Lori Walsh: During this pandemic who cares for the caregivers? Dr. Clarissa Barnes is a hospitalist with Avera Health. She also serves as the Medical Director of LIGHT. This program offers all Avera physicians, physician assistants and nurse practitioners, free wellness resources, and she joins us on the phone right now. Dr. Barnes, welcome. Thanks for being here.
Clarissa Barnes: Oh, thank you for having me
Lori Walsh: Now, this program, LIGHT, tell people what it stands for. This is not a new program. This is something Avera has had for providers in place, although now its importance is definitely being highlighted.
Clarissa Barnes: Yeah. No, LIGHT has existed for years now. At this point, it's like, well, I'm glad we did that when we did. But the idea is that there's a lot of unique challenges for people in healthcare, and certainly we've seen nationally a lot of increasing problems with burnout or physician suicide. So, we wanted to have a resource specific to people in those professions to help them raise awareness of the barriers, to helping make them well, as well as helping them find their own solutions.
Lori Walsh: Right. Providers are already under a certain amount of pressure, particularly rural healthcare providers. Tell us a little bit about some of the challenges that exist in rural South Dakota.
Clarissa Barnes: Currently, I practice in Sioux Falls, but I've worked in Pierre, I've worked in the Yankton, I've worked in smaller areas around the state. Some of that is you're just more alone, right? You don't have 12 other sub-specialists who can come in 10 minutes later and give you answers to questions. You're responsible for a lot more and you have to be a little bit more creative. Obviously the distance is also problematic. The need to see someone else, if you want to go from Pierre to Sioux Falls, that's a day trip for a patient. That's a big deal. If you need to do that, you have to make sure that it's really worth it for them.
Lori Walsh: Yeah. Give us an idea of how this program is expanding or serving because the need is greater than ever amongst healthcare providers right now.
Clarissa Barnes: Yeah, I think we're doing a couple things. I think part of it is, it's helpful to have people who are willing to talk about the things that we don't normally want to talk about. I can't tell you the number of conversations I've had with physicians or other healthcare providers over the last couple of weeks where they're talking about what they're afraid of, where they're talking about how do I keep my family safe? Then when I tell them I have these conversations all the time, other people around you worry about these things too, they're shocked. They're like, "Oh, I feel so much better to know that I'm not the only person like trying to figure some of these things out." Historically, we still have a little ways to go in terms of being willing to open up about the things that are on our minds, and we really want to try and normalize that because there's strength in numbers and knowing that you're in this together.
Lori Walsh: Yeah. One of the things that's been difficult for people in South Dakota is we've had a little more time to prepare, which is excellent, compared to what you see in, say in New York City or somewhere like that. That preparation is good, but it also gives time for that anxiety to build and for that sense of dread to build and for healthcare providers to look at the stories that are coming out of some other hospitals in Detroit and New York City where physicians are getting sick and nurses are getting sick, and also having to make really difficult choices, even when you look at what's happened in Italy and beyond. How are you working with people to say it's important to learn the lessons from those places, but it's also important not to give in to that sense of inevitability and to dread?
Clarissa Barnes: I think you've hit the nail on the head there. This time is a gift. It helps us be more prepared, but it's also a curse because it allows us to really think about these things longer and to see what other people are doing. You really have to sit down and say it's okay to be nervous, right? It's okay to be afraid of what's happening. It's okay to see what other people have had to experience and to think about, what if I'm in those situations, what choices am I going to make? I think actually once we're really more in the middle of it, it'll actually be a little bit better. I think healthcare physicians and nurse practitioners and physician's assistants, when crises happen, we just do.
I think once we're actually doing more, I think actually it'll be a little bit better. I just finished a week on McKinnon's COVID Unit, and yeah, you still have a little bit of anxiety, but it's actually a little bit easier when you're just like, I'm getting the work done, I'm getting the work done, and I will deal with whatever anxiety I have after it's over. I think that, once we're in it and there's really a lot more of it for people, it actually will be a little bit [crosstalk 00:05:10].
