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RHITU CHATTERJEE, BYLINE: About a year ago, when the pandemic hit the United States, Dr. Arghavan Salles was working as a researcher at Stanford University. Salles is a surgeon but wasn't practicing medicine at the time. But seeing the need for more doctors in New York City, she flew there in April of last year to volunteer her time at a hospital working in the ICU.
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CHATTERJEE: Now, remember spring of 2020. It was still the early days of the pandemic. And New York was the first city in the United States to be hit so hard.
ARGHAVAN SALLES: All my feelings and thoughts were dominated by far by the people dying.
CHATTERJEE: There wasn't much in terms of treatment for COVID-19 at the time. And the number of people getting hospitalized and dying was climbing fast.
SALLES: Almost every day for almost every patient, I'm calling saying there is no improvement. And maybe things are worse.
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CHATTERJEE: Right from the start of the pandemic, health care workers have stepped up beyond what many of them were trained to do. So to say that this past year has been stressful for them is an understatement.
SALLES: For me, I think it's mostly been anxiety. I think that I've had, definitely, tendencies toward depression. And I have seen a therapist in the last six months or so.
CHATTERJEE: A recent poll by the Kaiser Family Foundation and The Washington Post found that about six in 10 health care workers are struggling with mental health issues as a result of the stress of the pandemic. More than half say they're burnt out, which is a response to chronic stress at work.
SALLES: One of the things that has come out of my time in the ICU has been a need for more connection with people. I think when we see people dying every day, we need some reassurance that there is life.
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CHATTERJEE: So today on the show, we talk about burnout among health care workers, what it looks like and what it's doing to the mental health of doctors and nurses. We'll also discuss how institutions can address it. I'm Rhitu Chatterjee. And you're listening to SHORT WAVE, the daily science podcast from NPR.
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CHATTERJEE: Now, Dr. Salles, when you think back about your time in New York City around this time last year, what do you remember most vividly?
SALLES: Probably what I remember most is the feeling of disruption and disturbance and instability, you know, the uncertainty of everything that was happening at that time. You know, none of us knew whether we were going to have these lockdowns for a couple of weeks or a couple of months or a couple of years. We definitely had no idea how many people would be dying in the coming months. We didn't know how long New York City itself was going to be overrun.
CHATTERJEE: And what about your time in the hospital, in the ICU?
SALLES: Yeah. In the hospital, the main thing that really struck me then and continues to strike me now is the huge volume of people who are dying or have died.
SALLES: I'd never seen so many people for whom we couldn't really do a lot. And what I was really struck by, even in my first day or two in the ICU in this setting, was that many of the patients already were getting the maximum therapy that we had to offer. And yet they still weren't getting enough oxygen in their lungs. Or they weren't getting enough carbon dioxide out of their lungs. Or, you know, we couldn't treat them. We basically had no effective treatments.
CHATTERJEE: And what do you remember feeling at the time seeing this?
SALLES: The feeling that I had at that time was just an immense sadness that - for the suffering, for the suffering of the families, for the suffering of these patients and for the health care workers. The people I was working with were all amazing people. And they had colleagues also who were in the ICU or dying and had to just still show up for their shift in the ICU even though they were dealing with personal tragedy as well.
SALLES: And there was no space for them to have conversations with either other physicians or a therapist or anyone to really debrief or process what was happening. It was just death and dying all day and then come back and do it again tomorrow.
CHATTERJEE: In the days and weeks while you were doing the work, you know, what did you find yourself doing then with kind of the sadness and the death and the difficult family conversations that you were having?
SALLES: Well, I didn't really have a good process. I mean, I did find myself crying frequently, maybe not every day, but every other day or something like that.
SALLES: And then, I think, at home, you know, once I would leave the hospital, I would be reflecting on the awful things that happened. And sometimes I would write about it. Sometimes I would just turn on Netflix, you know, something...
SALLES: ...To try to take my mind off it.
CHATTERJEE: And what aspects of sort of the burnout experience have you experienced?
SALLES: Yeah. For me, I think it's mostly been the emotional exhaustion that just - it feels like there's not more that I can give, you know? And so - you know, with these conversations that we have with family, often, especially when things aren't going well, the person on the other end of the line is crying. And I'm a...
SALLES: ...I tend to be a pretty empathetic person. So that makes me cry. But I am supposed to be the strong one for them. And it's not about me, which is totally true. So I'm, like, crying and hiding the crying over the phone until I can get off the phone. And then I cry, you know? And at some point, you have to try to put up some kind of wall because I can't ride that - we can't ride that roller coaster with every single patient and every single family, every single day, or else we'll have nothing left at all, you know? We'll be a shell of a person.
