They left their children to fight a pandemic with no end. Would they do it again?
They begged Christine Haines not to go. First her father, who tried reason.
"You have two small children," he pleaded. "What happens if you die?"
Then Christine's daughter, whose sobs appealed to that elemental place inside her.
"Please don't go mommy," she cried. "I don't want you to go. Please don't get sick."
Christine's mother knew better. She said nothing. She wore dread on her face.
In March 2020, Christine and her husband Lawrence Haines, both ER physicians in New York City, were on a family vacation in Florida when they saw COVID-19 tear through their city with terrifying ferocity. Early in 2020, New York had the nation's largest number of cumulative cases.
The Haines believed they needed to return to their hospitals, Christine to Lenox Hill in Manhattan and Lawrence to Maimonides Medical Center in Brooklyn, but they couldn't risk bringing their children, Madison, 7, and Gerard, 3, back to the city. They decided to leave them in Florida in the care of Christine's sister and parents. New York City schools had gone remote, and the kids would be well cared for. Christine said it was a choice she reflects on now, but in those early days, it didn't feel like one.
"The world needed us. Our ER needed us. Our patients needed us. And we were willing a hundred percent to sacrifice, possibly even our lives, because that's what we signed up to do," she said.
They told their children they hoped to be gone no more than a week. One week turned into 10, and while the family eventually reunited, they continue to weather a crisis that never truly abated, only evolved. In some ways, the Haines say it's worse now. Christine and Lawrence are exhausted, demoralized and angry at the vaccine reluctance that has trapped the nation in a pandemic spiral. Their daughter is anxious, often wondering aloud when COVID will end. Their son does not understand a world without masks.
A year and a half after the pandemic upended lives, frontline healthcare workers have yet to exhale. While many Americans are moving around their workplaces without masks, embracing relaxed restrictions and reveling in the protection provided by highly effective vaccines, healthcare workers remain entrenched in a cycle of surges, variants and death. The number of people diagnosed with COVID-19 grows every day throughout the U.S. and more than 700,000 people have died. Meanwhile, burnt-out healthcare workers are leaving the field or wondering how much longer they can go on.
Even before the pandemic, about 60% of emergency physicians experienced burnout, according to the American College of Emergency Physicians. About 400 physicians die by suicide each year.
A meta-analysis published in the journal "Psychiatry Research" in 2021 shows high rates of psychological distress among healthcare workers, including concerning rates of depression and anxiety, as well as extremely high rates of insomnia. Previous research also suggests these workers are at risk for long-term mental health problems. A 2006 survey of healthcare workers who treated patients during the SARS outbreak found high levels of burnout, psychological distress and posttraumatic stress one to two years post-crisis.
"It's not like the pandemic ends and the symptoms go away," said David Cates, director of behavioral health at the University of Nebraska Medical Center. "And this one has yet to end."
'It was something that was unreal, almost unexplainable'
Christine said when she and her husband arrived back in New York, it felt like a warzone.
"It was something that was unreal, almost unexplainable unless you were actually in my hospital, walking by our refrigerated morgues that were on 76th Street," she said. "We ran out of room. I mean, there's nothing that can explain that other than wartime. They had nowhere to put the dead bodies."
When they weren't working, the Haines would return to their Midtown apartment and engage in anxious rituals – stripping off their scrubs, depositing them into the laundry, immediately showering. A lot of effort was devoted to the practice of avoiding sickness.
They sat together. They told one another horrible stories. Sometimes they tried drinking wine or watching a movie. Anything to distract from death.
"If you add up all the people that died in my career, I probably saw more death in March and April of 2020 than I did my entire 15 years," Lawrence said.
Neither slept well. Lawrence would fall asleep from exhaustion, but he was fitful. He had dreams of people getting sick, of his family getting sick, of death.
They missed their children. Christine cried often. It was difficult to FaceTime. Whenever they tried, the kids would beg to come home. Lawrence said he was grateful his kids were safe, but their absence was visceral. Madison lost two teeth during those 10 weeks apart. Gerard grew a shoe size.