Lori Walsh: There also is in a sense, and nobody's really talking about this, but I'm curious if people are saying this to you, where many of these healthcare providers, they got in the business to save people's lives, they got in the business to be of service, they got in this business. They have, with so many people who are out of work right now and are struggling with that transition, there's also great meaning in this, and hopefully not great sacrifice, but there is also a call to action, and these people are on the front lines. Are you also hearing people who are stepping into this role and saying, "This is what we've trained for, we trained for emergencies, we trained to be of service to our community, we trained to put them first, here we go?"
Clarissa Barnes: Yeah. That's how I feel about it. Honestly, I think when you look at the issues with physician burnout over the last several years, a lot of that is driven by all of the extra things. It's the paperwork, it's the bureaucracy, it's having to bow to the insurance companies and the pharmacies. I think the business of actually taking care of patients is what we came to this profession for. So, spending more time actually doing that, I think is going to be very centering for a lot of physicians. It's really more aligned with our core values of why we came to this calling in the first place. I think for some people, it's going to be a little bit ... it's going to be stressful for a while, but I think at the end of it, there's also going to be a real feeling of, that's why I picked this profession. This is why I was chosen for this. I'm glad that I'm doing more of that again.
Lori Walsh: Right. So much about being in this profession can be overwhelming. In this case, there is ... Many people are training to do things that maybe ... they're healthcare providers, but this wasn't their specialty, and now they're training to do something new, and they're volunteering for that at this point. Right?
Clarissa Barnes: Yeah. I've got friends who are sub-specialists or surgeons and they're asking, "Okay, well what do I need to look at to remind myself about vent management? I used to do that, but I haven't done it recently." Or people who are medicine sub specialists who used to do in-patient work, but now they're sub-specialty clinic. They're pulling things out and being like, "Okay, I'm ready. Put me in." People aren't running away and saying I'm not comfortable. They're volunteering to say I'm willing to help you because I know it's going to be all hands-on deck.
Lori Walsh: Let's talk about how those hands stay healthy because we want ... when we look at this whole concept of flattening the curve, of course the curve is meaningless if the number of healthcare providers drops. In some ways, it's not easy to make beds, but it's easier to increase that kind of capacity than it is to get more ventilators, than it is to get the right staff if the staff starts falling ill and unable to come to work, either because they've been exposed to the virus or because they have other health issues that are coming up because of chronic stress. Let's talk a little bit about keeping them healthy and start with personal protective equipment, and what has the call been for that to just keep them safe from exposure to begin with.
Clarissa Barnes: Yeah, I've been really impressed with our state. I think all of the healthcare organizations have been very clear that one of their priorities is to keep the people working safe. They're not asking people to do things that are unsafe and they're really trying to be creative in how they make sure that they have the appropriate supplies to do that. I know it's been difficult because a lot of those supplies, if you order things, they're going to get ... a lot of them get diverted, because New York's in a big crisis. They're going to [inaudible 00:08:54] to New York. But I think it's also hard for physicians. If somebody is in trouble, our instinct is to run into the room and want to help them, but the doctors can't help anybody.
So, you do have to make a little bit of shift. You can't just run into rooms. You really have to put your gear on, because you're not being a hero by putting yourself at risk. In fact, you're putting everybody at risk then, because if you're exposed then that's more work other people have to do on your behalf. That's more stress on your family. It's a little bit counterintuitive, but if you read the stories from physicians who used to take care of people with Ebola in different places in Africa, it's like that feeling of heroism to running into a room with nothing on, it gets you nowhere but sick.
Lori Walsh: Tell me a little bit about how testing is working for healthcare providers because we've heard a lot about the prioritization of that, because if a doctor or a nurse practitioner or a nurse is exposed, are they able to get the testing that would help them get back to work if they were asymptomatic? Because we all know by now, I think that this is a virus you can be a carrier of for quite some time without showing any symptoms, which makes things more challenging. How is testing of healthcare providers set up to take care of them?
