Ffatigue, distracted attention and the feeling that a crisis will soon be over contribute to bad judgment, last minute accidents and preventable deaths. This phenomenon ‘last kilometer, first smile’ takes place in the army, in law enforcement and in the final stage of disasters and crisis situations. This can happen to anyone while driving the last mile home.
Medical teams were not exempted from it. The end of the crisis phase is anything but ‘classless’ and goes back to normal life.
But it’s much more complicated than that.
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In a speech to the country in March, President Biden said he considered the fourth of July 2021 as the beginning of our independence from Covid-19. As restrictions are lifted and businesses and schools with greater capacity reopen, very often will feel feelings that are normal.
If vaccination keeps Covid-19 and its variants at a distance, as we hope it will happen, and most Americans are vaccinated, as we hope, reports of the pandemic will gradually withdraw from the front pages. Hospitals and healthcare systems will begin closing Covid-19 departments and resuming elective medical care, hoping to work themselves out of the Covid-induced financial hole in which they find themselves. They will also work hard to fill vacancies in medical staff, after losing some to the pandemic and others after burnout.
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As health workers emerge at the forefront of the work they have consumed since March 2020, they will cast their eyes in the shadow to meet the optimistic sunlight of a post-Covid world.
For many doctors, nurses and other health care professionals at the forefront, this transition can be challenging in ways that expose them to a high risk of burnout, anxiety, depression, post-traumatic stress disorder and even suicide.
Covid-19 day in and day out fighting, exposed to the danger of infection and worrying about bringing the virus; the psychological trauma and moral injury sustained during the treatment of patients who died alone with health workers playing the role of family members; care should be prioritized while balancing a lack of medical equipment, time and attention – all of these can take a serious emotional toll.
The transition of medical teams from the era to the Covid-19 must be planned, supported and done with the precision of a fine surgical procedure.
In 2020, I helped start a company called Dugri, which is the Hebrew word for straight speaking. It is a frontline health care support network that provides a 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 things we have learned that can help hospitals, healthcare systems and individual clinicians return from Covid mode to normal life.
The strong tendency to just go ahead and assume that everything will be in order must be resisted. Welfare, recovery and de-stressing practices in the form of debriefings, outdoor retreats and therapeutic / wellness resources such as cognitive behavioral training and mindfulness meditation should be used proactively. Clinicians need to be encouraged to share and defuse their huge emotional burdens – and to find the time and space to do so.
At the same time, leaders need to show their workers that they care, acknowledge their pain and serve as role models to stand still, look back on the hardships that Covid-19 is causing, and look to the future with hope and strength.
My experience with military special operations forces has taught me that this type of modeling creates a climate of non-judgment and acceptance even in the most culturally male organizations. Sharing burdens and showing vulnerability can help normalize stress during – and after – the crisis of a pandemic.
Self-care is important, but caring for others is crucial. If you work closely together during long shifts, health professionals get to know each other and they have a good idea of how co-workers feel. The last mile syndrome can impair the identification of a colleague in distress. For this reason, all members of the team should keep their eyes open for colleagues who are showing worrying signs.
Red flags of distress include a significant change in the mood of an employee, both high and low; eating too much or too little; giving away valuable or emotionally important possessions; making impulsive decisions; and uncharacteristically philosophical talk about the meaning of life and death. The feeling 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 advice” can save a life.
When we finally approach the last mile of the Covid-19 pandemic, health care workers must take it carefully, one curve at a time.
Yotam Dagan is a clinical psychologist, former SEAL commander of the Israeli Navy, trauma expert, and the co-founder and CEO of Dugri Inc., a support network for health workers and first responders.