Grief on the Front Line—and Beyond

Frontline clinicians have become the face of our pandemic. They represent the best of humanity, rising to treat critically ill patients, as well as the collateral damage from America’s fragile health care system and disordered government response. Scientific American asked doctors, nurses and respiratory therapists working in hospitals across the country how they were coping with fear, processing grief and tending to their own well-being. Interviews were conducted in late March and early April, as COVID-19 was rapidly upending life in the U.S. These essays reflect that period of extreme uncertainty; they have been edited and condensed.

Ana Delgado

Nurse Midwife and Clinical Professor
San Francisco, Calif.

There was a lot of talk early on about how this crisis was going to bring us all together. But what it has clarified for me is that we’re not actually all in this together. It has laid bare what most reproductive justice advocates already knew: inequity and racism have always been around. I work at the county hospital. The impact of shelter in place has been stark for my pregnant patients, many of whom are undocumented and were already living paycheck to paycheck, and now are unemployed. A patient came in yesterday and burst into tears from her desperation. I feel extremely overwhelmed by the need.

There are a lot of injustices that we as clinicians are aware of and feel powerless to do much about. People call this “burnout,” but one of my colleagues talks about how that seems associated with self-blame, like you got something wrong. Most people go into health care because of a deep commitment to supporting the health and wellness of their community. When you actually become a provider, you’re thrust into this system that is not really set up to promote health and wellness, and you’re constantly confronted with this discrepancy. The pandemic makes these issues worse, and it’s painful to witness. That’s not burnout, it’s a deep moral injury that people are experiencing.

Yes, I have to go work in the clinic and be exposed to people who might be COVID-positive, and that’s scary. But as a midwife, I still get to lay my hands on people, to touch and be with people on a daily basis. That’s part of my antidote. I struggle a bit with the hero worship of health care workers that’s going on. I want to be recognized for my hard work, but I feel like it will swing back to the other side, to mistrust and lack of support. That extreme exists because we don’t have a true public health network in this country, a model for developing healers from our communities where there’s a sense of trust. If that existed, everything would be different right now.

Roxy Johnson

Emergency Room Nurse
Dallas, Tex.

In late March I was running a low-grade fever and had to self-isolate at my house for several days before my COVID test came back negative. It was so hard to stay away from my family and even harder to stay away from my work, which I love. It felt like punishment, like I was losing my mind. I’ll admit that I was drinking more than I ever do. In early April I decided to start staying in a hotel so as not to accidentally bring the virus home to my husband and two kids, who could also spread it to my immunocompromised dad, who helps with child care. For me, the hardest part has been the isolation. I’ve had an eerie sense of calm and peace about all of this up until now, but recently I’ve started to feel something inside that is not me. I think it’s the separation, the loneliness of keeping everyone at arm’s length. Sometimes I get in the car, blast music and just go. I ran out of gas on a joy ride last week.

Matthew Bai

Emergency Room Physician
New York City

I honestly have no idea how I feel. I don’t have time to digest any of this. I go to work, and then I go to sleep. Training in emergency medicine in New York, with the speed and number of patients, probably prepared me somewhat for what’s happening now. But nothing can prepare you for an event of this magnitude. Everything is in flux. The upside is realizing the level of flexibility that’s possible in a hospital. I’m seeing new faces in the ER all the time—nurses and doctors from other departments, even surgeons, OBs and people flying in from all over the country. In the back of my head I’m constantly thinking, Can we manage our resources and keep our staff healthy for however long this lasts?

Sarah Bradt

Float Pool Nurse
Minneapolis, Minn.

You can never really be fully prepared for a pandemic. Thankfully, nursing is never routine, so we adapt quickly. I’m a float pool nurse, which means I work on almost every unit in my hospital. I rarely feel intimidated by something new. But many of my co-workers have been displaced and are now working in unfamiliar areas or jobs, creating chaos and stress. I’ve noticed the most tension on the new COVID rule-out floors. Many staff members are scared to even enter the unit and act like anyone working there is dirty. Patients have commented on how they feel like a burden. Nurses working on these floors are teaching everyone who enters a patient’s room how to properly put on and take off our protective wear, and I have been on the receiving end of many eye rolls and rude body language when all I was doing was trying to help. Fear of the unknown is certainly putting people on edge. I’m coping by just allowing myself to leave work at work. My dog has gotten more walks in the past few weeks than the whole year combined.

John Berk

Pulmonary Critical Care Physician and Associate Professor
Boston, Mass.

For providers, there’s a really complex psychology to all this. Everyone realizes the importance of what they’re doing but doesn’t want to be the next person felled by COVID-19. You’re grappling with fear of the unknown and your call to duty. My wife, who is also a doctor, and I have been at this game for longer than we care to admit, and we’ve never been in a situation where there was a real fear of interacting with patients like there is now.

In mid-March I was three days into a rotation in the medical intensive care unit, ramping up for the inevitable surge, when it was decided that those of us 60 and older would be pulled from clinical duty because of our higher risk of dying from COVID-19 infection. Now I have younger colleagues taking on a huge amount of work, and all of them have young families. There’s a significant element of guilt in not contributing. We ancients are currently figuring out how we can provide services to lighten their burden. It’s a nice gesture, but it’s a complicated process.

Patti Marshall Gilpin

Respiratory Therapy Navigator
Louisville, Ky.

I educate patients with chronic lung disease. My role right now seems a little silly; I can’t educate people about something we don’t understand. Worst-case scenario, I’ll go back to doing the critical care with the therapists who are in the trenches. When you read about what’s happening in New York and other areas on social media, it’s very difficult not to be scared. There’s a constant undercurrent of bracing for that potential surge. This huge push to ventilate more than one person on a single machine? Yeah, you should never do that. So we’re getting support from each other about how we’d handle having to do the wrong thing.

It’s humbling to see how everyone in health care is at the top of their game, improvising equipment, seeking out knowledge. I’ve watched transporters take patients from one place to another, interacting with them, being so optimistic when there’s this palpable dread all over the hospital. I’ve seen amazing courage when staff have to do CPR on one of these patients, no hesitation when you have to intubate. But when it’s over? My co-workers come into my office to vent and cry; some talk about problems with anxiety. When my shift ends, what do I do with this crap I’ve been carrying around all day, the things that happened, the things that could happen tomorrow? You can’t even name it. Then you go home, and you can’t have your typical social release because you fear contaminating your loved ones. Worrying that I’m going to spread this is the worst feeling of all.

Read more about the coronavirus outbreak from Scientific American here. And read coverage from our international network of magazines here.