ER Doctor Says He Walks Into A 'War Zone' Every Day

Dec 17, 2020
Originally published on December 17, 2020 1:31 pm

Emergency room physician Cleavon Gilman compares working in a hospital amid the pandemic to war.

"You can actually die at your job now, and that's never really been an issue before," he says.

He has the experience to make the comparison: Gilman served as a combat medic in the Iraq War.

"Health care providers are walking into a war zone every day where we can be killed by this virus, and even serve as a Trojan horse to bring it home to our family and to kill our loved ones," Gilman tells Rachel Martin on Morning Edition. "The amount of emotional strain our health care providers are under right now is just unimaginable."

The pandemic has created multiple crises for health care workers.

Hospitals are stretched thin — in beds, but more so in staffing. In Yuma, Ariz., where Gilman works, about half of the county's hospital beds are occupied by COVID-19 patients. That level is a "nightmare" scenario for staff, as one health researcher recently described it.

Then health workers have to worry about getting sick with COVID-19 themselves. More than 1,400 health care workers have already died, according to one count by The Guardian and Kaiser Health News.

And there's also mental health strain. Researchers expect many of those working now to be at enhanced risk of developing post-traumatic stress disorder. Physicians are already at higher-than-average risk of suicide, with one analysis putting the number at about 300 to 400 dying by suicide per year in the U.S., or about one per day.

Gilman has spent months writing about the virus and the strains it has caused for front-line workers, but he gained widespread attention last month after tweeting that there were no longer enough ICU beds at Yuma Regional Medical Center.

Gilman says he was let go because of the tweet, but the hospital later called it "a misunderstanding." On Monday, he was back at work, or "back on the battlefield," as he tells NPR in an interview about the challenges that he and other health care providers have been dealing with throughout the crisis. Here are excerpts.

Interview Highlights


How have you been doing?

This pandemic has been very personal. I've had three colleagues who have died from this. Two nurses, as well as my mentor, Lorna Breen, who got COVID in New York, and she took her own life. I think that this has just been extremely hard. I've also lost a cousin as well who was 27 years old, Simon Press. One thing I've kind of taken for granted is the toll that this has also taken on my family as well. We've been isolated, quarantining for 10 months. And this has really been very hard on my fiancée, who I've taken from New York and I've brought to a small community here.

Can you talk a little bit about the stigma of mental health and what it means for health professionals?

There's this false image that we are supposed to be perfect and that things can't really affect us.

I think even prior to this, I believe that one physician that committed suicide per day and that was twice the national average. It's a very hard job to be an ER doctor. You know, at baseline, we work under a lot of stress. Lives are in our hands. And we have to make split-second decisions that will affect an outcome of a person.

And enter the pandemic where upwards of 3,000 people are dying per day or 2,500 people are dying per day. That is unprecedented. And physicians and health care workers are not really trained for that amount of grief, amount of trauma.

One of the problems is if we say something about that, when you actually apply for a job, there's actually a questionnaire that you have to put psychiatric history on. So people are reluctant to have that follow them throughout their medical career.

When I was a resident in New York, three doctors committed suicide — actually four — over my four years there. And so this is a very prevalent problem and it needs to be addressed. One of the things that's occurring now is this Lorna Breen Act ... to create more mental health programs and well-being programs.

What was it like to watch the first health care workers get vaccinated this week?

It's really amazing because we've been waiting for this so long. And it's really important to get health care workers vaccinated because we are a limited resource. I'm really excited to get vaccinated here; it's supposed to happen on Dec. 20. ...

I've been doing this since March, for 10 months. God bless that I have not been sick. I've been very lucky.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

STEVE INSKEEP, HOST:

Dr. Cleavon Gilman felt like he had to get a message across. He's an emergency medicine physician at the Yuma Regional Medical Center in Arizona and is in the middle of working through his third pandemic surge.

RACHEL MARTIN, HOST:

The situation had gotten so bad in late November, he decided to post on social media about how there were no ICU beds left. He says he was then let go from his job. His post got a lot of support online. He even got a call from President-elect Joe Biden. And the Iraq war veteran, who is a musician in his spare time, is now back on the job. The medical center said in a statement that there had been a misunderstanding. And Dr. Gilman is now treating patients again.

CLEAVON GILMAN: I'm back at the hospital. It was really exciting to join my colleagues back on the battlefield.

MARTIN: The social media post you put out there that you say ended up getting you dismissed was about the scarcity of ICU beds. Has that been remedied?

