Why COVID is so emotional for physicians [PODCAST]

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“These encounters made my evening shift much more emotional than usual. I am still not sure what it was exactly that evoked such strong feelings of sadness. Was it having a patient who was a health care worker? Was it the rapidity in which all three patients’ conditions deteriorated? Was it realizing that without timely, expert care, all three would die very quickly?

Or, was it hearing people wanting to relax the measures and not wear masks, without insight into how quickly things can go wrong and end up deadly?

Or, was it the cost of empathy, and just feeling the pains of my patients way too deeply?

Or, was it talking to the family members of patients and trying to answer their many questions: How will it be in the ICU? Will it be lonely? Can you please let us visit? Just one time? What can we expect? When will they recover?

Or, was it my inability to answer some of these questions? My lack of a crystal ball? Or, was it being already emotionally exhausted from managing everyday challenges of keeping life as normal as possible, with remote learning, running a household, and helping elderly in-laws with lots of medical, emotional, and personal needs?”

Jasminka Vukanovic-Criley is a hospitalist and can be reached on Twitter @criley_md.

She shares her story and discusses her KevinMD article, “The emotional side of being a doctor during the COVID-19 pandemic.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Jasminka Criley. She is a hospitalist, and she wrote the KevinMD article “The emotional side of being a doctor during the COVID-19 pandemic.” Jasminka, welcome to the show.

Jasminka Vukanovic-Criley: Thank you, Kevin. Thank you for having me on your podcast. Thank you also for all the work that you do and for giving a voice to all of us physicians. It is great to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Jasminka Vukanovic-Criley: Yes, sure, I would be happy to. I am an internist and hospitalist. I’m also an associate clinical professor of medicine at UCLA School of Medicine, and I’ve been teaching there for over 13 years. I wanted to be a doctor since I was nine. I went into medicine and finished my medical school in Croatia. I did research at Hopkins and my internal medicine residency training at Vanderbilt. I’m very grateful for the amazing education and training that I got.

After residency, I went into hospital medicine with a plan to do it for about a year or two, but I loved it and have been doing it for over 20 years. Over the past year, I had the honor and privilege to take care of many patients. In addition to clinical roles, I also had a lot of leadership and administrative duties. I was director of inpatient teaching services, the hospitalist program, research, and medical clerkships, and associate residency program director. So there were very wonderful experiences along the way. I worked in both private practice and academic settings.

Kevin Pho: All right, let’s transition into your KevinMD article, “The emotional side of being a doctor during the COVID-19 pandemic.” Now, for those who haven’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Jasminka Vukanovic-Criley: That article was one of those mysterious things. I did not plan to write it; it came out naturally. I love writing, and I wish I had more time to write the things I want to write about, but I didn’t necessarily plan to write this one. It just came out, and I didn’t know why. Now, thinking about it, I think it was the result of lots of things accumulating over the months and preparing me to write the article.

Just to give you some background on what was happening at the time: Globally, we were in the midst of the pandemic. I was in contact with my colleagues all around the country. Some of them had an absolutely horrific time taking care of COVID patients. Some of them didn’t have enough PPE, and they were concerned for their own safety. There were a lot of people dying, some prematurely and unnecessarily, actually most of them. So that was really, really sad. Luckily, some of my colleagues, more than others, were concerned about their own and their family’s safety, and also, initially, about the lack of PPE.

I do have to say that our local community has been wonderful. People were very supportive, and they were offering to make masks and face shields. One of our sons even got hold of a pattern that people in the community were using to make face shields at home. So he ordered all the parts and assembled them all together. Some of the parts took weeks to arrive, but after he assembled them, he delivered them to local health care workers and also to teachers. He even shipped some to Texas, to one of his former science teachers who had moved to Texas. So that was some of the background.

In terms of working in the hospital, as we all know, the procedures and routines changed. It took much more to start work and also to end your work, because we needed to keep patients and health care workers safe, and also each other safe. So it took extra time. At home, I created a hot spot for everything hospital-related, to make sure my family was safe. One of our colleagues unfortunately got COVID early on, and that was unfortunate, but it was also scary for everybody and made everybody much more vigilant about the procedures.