"I longed for them," Lawrence said. "They went through milestones without us."
Christine said it was dangerous to pause in those days, to contemplate or sit quietly for too long.
"There was so much trauma, so much scariness. ... It was almost like you couldn't really stop to think about it at the time because you didn't know if you would want to come back the next day," she said.
In Florida, Gerard missed his parents, but relished what he perceived as an extended vacation, especially with his 3-year-old cousin holed up, too. But Madison – sensitive, astute and without a built-in playmate – struggled. She was quick to anger. She would burst into fits, shrieking and sobbing. Christine's sister, Marianne Bertuna, said some nights she'd stay up with Madison until 1:00 a.m. before she'd fall asleep. Then Bertuna would spend hours scrolling on her phone, looking for impossible assurances that her sister would survive.
"All I would do is look at the news and pray that my sister was safe," she said. "At some point, I just didn't think they were going to make it. ... I remember one night at dinner, my mom just started crying, and I thought, 'Oh my goodness, what is happening here?' Because it all takes a toll. It took a toll on all of us."
'There's really no reason to think that people are feeling better'
Healthcare workers cope with the same pandemic stressors as the general population, including fear of infection, the death of loved ones, social isolation and loneliness. But they also face additional challenges created by their work environments, including the deaths of patients, emotional and physical fatigue as well as fear and guilt that they may bring the virus home to their families.
"What I see all around me every day is unbelievably dedicated people, but everyone has their limit, everyone gets tired," said Susan McDaniel, chief of psychology and director of the Institute for the Family at the University of Rochester Medical Center. "There's a lot of issues for healthcare professionals to deal with and then going out in public and seeing people unmasked when they're asked to be masked, it's hard for people not to get, depending on their particular way of handling stress, angry or depressed."
Cates said there is every reason to continue to be concerned for the healthcare workforce. They are working as hard as ever, never got a break and – in contrast to the adulation of those early days – they are now feeling unappreciated and some hospitals are even dealing with hostility and violence from patients angry over COVID safety rules.
"There's really no reason to think that people are feeling better, especially with the kind of psychological dissonance of there being a vaccine and yet these institutions, in terms of the severely ill, are treating mostly unvaccinated people," he said.
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Cates said he talks with nurses who feel forgotten. Collective support is less visible and social support can be difficult to find when most people don't understand the nature or intensity of the work. Well-meaning family members or friends often ask, "Why do you do this?"
"Social support is critical to wellness," he said. "People who don't have social support are at higher risk of all kinds of negative health outcomes. Many healthcare workers feel pressure to justify their work."
There are also barriers to formal mental health care.
"There's stigma ... like thinking, 'I shouldn't need this help. I should be able to handle it,'" Cates said. "If you talk to healthcare workers, one of their fears is that whoever they talk to isn't going to understand. It's hard to talk to somebody who doesn't get it."
Christine said the support of her husband and colleagues has been crucial.
"I couldn't imagine if I was married to a financial person who had no idea what I was going through," she said. "But we both get it. We both understand each other's need to save lives."
'I just wanted to make sure you were still here'
On Mother's Day, the Haines reunited on a sidewalk in New York City. The kids were effervescent, bolting into the arms of exhausted, overjoyed parents. The four stayed locked for nearly a minute, a wet mess of kisses and cries and "I love yous." Eventually, Christine and Lawrence stood up and stepped back to stare at their children, marveling at what they'd been so long without.
It was wonderful to be together again, but they were marked. Months after her parents returned, Madison, once an excellent sleeper, would wake overnight, traveling to her parent's room to confirm they were where they belonged.
"I just wanted to make sure you were still here," she'd whisper.
After they were reunited, Christine found a letter her daughter wrote. She doesn't know who it was to. God, maybe. The universe.
"I hope that (everything) is ok Because of the coronavirus it is so Bad."
Christine said as time passed, Madison remained uneasy. She was afraid they'd separate again. Even now, she feels there's uncertainty as long as COVID looms.
"She asks me all the time, 'Is it over?'" Christine said.
