THE NEW YORK TIMES, TUESDAY, DECEMBER 1, 2020 N + D5spurred in part by the cavalier attitudes of
many Americans who seem to have lost pa-
tience with the pandemic.
Surveys from around the globe have re-
corded rising rates of depression, trauma
and burnout among a group of profession-
als already known for high rates of suicide.
And while some have sought therapy or
medications to cope, others fear that engag-
ing in these support systems could blemish
their records and dissuade future employ-
ers from hiring them.
“We’re sacrificing so much as health care
providers — our health, our family’s
health,” said Dr. Cleavon Gilman, an emer-
gency medicine physician in Yuma, Ariz.
“You would think that the country would
have learned its lesson” after the spring, he
said. “But I feel like the 20,000 people that
died in New York died for nothing.”
Many have reached the bottom of their
reservoir, with little left to give, especially
without sufficient tools to defend them-
selves against a disease that has killed
more than 1,000 of them.
“I haven’t even thought about how I am
today,” said Dr. Susannah Hills, a pediatric
head and neck surgeon at Columbia Univer-
sity. “I can’t think of the last time somebody
asked me that question.”Dreading the Darkness of Winter
For Dr. Shannon Tapia, a geriatrician in Col-
orado, April was bad. So was May. At one
long-term care facility she staffed, 22 people
died in 10 days. “After that number, I
stopped counting,” she said.
A bit of a lull coasted in on a wave of sum-
mer heat. But in recent weeks, Dr. Tapia has
watched the virus resurge, sparking sud-
den outbreaks and felling nursing home
residents — one of the pandemic’s most
hard-hit populations — in droves.
“This is much, much worse than the
spring,” Dr. Tapia said. “Covid is going crazy
in Colorado right now.”
Dr. Tapia bore witness as long-term care
facilities struggled to keep adequate protec-
tive equipment in stock, and deplored their
lack of adequate tests. As recently as early
November, diagnostic tests at one home she
regularly visits took more than a week to
deliver results, hastening the spread of the
virus among unwitting residents.
Some nursing home residents in the Den-
ver area are getting bounced out of full hos-
pitals because their symptoms aren’t se-
vere, only to rapidly deteriorate and die in
their care facilities. “It just happens so fast,”
Dr. Tapia said. “There’s no time to send
them back.”
The evening of Nov. 17, Dr. Tapia fielded
phone call after phone call from nursing
homes brimming with the sick and the
scared. Four patients died between 5 p.m.
and 8 a.m. “It was the most death pro-
nouncements I’ve ever had to do in one
night,” she said.
Before the pandemic, nursing home resi-
dents were already considered a medically
neglected population. But the coronavirus
has only exacerbated a worrisome chasm of
care for older patients. Dr. Tapia is belea-
guered by the helplessness she feels at ev-
ery turn. “Systematically, it makes me feel
like I’m failing,” she said. “The last eight
months almost broke me.”
At the end of the summer, Dr. Tapia
briefly considered leaving medicine — but
she is a single parent to an 11-year-old son,
Liam. “I need my M.D. to support my kid,”
she said.It Goes On and On and On
For others, the slog has been relentless.
Dr. Gilman, the emergency medicine phy-sician in Yuma, braced himself at the begin-
ning of the pandemic, relying on his stint as
a hospital corpsman in Iraq in 2004.
“In the military, they train you to do sleep
deprivation, hikes, marches,” he said. “You
train your body, you fight an enemy. I began
running every day, getting my lungs strong
in case I got the virus. I put a box by the door
to put my clothes in, so I wouldn’t spread it
to my family.”
The current crisis turned out to be an un-
familiar and formidable foe that would fol-
low him from place to place.
Dr. Gilman’s first coronavirus tour began
as a resident at NewYork-Presbyterian at
the height of last spring. He came to dread
the phone calls to families unable to be near
their ailing relatives, hearing “the same
shrill cry, two or three times per shift,” he
said. Months of chaos, suffering and pain,
he said, left him “just down and depressed
and exhausted.”
“I would come home with tears in my
eyes, and just pass out,” he said.
The professional fallout of his Covid expe-
rience then turned personal.
Dr. Gilman canceled his wedding in May.
His June graduation commenced on Zoom.
He celebrated the end of his residency in his
empty apartment next to a pile of boxes.
“It was the saddest moment ever,” he
said.
