First-responder anxiety rises with a second coronavirus wave
YONKERS - It doesn't take much to put Cathy Hopkins right back into the worst of the first coronavirus wave.
Just a mention and she's back behind layers of protective gear in the standing-room-only intake tent outside St. Joseph's Medical Center.
She's navigating a bumper-to-bumper ambulance bay, walking emergency-department halls clogged with gurneys of the sick and dying, with monitors signaling the last heartbeats of 11 patients on her first Saturday shift.
Hopkins shivers at the memory and her eyes brim with tears.
"Ooh, it comes all back, doesn't it?" she said, taking a deep breath. "I lost a part of my life in there. I think we all did. It was just a blur. It was going home, getting up and going back to work again."
For months last spring, on that work-home-work-home treadmill, work meant encountering death on a scale she'd never seen; home meant not having the energy to talk to her family about what she was going through.
Like other first-wave first-responders — EMTs, police and fire, doctors and nurses — Hopkins, a nurse practitioner who is now director of employee and community health at St. Joseph's, ran on adrenaline for months, only coming up for air when the curve at last began to flatten.
That's when Sharee Skalsky and the Westchester County Behavioral Health Response Team began to see their first wave: COVID first-responders seeking help.
"May was a rough month because that's when everything started, it seemed, to catch up to people, their feelings, what they've experienced," Skalsky said. "Numbers were kind of coming down at that time, so they actually had time to sit and think about what had just happened."
'My worst day is their every day'
Those thoughts brought them to Skalsky, program director at the St. Vincent’s Behavioral Health Center, on East Post Road in White Plains.
The center is affiliated with White Plains Hospital, which is a couple of blocks away. It is part of St. Vincent’s Hospital Westchester, on North Street in Harrison, which is a division of St. Joseph’s Medical Center, in Yonkers.
Skalsky said there are warning signs of stress that first-responders and their families should be on the lookout for:
- An inability to sit still;
- An inability to even move.
If those stresses are getting the better of them, if they're not sleeping or if they're having nightmares related to their COVID experiences, first-responders — including those whose work culture frowns on seeking help — should seek professional help. (Reach the Westchester County Crisis Prevention and Response Team at 914-925-5959.)
"We're seeing nurses, doctors, police officers, firemen and EMTs, the whole full gamut of first-responders," Skalsky said. "We're seeing mental-health professionals, as well."
Early in the first wave, Skalsky said, the ground was constantly shifting under them.
"Especially March, April, May, it was so much unknown. It was just heightened anxiety constantly because of constantly changing regulations. They'd walk in every day and (the state Department of Health) had new stuff.
"They never knew what they were walking into, just with laws and regulations, not even patient care, dwindling supplies of PPE, as staff got sick, having to work longer hours, cover shifts. All of those things really wore people down."
And it wasn't just doctors and nurses.
"A lot of times, the first ones on the scene — EMTs, firefighters and police — they would end up getting sick. It's not just specific to nurses and doctors in the trenches. It applied to them, as well."
Outreach to police, fire
First-responders have untold reservoirs of resilience, she said, but COVID has put that to a test.
"EMTs, police, firemen, my worst day is their every day, that's what they see," Skalsky said. "They're seeing a tremendous amount of grief, loss, pain. Especially with COVID."
Skalsky knew the virus had the potential to do a number on stoic police and firefighters, whose culture tends to shy away from sharing their feelings. In the first weeks of the pandemic, in March, she set up presentations at police and fire companies, to put them on alert for warning signs within their units: "Irritability, anxiety, inability to sit still or inability to even move."
The driving factor was COVID, but Skalsky knew the grim statistics:
"More firemen die by suicide every year than by fire," she said. "Thirty percent of first-responders have PTSD once in their lifetime; 37% have contemplated suicide. The pandemic just pushed it to another level."
There has been a steady stream since May, Skalsky said.
"We're hearing a lot of guilt and self-doubt, balancing the personal responsibility to the patient but at the same time trying to protect themselves and families," she said.
"We've had plenty of staff, first-responders say to us: 'It was really hard for me. This patient was holding on to me crying, "Don't leave, don't leave, don't leave." But it had already been 20 minutes and I was terrified I needed to leave the room because of exposure.' "
Unpacking those complicated emotions is best left to professionals, she said.
"I don't think people should be doing this on their own if they have anything more than just post trauma reactions," she said. "If you're starting to get into nightmares and sleep disturbances and stuff like that, that's not a do-it-yourself kind of situation. You can exacerbate your symptoms."
For Hopkins, who was pulled into all-hands-on-deck COVID duty at St. Joseph's from her normal assignment running Yonkers in-school clinics, the memories have already started to dim.
"Part of me, in looking back, thought 'Maybe I should have done a journal,' because you can't remember what you've been through. I think part of it can be protective."
Skalsky is wary of journals, in some cases.
"I always suggest do not do any kind of narrative writing or journaling if you're having extreme reactions while you're doing it, unless you're under the care of a professional," she said. "We help reconstruct that narrative so that it lessens the intensity of the memories and the reminders, or triggers. While you're doing that, you're doing relaxation skills."
Hopkins' better memories are those involving personal connections with the sick, including a colleague, a nursing supervisor whom she did not know well.
"The nurse stepped out and I went in. There was nothing I could do for her, but I held her hand. And she said to me months later, 'You don't know how often I tell my family members that you just held my hand.' Here I felt inadequate and the only thing I could do was hold her hand. And that was what she needed at the time."
"I touch people. If I can't go in and hold the colleague's hand who's so sick, then what's it all about?"