By early 2021, Christine thought the worst was behind her. Nothing, she believed, could be more difficult than separating from her children. Then COVID found her family.
On February 8th, Christine got a call from her father who said her 80-year-old uncle, Giovanni Bertuna, who had only received the first dose of the COVID vaccine, wasn't well. He had a cough and a fever. Christine told him to get her uncle tested, which revealed he was positive for COVID-19. He received monoclonal antibodies at Maimonides Hospital where Lawrence worked. Then he left.
Three days later, while Christine was juggling 12 patients during her clinical shift, her father called and said her uncle's oxygen was 70%.
"It was one of those days where I couldn't take one more thing and then there it was," she said.
She told her father not to wait for an ambulance, to drive to Lenox Hill, directly to her.
When her uncle arrived, he collapsed. Just as they were putting him in the wheelchair to go inside, her father began to leave. In that moment Christine felt the vastness of the gap between what she understood as a physician and what the rest of the world still could not seem to grasp about the gravity of the virus. So she told him.
"You can't leave," she said. "He's going to die."
That wasn't COVID's only assault on her family. Later that night, Christine's 105-year-old grandmother was also admitted to Lenox Hill with COVID-19. Since they were family, Christine couldn't treat them. The next morning, while feeding her son strawberries at home, the phone rang.
"He's in cardiac arrest," the resident told her. "Do you want to stay on the phone?"
She told them she didn't. She hung up. But a friend of Christine's who is a nurse manager in the emergency department called her when she heard her uncle was coding. She ended up hearing it all. He was gone for six minutes. Then he came back.
During the uncertain days that followed, Christine couldn't eat and barely slept. Her colleague Jodi Brown, a physician's assistant at Lenox Hill, said Christine was always at the hospital. She'd work her ER shift, stay late, and then come in on the days she wasn't working to check on her uncle and grandmother and speak to their physicians.
Christine calls them the worst days of her life. But in the end she says she got "a miracle" – a reprieve in a year of unthinkable loss.
"I don't know how," she said. "But I got them both home."
'There's a sadness. ... You could just see it sometimes in their eyes'
While much of the world has returned to some normalcy, Christine and her husband have not. They're still wearing N95 masks, surgical masks and goggles their entire shifts. Both say their hospitals have lost staff during COVID, so while they're seeing less sick patients, the pace remains intense.
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"We haven't recovered. We haven't had time," Christine said. "We've never had a chance to sort of stop and catch up and breathe."
At the start of the pandemic, the Haines were resolute that nothing would keep them from their work. Now, they're ambivalent.
"During the middle of the full surge in the springtime, I never doubted my job. I never doubted the fact that I was needed and I had to be there," Lawrence said. "Now, I'm questioning my life's work actually. I think we all are. Do I want to stay here in New York as a physician? Do I want to take a different line of work and move elsewhere? Maybe I want to try something new?"
According to a Washington Post-Kaiser Family Foundation poll this spring, about 3 in 10 healthcare workers have considered leaving their profession.
Haines said her dominant feeling now is frustration. There's a solution to the problem – the vaccine – but the patients coming in sick are often the ones unwilling to take it. Studies by the Centers for Disease Control and Prevention published in September show unvaccinated people are 11 times more likely to die from COVID-19 than vaccinated people.
Bertuna says her sister has changed. She's anxious, at times hypervigilant, especially when the kids get sick or anyone she cares about is exposed to the virus. There are more ambiguous changes, too.
"There's a sadness," Bertuna said. "You can't really put your finger on it. You could just see it sometimes in their eyes. Sometimes when we're watching the news or the kids are off playing."
For many people, the pandemic has been surreal and frightening, but most people's day-to-day lives haven't been textured by relentless death. Christine is still processing the enormity of what happened, what's still happening – the bodies lost, the bodies she sacrificed parts of herself to heal, and especially those two small bodies she spent an agonizing 10 weeks without.
"We're scared. Could this happen again? That's always on my mind. Maybe five years from now, there'll be a totally different virus," she said. "If this could happen once, obviously it could happen again. Can we go through it again? I don't know. I don't know."