI and police hostage negotiation trainer. He is the creator of Theory Y Executive Coaching—which he provides to CEOs, presidents, founders, and entrepreneurs—and is a TEDx and international keynote speaker.
He is the creator and developer of Surgical Empathy, a process to help people recover and heal from PTSD, prevent suicide in teenagers and young adults, and help organizations overcome implicit bias.
Dr. Goulston is the author or principal author of seven prior books, including PTSD for Dummies, Get Out of Your Own Way: Overcoming Self-Defeating Behavior, Just Listen: Discover the Secret to Getting Through to Absolutely Anyone, Real Influence: Persuade Without Pushing and Gain Without Giving In, and Talking to Crazy: How to Deal with the Irrational and Impossible People in Your Life. He hosts the My Wakeup Call podcast, where he speaks with influencers about their purpose in life and the wakeup calls that led them there. He also is the co-creator and moderator of the multi-honored documentary Stay Alive: An Intimate Conversation About Suicide Prevention.
He appears frequently as a human psychology and behavior subject-area expert across all media, including news outlets ABC, NBC, CBS, and BBC News, as well as CNN, Today, Oprah, the New York Times, the Wall Street Journal, Forbes, Fortune, Harvard Business Review,Business Insider, Fast Company, Huffington Post, and Westwood One. He was also featured in the PBS special “Just Listen.”
Diana Hendel, PharmD
Dr. Diana Hendel is the coauthor of Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD (Harper Horizon, December 2020) and Trauma to Triumph: A Roadmap for Leading Through Disruption and Thriving on the Other Side (HarperCollins Leadership, Spring 2021). She is an executive coach and leadership consultant, former hospital CEO, and author of Responsible: A Memoir, a riveting and deeply personal account of leading during and through the aftermath of a deadly workplace trauma.
As the CEO of Long Beach Memorial Medical Center and Miller Children’s and Women’s Hospital, Hendel led one of the largest acute care, trauma, and teaching hospital complexes on the West Coast. She has served in leadership roles in numerous community organizations and professional associations, including chair of the California Children’s Hospital Association, executive committee member of the Hospital Association of Southern California, vice chair of the Southern California Leadership Council, chair of the Greater Long Beach Chamber of Commerce, board member of the California Society of Health-System Pharmacists, and leader-in-residence of the Ukleja Center for Ethical Leadership at California State University Long Beach.
She earned a BS in biological sciences from UC Irvine and a Doctor of Pharmacy degree from UC San Francisco. She has spoken about healthcare and leadership at regional and national conferences and at TEDx SoCal on the topic of “Childhood Obesity: Small Steps, Big Change.”
About the Book:
Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD (Harper Horizon, December 2020, ISBN: 978-0-7852-4462-2, $17.99) is available in bookstores nationwide and from major online booksellers.
To learn more, please visit https://whycopewhenyoucanheal.com/.