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For providers with PTSD, the trauma of COVID-19 isn’t over

Stacy Weiner, Senior Staff Writer
June 29, 2021

They watched patients and colleagues sicken and die for months. Now, many front-line providers are struggling with symptoms of post-traumatic stress disorder.

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Brittany Bankhead-Kendall, MD, now a trauma surgeon at Texas Tech University Health Sciences Center, saw a flood of deaths during the pandemic and has suffered symptoms of PTSD. She is shown here scrubbing in for surgery.
Brittany Bankhead-Kendall, MD, now a trauma surgeon at Texas Tech University Health Sciences Center, saw a flood of deaths during the pandemic and has suffered symptoms of PTSD. She is shown here scrubbing in for surgery.
Courtesy: Texas Tech University Health Sciences Center

When COVID-19 hit Boston’s Massachusetts General Hospital in March 2020, Brittany Bankhead-Kendall, MD, shifted from training in trauma and surgical critical care to working 80-hour weeks in a COVID-19 intensive care unit. “We were offering the best we had, but patients just kept dying anyway — and then more would come,” she recalls.

Adding to her stress was Bankhead-Kendall’s fear that she could infect her two young children. So later that month, after finishing a 24-hour shift, she flew to Texas and left them with her parents. “I didn’t know if I would ever see them again,” she says.

Bankhead-Kendall moved to Texas that summer to start a new job as a trauma surgeon, but her experiences took a toll on her. By the fall, she had developed symptoms of post-traumatic stress disorder (PTSD), including recurring nightmares. In one, she watched hundreds of patients march toward her hospital. “They were all coming, all coughing, all needing help, and I couldn’t possibly help them all,” she explains. “It was awful.”

“[Providers] saw their colleagues die or had to intubate their co-workers, and they had to worry about ending up that way themselves. Those are huge traumas.”

Jessica Gold, MD
Psychiatrist at Washington University School of Medicine in St. Louis

Bankhead-Kendall is far from alone. Even before the pandemic, 16% of emergency physicians self-reported symptoms of PTSD. Recent data, including an unpublished survey conducted in the fall of 2020 and presented at the American Psychiatric Association’s annual meeting in May, suggest that as many as 36% of front-line physicians suffer from the condition. And that statistic omits those who don’t meet strict diagnostic criteria but have still experienced powerful psychological effects.

“Health care workers had to worry about not having enough beds, not having enough ventilators. They had to move into fields they didn’t know,” says Jessica Gold, MD, a psychiatrist at Washington University School of Medicine in St. Louis who treats physicians. “They saw their colleagues die or had to intubate their co-workers, and they had to worry about ending up that way themselves. Those are huge traumas.”

Leaders at teaching hospitals across the country have been working hard to try to prevent and address PTSD among providers by offering a range of wellness supports and mental health services. Still, those involved worry about what could lie ahead.

“All of us saw horrific things over and over for a really long time,” Bankhead-Kendall notes. “I think there are a lot more cases on the horizon.”

Reliving the nightmare

Symptoms of PTSD — anxiety, irritability, hypervigilance, and intrusive thoughts, among others — can be debilitating. But for Adele Summers*, MD, an emergency medicine resident at a major New York City hospital, the worst was a crushing flashback that hit her at work.

It happened this April as Summers and a colleague discussed intubating a patient. Suddenly, she was transported into a similar scenario from about a year earlier.

“I felt like I was seeing my previous patient, like I was surrounded by those other earlier patients who were intubated and crashing and by all the chaos of COVID at that time,” she recalls. “It was terrifying.”

­­­Summers’ other symptoms, including panic attacks and sudden bouts of crying, started back in July 2020. That was a few months after her most intense shifts. The time lag makes sense, experts say, because adrenaline and determination can carry a person through a crisis.

“It was once the surge started calming down that I began seeing more providers with the typical signs of PTSD,” explains Jo Vogeli, PhD, a psychologist in the Department of Anesthesiology at the University of Colorado Anschutz Medical Campus in Aurora. “That’s when more people came to me and said, ‘I don’t know if I can keep doing this job.’”

Of course, front-line providers expect moments of pain and loss, notes Vogeli. But COVID-19 was death on an outsized scale. “They couldn’t stop to process a loss because there probably were going to be 40 more coming,” she says.

“We’re supposed to have the mental, emotional, and physical toughness to always put the patient first. Part of that commitment is great, but there’s another part that can be destructive.”

Peyton Boldwill*, MD
Emergency medicine professor in Pennsylvania suffering from PTSD  

Certain COVID-19 providers may be more vulnerable to the effects of trauma, including those who are just beginning their careers, a spring 2020 study found.

