Fatigue, distracted attention, and the sense that a crisis will soon be over contribute to bad judgment, last-minute accidents, and preventable deaths. This “last mile, first smile” phenomenon happens in the military, in law enforcement, and in the final stages of disasters and crisis situations. It can happen to anyone while driving the last mile home.
Medical teams aren’t exempt from it. The end-of-crisis phase is all but “class dismissed” and going back to normal life.
But it is far more complicated than that.
In a prime-time address to the nation in March, President Biden said he is eyeing the Fourth of July 2021 as the beginning of our independence from Covid-19. As restrictions lift and businesses and schools reopen with increased capacity, many will start to sense regular, back-to-normal kinds of feelings.
If vaccination keeps Covid-19 and its variants at bay, as we hope it will, and most Americans get vaccinated, as we hope they will, reports about the pandemic will gradually retreat from the front pages. Hospitals and health care systems will start closing Covid-19 departments and resume elective medical care, hoping to work themselves out of the Covid-induced financial hole they find themselves in. They will also work hard to fill vacancies in medical personnel, having lost some to the pandemic and others to burnout.
As frontline health care workers emerge from the work that has consumed them since March 2020, they will be shading their eyes to accommodate to the optimistic sunlight of a post-Covid world.
For many doctors, nurses, and other frontline health care workers, this transition may be challenging in ways that might expose them to profound risk of burnout, anxiety, depression, post-traumatic stress disorder, and even suicide.
Fighting Covid-19 day in and day out, being exposed to the danger of infection and worrying about bringing the virus home; the psychological trauma and moral injury sustained while treating patients who died alone with health care workers playing the role of family members; having to prioritize care while balancing a shortage of medical gear, time, and attention — all of these can induce a heavy emotional toll.
Transitioning medical teams into the post-Covid-19 era needs to be planned, supported, and done with the precision of a delicate surgical procedure.
In 2020, I helped start a company called Dugri, which is the Hebrew word for straight talk. It is a support network for frontline health care workers that provides what we call psychological PPE. By connecting these workers to others in the trenches, Dugri facilitates meaningful emotional dialogues. Sharing burdens and vulnerabilities creates emotional flexibility that strengthens resilience.
Here are some of the things we have learned that can help hospitals, health care systems, and individual clinicians transition from Covid-mode back to normal life.
The strong inclination to just move forward and presume everything will be OK should be resisted. Well-being, recovery, and de-stressing practices in the form of debriefings, outdoor retreats, and therapeutic/wellness resources like cognitive behavioral training and mindfulness meditation should be proactively deployed. Clinicians should be encouraged to share and vent their huge emotional burdens — and be given the time and space to do it.
At the same time, leaders need to show their workers they care, acknowledge their pain, and serve as role models in pausing, looking back at the hardships wrought by Covid-19, and looking forward to the future with hope and strength.
My experience with military special operation forces has taught me that even in the most culturally masculine organizations, this type of modeling creates a climate of nonjudgement and acceptance. Sharing burdens and showing vulnerability can help normalize stress during — and after — the crisis of a pandemic.
Self-care is important, but care for others is crucial. Working closely together during long shifts, health care workers get to know each other and have a good sense of how co-workers are feeling. The last-mile syndrome might impair the identification of a colleague in distress. For this reason, all members of the team need to keep their eyes open for colleagues who show worrisome signs.
Red flags of distress include a significant change in a fellow worker’s mood, both high and low; eating too much or too little; giving away valuable or emotionally significant possessions; making impulsive decisions; and uncharacteristically philosophic talk about the meaning of life and death. Sensing that something might be wrong, an invitation to have a cup of coffee together, a compassionate look, and even a simple “How are you?” can expose hidden anxiety or depression, and a friendly “I think you should seek counseling” can save a life.
When we finally approach the last mile of the Covid-19 pandemic, health care workers need to take it carefully, one curve at a time.