A rising second wave
As first-responders continue to process the first wave, a second wave appears to be rising.
Last week, infection rates were rising nationwide, with at least 10,270,000 confirmed cases and at least 239,000 deaths.
New York has had 536,145 cases, with 33,707 deaths as of Wednesday, Nov. 11.
"We have about eight or nine patients now in the hospital who are COVID positive," Hopkins said. "There was a time we didn't have any patients there. Could we be back where we were a few months ago? Absolutely. That's what all the literature, all the experts are saying."
These latest patients aren't as critically ill as those in the first wave, when St. Joseph's opened a second ICU for critically ill, intubated patients.
"The patients we're seeing now don't seem to be as critical. Maybe that's because of the mutation, the changes that have gone on with the virus," Hopkins said. "We don't know."
What they do know is that the wave is rising just as flu season arrives.
"You come in with the flu, well, that sounds very much like COVID. So now we are mandated to not just do a COVID test, but we have to test people for flu. So instead of two swabs in each nostril, we're doing four now."
Then, with a smile, she said: "I bring grown men to tears, let me tell you. They start sneezing and tearing and everything."
In touch with emotions
Knowing what to expect doesn't make it easier emotionally.
As hospitals across the region begin what's called "surge prep," looking at best practices and reviewing procedures in anticipation of that expected wave, those discussions could trigger issues lying dormant.
As what she's feeling as the wave arrives, if it's dread or fear or some other emotion, Hopkins said: "It's not fear so much. It's the anxiety of it all."
She's also anxious for her family, including her daughter, Megan, expecting the family's first grandchild.
"It should be a wonderful, happy, joyful time, and I'm like, 'Whoa! What does this mean? What does it mean for my daughter and my son-in-law?' "
Skalsky listened to Hopkins, nodding along.
"She should react the way she's reacting," Skalsky said. "That means you're in touch with your emotions about it. You're not avoiding them because avoiding them is what leads to acute stress disorder, which is a precursor to PTSD. The more you avoid, the worse it's going to be."
Being in touch with your emotions, she said, means recognizing when they change, which is not easy.
"Trauma progresses very gradually. Most people don't notice it, especially when you're in the grind, when you're on the ground and in the trenches like that and it's just 'Go, go, go. Get the job done. Get the job done, get the job done.' You don't notice these little things creeping in."
Skalsky's clinic has been doing consultations, face-to-face evaluations to assess first-responders, hoping to identify "post-trauma effects" before they worsen into clinical symptoms.
If reached early, she said, the treatment can be much shorter, sometimes four or five sessions "to untangle the memories and put it into context that's healthier or more constructive and positive and realistic."
A second wave could easily bring a return of those old feelings, and a need for a refresher wave of support, Skalsky said.
"We've even had some that have come back because, although they were doing extremely well, now they've been triggered again and there's this anxiety hanging over their head. They come back just to make sure that they have the appropriate skills to be able to deal with whatever is thrown in their laps."
Cathy Hopkins appears to have those skills, but those searing memories are there at a mere mention, and the tears they trigger are real. It has the 65-year-old wondering if she can do what she might be called on to do again.
"I really have to be honest with myself: Do I have the stamina to do that all again?" she wonders.
Then she answers her own question.
"I mean, if it needs to be done, it gets done."
Listen to Catherine Hopkins describe life in the St. Joseph's Emergency Department during COVID first wave
If you need help
Reach the Westchester County Crisis Prevention and Response Team at 914-925-5959.
At the height of the COVID storm
Cathy Hopkins was looking down the barrel of the coronavirus gun in April, when she talked with The Journal News/lohud about her long days in the Emergency Department and ICU at St. Joseph’s Medical Center in Yonkers.
On the triage tent: “When we opened that tent, it was standing-room only. We were doing about 100 to 150 on a good day. We didn't have enough chairs.”
On her first Sunday in the Emergency Department, when 11 COVID patients died: “I've just never seen death like that. I've never seen anything like it."
On the separation of families: “To literally say goodbye to your relative, your loved one, as they're leaving in the ambulance and not know whether you'll ever see them again, it's just heart wrenching,” she said.
On the layers of PPE: “I don't like it because when I see patients, I look at their non-verbals, I look at their facial expressions and they're doing the same with me. The only thing they can see are my eyes. And although the eyes can be the windows of the soul, it's hard. I think it's harder to express the empathy and the sympathy and the compassion we want to get across behind all the garb we wear.”
On personal connection: "When I stop connecting, I might as well just go home and call it a day. To me, that's what it's about. That's the beauty of the nursing profession, my profession. I make relationships."
On the bright side of the first wave, Take 1: “You hit the door running and you leave kind of dragging, but it does make the time go fast.”
On the bright side of the first wave, Take 2: “I get in all my steps. I think I did 6 miles one day, just running around the hospital.”
On the grief: “There just aren't any words to explain what people are going through right now.”
On helping a son have a final chat with his dying mother: “We called him and said, 'OK, we're putting the phone up to your mom's ear.' We removed her oxygen cannula and the mask she had on and she could hear him. We don't know what he said, but I'm sure it turned out to be his last words to her. That's probably one of the most significant things we've done through this whole thing."
On worst and best: "There really are no words for what we're experiencing right now, everything from devastation to the best of mankind. And I can't go home and explain it to my husband. It would take too much effort.”
Peter D. Kramer is a 32-year staffer at The Journal News. He can be reached at email@example.com or on Twitter at @PeterKramer. Read his latest stories. Please follow the link on the page below and become a backer of this kind of coverage. It only works with you as a subscriber.