Another thing that affected me, too, was learning about Dr. Lorna Breen’s death. A colleague of mine trained with Dr. Breen, and that story was so tragic. She died from suicide. When that happened, my friend posted, “Her heart was as big as her smile. Her smile was as big as her heart.” That was so, so heartbreaking. I felt her pain deeply. I didn’t know her personally, but my heart went out to her friends and to her family. That was just one more example of MDs burning out and not seeing any light at the end of the very, very dark tunnel.

So that was some of the background that led to the evening shift, which inspired the piece I wrote. What happened on that evening shift is that I had three ER pages for patients who were short of breath, and they all needed ICU admissions, and they all needed to be intubated shortly thereafter. I had other admissions, too, to the PCU and other floors, but three admissions, three sick patients in a short period of time that evening, was just way too much.

In addition to people being sick, I was also being asked lots of questions by both patients and families. Patients were asking me things like, “When can I go home?” or “Can I leave tomorrow?” I was trying to be cautiously optimistic, but I was also realistic, knowing that things might get worse before they get better, and that is exactly what happened. On the family side, family members were asking questions about letting them stay with their loved ones. I wish I could do that, but I couldn’t. We had to keep everybody safe, and it just wasn’t safe for anybody.

So my ability to empathize with the patients and their loved ones, to understand their fear and their concerns, knowing that they were very afraid of the afternoon, it was all real. All of this put together, my patients’ presentations, their questions, family requests, and concerns, all of this accumulated and made things very, very hard.

Another thing I have to mention is that one of my patients was a health care worker. She worked in a nursing home, and this is where she contracted COVID. As you know, at the time, more than 1,700 health care workers died of COVID. Some of them died because they didn’t have enough PPE, and that is very sad, especially in this great country that we have here. So it was really, really sad.

Another thing I wanted to mention is the importance of empathy and compassion. Empathy and compassion are great clinical skills. I have a lot of empathy and compassion. That is who I am, and this is how I practice medicine, and I think it makes me a better doctor. Both of those are emotional connections to being a great healer. But as I wrote in my article, empathy and compassion can weigh heavily on physicians, especially in these difficult times. When we feel we are connected to everything, we might also feel that we are responsible for everything. This burden of the pandemic, this type of work that we carry on our shoulders, trying to help everybody, can be overwhelming, and it could crush us if we don’t know how to manage it. Being in the shoes of somebody else and understanding what they’re going through is great, but it’s also very important that we know how to extract ourselves from it, so we don’t get crushed or trapped in it. That is another very interesting aspect.

Another thing, Kevin, that I wanted to share is that I was very puzzled by the emotional impact that particular evening had on me. I was thinking about it, and I didn’t know why. Only after I slept on it, processed it more, and thought about it did I understand. What I think happened is that my emotional bank was empty. I think I was emotionally drained just going to work, from everything happening around us, but also because of a lot of demands on my time outside of work. I was just overextended and overcommitted. I was responding to every single text, every page, whoever needed whatever they needed. I would try to fix it and help them.

So I really did not prepare to go into the evening shift. The evening shift was just one of the additional responsibilities that I had, and I just did it. I did a great job. I took perfect care of my patients and provided the best care possible, but I think it did leave room to be emotionally affected more. It hit me straight in the heart, and I didn’t expect that. It surprised me. I think that has happened to a lot of us, especially now during this pandemic, dealing with everything medically but also with all these emotional overlays that are going on now, too.

As I was thinking more about that, I came up with an analogy. I think what happened is like driving a car at night and hitting a patch of black ice. You’re driving, and you lose control of your car. It is not going where you want it to go. Your car steers you through it, and you somehow end up coming back onto the road, and it feels like you had an accident. You didn’t have an accident, but it feels like you had an accident. So that was a similar feeling. I think that, working in that clinical arena, something affects you emotionally, very powerfully. You don’t know why, but it affects you, and that surprised me. I was asking why, and I think that emotionally, that is what happened, as I said, to many of us going through the pandemic. These are extremely difficult times on lots of different levels.

