PA Caregivers Face Additional Anxiety, Stress During Pandemic

PA Student Sara Naeem Shares Experience, Talks to Colleagues

By Sara Naeem, PA-S

March 25, 2021

Sara Naeem with her sister
Sara Naeem, PA-S, left, with her sister.

As a child of Pakistani immigrants growing up in the suburbs of New York City, my fluency in both Punjabi and English helped me navigate two very different worlds: one of newly-minted U.S. citizens facing the daily socioeconomic obstacles associated with immigration, and one of a young brown woman being raised in post-9/11 society. Growing up, I was constantly juggling my identities, and I found myself in different situations, with lots of different people, because of the two worlds I inhabited. What I ultimately learned from my childhood is that I enjoy interacting with people from diverse cultures. I love learning from and communicating with people from different backgrounds.

Becoming a PA
My experience as a child, and as a woman of color, set me on my path to medicine. I saw firsthand how racial disparities, healthcare disparities, socioeconomic status, language barriers, and more have affected my own loved ones in the management of their health. I decided to go into medicine so that I can have the opportunity to connect with underserved populations. Being a PA allows me to do so purposefully.

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As an undergrad at Hunter College, I developed a passion for advocacy and promoting diversity within medicine. I served as outreach coordinator for Hunter’s Minority Association of Pre-Medical Students (MAPS) chapter for three years. Clinically, I began working as a medical assistant in a family medicine clinic in which a majority of our patients were people of color. My understanding of the PA profession ultimately stemmed from my time interning at Memorial Sloan Kettering Cancer Center (MSKCC) in their Advanced Practice Provider (APP) Program (AP3). The AP3 program was specifically developed to encourage underrepresented minority women interested in entering medicine as APPs. At MSKCC, I shadowed multiple PAs across various specialties, connected with patients of all ages, and witnessed first-class team-based patient care. This experience solidified my desire to pursue the profession.

PA School During COVID-19
After my experience at MSKCC, it was time to think seriously about PA school. I decided to attend Wagner College’s PA Program in Staten Island, New York. In March of 2020, I was in my final semester of didactic year when my university’s campus went fully remote because of the COVID-19 pandemic. We were eight weeks away from the end of the year and the pandemic created difficulties across the board for our students. Our third-year students had rotations cancelled, which shortened the length of their clinical experiences. Luckily for me, my rotations and graduation date were not affected, but my learning and exams moved online and my classmates and I communicated solely electronically. COVID-19 didn’t just impact the way I was learning or talking to my classmates. I felt socially isolated and more anxious because of all the uncertainty that existed. My situation was made even more complex because of my dad.

[How to Stay on Track in PA School During a Global Pandemic]

Sara Naeem with her family
Sara Naeem, PA-S, right, with her family.

Caregiving
In 2016, my father suffered a stroke that left him wheelchair-bound. He lost his ability to walk, get in and out of bed, use the bathroom on his own, manage his emotions, and more. I was still in undergrad when it happened, and my mom, sister, and I became caregivers overnight. Being a caregiver was exhausting. I had to plan my class schedule around his meals, be home by a certain time to help my mom or younger sister put him in bed, and be as present as possible, which meant I couldn’t have the “typical” college student experience. Managing my time and commitments as a pre-PA student was the most difficult part. I did it, but a legitimate concern after being accepted to a PA program was how I was going to manage caregiving as a PA student. Fortunately, I have had the physical and emotional support of my mom and sister through it all, and I will forever be grateful to them for allowing me to focus on school while they take on my responsibilities in my absence.

Then, in November 2020, our family was dealt another significant blow. My mom was diagnosed with two brain tumors that required a six-week course of radiation treatments. I remember finding out and feeling numb: I now had two severely immunocompromised parents at home.

Caregiving During COVID
I physically started rotations in August 2020. Given my responsibilities at home, l was terrified to step out of the house as COVID-19 cases began to rise. I already suffered from anxiety because of PA school, but starting rotations in clinics and hospitals where I could easily contract COVID-19 felt unfeasible. I want to be a PA, though, so I would don my PPE and head to my rotation sites.

[The Ups and Downs of My First Year as a PA]

Sara Naeem with her mother
Sara Naeem, PA-S, left, with her mother.

