An Emergency Room Doctor On The Mental Toll Of One Hell Of A Year
2020 has been one of the most challenging years for our generation in recent memory; between the Australian bushfires that killed over 500 million animals, to the current pandemic that has infected 10 million people globally, to the social unrest over the senseless killing of George Floyd and the ongoing crisis of racial violence and police brutality that his death reminded us of, not to mention the economic fall out of the Coronavirus and the financial recession that has found many without any income, hope or housing.
It’s hard to properly measure the impact these events have had on our mental health, which is why I wanted to talk to a healthcare professional seeing patients everyday, and get their experience.
Māori doctor Terrillian Hui is an Emergency Medicine House Officer working at the Auckland City Hospital. These are her personal opinions, based on what she has viewed or experienced at her place of work.
What does your current day-to-day look like in level 1 here in Aotearoa? What kind of patients are you typically seeing? Has it returned to “business as usual”?
Our patients range from stable walk-ins to unstable patients who require cardiac monitoring and admission. An example of a patient requiring admission might be a 70 year old patient who presented to hospital after a collapse and has significant risk factors for cardiac disease (e.g. high blood pressure, elevated cholesterol, previous heart disease, smoker etc.), any patient who is septic (e.g. a young patient with a fever and sweats, with certain types of abdominal pain), or an elderly patient who presented confused with a fever, possible pneumonia or urine infection, which has created sepsis in the body and requires intravenous antibiotics. I review patients in the emergency department, investigate with blood tests and radiology if required, and then determine if the patient is admitted into hospital or discharged home.
Every day is different in the ED, and we are accustomed to seeing a range of illnesses and injuries, including patients presenting with symptoms of anxiety and depression, often with presentations of self-harm or suicidality. I have noticed that since the start of the pandemic patients tend to be presenting later to hospital with their symptoms, for fear of burdening the health system, and fear of catching other illnesses (particularly Covid-19). Often this is the view of many of our elderly patients, which is frightening as these are some of our most vulnerable patients. Sometimes we see patients presenting to ED after many days of putting up with their symptoms as they are self-employed or unable to take extra days off work due to the lockdown period putting such a financial stress on their business or family.
It definitely is back to “business as usual” although the logistics of patients in the department is slightly different now; every patient is screened to determine their Covid-19 risk – even a simple case of sore throat can mean that the patient is isolated into their own room, even if they have no known Covid exposure or travel history. Overall there is greater care taken with these patients, but also an increased anxiety surrounding their care. Not only do we care hugely about our patients’ safety, but we also care about our personal safety and the safety of our families. During the lockdown, some of my colleagues were asked to leave their flat as their flatmates were concerned about them “bringing home Covid”.
The coronavirus pandemic has put most countries on the verge of another health crisis; with daily doses of death, isolation and fear generating widespread psychological trauma. I’ve been thinking about this a lot in terms of how it pertains to our generation – both in terms of the economic fallout of another recession, and how triggering it is to constantly see so much devastation on our social media feeds. In your professional experience, has there been an uptick in the number of patients presenting with symptoms of mental health challenges?
It’s hard to comment on exact numbers, but I think what’s really evident is that the general population have been mentally impacted by the pandemic. We screen every patient for social aspects surrounding their employment, living situation, family/friends, alcohol and drugs, and nearly every patient that I assess comments on the effect the pandemic has had on them personally. For the working population, some patients comment on delaying their ED presentation due to their need to be working and providing for themselves or their family. A lot of people have commented on recent unemployment and the stress this has had. Many patients are waiting on accommodation from Housing NZ; I have had a 30 year old student living in a friends garage while she waits for social housing, and a single mother of three suffering from severe anxiety who is in emergency housing while she tries to find a rental property in Auckland that she can afford, that is warm and dry enough for her asthmatic son. For these patients, the wait times feel never ending.
Patients who have historically relied on social services prior to the pandemic are now presenting to hospital feeling overwhelmed, isolated and helpless due to the slowing of their services and the support they provided; imagine the patients who were being reviewed weekly by a support worker for something like depression or an eating disorder, and suddenly this service has been reduced or stopped providing 1-on-1 support. Then there are the patients who had been waiting for a detox service like CADS (community alcohol and drugs service) and now the waiting list has been prolonged due to the lockdown. I have had people present to ED begging for help, particularly for detox services. Unfortunately these services already had very large waiting lists, and they are now even larger.
For those who have exhibited symptoms of anxiety or depression, what common themes have you noticed and what sort of advice have you been giving out in terms of seeking support?
I think the coronavirus has exacerbated people’s general anxiety, or worsened patients paranoia. Common themes include unemployment, financial stressors (rent, mortgage), the increase in winter-related illnesses like asthma, particularly when it relates to families waiting for social housing, and concerned/helpless parents with children at high risk for these illnesses.
From a medical viewpoint, I always advise my patients to enrol with a GP. If they have a GP but do not feel listened to or don’t have a good relationship with their GP, I encourage them to ‘shop around’. Having a good GP is a key person in each person’s community. I think this is particularly important for patients who are discharged home from hospital, and will continue to have anxiety, life stressors and mental health concerns. Managing these issues is multi-faceted and often you will require a health professional to review you multiple times in the short term. GPs also have the ability to refer to community mental health services, including counselling, psychologists etc. Some people may be eligible for funded counselling services too, so your GP can advise on this.
On a personal level, what has your mental health been like in recent weeks with everyone you’re seeing on your feed and online, and how have you been taking care of yourself?
I have had some personal life stressors currently, but I have a great partner and family who support me. Personally I have a lot to be grateful for. I think being able to work throughout the pandemic has been a real privilege and, despite the angst, I am really grateful to be able to be working and helping people at their most vulnerable.
I am trying to stick with the basics of drinking plenty of fluids (I aim for 1-2 litres daily), walking daily and getting adequate uninterrupted sleep (ideally eight hours). We are having a lot of sick calls at work, which is what we usually see going into the winter period due to sickness and burnout. Often when colleagues call in sick, there is no additional cover provided so this means that the remaining staff have to work harder, longer and thus get burnt out a lot faster too. While we are often encouraged to cover these shifts, I think it is really important to keep time for myself and prioritise the wellbeing of myself and my family.
With everything going on in the world, I see this is a great opportunity for us to learn, to self-reflect on our personal biases and to have a proper look at our own Kiwi “backyard”.