Still of MUMC footage
On the psychological needs of healthcare workers
The many deaths, the family that is not allowed to visit, all this has left its mark on doctors and nurses. At MUMC+, the so-called psychosocial team keeps a close watch on the healthcare workers. “Society can applaud for you as hard as they can but, in the end, it comes down to the support from your colleagues.”
It is 1:00 hrs on corona ward A1. Nurse Marith Cimmermans (25) walks into a four-bed room and hears one of the corona patients say that he is not feeling very well. One hour ago, the man was asleep, no peculiarities. Now he has a grey sheen over his face. Cimmermans ascertains that the patient has a fever of 39.7 degrees, and that the oxygen level in his blood has dropped to 83 per cent.
After consulting the internist, she takes an extra blood sample and does an ECG. The man improves slightly but is still gasping for breath. Cimmermans places an oxygen mask on his face and phones the internist again, who arrives within one minute. The Emergency Intervention Team is also contacted; they assess and treat patients upon request from the nurses.
When she, another nurse and an internist are standing around the bed, things go awry. Oh no, Cimmermans thinks, there he goes. The adrenaline shoots through her veins, she tries to attach a second drip, but it is too late. The man dies as she works on him. This all happens within fifteen minutes.
Cimmermans, in her first week on the corona ward, has hardly gotten over the shock when she suddenly realises that the three other patients have heard everything from behind the curtain. She checks on them and hears the fear in their voices. They are terrified that the same fate awaits them too one of these days. They won’t be able to sleep that night. Cimmermans immediately informs the mental healthcare providers.
In the past, when A1 was mainly for oncology patients, people died too, but not so fast and not so often as now. Patients also die alone more often. “It has happened a few times already that I found patients dead in bed.”
On the whole, Cimmermans is doing well, she says. Although she has put herself on a strict news diet. She watches the News once a day, for self-protection. It is corona this and corona that, she doesn’t want to be constantly reminded of it.
And “switching off” is of vital importance, says psychologist Jeanette Dijkstra, head of the psychosocial team, which supports the MUMC+ employees emotionally and psychologically. The team was created in the middle of March and consists of psychologists, social workers, mental healthcare workers and members of the business support team.
“In the case of this switching off, it is important that supervisors lead by example, not sending schedules out in the evening for the next day. Preferably, one diverts oneself at home, pick up a book or go and exercise.”
The psychosocial team is present three times a day, when the doctors from internal medicine and lung diseases hand over; after that, the team holds small-scale group sessions with those who have finished a shift. They talk about what they have been through so that they can turn work off when they head home. The team is also present for the handover after a shift on the corona ward; in those meetings nurses are given the opportunity to tell their stories as well.
Those who are at the end of their tether, may request an individual session, but such meetings are rare. So far, about fifteen employees have asked for help, says Dijkstra. “Usually these are people who were not feeling one hundred per cent before the corona crisis. They include doctors, nurses but also cleaning and catering staff. A cashier was so afraid of becoming infected that she reported sick.”
Nurses often struggle with the strict visiting regulations, which say that only two members of a family may visit a corona patient. Cimmermans: “Normally, we put an extra bed in a patient’s room and the family can keep vigil. Now, the moment of saying farewell has to be planned. Without knowing when your loved one will die, which could be the same evening but just as easily a week later. They will at any rate not see the patient again.”
It brings to mind a patient who was brought in with stomach complaints before the crisis. “He had such bad luck, with one post-operative complication after the other. Then, he also caught the corona virus. In the end, there was nothing left of him, completely drained, physically as well as mentally. I remember at the parting that one of the family members fell to her knees from despair. Very intense.”
Dealing with families also provides a lot of “moral stress” for the doctors, says intensivist Nathalie van Dijk. “It is a constant compromise between safety and humanity. I have had a lot of contact by telephone with a woman from the north of the country, whose husband was in the IC in Maastricht. She cried her eyes out and was very worried. The situation didn’t improve, and in the beginning, she was phoned by a different doctor each time. You want to provide humane care, so I allowed this woman to come and visit.”
For who do you and don’t you make an exception? “Some relations understand the situation and are satisfied with video calling. Others just can’t handle it, and as a doctor you sometimes also become emotionally involved. I once allowed two family members to visit a patient who was about to be put on a ventilator. I told them that this was possibly the last conversation they would have. In those ten minutes, one of them filmed the conversation which was then sent to the family. They were extremely grateful, also because the patient never regained consciousness.”
Van Dijk had sleepless nights when a shortage of IC beds threatened and code black was imminent. “Then you would, so to speak, have to refuse everyone over seventy. I was really afraid of that. Fortunately, I have a safety net at home, my husband is also an intensivist. I was able to unburden myself to him.”
In the meantime, the number of patients in the IC is dropping and everyone has more room to breathe, says Van Dijk. But be aware: a new wave of postponed care is waiting. “This, while IC employees are at the end of their tether and in need of rest, but are they going to get it? It is a moral dilemma. The anaesthesiologists, the anaesthesia and operating assistants have been on the go continually in the IC; will they have to immediately continue on with all those operations?”
Then there is the danger that the corona virus rears its ugly head again, creating a new wave of patients. It wouldn’t surprise her if many healthcare workers will then collapse. “I am thinking in particular of the nurses who have been working on the wards around the clock. Doctors have more control over their agendas and have more freedom, which makes life easier. With the nurses, it is even more important that their supervisors pay attention to their needs and wishes. Society can applaud as hard as they can, which is much appreciated, but in the end, what matters is the support from your colleagues.”