'We Are Human Beings': California's Health Care Workers Are Asking for Empathy

In December 2020, KQED's Forum interviewed four health workers experiencing the front lines of the COVID crisis in California. At the time, cases were surging in California, and no coronavirus vaccines were yet available.

Nine months later, Forum’s Mina Kim spoke with the same four health workers about the changes they have seen, and the challenges they have faced in the last year.

Read on for the highlights of their conversation.

A glimpse inside our hospitals

Amy Arlund, a registered nurse at Kaiser Permanente Fresno Medical Center, noted that the dire capacity levels in her facility's ICU experienced in the winter of 2020 had only gotten worse.

In December of 2020, said Arlund, "my ICU was at 100% capacity. I have a 12-bed ICU."

"Here we are nine months later, my ICU is at 200% capacity. We've tried to divert patients to other hospitals, but unfortunately, there are no ICU beds available in the Central Valley for about a four-hour drive radius from here," she said.

The overflow of patients in the Kaiser Permanente Fresno Medical Center has led to holding patients in the emergency room for days, and "patients who are in cardiac arrest on the regular floors," said Dr. Parimal Bharucha, a pulmonary critical care specialist for Dignity Health in the Sacramento area.

Dr. Alex McDonald, a family medicine specialist at Kaiser Permanente Fontana Medical Center in San Bernardino County, emphasized the importance of getting a flu shot to prevent a flu surge "on top of our already covered [COVID] surge."

"For the first surge, people [had] a fear of COVID," said Mawata Kamara, a registered nurse at Alameda Health System's San Leandro Hospital. "But now it seems like everybody's out, everybody is over the pandemic.” However, there are still patients who come into medical centers and ERs with symptoms of COVID and refuse to get vaccinated, she said.

'We are the targets'

Conversations with patients about COVID have not gotten easier in the past nine months, say the health care workers who spoke with Forum.

Medical and health professionals are "contending with misinformation about the vaccine" being spread online and through social media, said Kaiser Permanente Fresno Medical Center's Arlund, who noted that she lives and works "in a conservative part of the central San Joaquin Valley."

Arlund said she's had to make difficult decisions in the ICU throughout the pandemic — and continue to have hard conversations with her patients.

"I was having to face dealing with these patients who were needing to compete for an ICU bed," she said. "It has become more and more difficult to get through to people when they are lacking on oxygen to their brain for very prolonged periods of time."

The amount of misinformation patients are encountering, said Arlund, is "voluminous."

The health care workers who spoke with Forum emphasized the growth in threats and violence against medical professionals — although such workplace violence is something "we have always had to deal with," said Arlund.

It is, she said, "sometimes very hard to put your own feelings and your emotions aside" when violence occurs. "It may not be personal, but ... your own survival instincts kick in," Arlund said.

"We had to go on lockdown about two weeks ago when we had a family member come into the ER," said Kamara of Alameda Health System's San Leandro Hospital. She related how a family member became agitated, was removed from the hospital and threatened to bring a firearm.

"It was really scary. It's one of those things that you never believe that is going to happen at your facility. But then it does," said Kamara.

"In December last year we were heroes," said Sacramento's Bharucha. Now, he said, "we are no longer heroes. We are actually villains. We are the targets."

According to Bharucha, the conflict with patients and patients’ family members starts when there is initial mistrust. "It's mind-boggling to me that patients and public out in the community are not ready to believe science, including the vaccine," he said.

"We do treat all the patients with the same empathy," stressed Bharucha. “We are here to serve them. Except that we do ask for a little bit of dignity — a little bit of trust and respect."

Family medicine specialist McDonald offered his perspective of COVID in an outpatient care setting, and spoke about the importance of establishing a relationship with his patients over many years.

"But when it comes to COVID, or the vaccine, there's like this alternate reality in some of these patients' minds — and they completely disregard [me], and they don't want to hear anything." said McDonald.

"It's really insulting that they want to sort of pick and choose what pieces of information they want," said McDonald. He recalled a recent patient who demanded to be prescribed ivermectin and hydroxychloroquine: "Both of which have been proven not to be effective at all to treat COVID," and are not approved by the FDA for COVID treatment.

After the last eight months, McDonald said that his work has become "emotionally draining."

Looking to the future

When asked about the efficacy of new COVID treatment options, Bharucha emphasized that current studies show "it is not a magic bullet."

These treatment options work in the first five to 10 days, he said, "by reducing the amount of symptoms and by reducing the amount of time that you will share the virus with other people." But the available evidence has "never shown that it will improve the rate of mortality."

Bharucha said that monoclonal antibodies are "a whole different set of treatment options, which we give to patients who come to urgent care or [the] emergency room in the very beginning phases of COVID, and who are at risk of progressing to the level that they can end up in the ICU."

Bharucha stressed the importance of getting vaccinated. "If you have a vaccine, you can still get infected with COVID, but your risk is 1 in 11,000 versus 1 in 8 [if you're unvaccinated]," he said.

COVID patients are getting younger

Arlund has noticed an increase in younger COVID patients in hospitals.

"I have had to watch patients that are the same age as me in their mid-forties leave their children orphaned, because neither of the parents were vaccinated," said Arlund. "Ninety percent of the patients that I see are unvaccinated."

Kamara said that she sees her young COVID patients "apologizing for not getting the vaccine. They realize that we're risking our lives to take care of them."

However, this is not the time to judge patients, she said, but rather a time to provide emotional and medical support. And health care workers are telling these stories "over and over again," she said, out of a desire to motivate unvaccinated people to get their COVID shot. "Do it now. Don't wait until you're with us in the hospital,” said Kamara.

"We offer the vaccine to absolutely everyone that comes through the [hospital] doors," echoed Arlund.

Mental health on the front line

The health care workers who shared their thoughts with Forum all spoke to the toll COVID — and the misinformation around it — has taken on medical and health professionals.

"Having refrigerated trucks and a three-month backup at the morgue have never let up," said Arlund. "Suicides are on the rise. I've had co-workers who have killed themselves because of the stress and the isolation."

Bharucha speaks of the "mental exhaustion seeing patients suffer, day in and day out."

"How long can one keep on doing this?" he asked.

Arlund stressed how the long-term emotional, mental and physical toll of the pandemic is prompting medical and health professionals to quit. "They are retiring much earlier than they had planned on," she said.

There is "no way" she said, "for us to replace these nurses that have had 20, 30 years of experience.

As for the help available to health care workers, McDonald particularly praised Kaiser Permanente’s Rise and Renew program, which provides mental health services for frontline health care workers. Arlund's union encouraged her to seek mental health services. "I was given the opportunity to step back” she said, and "that's what I've had to do for my own mental health."

Bharucha told Forum about Dignity Health's employee assistance program for its health care workers, whose services include confidential counseling.

"We are human beings at the end of the day," he said.