This is especially the case for our frontline healthcare workers, and those who support them. Those who serve in our healthcare system are the tip of the spear in the battle against the novel coronavirus.
Doctors, nurses, technicians, EMT’s and paramedics, embedded behavioral health providers and hospital cleaning staff — all of whom are risking their lives to save ours — face another threat. It’s the increased risk of trauma from doing their jobs under such extremely difficult circumstances.
Many of these warriors are also military veterans. Because they are able to compare this situation to being in the combat zone, it carries a lot of weight when they tell me this is creating more trauma than they experienced during their military service.
They also tell me that it’s a punch in the gut to see people clustered together, doing outdoor workouts and other social gatherings that could put them at continued risk. They need Americans to make the connection that our behavior has a direct impact on their safety, and the safety of those they love.
Healthcare workers are warriors in scrubs
Here are some ways to understand what they’re going through and how you can support them.
An invisible enemy. The threat they are fighting is impossible to see and even harder to contain. Since the virus is invisible, and there is a delay between infection and the presence of detectable symptoms, our healthcare workers must try to stay two steps ahead of what they can’t see.
A battlefield mindset. Like our nation’s warriors, our healthcare workers are expected to be ever vigilant to a threat that has life or death stakes. They may not meet criteria for a diagnosis of post-traumatic stress disorder (PTSD), but many will have a condition that I call “chronic threat response.”
Chronic threat response is defined by an escalation of many of the hyperarousal symptoms associated with post-traumatic stress — sleep difficulties, floods of anxiety, irritability, problems concentrating, and a hair-trigger startle response.
Everyone can be re-assigned. In the military, one’s “MOS” is one’s “military occupational specialty.” Yet, for many veterans, there can be a loose connection between their MOS on paper and what they do when deployed to the combat zone.
When we need “all hands on deck” in a time of war, anyone can be reassigned to fill a critical gap– as door gunners, convoy truck drivers or other roles that may be far outside their role on paper. Right now, health care workers are also being asked to step up in ways that may not align with their training.
Physical and emotional exhaustion. Because we need them, healthcare workers are being asked to push through exhaustion. Like our warriors, healthcare workers have training and skills that cannot be replaced by others in our society. To live in this perpetual crisis state, many of our healthcare workers have effectively moved into hotels near their work or are sleeping in the hospitals and medical facilities between shifts.
Working despite equipment shortages. In the early days of the Iraq War, we did not have the infrastructure or the necessary equipment to protect our warriors. They traveled in Humvees without special armor and many did not have the body armor that was provided as the conflict played out. Likewise, equipment shortages mean many of our healthcare workers are not properly equipped with personal protective equipment to face the coronavirus threat.
Impossible choices with limited information. The best medics in the military know that they cannot save everyone or make the right call in every case based on the limited information they have. Healthcare workers are facing those wartime-like decisions now, and we can see it in the “1,000 mile stare” experienced by many veterans. Their haunted look is created by a level of trauma combined with emotional exhaustion that cannot be put into words.
They see trauma they will never forget. They are seeing things that are hard to put into words — traumas that will burn themselves into their memories forever. As one military veteran and ICU nurse in my network said, “I return to another shift and hold the hand of an elderly man or a very young woman who had to die alone because we cannot allow visitors right now.”
Guilt over who can’t be saved. When health care workers lose a patient, it weighs on them. Even if they know that logically they made the best choice they could, the feeling of helplessness is a burden that weighs on our healthcare providers. They may have nightmares that emphasize a loss of control.
They risk losing their colleagues. As they work to stem the tide of this threat, thealthcare workers are bracing themselves for some of their colleagues to fall ill and potentially die from the threat. And when they lose a colleague, like our warfighters, they may feel a suffocating form of survivor guilt, wondering why they were spared when their fellow workers have fallen.
Their family’s sacrifice. Health care workers are burdened by the knowledge that their families are impacted by their absence, and the risks they take to do their jobs. They know their families, including their partners, young kids and elderly parents in fragile health, are separated from them during a time of skyrocketing anxiety.
Let’s support our health care workers
Unlike those often unseen sacrifices made by those who serve in foreign war zones, we can directly witness our healthcare workers’ sacrifices. That may make it easier to support them from just a few miles away. Here’s how to help.
Offer support proactively. Trauma is inherently destabilizing and disorienting, so don’t ask them if they need anything. Offer meals, laundry support, treats for their kids (all delivered without contact) or even a card that says thank you. Those on the frontlines of care will benefit from a proactive approach that does not wait for them to “opt in” to get support.
Don’t require resilience. In the fluid chaos of this crisis, our health care workers will struggle at times. They will be tested more than most of us. From working with military veterans, I know that during times of personal struggle, the memory of being called “resilient” can push a person away from the support of others, into a kind of solitary mental exile.
I would suggest the alternative goal of encouraging our healthcare workers to draw strength not from their own resilience, but from leaning on us to support them well as they face these unprecedented challenges.
Offer a safe space to express emotion. Many people withdraw from others’ grief and loss, feeling unsure of how to support those who are grieving. One of the most helpful things we can do is to create an emotionally safe space and allow others in our lives to feel and express whatever they are thinking and feeling.
This is a gift we give them, especially at a time when we ourselves are carrying extra anxiety and stress. We can bear witness to their pain, and trust them to draw strength from our support.
Step up to make masks. Psychologically, it’s not good for any of us to sit in our foxholes and wait for more bad news. If you have skills with your hands, you are needed right now. You can make good use of your time and skills to protect our healthcare workers in practical ways — by sewing masks and making additional protective gear.
Just as we called out an under-appreciated workforce during World War II to make munitions to protect our nation, let this be a call to our society’s makers to use their skills to do battle on this deadly virus.
Share their stories to encourage social distancing. Despite urgent warnings from credible healthcare authorities, lockdowns in major cities, and laws passed to enforce social distancing, many people still aren’t taking these measures seriously.
One of the best ways to influence our peers is to tap into the good will most Americans feel right now for those in the military and first responder communities. These fellow citizens are making tremendous personal sacrifices.
Consider your decision to wear a mask and practice social distancing another thank you for their sacrifice.