On+the+front+lines

On the front lines

Introduction

   March marks the one year anniversary of quarantine. What we once believed would be an “extended spring break” has now encapsulated months of a raging pandemic that has killed millions across the world. 

   During those months, our healthcare workers on the front lines have been facing harrowing conditions working to keep communities safe. COVID-19 put life on hold for billions of people across the globe. But for healthcare workers, the sudden onset of the pandemic was like stepping onto a treadmill set at maximum speed—one that still hasn’t shut off. For nearly a year now, doctors and nurses surrounded by patients sick with COVID-19 have endured long shifts, little sleep, and unimaginable stress. 

A Day in the Life

 

     The Paw Print had the privilege of interviewing Dr. Tonia Cohen, former professor and current office manager for an infectious disease clinic owned by her husband Dr. Michael D. Cohen, MD. She described what a typical day for both of them has looked like over the past year. 

   Dr. Tonia Cohen explained that Dr. Michael Cohen is “an infectious disease doctor trained in the late ‘80s when the AIDS epidemic was happening” and is “very familiar with what an epidemic can do and how devastating it is to communities.” 

   However, she noted solemnly that “nothing prepared him for COVID.” 

   Nothing was prepared, including hospitals. Healthcare workers were forced to dive headfirst into their work last March and have constantly endured a shortage of Personal Protective Equipment—PPE. 

   Sharon, a nurse in the Los Angeles area who asked that we not reveal her last name, has been working in the coronavirus ward at her hospital for the past 11 months, and she described her experience in an interview with The Paw Print.

   Sharon described, “When we go into the COVID floor—it’s what’s now called the isolation floor—we have to wear special gowns, a special mask, and sometimes we have to wear a helmet. It’s basically an isolation helmet, which is a helmet that covers your entire face, and it is connected to its own power source that’s blowing air… So you have special masks, special gowns, [and] you have gloves— that’s only for the COVID floor. Even when you go to the hospital, you have to change into [the hospital’s] scrubs. As nurses, we wear scrubs from home, but because it is such an isolated environment, they want you to wear their scrubs. So, you change into their scrubs first, and you go to the unit, where they give you different masks and gloves, which you have to wear on top of the scrubs that you got from the hospital. And you have to keep it on the whole 12 hours you are there.”

   Sharon explained how her hospital was hit hard by COVID. 

   “As the pandemic evolved, the situation in the hospital evolved, too. We are facing what we never, as nurses have faced before. Even the nurses who are older than I am, and have been in the field for 30 or 40 years, have never experienced anything like this. For us who come from other countries, we would have never thought that the United States would have a problem where you would be short on gloves, you would be short on gowns, and you would be short on masks. In the hospital, if you’re working with a COVID patient, you have to wear what’s called an N-95 mask, and there is a big shortage. Now, when we go to the hospital, we get an N-95 mask, which are kept locked. Before the pandemic hit, they used to be everywhere—you could just grab one, use it for 10 minutes, and toss it away. But now, they’re in locked places—you have to get one from your manager, and you use one mask for over a week, or even 10 days. You get a special bag on which you write your name, so at the end of your shift, you put that mask back in the bag, so that when you come back the next shift, you use the same mask,” she said. 

   Dr. Tonia Cohen echoed this sentiment, detailing how her husband dealt with a lack of PPE in early 2020. 

   “In the beginning, he just had the little yellow thin gown and booties and one N-95 mask—which he had to reuse everyday—and gloves,” she said. 

   Hospitals around the country have been experiencing a situation similar to the one at Sharon and Dr. Michael Cohen’s hospitals. According to the Washington Post, the shortage of PPE across the nation is not yet over. N-95 masks have climbed in demand by 500 to 1,000 percent, and this has resulted in healthcare professionals having to use the masks for extended periods of time. Shortages of PPE have been credited to a decrease in exports, not enough production, and a flawed government response to the pandemic. 

   Although hospitals have been short of PPE, there is a light at the end of the tunnel. As stated by the New York Times, there are three vaccines being developed—Moderna, Pfizer, and Johnson & Johnson—and according to NPR, about 75 million doses of the COVID vaccine have been delivered, which covers about 15% of the American population. ABC7 reports that as of Mar. 7, over 10,500,000 vaccine doses have been administered in California.

   The end of the tunnel can’t come soon enough for healthcare workers submersed in traumatic and highly stressful situations every single day, with little time or ability to sleep. 

   Dr. Tonia Cohen laid out a day for Dr. Michael Cohen during COVID. 

   “He goes to Palmdale Regional, and he goes to Henry Mayo, and so on Mondays he would go to Henry Mayo super early. Then he’d go to the office and do a clinic through Telemed,” she explained. “And then, the clinic would end at 12:30 and he’s driving to Palmdale.” 

   Dr. Tonia Cohen’s “very full day” starts at 8:30—as she goes through voicemail messages that the clinic received overnight—and she often has to “do some extra work on the weekends.” 

   As Dr. Michael Cohen “goes in the rooms” and “shakes hands, touches shoulders, and examines the patients,” Dr. Tonia Cohen takes care of phone calls from loved ones who wish they could be in the hospital room themselves. 

   “During COVID, loved ones cannot be with their person in the hospital,” she explained. “So who are all those family members going to call to try to get information? They’re calling nurses, they’re calling the office, they’re calling me.” 