Kevin Pho: Now, you wrote that article back in July, and we’re speaking now in the second week of December, and we’re in the midst of pretty much the worst wave of the pandemic. You’re so right, in that a lot of the clinicians I talk to, especially on this podcast, are feeling the emotional strain, and that is taking away from the compassion and the empathy. So my question is: What kind of advice can you give to these physicians who are getting emotionally drained, especially during the worst wave of the pandemic, which can affect how they empathize with and care for patients? Can you share anything from your experience that can help these doctors?

Jasminka Vukanovic-Criley: Oh, absolutely. Well, the first thing is you cannot run on an empty tank. You have to have your emotional bank full. You have to make time to take care of yourself. You need to make time to sleep, you need to make time to exercise, and you need to have good nutrition. You also need to set limits on what you can and cannot do. You also probably need, much more than ever, to prioritize what is important and what is not important. In general, I think health care workers are helpers, they’re givers, they’re fixers, and we want to be there for everybody and help everybody. But that is really hard, because there are just so many demands on our time, and as you said, this time is also so emotional. People are getting drained. You just need to make an extra, extra effort to take care of yourself.

Another one, and that would be one of the lessons that I learned, too, is that it is very important to take time and process your emotions. We do not talk about that often. I think we often suppress them. So instead of suppressing them, take time, pause, stop, reflect, share. If you’re happy, be grateful for it. If you’re sad, if you’re angry, if you’re fearful, that is OK. It’s very, very important that we start talking more about those emotions instead of sweeping them under the rug. If you sweep them under the rug, they are going to create a bump, and you might fall over it, and they might raise an even uglier head and make it even more difficult. It’s like they’re being accumulated, so in the end, with all these emotions, it might be enough to have just one extra little drop in a full cup, and then you just lose it. You can’t do it anymore.

So I think expressing emotions is extremely important. As I wrote in my article, unexpressed emotions never die. They’re there a bit to you. And how do you work through it? I think it all depends on the person. Some people talk, some people like to be alone, some people exercise, some people cook, and some get a therapist or a friend or somebody to talk to. So there are different ways, but I think it’s very, very important to stop, take time, reflect, and process what is happening.

Kevin Pho: We are talking to Jasminka Criley. She is a hospitalist, and she wrote the KevinMD article “The emotional side of being a doctor during the COVID-19 pandemic.” Jasminka, what is your take-home message that you want to leave with the KevinMD audience?

Jasminka Vukanovic-Criley: My take-home message is probably that it is very important to know that, as a physician, you cannot do it all. You cannot save the world; no one can. So you do what you can, when you can, whatever you can, the best you can, but also, at the end of the day, make sure to take care of yourself. Self-care is extremely important. It is not selfish; it is important.

Another thing that goes along with self-care is making sure to get enough sleep. I can tell you, Kevin, more about my interest in sleep: Sleep is extremely important. When I started working on sleep, it actually all started with my medical murder mystery, the sleep mystery class workshop. It was just extremely, extremely popular, and afterward I got an NIH award to create a digital game that had to do with the sleep mystery. The more I was learning about sleep, the more I was surprised by how much I didn’t know about what healing power sleep has. Sleep is important for our emotional health, for our physical health, and for our mental health. If you sleep better and you get an adequate amount of sleep, you react better and you’re less anxious. There is less ADHD, and there are fewer accidents. There is a benefit for your long-term health as well; there are fewer chronic diseases. You just think better. So sleep is just extremely important, and you need to prioritize it.

I do have to share this, and you know that doctors are not as good at taking care of themselves, and they’re also not good at sleeping. Our boys did a science research project. They were looking at how much people sleep in different professions, and they found out that even pre-COVID, doctors are sleeping less than other professions. So I think, just as a profession, we really need to emphasize that one way of taking good care of yourself is having good, good sleep.

Kevin Pho: Jasminka, thank you so much for sharing your time and insight, and thanks again for being on the show.

Jasminka Vukanovic-Criley: You’re very welcome, Kevin.

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