Philippe Nuss is the chief of the psychiatric unit for early psychosis at the Saint-Antoine Hospital, in Paris, and a researcher, specializing in the biophysics of schizophrenia, at the Sorbonne. Since the Bataclan terrorist attacks of 2015, he has devoted part of his clinical practice to counselling doctors and other carers about the strain of their work. I heard about Nuss from my brother-in-law, an intensive-care doctor at a clinic in Seine-Saint-Denis, a department just north of Paris. Every available bed in intensive care is full there; patients are now being transferred to the cities of Orléans and Rouen. Five doctors have already died in France of the coronavirus, where yesterday the number of diagnosed cases surpassed forty thousand; a group of more than six hundred doctors and other medical workers is suing the former Minister of Health and the Prime Minister for “culpable negligence” in failing to prepare for the epidemic. The French health-care system is one of the world’s best, but it has suffered under austerity. Amid a severe shortage of respirators, tests, and—most preventable—masks, personnel are underequipped and overstressed. “The means to do their work has been reduced dramatically in recent years, so the carers now are very fragile,” Nuss told me, over the telephone. “Everyone is lost, and everyone is afraid, and they need support.”
Nuss has spoken to around a hundred medical workers—doctors, nurses, nurse’s assistants, orderlies—since the beginning of the crisis. Over the course of these conversations, he has begun to develop what may be one of the most nuanced understandings we have of the pressures that are bearing down upon the people we are counting on to lift up everyone else. On top of the usual stressors of sleep deprivation, overwork, and guilt, one of the things that make the coronavirus especially difficult for medical workers to manage, from a mental standpoint, is its duration. “Yesterday I was with two doctors,” Nuss said. “Both were young, something like thirty. They said to me, ‘I know this weekend will be horrible. Last weekend, we were waiting and no one came, and, this weekend, we know that people are coming, and we are already exhausted.’ ” Nuss continued, “I’m seeing negative anticipation, and the impression that the crisis will last too long, with too little means and quickly changing guidelines.”
At one hospital, Nuss encountered a nurse’s assistant who refused to wear a mask, to the horror of his colleagues. When they spoke, the man said that the hospital often assigned him to inconvenient shifts. When they spoke more, he said that the television channels were changing shows around to times that weren’t good for him. Nuss, recognizing signs of psychosis, put the man on medication and suggested that he go on leave, but a médecin du travail—a labor doctor—sent him back to work. (Nuss’s civilian patients have also been having a “very, very tough” time, he said, with high rates of relapse—one schizophrenic patient, having heard that Vitamin C was effective against the coronavirus, skipped his medications and was eating nothing but oranges.) At another hospital, earlier in the pandemic, the head of a critical department, managing thirty or forty doctors, was also refusing to wear a mask. Nuss said, “The result was that the doctors who wanted to be thought highly of were not wearing masks, and those who did were stigmatized.” Hell on morale in the best of times, office politics can become crushing in degraded conditions. “Many colleagues have told me that it’s their last battle, that, after coronavirus, they’ll quit the public hospital because it’s too unfair to them,” Nuss said. To combat burnout at Saint-Antoine, he has asked department heads to force staff to go home immediately after their shifts rather than sticking around to try to help their colleagues.
Doctors are used to performing under intense pressure, but, in countries where the rate of coronavirus infections threatens to outstrip the capacity of the health system, they are confronting ethical quandaries for which nothing in their training prepared them. Nuss recalled, “Yesterday, I had the chief of an emergency unit on the phone, who told me, ‘We will only have one respirator for every two people, so we’re trying to come up with a way for them to share it.’ And it’s not easy. The logistics weren’t there.” Nuss observed, “These are perfectionists. You want to be perfect, but you have no ability to be.”
Nuss was on duty at Saint-Antoine on November 13, 2015, the night that Islamist terrorists killed ninety people during a rock concert at the nearby Bataclan theatre. At one point, a nurse went into a room to tend to a wounded patient, who told her that his wife had been shot right in front of him. She walked back out of the room, telling Nuss that she was too shaken to continue. “She was afraid that she was illegitimate, that the level of care that she was being asked to give was disproportionate to her skills,” he recalled. “I said, ‘Just manage what you have to do. The rest will be taken care of.’ ” When medical personnel are overwhelmed by the feeling of having to bear the burden of a crisis, he tries to remind them that they are part of a chain of carers. Perhaps the most anxiety-inducing feature of the coronavirus epidemic is that it adds uncertainty to injury. In helping, a carer can end up inadvertently hurting herself or others. “With the attacks, we knew that the terrorists couldn’t come into the place where we were,” Nuss said. “Whereas, here, the terrorists are inside, and we are not comfortable, because we fear for our lives as well.”
More Medical Dispatches
- Surviving a severe coronavirus infection is hard. So is recovering.
- Some hospitals have postponed cancer surgeries because of the coronavirus crisis. How do doctors assess urgency during a pandemic?
- It is not too late to go on the offense against the coronavirus. This five-part public-health plan may be the key.
- The loneliness and solidarity of treating coronavirus patients in New York.
- To fill the vacuum left by the federal government, doctors are relying on informal networks to get the information and support they need.
- Conflict and confusion reign at New York hospitals over how to handle childbirth during the pandemic.
- In countries where the rate of infection threatens to outstrip the capacity of the health system, doctors are confronting ethical quandaries for which nothing in their training prepared them.
