By late September (2021), Rikki Koberlein couldn’t take another day.
For months, she had been yelled and cursed at, called a “political pawn” and told she wasn’t doing her job properly.
As an intensive care unit (ICU) nurse at West Valley Medical Center in Caldwell, Idaho, United States, Koberlein says, “Nursing is my calling.”
But the abuse day after day, month after month, wore her down.
Twenty months into the Covid-19 pandemic, healthcare workers are far from the days when they were widely viewed and treated as heroes on the frontlines of the coronavirus fight.
The treatment from Covid-19 patients and their families has worsened, especially since the Delta variant spread throughout Idaho this summer (2021), healthcare workers say.
One patient’s family members recently berated Koberlein for two straight days while the patient neared death, she says.
They accused her of mistreating the patient and demanded certain unproven medications.
At one point, a family member said, “I want the medications that my president received”, recalls Koberlein.
He continued saying he didn’t serve in the military for this, even though his demands wouldn’t have helped the patient, she says.
Eventually, she called for mediation.
Koberlein, 45, began her healthcare career as an emergency room technician in 2013 and graduated from nursing school in 2018.
She has coped with the recent stress and trauma by bonding with colleagues.
Despite the challenges, she carried on with her job.
Until Sept 26 (2021).
“I broke,” Koberlein says by phone. “One day I was here at home, and I had to go back to work the next day, and I just couldn’t do it.
“I couldn’t do another day of giving people my all and having it be thrown in my face saying I’m doing nothing.”
She says she went into a deep depression with no energy.
It would take days for her to recover from each of her three 12-hour shifts a week.
She became numb to feeling joy and anger. Household chores went undone. She didn’t socialise with friends.
Living through the fight against Covid-19 was inescapable at all times.
Given what she was dealing with, Koberlein took a month of leave.
“This is what I feel I was born to do,” she says.
“To have someone say I’m not doing everything I can for their loved one, it’s a stab in the heart.”
Viewed as the enemy
Fighting to save patients with Covid-19 was already “hugely challenging,” says Dr Ashley Carvalho.
Now, treating the disease has come to mean navigating tense conversations with patients’ family members, explaining research studies and fending off accusations.
In mid-September (2021), she was treating a Covid-19 patient in the ICU, but the patient’s family declined treatments like remdesivir and steroids, which are proven to be beneficial, she says.
Instead, the family insisted that the patient receive ivermectin, which hasn’t been approved by the US Food and Drug Administration (FDA) to treat Covid-19.
Ivermectin is an anti-parasitic drug that’s used to treat diseases including parasitic worms and head lice.
Dr Carvalho says physicians aren’t licensed to prescribe the drug for Covid-19 patients.
When she tried explaining that to the family, she says the situation became “highly emotionally charged”.
Then a family member threatened her with violence.
“I have lots of ways to get people to do things I want them to do,” she recalls the family member saying, “and they’re all sitting in my gun safe at home.”
Dr Carvalho called for security, and the family was escorted out of the hospital.
She was disturbed by what was said. And because of the refusals, she was upset she couldn’t help the patient more.
While that was her most upsetting experience, Dr Carvalho says, she’s now used to facing confrontations at least once a day.
“It’s actually just very demoralising,” she says by phone.
“It’s hard when you’ve gone into a profession to help people, and help them with the recommendations of the best evidence and the best science you can learn about.
“... It’s frustrating because both me as a physician and the patient’s family, we want the patient to get better, but I feel that all of my knowledge and training is overlooked by people’s families.
“I’m kind of more viewed as the enemy.”
Dr Eric Donahue, who practises at West Valley Medical Center, says the most challenging part of the abuse he’s faced is dealing with patients’ angry family members.
He’s similarly dealt with verbal attacks and accusations.
Before the pandemic, he rarely had these confrontations – once or twice a month, he estimated.
Now it’s multiple times a day.
Dr Donahue says he hasn’t been physically assaulted, but he’s been consistently accused of killing patients rather than attempting to save them.
Accusations that he doesn’t care about patients is what he’s experienced the most.
“You’ve got to sell it to try to even get them to take whatever medication,” he says by phone.
“Especially for Covid, you have to convince them you’re not trying to harm them, but that you actually have motives that are kind and humane.”
Misinformation and politics
The number of non-fatal workplace injuries and illnesses due to violence increased each year from 2011 to 2018 in the US healthcare industry, according to the US Bureau of Labor Statistics.
In 2018, healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence.
Abusive situations have stemmed from patients and their families experiencing some of the worst days of their lives and heightened anxiety that has existed since the start of the pandemic.