Within weeks, he, his fiancée, Maribel,
their two daughters and his mother-in-law
had relocated to Arizona, where caseloads
had just begun to swell. Dr. Gilman hun-
kered down anew.
They have weathered the months since in
seclusion, keeping the children out of school
and declining invitations to mingle, even as
their neighbors begin to flock back together
and buzz about their holiday plans.
There are bright spots, he said. The fam-
ily’s home, which they moved into this sum-
mer, is large, and came with a pool. They re-
cently adopted a puppy. Out in the remote-
ness of small-town Arizona, the desert has
delighted them with the occasional road-
runner sighting.
Since the spring, Dr. Gilman has become
a social media tour de force. To document
the ongoing crisis, he began publishing
journal entries on his website. His Twitter
wall teems with posts commemorating peo-
ple who lost their lives to Covid-19, and the
health workers who have dedicated the past
nine months to stemming the tide.
It’s how he has made sense of the chaos,
Dr. Gilman said. What he’s fighting isn’t just
the virus itself — but a contagion of disillu-
sionment and misinformation, amid which
mask-wearing and distancing continue to
flag.
“It’s a constant battle; it’s a never-ending
war,” he said.Reaching the Breaking Point
Nurses and doctors in New York became all
too familiar with the rationing of care last
spring. No training prepared them for the
wrath of the virus, and its aftermath. The
month-to-month, day-to-day flailing about
as they tried to cope. For some, the weight
of the pandemic will have lingering effects.
Shikha Dass, an emergency room nurse
at Mount Sinai Queens, recalled nights in
mid-March when her team of eight nurses
had to wrangle some 15 patients each —
double or triple a typical workload. “We
kept getting code after code, and patients
were just dying,” Ms. Dass said. The pa-
tients quickly outnumbered the available
breathing support machines, she said, forc-
ing doctors and nurses to apportion care in
a rapid-fire fashion.
“We didn’t have enough ventilators,” Ms.
Dass said. “I remember doing CPR andcracking ribs. These were people from our
community; it was so painful.”
Ms. Dass wrestled with sleeplessness
and irritability, sniping at her husband and
children. Visions of the dead, strewn across
emergency room cots by the dozens, swam
through her head at odd hours of the night.
Medical TV dramas like “Grey’s Anatomy,”
full of the triggering sounds of codes and
beeping machines, became unbearable to
watch. She couldn’t erase the memory of the
neat row of three refrigerated trailers in her
hospital parking lot, each packed with bod-
ies that the morgue was too full to take.
One morning, after a night shift, Ms. Dass
climbed into her red Mini Cooper to start
her 20-minute drive home. Her car chugged
onto its familiar route; a song from the 2017
film “The Greatest Showman” trickled out.
For the first time since the pandemic began,
Ms. Dass broke down and began to cry. She
called her husband, who was on his way to
work; he didn’t pick up. Finally, she reached
her best friend.
“I told her, ‘These people are not going to
make it; these people are not going to sur-
vive this,’ ” she said. “We’re there to save a
person, save a life, stabilize a person so they
can get further management. And here I
am, not able to do that.”
Shortly after, she phoned a longtime
friend, Andi Lyn Kornfeld, a psychothera-
pist who said Ms. Dass was in the throes of
“absolute and utter acute PTSD.”
“I have known Shikha for 13 years,” Ms.
Kornfeld said. “She is one of the strongest
women I have ever met. And I had never
heard her like this.”The Sounds of Silence
Long gone are the raucous nightly cheers,
loud applause and clanging that bounced off
buildings and hospital windows in the
United States and abroad — the sounds of
public appreciation at 7 each night for those
on the pandemic’s front line.
“Nobody’s clapping anymore,” said Dr.
Jessica Gold, a psychiatrist at Washington
University in St. Louis. “They’re over it.”
Health workers, once a central part of the
coronavirus conversation, have in many
ways faded into the background. Some, like
Dr. Gilman, in Arizona, have had their sala-
ries slashed as hospitals weigh how to cover
costs.
Many have guiltily recoiled from the
“hero” label emblazoned in commercials or
ad campaigns, burdened by the death
march of the people they could not save and
the indiscriminate path of the coronavirus.
The word “hero” evokes bravery and su-
perhuman strength but leaves little room
for empathy, said Dr. Nicole Washington, a
psychiatrist in Oklahoma. When portrayed
as stalwart saviors, health workers “don’t
have the room or right to be vulnerable.”
