The Psychological Toll of Working on the Front Lines: Dr. Sanjay Gupta’s coronavirus podcast for May 6

Health care workers on the front lines are risking not only their lives, but also their mental and emotional well-being. CNN Chief Medical Correspondent Dr. Sanjay Gupta speaks with Dr. Steven McDonald, an emergency room doctor at New York-Presbyterian Allen Hospital, about the psychological toll of his everyday reality.

You can listen on your favorite podcast app or read the transcript below.

Jake Tapper, CNN Anchor, “The Lead” and “State of the Union”: Doctors and nurses risking their lives to save you and me and patients.

Dr. Ken Duckworth, chief medical officer, National Alliance of Mental Illness: I do worry about our first responders and health care workers, in terms of the trauma they are exposed to.

Ana Cabrera, CNN Anchor: Even physicians are victims of this unprecedented public emergency.

Dr. Sanjay Gupta: Since the beginning of this pandemic, health care workers have been dealing with this virus head-on, putting their own physical health at risk.

According to a CDC [Centers for Disease Control and Prevention] report released in April, more than 9,0000 health care workers have been infected with the coronavirus. … And because of the limited data we have, that number is likely higher.

But we shouldn’t forget the other risks our health care workers are facing. I’m talking about the emotional and psychological ones.

[Pots and pans banging, people cheering for health care workers]

Gupta: Every night in cities around the world, we celebrate our health care workers. But the thing is, even before this pandemic, their jobs were demanding.

They’re in high-stress life-and-death situations with long hours.

So in this episode, I want to talk about the pandemic’s psychological cost to the people on the front lines — and what’s being done to help them.

I’m Dr. Sanjay Gupta, CNN’s chief medical correspondent. And this is “Coronavirus: Fact vs. Fiction.”

Dr. Philip Breen: She was a doctor. Every bit of the word that a doctor should be. She put her life on the line to take care of other people.

Gupta: That is Dr. Lorna Breen’s father.

Last week, Dr. Breen, a New York City emergency room doctor, died by suicide.

She had actually contracted Covid-19 herself. After recovering she went back to work.

Breen: She was like the fireman who runs into the burning building to save another life and doesn’t regard anything about herself.

Gupta: There is so much about this virus that is new and unfamiliar, making everyday life more challenging.

I’ve heard that from my colleagues.

Every day they wonder: Are they safe? And if their families and loved ones are safe as well.

I recently spoke with Dr. Steven McDonald. He’s an ER doctor at the same hospital as Dr. Breen.

He’s been on the front line for weeks, taking care of patient after patient … after patient. New York has been the US’ pandemic epicenter, with more than 321,000 people infected and 25,000 deaths.

I asked Dr. McDonald about how he’s coping with his everyday reality as well as the loss of a colleague, and how he’s taking care of his own mental health.

Gupta: So how is life, Dr. McDonald?

Dr. Steven McDonald: First of all, things are changing day-to-day. I think life a month ago looked very different than only two weeks ago than it does today. Thankfully, emergency department volumes are significantly down.

But also, as you can imagine, the tenor of my department is depressed. We just lost one of our faculty members, one of our physicians. And so there’s definitely a pall that’s been cast over my department — in addition to this pandemic.

Gupta: I’m so sorry to hear that. I don’t think people always recognize both the physical and psychological toll on frontline workers like yourself. At what point for you did it become something that was personally frightening?

McDonald: As we were approaching the peak, I would walk into the emergency room and it was in a state of chaos. And it was overwhelming to an extent that I had never really seen before. It felt — I keep describing it as though a caged animal had been kind of let loose, and no one could see it or get it back into the cage.

Gupta: Wow. You know, I’ve been — I finished med school in 1993, so I’ve been doing this for a long time. And typically, you know, the family is there. There’s an additional line of support.

But what you’re describing is people who are coming in, almost always by themselves because families can’t come in. And now they find themselves in a position where they may suddenly die. It’s tough. I don’t mean to paint it so stark, but it sounds like that is the reality, at least in some of these situations.

Let me ask: How worried were you about contracting the virus yourself?

