Healthcare worker wearing PPE kit at the ambulance after shifting a patient at Civil Hospital in Ludhiana. Express Photo by Gurmeet singhRising anxiety, fear, disturbed sleep patterns and a constant feeling of helplessness are only a few factors wreaking havoc on the mental health of frontline doctors— as Covid-related death toll continues to increase— and India enters the eighth month of battling the pandemic.
This deterioration in the mental health of doctors has been a direct consequence of the persisting pandemic. Working shifts of 12-hour or more, while being a bystander to unabated deaths has begun to show its toll on the healthcare staff.
As per a psychiatrist posted at the civil hospital of Panchkula, at least 40 per cent of the doctors at the hospital, who are directly involved in dealing with Covid ICUs or sampling have approached him, seeking counselling or advice regarding mental health issues.
“I keep looking at their history. Did I miss something?”
A city-based anaesthetist, who runs his own unit where he provides assistance to private hospitals for Covid care, speaking on condition of anonymity, said, “A consistent rise in death of patients affected with Covid-19 has been extremely disturbing and frustrating to the extent that I have had to go on anti-depressants as my last solution.”
“Even though we are prepared to see deaths in our lives, we at least found peace in the fact that we did everything we could. It is not the same with Covid-19 patients who are well one day and are no more the next. No matter what I do, someone dies everyday,” he said, adding that in the aftermath of the deaths, all he does is “keep looking at their history” and ask himself, “Did I miss something?”
The doctor has not seen his family for over six months now, despite living right next to them. “I live with my grandparents but have a separate room, isolated for myself. We just greet each other with a hello from afar sometimes. I prefer staying at the hospital I work in. I have only been home for half an hour in the past three days, and it was for a change of clothes.”
Head of Psychiatry department of Panchkula, Dr MP Sharma, who is often posted at Covid ICUs also points out several first-hand experiences and symptoms of deteriorating mental health conditions of not just the doctors but also other frontline staff workers.
As the pandemic stretches on, the distress amid doctors further increases.
“The first symptoms you may easily spot are irritability factors. We can gauge that everyone is at their edge. Arguments inside the hospital have risen. Depression and sleep disturbances are also increasing. Working and staying not just alert but awake throughout the night is a task. Several doctors are resorting to substance dependence to keep themselves functional,” he said.
While some doctors have opted to treat themselves medically and take medicines to reduce anxiety and keep themselves awake for long hours, another substance dependence that has dramatically increased, said Dr Sharma, is alcohol.
As the pandemic stretches on, the distress amid doctors further increases.
“No one knows when this will end and it is making the frontline workers even more anxious,” he said.
The severity of the pandemic accompanied by a feeling of helplessness due to shrinking resources and less than required paramedical staff, has left the doctors impaired— as they witness death of their patients everyday. “Many patients come in on day one with fever, get breathless by day two and slip out of our hands by day three. We have no medicine to prevent it. This has been the direct result of investing the least amount of our GDP towards healthcare infrastructure. No one has been concerned enough to ramp it,” he said.
“Explaining the death of a patient is harrowing”
Meanwhile, reporting and explaining such deaths to the families of patients has proved to be a more difficult task, said a doctor posted at a private hospital in Mohali, requesting anonymity. “To explain the process, the circumstances that led to the death of the patient is harrowing to say the least. How do you explain it to them? There is no investigation to prove that the lungs of the patients were tired, they were giving out so we had to put them on ventilator. It is something we doctors check physically and know. There is no physical report for it. We cannot tell them that it was a delay in reporting the case that led to the cytokine storm which became the cause of their family member’s death.”
The issues of the frontline doctors do not stop at mental well-being, but hamper their physical health too.
Working long hours in PPEs leading to depletion of physical health
The issues of the frontline doctors do not stop at mental well-being, but hamper their physical health too.
Working in PPEs amid rising temperatures and with chronic health conditions of their own, including migraines and asthma, has further traumatised the doctors. A second year anaesthesiology resident at PGIMER, Abhishek Arya, posted at the Covid ICU ward recounts the trauma of a colleague.
“A senior posted at the ICU with us had a sudden episode of migraine while she was in her PPE. She started vomiting as her vision got blurred. She had to doff it in an emergency. Let alone the risk of infecting yourself when such episodes happen, the risk of severe trauma which may turn into a phobia remains high. I do not think people understand that being in a PPE equipment for several hours is a task most would not be able to do. The air-sealed goggles, long working hours and sleepless nights become the catalyst for aggravating present health conditions.”
As doctors continue to test positive, the fear of spreading the disease to their families also has a cascading effect on their mental health. Abhishek, hailing from Delhi, had last met his family in December.
“The loneliness can take a toll on anyone’s mental health. While I have kept myself above water by talking about it and interacting with friends and family, there are several who have succumbed to it. The job does not stop. We remind ourselves of our purpose each morning. It is even more difficult for people who have to go back to their families. I know several who live with their families but have not actually met them for months,” said Arya.
Studies getting affected
The studies of residents across the country have been affected by the pandemic.
“We are still students. We had to learn at this time. It is still better for people involved in courses of intensive care as we get to do what we came to learn. But those who enrolled for orthopaedia, gynaecology, et al, they are also on Covid duty. They have not been able to focus on their own curricular,” said Arya.
While being a prime time for submission of thesis protocols, young doctors have been scrambling from Covid wards to libraries, to simultaneously do their duties and earn their degree.
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