Clarissa Barnes: I think we're getting to that point. Right now, the testing, it's so fluid. It's changing on a day to day basis. A couple of weeks ago, it was everything was going to the state lab, and it's like well now we've got other places that can do the test, but it takes a couple of day turnaround, to now, this week we're going to finally have access to some tasks that are more like a 45-minute turnaround, which is going to be amazing. If you asked me today what the testing plan is, it may not be the same. It's always changing. But I think the ideal state, when we've seen places that have been most successful, it is, in fact, testing all of your workers on some basis to make sure that you're not sending people in who are asymptomatic carriers. I think we're probably not quite there yet, but there have been places that have been very successful with that.
Lori Walsh: The importance is there though. You get the idea that the value is being placed on it and that it's being built to that point, even if we're never at full capacity, do you think people are taking that seriously?
Clarissa Barnes: Yeah. At this point, I think there isn't enough testing and supplies to test in that way, but I think that that is a goal, and I think we're trying to get there.
Lori Walsh: Yeah. Let's talk about keeping people on their feet from the other things, from the burnout and from the exhaustion and from the trauma that can be from working long hours. What are some strategies going in for healthcare providers that if they're listening, what are some of the things that they can do to build resiliency now? Because there's going to be days when those reserves are going to be tested.
Clarissa Barnes: Yeah. I think most people inherently know these are the things I need to keep myself well, whatever that happens to be. If you're the kind of person where it's like I need to run every day, now is not the time to negotiate that away. You need to keep doing that. I think for other people it's going to be different things. It's going to be a hobby or a conversation with somebody who means a lot to them. I think it's important to have some ... almost like an early alert system, like somebody in your life who can tell you that maybe you're getting a little bit more stressed out than you realize because I think we're ... it's a little hard. Sometimes we don't even know we're so in the middle of it that it takes somebody else to say, "Hey, I think you need to take a step back and eat a snack and go for a run." Or you need to have whatever it happens to be. You can't just rely on yourself to be the only person looking out for you. You need somebody else helping you out.
Lori Walsh: Yeah. In my family, that's my daughter who says, "You're not the only one who's doing this work, mom. You're not the only one." She is constantly reminding me that we're not alone in the work that we're doing as journalists, and that's something I think for healthcare providers too, just to say, you don't have to take care of every single piece. You can't carry the burden for all of humanity. You can only do what's right in front of you right now as best you can.
Clarissa Barnes: Yeah. But they want to try. That's the feeling that we all carry with us is that, I have to do it. I have to do everything. It's very, very hard to be vulnerable enough to say, I can't do this. I have to do this for me or I'm not going to be any good to anybody. That's important.
Lori Walsh: All right. It's all about longevity right now, and that can be weeks. There could be weeks, and when we talk about ... we are all talking about the peak, but for these people, there are patients in the hospital now that they're dealing with their healthcare needs, and those numbers of cases is rising exponentially. That peak is coming fast.
Clarissa Barnes: Yeah. I think when people initially looked at this, they thought, okay, well, I'm going to do these things, whatever they happen to be. Or I'm going to distance my family and live in the guestroom and I'm going to do this for ... it's going to be like a week or two, but people are finding ... I actually know it's going to be more weeks, it's going to be quite a while, and so you really have to build in what are the things I need to do to make myself well and do them and not let the exhaustion of work convince yourself that you can't do them. You have to make the time or it's going to be a very long, several weeks.
Lori Walsh: Right. Does a doctor or does a healthcare provider have someone to call at the end of the day if they really need some crisis intervention if they're having a hard time dealing with things? Has that shifted at all through the LIGHT program or through Avera?
