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Tanzina Vega: It's The Takeaway, I'm Tanzina Vega, and thanks for spending some time with us. On Tuesday, close to 160,000 Americans were diagnosed with the coronavirus, a 79% increase from just two weeks ago. As COVID cases climb and hospitals around the country fill to capacity, nurses, doctors, and other healthcare professionals who are caring for these patients say they are burned out.

Elizabeth Riley: I am Elizabeth Riley and I'm a registered nurse.

Tanzina: Elizabeth works in Cumberland, Wisconsin, where coronavirus cases have skyrocketed over the past few weeks. Back in the spring, she volunteered to go to New York City where infections were surging there and work in an intensive care unit, but now she's seeing troubling echoes of that earlier stage in the pandemic in her own hospital.

Elizabeth: When we don't have staff because they're out sick or out quarantined, then we've got people who are picking up extra shifts and we have people working long, long hours, many days in a row and that was something I did when I was in New York. I didn't make it my full 21 days just because I was so sick and so tired because I worked that many days in a row of 12-hour shifts. Now we don't work 18 days straight of 12-hour shifts, but we will work a lot of extra hours, a lot of extra days. Everybody has banded together as a team. I think you're going to see that in any organization, especially this one where I work.

Within the last probably eight weeks, we have seen a huge spike in COVID cases and it has had a profound effect on what we want to do and what we can't do. Both in that there are high, high numbers of infected people in our communities, many of whom are winding up coming to our hospital, but we also have staff members who get infected with COVID and then they can't work.

Tanzina: Even as Elizabeth and her colleagues have banded together, she struggles with the number of people in her community who continue choosing not to wear masks.

Elizabeth: It's, I don't want to say hurtful because I think that people who decide not to wear masks are not necessarily trying to be hurtful. I think a lot of those people simply don't understand the truth of the situation or choose not to believe the truth of the situation. When that affects my coworkers in the way it has, I find it quite upsetting because I believe I work with the best healthcare professionals in the country, in the world.

I feel like they're sacrificing themselves to some degree for people who, for whatever reason, don't want to believe it's as big a problem as it is. It hurts my heart to see such really wonderful professionals having to put themselves on the line all the time, just trying to get through in the community without getting sick.

Tanzina: That's a feeling other medical professionals say they understand.

Jean Ross: Hello, my name is Jean Ross and I am president for National Nurses United. I live in Bloomington, Minnesota. It's a suburb of Minneapolis.

Tanzina: National Nurses United is the largest organization of registered nurses in the United States and we spoke to Jean at the end of March as the pandemic was gaining steam and nurses and doctors in hospitals were scrambling to respond. Today, Jean says resource problems still exist and there's a heavy burden on nurses to set clear boundaries in their COVID work.

Jean: We have to be able to speak up as professionals and say, "No, I won't accept this assignment, there aren't enough of me to take care of that type of patient. No, I won't go into that room with what you're telling me is acceptable PPE when I know better. No, you cannot put that patient in with other non-COVID patients because they should be separated. That patient is showing signs of COVID or SARS-CoV-2." Those are the kinds of things nurses as professionals need to be able to do to represent their patients in themselves.

It does take a huge toll on nurses to have to be doing that because we are fighting so hard right now to do the right things so that we don't become infected so that we don't infect others, and every little stressor that you put on a nurse at this point is going to cause her or him to have that one little chink in the armor, so to speak, that they're fighting, all that cortisol, all that stress.

I listen daily now, semi-daily, to nurses being asked about burnout and how stressed they are, how anxious, how little sleep they're getting. I think most of us nurses will tell you it's okay. We know that for a period of time it would be bad like this, but we really expected better. We expected some relief, some respite don't worry so much about our burnout. If you do what we asked you to do, then we will be just fine.

Tanzina: What they need, she says, includes broad public support in petitioning the Trump administration to gear up manufacturing for more personal protective equipment here in the United States.

Jean: You have trusted us year after year; we end up at the top of the pole for the country's most trusted profession. There's a reason you trust us. You can trust us now, please, please listen.

Tanzina: Over in Chicago, hospitals have seen an influx of COVID patients for the past two weeks.

Khalilah Gates: My name is Khalilah Gates. I am a pulmonary and critical care specialist at Northwestern Medicine in Chicago. Back in March, April, there was that fear of the unknown. We didn't know what these patients present. We didn't know exactly how to treat them. Now we have a much better understanding of how to treat them, but we are definitely exhausted. We have been doing this since March.