The Mental Toll

   The lockdown has characterized an unsteady shift for healthcare workers as the harbinger of restless nights, distress, and constant work. A study led by the University of Utah Health revealed that over half of the healthcare population involved with COVID-19 could be at risk of a combination of mental health disorders such as: acute traumatic stress, depression, anxiety, and problematic alcohol use. Horrifyingly enough, the research confirms that the number of healthcare workers at risk for these conditions matched the rates observed after “9/11 and Hurricane Katrina.” As healthcare workers are fighting head-on against “the unknown” day after day, they subsequently easily phase into “‘both resilient and pathological trajectories.’” Simply put, the healthcare workers on the frontlines had no time for self-care—and the effects are traumatizing.

   Beginning the interview, Dr. Tonia Cohen prefaced her concern for all healthcare workers, “They don’t have time to take care of themselves—the doctors and the nurses.” Dr. Michael Cohen goes between two hospitals—Henry Mayo in Santa Clarita and Palmdale Regional—to meet his patients. 

   She told The Paw Print that because “communities of color were more impacted by this infection” and “Palmdale is a very large population Hispanic and African American,” the infectious disease specialist had many, many people to treat, and it “was really intense for him.” 

   The intensity of their work “was another layer of stress” added to the usual routine, and moreover, “the anxiety, sadness, and the stress level was exponentially higher than usual,” sighed Dr. Tonia Cohen. Individuals on the frontline such as Dr. Michael Cohen and Sharon are tasked with giving their patients all of their compassion. They are tasked with the job of everything. 

   “Michael sees a patient every day for three weeks in a row and then, and then they pass away. How would that make you feel,” asked Dr. Tonia Cohen, “if you just spent time with that person for three weeks in a row telling them ‘you can do this,’ ‘keep fighting,’ ‘we’re going to try plasma,’ ‘we’re going to do this and this for you,’ you know, and then they don’t make it… And then someone else just comes right in that room—another COVID patient.”

   Sharon shared a similar experience: “Seeing a person dying without any family members around them—not just an old person, but even young people who are in their 30s, dying without any family members around them-—is heartbreaking. Seeing so many people dying in pretty much every shift that you work takes a toll on you. No nurse or doctor wants their patients to die, but that is the reality of the hospital: we have sick people, and death is always part of the hospital. Seeing death taking place so often takes a toll on you. It scares you too, because you are surrounded by the coronavirus, but that’s the job you do.”

   Clinical psychologist and supervisor Dr. Ana Mena understands the struggle of mental health during this time and shares her thoughts on what we can do. 

   “I think it is important to understand that every individual is different with what is going on around the world right now. Some people are naturally more resilient than others and some people do well with change a little bit more than others so I think it’s very tailored to each individual person,” Dr. Mena explained. “For me, I think that a lot of the coping skills that have helped is to implement those boundaries during my work so knowing when work is work and home is home and being able to really differentiate and make that separation between the two.” 

   She shared her own experiences with mental health during the pandemic: “My mental health has been affected in ways that I don’t necessarily see sometimes. At the moment I see the effects when I’m checking my email while I’m also prepping for dinner where before that would not have been the case. I would have left the office, turned my cell phone off. I would have left my computer in the office instead of bringing it home with me. I have to implement self-care and some boundaries with myself as a supervisor to not sit here and be on my computer in my home at 8:00 at night because I have the luxury to do so. I have to really remember that after 5 o’clock my day is over and I get to no longer be Dr. Mena but just be Ana in my home.”

   The boundaries between work and home have been extremely difficult to keep track of while in quarantine. Not only has Dr. Mena had to implement these boundaries but also cope with the lack of social interaction that so many people miss. 

   “I’m a social butterfly by nature, I love to socialize with others. I love having conversation and I love presenting, doing conferences and public speaking. All that came to a halt really quick back in March 2020 and it has been an adjustment to say the least for myself,” she said.   

   “I have found myself feeling somewhat depressed, somewhat anxious, feeling more almost paranoid to some degree when I go out and about, whether it’s me going to the grocery store or me going to the office,” Dr. Mena admitted. “It’s because I’m thinking, ‘Am I exposing myself?’; that is always in my mind, ‘Am I going to bring it home?’ So I think in all of those ways my mental health has been affected, but I think it is important to take really good care of myself. And get creative in ways that I probably wouldn’t have been taking care of myself prior to the pandemic.”

Conclusion

 

   Despite all our healthcare workers have been enduring for the last year, there are still many who insist that the virus is just a hoax. This is in fact a reality reflected within the COVID wards—both Dr. Tonia Cohen and Sharon shared experiences of treating COVID patients who were deniers. 

  “I would say, for people who don’t believe in coronavirus, just come and spend one day in the isolation COVID unit,” said Sharon. “And you would realize.”

   Indeed, the incessant politicization of the pandemic has made it seem there will be no end. However, there is hope on the horizon: vaccines are being administered. As the New York Times reports, as of Mar. 4, the “average number of vaccine doses being administered across the United States per day topped two million for the first time on Wednesday [Mar. 3]”. According to The Associated Press, the Biden Administration projects that every adult in the United States will be able to receive a vaccine by the end of May 2021.

   Until then, it is up to all of us to keep each other safe: practice social distancing, wash your hands, and wear a mask. 

   Sharon elaborated upon the proper way to wear a mask: “What you want to do while wearing a mask is you put your hand over it, and try to blow over it. If you feel air is coming out, that means your mask is not tight enough. The most important thing about wearing a mask is that it should be tight enough to seal around…  And the mask should cover the nose also, not just the mouth. You need to cover your nose, as well.”

   With cooperation and support, we will be able to get through this. Healthcare workers, thank you for your sacrifice. 

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On the front lines