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Thursday, July 07, 2022

Struggling in an overwhelmed system, doctors are facing their own mental health crisis

There’s the crippling helplessness and dejection at losing lives due to the acute shortage of basic necessities like medical oxygen

Written by Shwetank Bansal |
Updated: May 18, 2021 9:58:08 am
A doctor with a covid patient in Delhi hospital (Reuters)

“I’m tired of pronouncing people dead. I feel broken. I can’t go on like this,” says a senior resident, during a therapy session. The doctor is on Covid duty at one of the largest government hospitals in Delhi. She fights back tears and her helplessness is palpable, even on a Skype call.

This young doctor, like many of her colleagues all over the country, has been engaged in battling the Covid-19 pandemic as it rages on in its devastating second wave. We’ve been trying to zero in on the root of the problem she has been facing — trouble with sleeping. It’s a problem that may seem odd considering that it follows the crushing 30-hour long duties she’s routinely putting herself through at the hospital.

As a psychiatrist, I’ve had the chance to meet a few doctors working on the frontlines. The sessions proceed quite predictably. In fact, it’s so consistent that it’s almost down to a pattern. It starts with an almost defensive and reassuring attitude that there’s really nothing to worry about. I usually play along and then begin to prod gently. Then there are passing mentions of trouble with appetite or with sleep, a sudden sinking feeling while otherwise calm, splitting headaches, episodes of zoning out in the middle of work, and other minor “glitches” in the system. I facilitate further disclosure and, invariably, we reach the source of the problem — a mix of misplaced guilt and helplessness in the face of the death of their patients.

It’s something I’ve been coming across with doctors of all ages, scattered across different stages of their career; friends, colleagues, seniors, and juniors. The sheer number of lives slipping through the gaps between their fingers is something that they are not able to process. The tsunami of the critically ill that the second wave has brought has overwhelmed the healthcare system, and the vanguard is bearing the brunt of it. And while they may try to be careful about precautions to keep themselves protected from the deadly virus, it’s what they are ignoring that’s taking a beating — their mental health.

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The current situation has placed doctors on unfamiliar turf, with a lot of factors outside their control. There’s the illness, a novel entity in itself, which most of them haven’t previously had any experience of handling. There is the mounting death toll, with each life lost seeming like a battle ultimately in vain. Then there’s the crippling helplessness and dejection of losing lives due to the acute shortage of basic necessities like medical oxygen, something that was never expected to be the determinant of life and death. Add to this the apathy of the current government. With the pandemic claiming the lives of more than 800 doctors so far, there’s the constant, looming fear of getting fatally infected, and perhaps worse, carrying the infection back to their families. All of these factors together constitute what can perhaps be described as an individual as well as a systemic psychological crisis for India’s doctors.

But while many acknowledge the trying circumstances and the fact that they are struggling, they jump right back in, the years of autopilot training taking over — pushing down vulnerability and emotional upheaval in an attempt to save the next patient. But this suppression comes at a price.

In the past few weeks, the signs have been visible. From the managing director of a prominent Delhi hospital to residents posted on Covid duty, we’ve seen numerous doctors break down on camera while communicating the limitations they face. There have unfortunately been many reports of doctors dying by suicide, such as the young first-year resident who was found hanging at his home. He had been attending to critically ill patients suffering from Covid for a month at a private city hospital and was reportedly “frustrated” because of the number of patients dying on his watch. Doctors are struggling to cope mentally with the enormity of the human suffering they find themselves combating, their hands tied by the limitations that engulf the system.

Complicating this is the lack of insight that the medical community has into its own mental health, and the reluctance to seek help for it even while being aware of the problems it poses. One could easily be forgiven for believing that this is by design — there is hardly any time devoted to mental health in the training we receive. It’s only those who choose to train in psychiatry during their MD who get any significant exposure.

It’s no wonder that most of the doctors I get to see in my sessions cross a formidable internal (and sometimes external) resistance to make that first rendezvous. And this resistance has stayed constant over the last few years. But it’s a constant that we can no longer afford to uphold. The battle that we’re fighting against Covid is not only in the body but also in the mind.

As I conclude my session with the young doctor, we take a moment to summarise some of the controllable factors that she can focus on, while delineating the ones that she cannot. We reach the realisation that she’s been riddled with guilt that is not hers to have and that it’s been holding her back. I provide her with a prescription for a short term medicine to help with her sleep and ask her to follow up in a week. She takes a deep breath and then dives back in.

This column first appeared in the print edition on May 18, 2021 under the title ‘Healer on the precipice’. The writer is a Delhi-based psychiatrist

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