Summers understands what that’s like. “I was an intern, still figuring out how to be a doctor, when I was thrown into treating high-risk COVID-19 patients,” she recalls. “I remember riding the train going into my shift trying to watch videos on how to manage ventilated patients.”

One group of providers is especially at risk for PTSD: those who were already feeling burnt out. That’s worrisome, experts note, since 42% of physicians reported burnout before COVID-19.

Those involved point to another factor that can fuel PTSD. “Often, doctors are taught to ‘suck it up,’” says Peyton Boldwill*, MD, an emergency medicine professor in Pennsylvania who is suffering from PTSD. “We’re supposed to have the mental, emotional, and physical toughness to always put the patient first. Part of that commitment is great, but there’s another part that can be destructive.”  

Hospitals hope to help

In response to pandemic-related stresses, teaching hospitals have been offering a range of mental health supports from wellness trainings to therapy sessions.

At the Yale New Haven Health System in Connecticut, experts quickly built an online stress assessment. After results appear, employees can click to connect with help. Among other assistance, volunteer clinicians who are trained in an evidence-based approach to preventing PTSD offer one-on-one sessions that cover such skills as how to handle disturbing, intrusive thoughts.

Yale and other institutions also actively reached out to hard-hit units. “We recognized that if you build it, they may not come,” explains Deborah B. Marin, MD, director of the Mount Sinai Center for Stress, Resilience and Personal Growth in New York City, so the center sent out teams to promote its services. Among the obstacles, Marin says, are stigma and fear of professional setbacks from seeking help.

At Chicago’s Rush University System for Health, mental health experts visited specific departments daily during tougher pandemic times — and continue to do so upon request. When appropriate, a team member could accompany an employee to a wellness room to help them destress and connect with mental health services.

Other institutions have offered town halls and other sessions focused on wellness. At Anschutz, Vogeli built a weekly Be Well Bootcamp: a series of half-hour recorded trainings on specific issues of concern.

“A lot of people began coming to me paralyzed in their decision-making” because trauma can make choices feel excessively weighty, explains Vogeli. She created a session on that topic as well as ones on communication for employees experiencing their own — or others’ — trauma-related irritability.

Vogeli has also increased her availability to meet with staff seeking support. Previously, she might have seen 50 people a year. In the past 18 months, she’s seen at least double that number.

At Mount Sinai’s center, which was created in April 2020 to address the impact of COVID-19, staff can receive up to 14 therapy sessions — all for free. Since October, the center has received more than 1,100 visits.

Though Mount Sinai’s offerings are fairly unique, Chief Wellness Officer Jonathan Ripp, MD, MPH, says he’s seen impressive efforts elsewhere.

“Because of available resources, some places were better equipped to provide a robust response than others,” he explains. Even at Mount Sinai, “there are folks who feel that we could have done more. … But on balance, I feel very proud of the effort that we put forth.”

An uncertain future

For providers suffering from PTSD and the hospitals that rely on them, what lies ahead is unclear.

Once a person develops PTSD, it can last for years. More than a decade after the 9/11 World Trade Center attacks, 27% of police responders were still suffering symptoms, for example.

But certain treatments, including anti-anxiety medication and cognitive behavioral therapy, have been shown to help. Bankhead-Kendall certainly finds her therapy useful. For one, she’s learned to cry more.

“My counselor told me I needed to not keep things bottled up, and to grieve, so when I’m feeling really sad, I find an appropriate place and I cry,” she says. “It seems really simple, kind of silly, but it helps.”

“I know now that we really did all we could. There was nothing lacking in my or my co-workers’ desire or ability to heal people. This was just a terrible disease that overtook the globe.”

Brittany Bankhead-Kendall, MD
Trauma surgeon at Texas Tech University Health Sciences Center

Summers values having a sense of what to expect. Because milestones can be challenging, her therapist helped her prepare for the anniversary of her worst workday — April 4.

“She gave me ways to cope. She said, ‘You need to do something happy on that day.’ So, I went for a run and sat in the sun in the park,” she recalls. “There were all these kids playing and laughing and people walking their dogs. And I had hope, like maybe the world will go back to normal one day.” 

Bankhead-Kendall notes that finding meaning in work can make a huge difference.

“I know now that we really did all we could. There was nothing lacking in my or my co-workers’ desire or ability to heal people,” she says. “This was just a terrible disease that overtook the globe.”

“We also saved a lot of lives,” she adds. “Those lives are worth celebrating just as much as we grieve the ones that we couldn’t save.”

*Name has been changed

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