But the trope of invincibility has long
been ingrained into the culture of medicine.
Dr. Tapia, the Colorado geriatrician, be-
gan taking an antidepressant in September
after months of feeling “everything from
angry to anxious to furious to just numb and
hopeless.” The medication has improved
her outlook. But she also worries that these
decisions could jeopardize future employ-
ment.
Many state medical boards still ask intru-
sive questions about physicians’ history of
mental health diagnoses or treatments in
applications to renew a license — a disin-
centive to many doctors who might other-
wise seek professional help.
Being on the front lines doesn’t make
health workers stronger or safer than any-
one else. “I’m not trying to be a hero. I don’t
want to be a hero,” Dr. Gilman said. “I want
to be alive.”
As social bubbles balloon nationwide forthe chilly holiday months, health care
workers fret on the edges of their communi-
ties, worried they are the carriers of conta-
gion.
Dr. Marshall Fleurant, an internal medi-
cine physician at Emory University, has the
sense that his young children, 3 and 4 years
old, have grown oddly accustomed to the
ritual of his disrobing out of work clothes,
from his scrubs to his sneakers, before en-
tering his home.
“I do not touch or speak to my children
before I have taken a shower,” Dr. Fleurant
said. “This is just how it is. You do not touch
Daddy when he walks in the door.”
A week of vacation with his family star-
tled him, when he could scoop the little ones
up in his arms without fear. “I think they
must have thought that was weird,” he said.Bracing for the Next Wave
Trapped in a holding pattern as the corona-
virus continues to burn across the nation,
doctors and nurses have been taking stock
of the damage done so far, and trying to
sketch out the horizon beyond. On the na-
tion’s current trajectory, they say, the fore-
cast is bleak.
Jina Saltzman, a physician assistant in
Chicago, said she was growing increasingly
disillusioned with the nation’s lax approach
to penning in the virus.
While Illinois rapidly reimposed restric-
tions on restaurants and businesses when
cases began to rise, Indiana, where Ms.
Saltzman lives, was slower to respond. In
mid-November, she was astounded to see
crowds of unmasked people in a restaurant
as she picked up a pizza.
“It’s so disheartening,” she said. “We’re
coming here to work every day to keep the
public safe, but the public isn’t trying to
keep the public safe.”
Since the spring, Dr. Gilman has watched
three co-workers and a cousin die from the
virus. Ms. Dass lost a close family friend,
who spent three weeks at Mount Sinai
Queens under her care. When Dr. Fleurant’s
aunt died of Covid, “we never got to bury
her, never got to pay respects; it was a
crushing loss.”
In state after state, people continue to
flood hospital wards, where hallways often
provide makeshift beds for the overflow.
More than 12 million cases have been re-
corded since the pandemic took hold in the
United States, with the pace of infection ac-
celerating in the last couple of months.
Jill Naiberk, a nurse at the University of
Nebraska Medical Center, has spent more
of 2020 in full protective gear than out of it.
About twice a day, when Ms. Naiberk needs
a sip of water, she must completely degown,
then suit up again.
Otherwise, “you’re hot and sweaty and
stinky,” she said. “It’s not uncommon to
come out of rooms with sweat running
down your face, and you need to change
your mask because it’s wet.”
It’s her ninth straight month of Covid
duty. “My unit is 16 beds; rarely do we have
an open one,” she said. “And when we do
have an open bed, it’s usually because
somebody has passed away.”
Many of her I.C.U. patients are young, in
their 40s or 50s. “They’re looking at us and
saying things like, ‘Don’t let me die,’ and, ‘I
guess I should have worn that mask,’ ” she
said.
Sometimes she cries on her way home,
where she lives alone with her two dogs.
Her 79-year-old mother resides just a cou-
ple of houses away.
They have not hugged since March.
“I keep telling everybody the minute I
can safely hug you again, get ready,” she
said. “Because I’m never letting go.”Covid Combat Fatigue Takes a Heavy Toll
CONTINUED FROM PAGE D1Mount Sinai Queens in New York. Shikha Dass, an emergency room nurse there, is haunted by the memory of a row of refrigerated trailers in the hospital’s parking lot, each packed with bodies that the morgue was too full to take.
KHOLOOD EID FOR THE NEW YORK TIMESCORONAVIRUS IN DEPTH