The frontline soldiers fighting an invisible war:
How an emerging doctor handles the emotional adversity of being a frontline health worker during the pandemic.
Amal Abayed, a 25-year-old orthopedic resident walks into her second day of orthopedic training at Charles Nicole hospital in Tunis. In her mind, Amal anticipates a regular workday that begins with a meeting between senior and junior staff and transitions into patient rounds. The echoes of an emergent flu-like virus had reached her, yet nothing could mentally brace her for what’s to come.
Before any of the new resident doctors at Charles Nicole could be briefed about the proper covid-19 scrubbing, patient interaction, and sterile field protocol, they are thrust into their first covid-19 shift, having already worked for 72 hours straight. A deer in headlights, Amal’s physical exhaustion is only surpassed by the anxiety of treating patients for a disease she knew very little about. “We knew that a pandemic is deemed to occur cyclically once every 20 years, but we had no idea how contagious or deadly this one is compared to the Flu” recalls the young doctor.
A few months go by and the covid-19 shifts multiply. Amal spends most of her shifts at the emergency department. Her daily routine as a doctor shifted; to minimize human interaction within enclosed spaces, staff meetings, and patient rounds are now a thing of the past: a necessary evil that greatly diminishes the quality of her academic training. Although Amal and her colleagues made peace with the limited interaction with their mentors, some changes weigh heavily on their spirits. With the full protective gear on, all that Amal has to interact with her patients are two chestnut brown eyes, peering from behind her mask and visor. She carefully accentuates her sentences with a benevolent informative tone but to no avail. “The thing that really bothered me is that I wasn’t capable to release the pain of patients at the ER or showing them the empathy they needed because of the mask” the orthopedic doctor notes.
As the cases spike again in September of 2020, the anaesthesiology and reanimation department of Charles Nicole considers switching back to full covid patient occupancy. Shockingly, the decision is finalized in a matter of hours, and the process of vacating ICU beds starts. Almost immediately, Amal witnesses two terminally ill patients being moved out of the department. Not a moment later, a third patient passes away, his ICU bed is emptied with no questions asked. The young doctor leaves the department for some fresh air, and upon her return, she learns that the department lost a fourth patient. A sense of limitation and helplessness looms over Amal as the covid-19 shifts stretch. For the first time in her medical career, she races the grim reaper, though his scythe was much faster than anything medicine could offer her patients. The deafening silence of the reanimation department chases her off the floor in tears.
The emotional distress of working on the frontlines of a worldwide health crisis does not end at the reanimation department. In October, a patient of the gynecology department develops post-operative asphyxiation and requires an X-ray scan. As she moves the patient to a different hospital for her scan, Amal conceals a lingering suspicion that the patient is covid-positive, careful not to cause distraught. With the X-ray coming out negative, the patient submits to a PCR test a few days later that confirms Amal’s suspicions: the patient is covid-positive. The doctor’s suspicions grow, her stomach in knots, as the worst-case scenarios fill her head. What if she contracted the virus from her patient, thus infecting the entire medical staff of both hospitals? What if she loses her medical license for not informing a higher-up of her suspicions?
A week later, Amal is assisting on a c-section surgery, a senior resident doctor barges in locks eyes with the young doctor, and calmly says “Amal, scrub out and leave the operating room immediately”. The young doctor leaves the OR with a pit in her stomach and suspicions racing in her mind. As soon as the senior doctor utters the words “You’re covid-19 positive, but no one else is”, a wave of relief washes over her. Although she contracted the disease, she knows that did not put anyone else in danger.
According to a study published in Cambridge University’s psych bulletin by psychiatrists Niall Galbraith and David Boyda, healthcare workers are placed during any major health crisis under enormous amounts of stress. As the number of patients in need of treatment increases, doctors are obliged to work longer shifts. Healthcare workers are also more likely to contract diseases from their ill patients, yet they struggle to admit it, which adds more pressure to their work lives.
Amal quarantines in her apartment, secluded from her family and loved ones. At that point, the doctor who had made it a habit to visit her family weekly has not seen them in 3 months straight. She breathes deeply as she gets to rest for a moment and not worry about the grueling daily routine of gearing and scrubbing out in the hospital, disinfecting, and showering at her apartment. Though she feels guilty for the extra workload her colleagues are handling due to her momentary absence, Amal decides to preserve her mental health by making the best out of her quarantine. She spends her mornings catching up to e-mails and delivering online training to the members of AssociaMed: the Tunisian student medical society. she concludes every training by sharing her experience of being covid-positive as a cautionary tale. In the afternoon, Amal surrenders to consuming TV shows mindlessly. “I just watch the scenic cinematography of Emily in Paris and zoned out” comments the young doctor. Taking time off from the hospital also allowed Amal to view how her job fits within the bigger picture of the pandemic. She realizes the weight every saved patient holds beyond the hospital doors and the tremendous number of lives she positively affects without realizing it.
In some sense, getting covid-19 was a breath of fresh air for the young doctor who feels at the edge of burnout. Seen that she is at the beginning of her medical career, she works 24hour shifts constantly and does not want to ask for days off in fear of giving her supervisor a bad impression of her work ethic. After a shift at the hospital, Amal volunteers to answer the covid-19 hotline at the short-staffed health ministry. She connects with over 200 families in one shift, attempting to be as informative and supportive as possible while keeping the interaction brief and professional. This rotation between hospital and ministry shifts exhausts her quickly. The once bubbly talkative doctor now roams the halls of the hospital on “autopilot mode”. A shell of the person she once was, Amal finishes her tasks with minimum human interaction.
One of the hardest instances of working covid-19 shifts is confronting the families and loved ones of those who don’t survive the pandemic. Amal attempts to handle the situation professionally: she breaks the news as clearly and calmly as possible then leaves. Though losing a loved one is always difficult, something about the lack of closure associated with the covid-19 burial protocol accentuates the agony. “We had to hide because we couldn’t bear the screams, we’d hear the family go insane behind closed doors but couldn’t do anything to help ease the pain, we had to respect the strict protocol” shares Amal. As painful as these moments can be, they also remind the medical staff why they sacrifice their time and wellbeing in combatting covid-19: to spare a family from the pain of losing a loved one horrendously.
Beyond the atrocities of being a frontline health worker during the pandemic, working covid-19 shifts affects Amal’s entire professional trajectory as a doctor. Thrust on the frontlines of the world’s prime health crisis as an intern, Amal Abayed matures as a doctor faster than she could’ve imagined. She handles heavier responsibilities at an unprecedented pace, reacts to emergencies calmly, and juggles the emotional weight of her professional life while learning to prioritize her mental health.
To Amal Abayed, the silver lining of her experience is that when something is important enough, you do it even when the odds aren’t in your favor. She lives with the memories of the patients she lost, cherishes them, learns from them, and allows them to carry her throughout her battles so that their loss can be meaningful. The young doctor concludes “Health matters to us, and we serve despite the circumstances. Because it’s important enough you do it”.