Clarissa Barnes: Yeah, I think historically LIGHT's been more business hours, but at the beginning of this, both myself and our directors, put out our emails and our cellphone numbers and we said, "Call me anytime." If a physician is in the ER and something happens at 3:00 AM and they really need to talk to someone, they can call me and that's okay. There's other resources for critical incidences built into the system from long before this. There's always somebody available to talk to. I think for us, it's not just making sure it's available because it's available, but also making sure people know that it really is okay to call and not to try and shoulder all this yourself.
Lori Walsh: Then other people are calling too. That's another challenge is when people think, it's not so bad for me. Other people have it worse off that you can get stuck in this trap that you don't need to reach out because you want to leave room for somebody else to reach out, and that can be muddied thinking, go ahead and make that call. Right?
Clarissa Barnes: Yeah. No, I think if you're wondering, should I call someone? Then the answer is yes. I think that's the line.
Lori Walsh: Yeah. If that sort of early alert person in your life says, maybe we should call somebody, the answer is yes as well. Let's talk about what happens afterwards in the sense that at some point there's a peak, we hopefully rise to the occasion and the capacity is not overwhelmed because South Dakotans are doing what they need to do right now with social distancing. The best-case scenario, doctors and healthcare providers provide the best care possible, save as many people as they can. Going forward, these changes everything in a generation of healthcare providers. There can be trauma that your body will take forward. There can be anxiety that your body will take forward. There are losses that you will take forward. Is there a way to plan for that now so that when we know what's coming, we can navigate it as best as we can?
Clarissa Barnes: Yeah, it's hard because I do think that there will be trauma. I think for most of us, every time a patient dies, it leaves a little bit of a wound that stays with us forever. I remember everybody I've ever known and I've taken care of who died. Those are stories I carry with me forever. There's going to be a lot more stories in the next couple of weeks. But I also don't know that you can necessarily know how any individual's going to react. Some people may end up with PTSD like syndrome after this is over, but other people may find that this really instigates some real personal growth, that they found that they were nervous about what happen, what was going to happen and they did it anyway, and they found out that they had a lot of courage and they felt really good about that.
It's hard to know how any going to do. I think as a group we know there's going to be people who are going to struggle afterwards, and we're already making some plans for how we deal with that. Probably increase need from baseline. We've got some overflow plans and some access to some other mental health professionals that we may have to utilize.
Lori Walsh: What's your advice or what's your message to South Dakotans, not in healthcare who are facing some of those challenges of staying at home a little longer than they thought they were going to have to of keeping distance from people they deeply care about a little longer than they thought they would have to? They're getting a little itchy or antsy. Is this really worth it? What do you think you would like to say to the people who are asking you, are the efforts we're putting in now making a difference?
Clarissa Barnes: If you're making those efforts, then I'm very thankful. I see my husband, he's staying at home, he's single parent, essentially at this point, to our three children and homeschool teacher. This has been very difficult for him and for lots of people in very similar positions. I get it. It's still crazy, it's maddening. It's very difficult. I look at the numbers and I say, well, if we get to the point where we have more sick people than we have places to put them, or more ventilators or more staff, you're taking what's going to be a traumatic pandemic for us and you're making it worse, because now there's going to have to be a lot of other discussions about, well, how do we choose, how do we get 10 ventilators when we have 20 people?
Those things are very difficult and not choices that I think anybody wants to have to make. We don't want to be in a New York situation where you have physicians saying, well, we have codes every hour and people intubated sitting in the ER, I think that sounds terribly traumatic. If you're willing to be inconvenient so that we don't have to go through that trauma, then I'm very appreciative. Please stick it out.
Lori Walsh: Please stick it out. Dr. Clarissa Barnes is a hospitalist, and she's medical director of Avera's LIGHT program and she joined us on the phone today from Sioux Falls. Dr. Barnes, thank you so much and be well on the days ahead. We appreciate all you're doing for us and all you're about to do for people in South Dakota.
Clarissa Barnes: All right. Thank you so much.