GILMAN: The situation in Arizona is - has not improved since that tweet.

MARTIN: Is that still a problem in your hospital where you work?

GILMAN: We've actually been able to increase ICU beds in the hospital I'm at, and they've been able to fly out patients under the surge line, which is great. But our COVID cases are increasing, and our doctors and nurses are kind of bearing the brunt of that increase. I believe that tweet - or that sounding the alarm did exactly what it was supposed to do. It got people on alert. It got policymakers to address the issue. And, you know, the situation is still dire here.

MARTIN: How have you been doing?

GILMAN: This pandemic has been very personal. I've had three colleagues who have died from this - two nurses, as well as my mentor, Lorna Breen, who got COVID in New York, and she took her own life. I think that this has just been extremely hard. I've also lost a cousin as well who was 27 years old, Simon Press. One thing I've kind of taken for granted is the toll that this has also taken on my family as well. We've been isolated, quarantining for 10 months. And this has really been very hard on my fiancee, who I've taken from New York and I've brought to a small community here.

MARTIN: Yeah. You mentioned your colleague, Dr. Lorna Breen, who took her own life after she had been in the front lines dealing with COVID patients at New York Presbyterian. Can you talk a little bit about the stigma of mental health and what it means for health professionals, how it can stick on medical records and your professional resume and loom there?

GILMAN: Yeah, it's - medical professionals are - there's this false image that we are supposed to be perfect and that things can't really affect us. I think even prior to this, I believe that one physician that committed suicide per day and that was twice the national average. It's a very hard job to be an ER doctor. You know, at baseline, we work under a lot of stress. Lives are in our hands. And we have to make split-second decisions that will affect, you know, an outcome of a person.

And enter the pandemic where, you know, upwards of 3,000 people are dying per day, or 2,500 people are dying per day. That is, you know, unprecedented. And physicians and health care workers are not really trained for that amount of grief, amount of trauma. One of the problems is if we say something about that - when you actually apply for a job, there's actually a questionnaire that you have to put psychiatric history on. So people are reluctant to have that follow them throughout their medical career.

When I was a resident in New York, three doctors committed suicide - actually four - over my four years there. And so this is a very prevalent problem, and it needs to be addressed. One of the things being - that's occurring now is this Lorna Breen Act...

MARTIN: Yeah, there's a bill before Congress to address this very issue.

GILMAN: Exactly, to create more mental health programs and well-being programs - and I really hope that all of Congress would help us, as we are helping the country, to get that bill passed.

MARTIN: What was it like to watch the first health care workers get vaccinated this week?

GILMAN: Oh, it's really amazing because we've been waiting for this so long. And it's really important to get health care workers vaccinated because we are a limited resource. I'm really excited to get vaccinated here. It's supposed to happen on the - December 20.

MARTIN: Not that you're counting the days or anything.

GILMAN: (Laughter) You know, it's - you know, I've been doing this since March, you know, for 10 months. God bless that, you know, I have not been sick. You know, I've been very lucky.

MARTIN: When we were doing our research, we found this song online that you wrote in 2018 called "Rise Up Now"...

GILMAN: Oh, yeah.

MARTIN: ...About how doctors can burn out. And some of the lyrics feel really prescient - right? - to the situation we're in now.

GILMAN: (Laughter).

(SOUNDBITE OF SONG, "RISE UP NOW")

GILMAN: (Rapping) The days blend, can't tell where they begin. Candle lit at both ends, time to lean on friends.

MARTIN: I wonder if you've reflected on that song since the pandemic.

GILMAN: Indeed, indeed. I actually played that song - I actually play it almost every other day here. The amount of emotional strain our health care providers are on right now, it's just unimaginable.

(SOUNDBITE OF SONG, "RISE UP NOW")

GILMAN: (Rapping) It's impossible to clear my mind and rest, the way hospitals juxtapose life and death.

MARTIN: Well, we appreciate you. We appreciate the work that you're doing.

Dr. Cleavon Gilman in Yuma, Ariz., thank you for your time.

GILMAN: I really appreciate it. Thank you.

(SOUNDBITE OF SONG, "RISE UP NOW")

GILMAN: (Rapping) No vacation, see the next patient.

UNIDENTIFIED SINGER: (Singing) I will rise up now.

MARTIN: If you or someone you know is thinking about suicide, there are free trained counselors available 24 hours a day, seven days a week. You can call the National Suicide Prevention Hotline at 1-800-273-8255. Transcript provided by NPR, Copyright NPR.

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