Dangerous Medical Stress and Fatigue

It has been hard for me to see the scenes of overwhelmed medical personnel. To see the frantic pace of doctors, nurses and respiratory therapist working in intensive care units, emergency rooms and temporary hospital structures. I can barely imagine trying to work in tents setup in convention centers.

I spent years working in the neonatal intensive care unit. There were times when we struggled to keep up. But we were never put in the situations I see in the COVID-19 wards today. There were occasionally times when we were short of ventilators, but there were always ways to get them from other hospitals or medical vendors. I don’t remember there being long term shortages of other necessary equipment or supplies.

NOTE: Permission was obtained to publish these photos because they were used in public publications.

One of the most important services of a regional neonatal center such as the one I worked at, is to go to community hospitals to stabilized and transport critically ill newborns back to the NICU. These transports can take a long time. Some hospitals we went to were over 2 hours away. We covered the whole state of Indiana. Occasionally we would use helicopters for long distances or critical situations. And depending on the baby’s condition, we might need to spend several hours at the local hospital before the baby was stable enough to transport. So these transports can take a significant amount of time of a neonatologist, neonatal nurse and neonatal respiratory therapist. Medical personnel without neonatal experience are of limited use. Some of the most intensive procedures need to be done in local hospitals, and local medical personnel often have limited experience. The conditions are often crowded and certain equipment that would be helpful is not available. We stock the neonatal ambulance with what is essential.

There is a transport call schedule, but there are times when more than one transport is going on at the same time. That led to the time I was probably most “stressed out.” I ended up going on three back to back neonatal transports. Obviously there a different levels of severity of the diseases and conditions of the babies. The babies on these three transports were all critically ill and required a lot of work to stabilize. And had to be carefully monitored the whole trip back to our regional neonate center. These three transports had me working 20 out of 24 hours, and being totally exhausted. It was a struggle to remain alert at the end of the third transport.

Another stressful situation involved a baby that was so critically ill that we used a helicopter to get to the hospital as fast as we could. The trip by ambulance would have taken about two and a half hours. We had to perform resuscitation on the baby many times at the local hospital. And, new for me, was performing resuscitation, multiple times, in the small area of the helicopter during the flight back.

I’m trying to make the point that I have experience with stressful conditions.

But I have never experienced the stress of medical personnel working with COVID-19 patients. There should never have been this many infected people and deaths in the United States. The Federal government’s lack of planning and response is responsible.

And it is outrageous that the lives of medical personnel were endangered by the lack of personal protective equipment (PPE). I can’t even imagine how it felt/feels to know the danger you are exposing yourself to. And probably the even greater fear of infecting your loved ones. An absolute failure of government.

But these doctors, nurses, respiratory therapist, lab and x-ray technicians, housekeeping staff and others continued to show up. All working toward the time when the virus is brought under control.

It is so cruel and senseless to encourage “re-opening” before the number of new cases have declined, which will certainly lead to many more infections and deaths.

But I fear the worst effect of “re-opening” now will be on medical personnel. We’ve heard so many stories about how stressful it has been, and is, to work under these conditions. We know of the tragic suicide of at least one physician. We’ve heard of people saying they will leave medicine or transfer to another medical service when this is under control.

I expect a large number of physicians, nurses, respiratory therapists and other healthcare personnel will not be able to continue this work now, knowing there is really no end in sight. Knowing politicians will not do what needs to be done to get the pandemic under control. Will continue to put politics above the welfare of medical personnel and the public.

I’ve heard politicians say we will be better prepared for the next epidemic. That is ignorant. We might have better supplies and procedures. But I don’t think there will any longer be the numbers of medical personnel willing to expose themselves to infection and death when they see tragic government policies that will only make the pandemic worse.

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