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Even while celebrated as heroes, health care workers are exhausted and struggling with burnout

Samantha Fabian, 32, is a nurse treating COVID-19 patients and dealing with a lot of sadness, fear, and anger. She is the mother of two young children and worries about getting them sick. Her sons are Lucas, 3, and Thomas, 11 months.
Samantha Fabian, 32, is a nurse treating COVID-19 patients and dealing with a lot of sadness, fear, and anger. She is the mother of two young children and worries about getting them sick. Her sons are Lucas, 3, and Thomas, 11 months.Suzanne Kreiter/Globe staff

It was supposed to be a quick jog around the Chestnut Hill Reservoir while pushing his baby in a stroller, but soon the young doctor found himself running 13 miles — and erupting in tears twice.

He couldn’t shake the darkness enveloping him after weeks of treating severely ill COVID-19 patients at Boston Medical Center. The fear in their eyes as he told them they needed to be placed on ventilators. Their shaky voices telling their children over FaceTime they loved them. And the worst, the patients who succumbed, alone, while their grieving families watched on a screen.

With no established medication or cure for the virus, the doctor and his colleagues felt helpless and anxious. He had nightmares that he was a superhero with no powers.

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“Yeah, we’re helping people, but really we’re bearing witness more than anything,” said Dr. Lakshman Swamy, 36, a pulmonary critical care fellow. “People want to describe it like a war zone and we’re these heroes, but really, it feels like you’re walking through a graveyard and you’re watching this horrific stuff happen."

Although new daily coronavirus cases are declining, doctors, nurses, respiratory therapists, and other health care workers are struggling with exhaustion from long hours and a crushing emotional toll from the drawn-out crisis. They’re seeing more severe illness with fewer treatment options, and more death. Often working with far-from-ideal protective gear, they’re fearful of getting sick or infecting their families.

Even before the pandemic, the medical profession faced rising rates of workplace exhaustion, with more than half of doctors saying they felt burned out in 2017 due to reasons such as long hours and increasingly bureaucratic tasks, one national survey found.

The pandemic pushed many health care workers to the brink as it came close to overwhelming some hospitals in Massachusetts, which experienced one of the worst outbreaks in the country, with 6,640 deaths as of Thursday.

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Now, as the state reopens the economy in phases, the relief over a narrowly missed catastrophe is giving way to fears among medical workers that a second onslaught of infections may erupt.

“I’m physically and mentally exhausted,” said Andy Schwartz, 49, a respiratory therapist at Massachusetts General Hospital. “If we get a peak like we did some weeks ago with an already depleted and exhausted health care system, it will be devastating.”

Medical workers are struggling with the lack of established best practices to treat the severely ill COVID-19 patients, said Dr. Ruthann Rizzi, an assistant professor at the University of Massachusetts Medical School and a psychiatrist who has treated doctors and nurses on the coronavirus front lines.

Health care professionals are often reluctant to seek mental health services and become patients themselves, Rizzi added.

“It has to do with a historic culture of medicine where you’re expected to be all for everyone, and don’t have any needs for yourself,” she said. “That’s only going to be heightened during COVID because they’re just so much more needed right now."

Across the board, health care workers are fearful about contracting the disease, but even more worried about infecting their families, she said. Some who live with particularly vulnerable relatives are now living in hotels, which has led to deep loneliness.

Samantha Fabian, 32, a nurse at Cooley Dickinson Hospital in Northampton, said she struggled with whether to continue living at home with her husband and two sons while treating coronavirus patients. But she felt it was important to keep nursing her baby. She plans to sleep in a friend’s camper if she ever believes she has been exposed to the virus.

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“Sometimes I feel guilty: am I a bad mom for still coming home?” Fabian said. “I don’t want to not nurse him and give him nutrition — it’s such an awful, mentally tormenting feeling.”

Samantha Fabian, a nurse in Northampton who treats COVID-19 patients, fears that she could bring the infection home to her sons, Lucas, 3, and Thomas, 11 months.
Samantha Fabian, a nurse in Northampton who treats COVID-19 patients, fears that she could bring the infection home to her sons, Lucas, 3, and Thomas, 11 months. Suzanne Kreiter/Globe staff

Fabian said her hospital has done an excellent job handling the crisis, but the nationwide lack of personal protective equipment has been a constant source of stress.

“We feel like our lives don’t matter,” she said. She’s written three e-mails to the White House urging officials to provide health care workers with more durable, reusable protective gear such as powered air-purifying respirators.

Work has gotten so depressing, Fabian said, that sometimes she struggles to make herself get out of bed and go to the hospital. Since family members aren’t allowed to visit patients now, nurses are often the only ones supporting people as they die, she said, holding their hands, speaking to them, and video-calling their family.

“It’s very, very sad,” Fabian said.

Witnessing that kind of death pains medical workers, said Dr. John Herman, associate chief of psychiatry at Mass. General.

“Nobody is prepared for that,” Herman said. “This is not why we went into medicine. We went in to relieve suffering, and to have to watch this kind of suffering . . . is one of the most difficult things."

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Hospitals are offering mental health services to workers, from one-on-one counseling to group sessions. More than 1,000 workers have attended 200 support groups across MGH and Brigham and Women’s Hospital, said Herman, who is also the medical director for Partners HealthCare’s employee assistance program.

The system encourages huddles before or after shifts for work teams to discuss how they’re doing, he said.

Human resources is footing the bill for hotels if staffers need a place to stay apart from family members or if they don’t want to commute home between long shifts, Herman said.

The hotels have been a huge help, said Schwartz, the MGH respiratory therapist, who has used them several times to avoid having to drive an hour home to Dudley. Respiratory therapists handle ventilators, and their workloads have exploded.

Before the pandemic, the department would run 40 to 60 ventilators at a time, he said. In April, they had almost 200 running. Moving between patients in an intensive care unit, he said, his Apple watch would record him walking 6 miles in one day.

The respiratory therapy department converted a former manager’s office into a relaxation area. Medical workers at hospitals around the state also say they are cheered by the thousands of drawings, photos, and cards from thankful community members, and the donated breakfasts, lunches, candy, pizza, ice cream, and pasta.

But some front-line workers say the hospitals aren’t doing enough, and are making them feel undervalued through frequent reassignments.

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Jaclyn O’Halloran, 30, a registered nurse who lives on the North Shore, said that since the crisis began she and many other nurses have been constantly reassigned among units. She said nurses cry on every shift, largely because they are anxious about having to reuse their N95 masks and deal with unfamiliar medical conditions.

“I just feel like a number on a spreadsheet or a chess piece that someone wants to move around," said O’Halloran, who declined to say which Greater Boston hospital she works at for fear of retaliation. “It’s a very disheartening feeling when we’re putting our families at risk and ourselves at risk."

For Swamy, the BMC doctor, the intensive-care unit has become a darker place. But there was one bright spot for him during the surge: he could spend more time helping patients and less time typing electronic medical records because his notes were similar for all patients.

“We had the luxury of just providing medical care and there’s an incredible amount of meaning in the work," he said. "We’re here in the moment for people when no one else can be.”


Naomi Martin can be reached at naomi.martin@globe.com.