Those elements have created a “perfect storm” for dangerous interactions, says St Luke’s Health System clinical practice integration senior vice president and chief nursing executive Elizabeth Steger.
“That negative energy or aggression that seems to be a little bit of friendly fire when it comes from those that we serve, it just exacerbates the situation,” she says.
She doesn’t believe misinformation is causing most of these combative behaviours.
Instead, she says the cause is more frequently underlying tensions that bubble up among patients and their families.
“Our visitation has changed, access to patients has changed, the number of visitors has changed due to the nature of Covid,” she says in a video interview.
“And I think that’s been a challenge for people – less access to information.
“So that’s really created some heightened frustration too.”
But others in the healthcare field did say misinformation is causing friction with patients and their families.
Dr Carvalho says misinformation has made people wary of research and evidence.
She adds that she observed a shift in patients’ behaviours based on politics about receiving the vaccine.
“I wish (community leaders) would stop spreading misinformation, because I truly think that’s the source of a lot of the aggression that healthcare providers see,” she says.
“That’s easier said than done.”
Given that patients’ relatives are desperate to save their loved ones, Koberlein says she understands where they’re coming from.
But she says she wouldn’t ask for something drastic, like a treatment that isn’t proven.
She also points to the politicisation of vaccines as a dangerous precursor for confrontations.
She says she’s been falsely accused of withholding unproven treatments for political purposes.
“The change was politics regarding the vaccination and huge, huge misinformation. Ridiculous misinformation,” she says.
“That was the biggest change.”
Since May 15 (2021), unvaccinated people have accounted for 88% of Idaho’s Covid-19 hospitalisations and 86% of the US state’s Covid-19 deaths, according to the Idaho Department of Health and Welfare.
Worn down and traumatised
On top of trying to treat people for Covid-19 while crisis standards of care remain activated, doctors and nurses are worn down by the way they’ve been treated.
Some say the abuse could result in a smaller workforce.
“All of this together is really making them consider if they’re going to stay in healthcare or not,” Steger says.
“That’s obviously concerning for all of us, because we need our talented and skilled clinicians and providers to be here with us.”
At least three people in Koberlein’s unit took leave because of the trauma they experienced, she says.
Nearly all of the nurses in the unit are attending therapy to help them cope, she says, and four or five other people have left the unit.
During her leave, she put together puzzles on her dining room table, took care of plants around her house and made pottery.
Those hobbies help her relax.
As she discussed what she experienced, she held back tears. “It’s torture,” she says.
The time and energy put into explaining procedures with patients and their families takes away from what could be spent on trying to treat patients.
While nurses and doctors are doing their best, they’re increasingly burnt out, says Dr Donahue.
“That’s a hard toll on any human, whether you’re a nurse, a doctor or someone in the military that’s fighting a war,” he says.
“What it feels like is you’re at war every day.”
Both Dr Donahue and Koberlein say they’ve forged stronger bonds with their colleagues as a result.
They check in on each other regularly, and they’ve become more honest with each other.
Leaning on each other is the only way to handle how they’re treated, Dr Donahue says.
Instead of questions that might elicit an “I’m fine” answer, people in his unit have been asking more specific ones, like “How much sleep are you getting?”
Koberlein mentions how nursing used to be one of the most trusted professions.
Gaining trust is now one of the biggest hurdles she faces.
Dr Donahue believes the solution is simple: just be kind and respectful.
Adults should apply the lessons children learn in preschool and that parents give to their own children.
“We have just kind of gone crazy, and we stopped respecting one another, and we’re pretty rude as Americans to other people with different opinions,” he says.
“I think we just need to have some common decency.”
Steger thinks the situation will improve as Covid-19 hospitalisations decline and hospitals eventually return to how they operated before the pandemic.
At that point, there could be more access to visitors, and she hopes, less tension.
Oftentimes, patients beg to receive a Covid-19 vaccine when it is too late, Dr Carvalho says.
Given how the virus continues to spread, she says people no longer have the luxury of time to wait to get vaccinated.
However, while more people getting vaccinated could help, she says, “I don’t know if there’s an easy fix.”
Covid-19 patients who aren’t vaccinated aren’t set up for success, Koberlein says.
That makes it a steeper challenge to treat them and a more dire situation.
That means more dangerous outcomes and more highly emotional interactions with family members.
Though she’s sceptical of how achievable it is, Koberlein says the solution is helping people understand that healthcare workers are doing everything they can to save patients.
“Each day we should just treat everyone with love, kindness and compassion,” she says.
“We’re all on the same team.” – By Paul Schwedelson/Idaho Statesman/Tribune News Service