CHATTERJEE: So you've just described sort of two elements of burnout - right? - the emotional exhaustion and kind of the distancing from the people that you're dealing with at work. And, you know, work-related burnout, as we know, also increases people's risk for mental health problems like anxiety, depression, substance abuse, suicide. What are you seeing and hearing among your colleagues?
SALLES: Yeah. I think that people feel like they're not able to be there for patients in the same way that they would like to be because they have just been putting themselves out for so long. Like, they just can't be as emotionally available as they...
SALLES: ...Might have been in the past. And I think that people also feel that with their families. Like, they're not able to be who they want to be with their families even because of the stress of the job and the burnout that they're experiencing. And so I think it's just been, you know, definitely the most challenging time to be a doctor in my lifetime. And I don't know where it goes from here, you know? Are we going to have...
SALLES: Let's say, six months from now, are we going to see a huge wave of physicians and nurses and maybe other health care workers leaving health care? I think it's possible.
CHATTERJEE: Wow. We should mention that burnout was a problem among doctors and nurses even before the pandemic hit, right?
SALLES: Yeah. I mean, for sure. You're absolutely right. We've had a huge problem of physician wellness prior to the pandemic. So it's basically we were already in a state of emergency. And then we added the biggest stressor anyone could have ever thought of, which is this pandemic.
SALLES: I think people, fundamentally - and this is all humans - need to feel valued. We need to feel like we're doing work that is meaningful in some way. And we did not get it with the pandemic despite all this talk of heroes or whatever. When at your local hospital, you are working more, having benefits taken away, it's hard to feel like you're valued. When you raise concerns about working conditions, having too many patients on the service - meaning too many patients for one team of doctors to take care of - and you're told to suck it up, you don't feel valued. When you make really hard decisions about access to limited resources, like who gets a ventilator and who gets the dialysis, and then you're not supported by those administrators, you do not feel valued.
CHATTERJEE: And not feeling valued and not getting positive feedback has - you know, we know from decades of research that is one of the main contributor, besides sort of just sheer workload, that contributes to burnout.
SALLES: When you feel really devalued and the work that you're doing is really hard, it's - the sense of personal accomplishment is pretty low. Burnout is a consequence of a system that puts people in a situation that is not sustainable, that is too taxing. And then the outcome of that system is burnout among the individuals.
CHATTERJEE: Yeah. Is there a recognition among hospitals, institutions, that the workforce is so badly burnt out? And are they doing anything about it?
SALLES: You know, I think that we have seen some - even prior to the pandemic, there were some institutions and places that were recognizing this challenge and hence started some workplace wellness programs. And there are even some institutions that have hired chief wellness officers. But so far, I think our sense, as a - you know, I'm speaking just broadly for the physician community for just a moment. I think our sense on the whole is that these efforts have not been effective. You'll see people lashing out about yoga and meditation are not going to fix this problem. And mindfulness is great, by the way. And meditation is great. And I love yoga. It's not a hit on any of those.
CHATTERJEE: But they're not going to solve the systemic issues that you were referring to.
SALLES: Exactly. And so I think people feel like it's a lot of lip service. And then during the pandemic, I think we've seen places put up signs thanking health care workers. We've seen people giving out shirts, which, again, are not bad things to do. But they are wholly insufficient. What people need is time to be away from work. They need, probably, therapy. And they need compensation. And they need to feel valued.
CHATTERJEE: Yeah. So you mentioned some potential solutions. But are there things that - sort of near and long-term solutions to address this so that you and your colleagues in the health care workforce can recover from the burnout and kind of come back to jobs that they, you know, love and are able to give all of themselves to it?
SALLES: Yeah. That's a million-dollar question. There's huge pressure to keep seeing more patients. So they're trying to address, you know, basically, every health care problem in a 15-minute visit, which is absurd if you think about it. I think we have to adjust what our expectations are of a normal workday and a normal workweek because, right now, we're expecting them to be robots.
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SALLES: Like, just work all day, every day and take on all the pain and suffering of everyone you're seeing and just keep on going. No big deal. And the thing is, it is a big deal. And we cannot do that because we are human. As much as we - I mean, I wish I could be a robot just, like, truck ride along. But I'm not.
CHATTERJEE: Thank you, Dr. Salles. I so, so appreciate this and your being willing to talk about your experiences, but also what your colleagues are facing. Can't thank you enough.
SALLES: Oh, thank you.
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CHATTERJEE: This episode was produced by Rebecca Ramirez, edited by Gisele Grayson and fact-checked by Rasha Aridi. Josh Newell was the audio engineer. I'm Rhitu Chatterjee. Thanks for listening to SHORT WAVE, the daily science podcast from NPR.
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