McDonald: If I’m being honest, you know, early on, I think this was probably mid-March when this was first starting. I had a moment at home by myself, borne out of complete irrationality, where I suddenly was convinced that I was going to die of this. I can’t explain to you where that came from. I think it was just maybe having read a couple too many of these cases and having talked to a couple of colleagues who had pronounced young people dead of this.

And I just suddenly was gripped by that conviction. And it was frightening. It was really frightening, just to feel like there’s nothing that I can do in this. I have truly no agency over my death in some regard. There’s no amount of PPE that will protect me from this. And I know that to be irrational. I know that to not be true, but I was so gripped by it in one moment.

Gupta: I agree with you, and I think that’s a really interesting way to put it. You know, we do all the right things, but there are things in life, especially with a microscopic virus that’s inexplicable. So you’re really putting yourself at risk.

McDonald: Right.

Gupta: Did you ever think about sitting it out? Saying, you know what? It’s not worth it.

McDonald: You know, I did have a moment where — I think it was a Sunday night and I had my first shift in a couple of weeks on the Monday. And I was, to be totally honest with you, I was a wreck. I was a wreck. I was calling family and friends. And I was really upset.

And I was thinking about the number of people who I was going to have to pronounce dead or have to have end-of-life conversations with. And I found it so overwhelming in the abstract on that Sunday night.

I thankfully have a great support network, a great therapist — and spoke with her a bit and was able to sort of pull myself together and work and be a physician the next day. But that was a difficult 24 hours.

Gupta: You know, Steven, it’s always struck me that even within the medical community, there is still a stigma about seeking therapy, seeking mental health support. Yet it’s so important, maybe never more important, than it is right now.

Do you sense that stigma? I mean, has it manifested at all in your life?

McDonald: I mean, you know, absolutely. I would say physicians don’t talk about mental health issues. I don’t know if any job is really that open about this, but I think medicine in general breeds a culture of silence about this.

Gupta: And you do hear about physicians who die by suicide. Compared to the general community, it’s typically higher across the board.

There was a lot of news about Dr. Breen lately. And I know you knew her somewhat. When you heard this, were you surprised?

McDonald: Absolutely. I was completely floored. She always — again, I only knew her in a professional capacity, but she struck me as someone who was so self-possessed and so capable, really tough as nails and able to deal with any situation head-on.

And, you know, I esteem all of my colleagues as being that tough.

Gupta: Has there been anything good that’s come out of this for you?

McDonald: So I think there has been incredible camaraderie among physicians. At the peak of this, we had orthopedists and urologists coming down and managing critically ill patients and doing blood draws and doing things that are way below their level of training just to help out, and to see colleagues who were so willing to be part of this effort was really inspiring.

You know, secondly, and I think this remains to be borne out, but one hope that I have: This virus, I think is sort of peeling back the onion skin and showing us at the core of American society, things that really need attention on a federal and legislative level.

So, the inequalities that this is exposing, the problems in the health care system that this is exposing.

And I hope that these are conversations that are started and carry weight and are not forgotten after we beat this thing.

Gupta: Camaraderie as well, you’re absolutely right about — I’ve seen that in our own hospital. Although it does make me think of this joke that you probably heard: the definition of a double-blind study?

McDonald: No?

Gupta: Two orthopedic surgeons trying to read an EKG.

McDonald: Hahahaha. I love that. I will not be telling that to my orthopedic colleagues, but I love that.

Gupta: I want to ask you about, you know, if there’s been a best moment and a worst moment.

McDonald: Yes. Worst moment for me was. … It was during the peak, and I was coming into a shift. I received sign-out on probably 40 patients who were all critically ill.

And so I was in this awful situation where I was pulled into one room to be with a critical patient who was dying. And then the nurse comes and gets me and says, you also have a critical patient who’s dying in this other room.

And so I run through to this other room, and this woman is near death. Her heart has nearly stopped. Her oxygen levels are falling. She’s already on a ventilator. She was in her late 80s.

And the team is, the team of residents is looking to me, to ask: What are we going to do when this woman’s heart stops, as it appears it’s going to in the next 10 seconds, 15 seconds? And this woman had no established advanced directives. And we had made multiple attempts to get in touch with family and were unable to.

And, you know, all the data shows that someone of this age who’s already on a ventilator, this person is not going to live no matter what interventions you make. And so, talking to you now, it seems very obvious to not attempt to prolong life. But in that moment, it was very hard for me to make that decision. It was — there was no clarity about it.

