Maybe it was just me, but I was fairly positive at the start of the circuit breaker (CB). At that time, SARS–CoV–2 was just thought to cause a respiratory illness and little else. Then came the community CB and continued bad news – the virus could cause an autoimmune reaction in children, affect the brain, emerge through different fluids below the navel from our bodies, and the last straw came when the New England Journal of Medicine published a letter reporting that the virus could transmit between domestic cats and that lions and tigers were infected in a New York zoo. When was all this going to end? We all need to take a deep breath, collect our thoughts and look at the sky.
Doctors, like everyone else, have been impacted in some way by the coronavirus, the extent of which depended on the place of practice. Junior doctors were redeployed to roles they did not choose, specialists were redeployed to emergency rooms to help screen patients and private practitioners were affected by the CB. One of the things that hit us, but was not spoken much about was the impact of the reduced social interaction between friends and colleagues, and also how strange people sounded with voices muffled by their masks. Luckily for Singapore, the number of deaths from COVID-19 has been relatively low and personal protective equipment (PPE) has been available to healthcare workers, which reduced the risk of burnout from having to worry about being infected while making tough choices for patients. Doctors who have gone through our training and selection are a resilient bunch. The Achilles heel is our sense of responsibility to the patient and need for control of a situation. The coronavirus disrupted that order. To keep performing at our best in this marathon COVID-19 fight, we really need to pay attention to our mental health and resilience.
No one knew better about being lit on two ends of the candle than Alice* who called me the other day. As a resident in training with primary school-aged children, she had to cope with seeing patients in the day and powering up again when she got home to help her young kids with home-based learning. She candidly admitted to me that screaming did happen from time to time, and that she sometimes just answered the questions for the kids so she could get to sleep on time. She felt fatigued yet could not stop worrying about whether she brought any bugs home from work and whether her kids were keeping up with their education. It did not help that after two weeks of this punishing routine, she started waking up at 3 am before falling asleep again at 5 am to catch some more sleep before work. Another ex–colleague, Ronald*, also messaged me on the pretext of asking for advice for a patient. He had opened his general practice two years ago and business has dropped significantly during CB. He had to grapple with the expenses of the business and source for PPE, and he was getting really anxious about the depressed financial markets. Although still able to work, he had no choice in the matter, so he felt more irritable, on edge and without peace of mind. He wanted to know what he could do about it as his wine collection was disappearing at a faster rate than usual.
There are many ways to keep our spirits up for the long COVID–19 run and different strategies may work for different people. One of the most effective ways is to call someone to chat and keep the chat positive. Exercise is also important, but in reality not for everyone, though anyone can walk in a park. Acts of kindness bring hope to others and many have been moved by well wishes, small tokens of appreciation, and food. When one can find quiet time, focusing on our spirituality is essential. While some have drunk more alcohol, others have snacked more – moderating snacking and drinking is part of self-care. While the news is inundated with COVID-19, there are lots of other good things happening in the world. Spending time to watch videos on cute animals, nature or just non-COVID-19 news can be very therapeutic. For those who have significant depressed mood, irritability, anxiety or insomnia, the SMA and Singapore Psychiatric Association (SPA) have collaborated to organise a list of our mental health colleagues who are willing to help doctors and self–help resources. The list can be found on their respective websites.
While we await the end of the pandemic, as doctors, we need to acknowledge our own humanness and attend to our physical as well as psychological needs. While uncertainty is the new normal, what is certain is we can choose to care for ourselves and those around us. And when self–care is not enough, we have family, friends and colleagues that we can turn to, who can care for us.
*Names used in the article have been changed
Mental health support for our HCWs
Consolidated below are some resources healthcare workers can tap on during the COVID-19 pandemic for psychological wellness and support.
Taking care of my mental health (courtesy of Woodlands Health Campus): https://bit.ly/3csawt0
Burnout infographics (courtesy of Woodlands Health Campus): https://bit.ly/2Xod33d
Mental health tips (courtesy of Tan Tock Seng Hospital Staff Support Staff Programme): https://bit.wly/2Koj9cI
List of psychiatrists/counsellors who can see doctors either for informal support or medical consultation: https://bit.ly/3dqtMsi
List of psychologists and workshops relating to COVID–19: https://bit.ly/2AvYcL0
National Care Hotline: 1800–202–6868
To find out more about the resources and support available: https://www.sma.org.sg/covid19