COVID patients didn't go away. This idea that now we're taking care of COVID patients, again, we never stopped taking care of them. There's this level of exhaustion. There's this level of frustration in which we fear that we would be back here and we hope that we could do things differently so that we didn't get back here and it's just we weren't able to do that. There's this fear of frustration on top of exhaustion.

Tanzina: Dr. Gates and her colleagues have found some ways to manage that exhaustion.

Khalilah: Now, more so than ever, this idea of wellness is very important and it's very much propagated. What do we do to keep ourselves well? A lot of that is a personal determination, but a lot of it is things that we do in the ICU. After rounds one day we had a stretching session where we were just able to all get up with the nurses and stretch. Just talking with the nurses and sitting down and decompressing and just letting people know that we're in this together and we're going to make it through this as well.

Tanzina: Despite the burden the pandemic has placed on healthcare workers like Dr. Gates, she says she's not going anywhere.

Khalilah: I didn't sign up for this. I didn't choose critical care medicine knowing that there was a pandemic in the near future, but at the same time, this is what we signed up for. I think that's the approach that we take and so, yes, it's challenging. I would not be telling the truth if I sometimes didn't at least pause and say what am I doing? But at the same time, this is why I've chose this, is to be able to help people.

This is why I'm an academic medicine to be at the forefront of a new illness and be able to present information and data, to help all of us get through. Yes, it's challenging and at times you do question like, what are you doing? But at no point, did I ever truly say I don't want to do medicine anymore. This is what I've trained for and I'm able to do that. I think many of us feel the same way.

Tanzina: In Columbus, Ohio one doctor is facing many of the same questions about how to stay well while carrying out this critical work.

Matthew Exline: My name is Matthew Exline. I'm a physician at the Ohio State University Wexner Medical Center. I also serve as the medical director of the medical intensive care unit. We are in a distinct second peak at our hospitals.

Tanzina: The Ohio State University Wexner medical center in Columbus, Ohio was hit with an early wave of cases in the spring, which was driven back then by prison and nursing home outbreaks in the state of Ohio. Today it's a different picture.

Matthew: What we're seeing now is larger numbers of patients and they're coming from everywhere. They're community members, community spread. There's not really a theme to who is getting admitted other than they tend to be older and with other underlying medical conditions, but in terms of where they're catching COVID, all different tons of exposure, and the numbers were probably at least twice as high as we were in the early fall and probably three times as high as we were at the low point in the early summer.

I am in the short term very concerned, on the one hand, you spend all day working and planning on how you're going to manage these patients, and then all of the ways you would unwind when you get home have been taken away. Sports here at Ohio State we weren't able to watch the Buckeyes football game last weekend because of COVID. I can't go to the gym because of COVID. I can't take my family out to a restaurant because of COVID and so it does feel like you can't escape the virus.

Tanzina: In a given week he works with COVID patients managing symptoms at home, as well as the most critically ill COVID patients in the ICU.

Matthew: There's the patients who are awake and breathing on their own and we're using a lot of oxygen to support them, and then the other group of patients are those that are really sick and they end up on the ventilator and then the frustration is obviously, they're no longer generally speaking, not awake enough to interact with us. On the unfortunate cases where the patient's not doing better, it's a real struggle because when we normally have a patient who's dying in the ICU, we really want to make the family part of the care team and really want to let the family understand what's going on and let them be with their loved ones as much as possible.

Unfortunately, COVID doesn't let that happen and so I know you've seen all the media reports and everything as families having to say goodbye over Facebook Live or Zoom calls, et cetera, but if you're on the ICU, if you're on the ventilator, you're not even awake enough and you can't have that connection of just like a loved one holding your hand and so that's strong. I think that usually some of the catharsis for healthcare worker is, even if you can't help the patient, you feel like you can help the family deal with the grief and so our nurses, our doctors, they don't even get that feedback and so I think that's a real struggle when we take care of these patients.

Tanzina: Dr. Exline says he keeps looking for ways to cultivate joy every day.

Matthew: Just judging from my friends, I was inspired to put my Christmas lights up a lot earlier than I normally do, partly because the weather was nice, partly because I was going to have to work over Thanksgiving weekend, so I wasn't going to have time then and partly just you want a little more joy in your life. With Christmas and the New Year comes new hope that 2021 is going to be better.

Tanzina: Here's to that hope indeed and we're very thankful for the medical professionals you just heard from. If you're in the medical profession, give us a call at 877-869-8253, about your experience with burnout. We'll keep listening.

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