And so, I declined to perform CPR. But then I felt terribly about that in the moment. That was really the lowest moment I’ve had during this, where I just felt like I ended someone’s life without any data.

I guess, in terms of bright spots of this — so you’re familiar, I’m sure, with the 7 o’clock clap for providers and essential workers. And so, after Lorna Breen’s passing, I was working that next day. And we did at 7 o’clock go out to the front of the emergency department.

All the doctors who were able and the nurses and everyone, and we just had a hell of a clap for those whom we’ve lost. And it doesn’t in any way redeem what’s happened. But it was a really nice moment of camaraderie and to celebrate the accomplishments of those whom we’ve lost, including Dr. Breen.

Gupta: Wow. Well, I mean, going back to the worst moment for a second, for what it’s worth, Steven, that was a tough decision. I’m sorry that obviously left such a mark on you. But from what you described, you know, it was the correct decision.

McDonald: Thank you.

Gupta: Do you worry that you’re suffering from post-traumatic stress?

McDonald: It’s hard to say. I mean, I think like post-traumatic stress disorder, when you’re in the thick of it, you don’t think about it. And it’s only once things calm down that you begin to have things like flashbacks or intrusive thoughts.

So far, I’ve been very fortunate in that I have not had those symptoms, but I can’t tell you with any certainty that I won’t in the future. And so that is a perpetual source of anxiety and concern.

Gupta: Well, I mean, I will clap harder and cheer even louder after hearing your story about how that made you feel. I mean, it’s the least I think that people can do and people really owe you a debt of gratitude. So, thank you very much.

There’ll be books written about the sort of work that you’ve done. I know you’re in the midst of it right now, so it’s hard to sense that, but thank you.

McDonald: Thank you. Thank you so much.

Gupta: Like Dr. McDonald said, doctors are facing so many challenges right now. There are these long, demanding shifts, the risk of exposure to the virus and the number of patients that are dying, which is unlike anything we have ever dealt with before.

Dr. John Krystal, Yale University professor of psychiatry and neuroscience and Yale-New Haven Hospital chief of psychiatry: You know you think of the first wave of illness being the wave of patients coming in and presenting with illness. But for these health care workers, the stresses are somewhat cumulative.

And so you can think of a second wave of stress coming through for the Covid health care workers.

Gupta: That was Dr. John Krystal. He heads the psychiatry department at both Yale University and Yale-New Haven Hospital. He’s been tasked with leading a group that identifies health care providers who are struggling and provides them with support.

Krystal: One kind of support that we have is giving people a place they can drop into any day they want, every day, five days a week. We have what we call stress and resilience town halls. They’re open to everybody in the community: staff, trainees, doctors.

The idea was they should connect to deal with the isolation that they’re often feeling. They should unload, you know, they should just share what it is that they’re going through and then to learn a few skills. And so we teach people relaxation skills, and we teach people sleep hygiene. And so far, I think in our community, over 1,400 people have made use of them.

Gupta: Dr. Krystal and his team also established a buddy system — pairing health care workers with their peers. And then they dispatched volunteers to provide psychological support to anyone who wants it, over the phone.

But both Dr. Krystal and Dr. McDonald bring up a more deeply rooted issue about the culture of medicine.

Krystal: You know, some of the challenges are that some of the characteristics that we have historically admired most about physicians: They’re willing to sacrifice themselves for others, their reluctance to complain about things.

All of those are admirable, wonderful traits, but somehow, we haven’t always inculcated in the values of our medical system that self-care is as much a duty and a responsibility as caring for the patient.

And my hope is that this is an opportunity to have broader discussion about that. And to make it OK for more doctors who need help to seek help.

Gupta: This pandemic has really tried and tested the best of us.

But I am thankful that mental health services are available for our doctors and medical workers who need it the most.

A fund was recently set up in honor of Dr. Breen — it’s called the Dr. Lorna Breen Heroes’ Fund, and it’s there to provide mental health services to medical workers.

It’s my sincere hope that the support that’s been marshaled to help health care workers in this pandemic will last beyond this moment — that they’ll become a fixture in the way we think about care.

We’ll be back tomorrow. Thanks for listening.