Dr. George Alba couldn’t share in the final weeks of his wife’s pregnancy last spring — no last jaunts to movies and restaurants, no placing his hand on her belly to feel the baby’s first kicks. He had to stay away from her.
Alba, a critical care doctor, was spending long hours in the COVID-19 intensive care unit at Massachusetts General Hospital. He feared infecting his wife, Dr. Lucy Schulson, a primary care doctor. So he lived in the guest room and, achingly, kept his distance.
Thinking back on the last COVID-19 surge, Alba said, “It was a very traumatic experience for all providers on the front lines. We were all worried about catching it and spreading it to folks at home.”
Now as Alba and other physicians confront a renewed rise in the number of COVID-19 patients, the traumas of the spring remain raw: the uncertainty about protective equipment supplies. The frightening mysteries of a new virus. The struggle to treat dozens of desperately sick people at once — and watching so many die anyway.
Alba and others are entering the second surge with new confidence in their ability to protect themselves and manage the illness, now much better understood. But they express weariness, and frustration at the needless toll of a virus whose spread could have been curtailed.
“I’m calm about it in certain ways,” Alba, 35, said recently. “We know what we’re dealing with. But nobody is very happy about what’s happening. …It’s very disheartening.”
Alba, who normally spends most of his time seeing lung patients and recovering COVID-19 patients in a clinic, expects to be called upon to work long ICU shifts once again. But this time, when work ends, he’ll come home to his baby daughter, Penelope, who was born May 14 and today provides “a real light in the darkness.”
Dr. Nicole Christian-Brathwaite, a psychiatrist who treats a number of Boston-area physicians, said she worries about the pandemic’s effects on health care workers.
“Many of my patients have lost so many patients in a short period of time,” she said. “People have described not having tears left to cry. … We go into medicine to help people. We don’t go into it to watch people die.”
Dr. Megan Ranney, an emergency physician and researcher in Rhode Island, said that in the spring, health care workers drew strength from public displays of support — the thank-you signs and gifts, the nightly cheering and pot-banging in New York and elsewhere.
“As the pandemic has gone on,” she said, “that outward support has largely disappeared, and has been replaced in some places by not just loss of active support, but instead active distrust,” as conspiracy theorists deny the severity of the pandemic and President Trump falsely accused doctors of inflating death counts for profit.
Every sector of the health care workforce feels the stress, she said, including nurses, doctors, orderlies, security guards, and cleaning staff.
“It feels like we’re heading into a siege with no help or hope in sight,” Ranney said. “That’s a lot on top of what we already knew existed, the silent epidemic of suicide and mental health problems among health care workers.”
Physicians are thought to have a higher suicide rate than the general public, although the data are murky. And physician burnout — job stress that leads to exhaustion and cynicism — was a worry long before COVID. One survey conducted before the pandemic found that 42 percent of doctors consider themselves burned out.
In a survey earlier this year of 7,500 physicians worldwide, including 5,000 in the United States, two-thirds reported that burnout had intensified during the pandemic and one-quarter of US physicians were considering early retirement.
In interviews with the Globe, doctors talked about the stress — but equally as often they spoke of camaraderie, resilience, and grit.
“Many of us will remember that time [the spring surge] as part of something really powerful and important,” said Dr. Jessica McCannon, critical care director at Mount Auburn Hospital in Cambridge. “While it was frightening, it was amazing to pull together and work as a team with a cohesion that was always there. … We were in battle together. Despite the fear and the worry, there was a tremendous amount of power about doing that work together.”
Like Alba, McCannon, 46, made a painful personal sacrifice to keep doing that work. She moved into an apartment in Cambridge and for two months didn’t see her husband or two children, ages 9 and 11.
“I watched my two boys hugging each other because I couldn’t hug them,” she said.
McCannon assumed she would become ill and contemplated the possibility that she would die.
Now, as the ICU starts to fill up with COVID-19 patients again, she says the main difference from the spring is “the element of sadness” at the huge, needless toll of an illness that could have been brought under control. Members of the ICU team “often lock eyes in disbelief that we are here again,” McCannon said.
Another change for McCannon: She’s living with her family this time. She has a better understanding of how the virus spreads, and confidence that the protective equipment will keep her safe. Or safe enough. “Taking some amount of risk to be with my family is worth it for our collective family wellness,” she said.
The stresses that COVID-19 poses are familiar to ICU doctors, said Dr. Michael McBrine, a pulmonologist and critical care physician at Tufts Medical Center.
“Most critical care doctors kind of get used to going with the flow, having a lot of ups and downs,” he said. “Everyone finds a different way to deal with the stresses of their job.”
But critical care doctors, while closest to the worst consequences of the pandemic, are not the only physicians whose lives have been upended.
Dr. Marie-Elizabeth Ramas, a 39-year-old family physician in Nashua, N.H., was taking care of immigrant families at a community health center and delivering babies at the local hospital when the pandemic struck. Seeing that personal protective equipment was in short supply, she lost many nights of sleep worrying about getting sick and infecting her family.
“There’s a high chance that as a Black woman woman I could also get very ill,” she said. “I signed up to do no harm for my patients. I didn’t sign up to be put in the face of death by doing the right thing for my patients.” Ramas said she has lost colleagues to COVID-19.
In the end, working with national and local organizations, Ramas was able to procure PPE for her hospital and clinic. But she wept alongside her frightened pregnant patients, forced to acknowledge that she had no answers about the risks they faced.
Since then, Ramas has seen a therapist and resumed taking care of herself, eating better and exercising, and making the most of every possible moment with her husband and three children.
And she took a new job, as the primary care doctor at an addiction treatment program. She concluded it was the best way for her to continue treating underserved populations while protecting her family.
Lately Ramas has watched as local hospitals cope with the results of heedless Thanksgiving gatherings, and contemplates what lies ahead.
“I’m starting to mourn, already, the loss that’s to come again and the pain that’s to come again — that potentially could be prevented,” she said. “Maybe it’s grief I’m feeling right now. Expectant grief.”
Dr. Joshua A. Barocas was on the front lines in a different way. An infectious diseases specialist at Boston Medical Center, he worked around the clock to locate places for homeless people to stay when recuperating from COVID-19 and devised infection control procedures for those places.
The pace was frenzied. He’d get a call requiring immediate action and kiss his family goodbye, often coming home after his two children were asleep.
“I went days without seeing the family,” he said. “I don’t think I was tired. I don’t think I was thinking about how horrible everything was.”
Running on adrenaline, he was driven by visions of disaster: an outbreak blazing across the community of homeless people, an entire shelter’s population needing to be hospitalized. But while the virus was detected in about a third of Boston’s homeless people, few got seriously ill, and the big challenge was finding a place for them to stay where they wouldn’t infect others.
“What it showed is that in times of struggle, times of panic and emergency, people have an amazing ability to forget about themselves,” Barocas said. “It was remarkable to see the selflessness.”
But it took a toll, and for once, that toll has been publicly discussed.
“If anything good is coming out of this for health care workers, it has been an openness and willingness to talk about burnout and mental health among doctors,” Barocas said. “There’s no shame in being vulnerable, sad, depressed. It’s probably the most normal human reaction.”
When asked what sustained him through it all, Barocas offered a striking, one-word response: pride.
He’s proud of joining with others in serving the greater good. For the first time, he said, he understood what his father, a military man, meant when he talked about his pride in serving his country.
That pride, Barocas said, “gets me through the idea that I’m going to have to do this again.”