I live in fear, and with guilt. Constantly. I’ve spent the last 11 months worrying that I’ll infect either one of my parents, which may lead to a fatal outcome. No one will ever know what it feels like to be a caregiver unless they’ve experienced it themselves. Being responsible for another person’s health and well-being is draining. I find that I can’t eat, sleep, or study until my parents’ needs are taken care of. My responsibilities can be overwhelming: managing our bills and grocery shopping, scheduling my parents’ medical appointments, dealing with their health insurances and home health aides. The only way I make it through is by working with my family. My parents have given me the gift of an education, and I find that being their caregiver has been a humbling experience. It has made me more compassionate, and I hope that the lessons I’ve learned will translate into me being a thoughtful clinician in the future.

These last few months have been both physically and mentally taxing. Potential exposure to COVID-19 is something I still struggle with, as it is inevitable. I have no choice but to live with my parents, and we have all silently acknowledged that I now pose a risk to their life as a PA student. With my dad having so many physical needs, it’s impossible to avoid contact with him. Other than my usual sanitizing routine after coming home, there isn’t much else I can do. Honestly, I feel helpless most of the time.

I know my own mental health is important during this trying time. My sister has been the closest thing to therapy for me. Despite being two years younger than me, she is the only person in the world who knows what I’m feeling because she feels it too. Given all that’s going on in my life, I’ve not yet met with a therapist, despite knowing it can be beneficial. I find myself seeking other tasks to serve as distractions, or isolating myself because bottling my emotions is how I’ve dealt with it all since 2016.

As healthcare workers, it is often easy to neglect our emotional health as the stresses of our personal and professional lives begin to intersect. How do we continue to do our work while also preventing our loved ones from contracting a possibly deadly virus? How do we take care of ourselves? I wish I had the answers. Truthfully, I’m still learning and I’ve been taking it day by day since COVID-19 made landfall in the U.S.

As I’ve navigated the last year, I’ve found that there are more PA caregivers than I anticipated. I’ve connected with some of my colleagues over our shared situations.

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Karlina Nguyen
Karlina Nguyen is a full-time critical care PA at Mount Sinai Beth Israel in New York City and an alumna of Wagner College’s PA program. Her mother was diagnosed with ovarian cancer in 2019, while she was on rotations in her second year of PA school. She explains: “It was hard being a caregiver for my mom given that I was on rotations and my schedule was not the most flexible. During this time, my brother was the one who took her to her chemotherapy appointments, but I was the one most involved in her medical care given that I had the medical background.”

Karlina Nguyen with her mother and brother
Karlina Nguyen, PA-C, right, with her mother and brother.

Six months after Nguyen started working in the ICU as a new grad, COVID-19 surged in New York City. Within two weeks, her 16-bed ICU was filled to max capacity with COVID patients. “I was constantly around COVID, and it freaked me out knowing that I had an immunocompromised mom at home waiting for me,” she said. “I would drive home with panic attacks, asking myself, ‘What if? What if I bring this home and this kills her?’ That fear lived with me and would eat at me.” Nguyen decided to move out of the house she shared with her mother early in the pandemic to keep her anxiety at rest and to protect her mom. She found herself in a unique position: she was a caregiver from afar. Her brother, who was able to work from home, took their mom to appointments, and Nguyen managed her mother’s medical care over the phone. “I didn’t see my mom for three months. In order to keep my anxiety tolerable, I started to swab myself every time before seeing my mom. I would wear freshly clean clothes around her, spray my car down and wipe every surface before she could touch anything.”

Nguyen found herself in a never-ending battle. She needed to be a caregiver, a PA, and a daughter, all at the same time, all during a pandemic. She describes it as being in a constant state of fight or flight. She struggled with anxiety before the pandemic, as she felt that she had to fix everything. “I had to find the solutions for my mom. Whenever I wasn’t able to, I would feel this layer of anxiety and helplessness. The feeling got worse as I worked through the pandemic. I had patients dying at work and my mom’s cancer at home. It took a toll on my mental health dramatically where I would wake up with nightmares and suffered from insomnia.” Currently in therapy, Nguyen is an advocate for self-care; she knows she cannot take care of others without taking care of herself. She started therapy to deal with her anxiety and trauma from COVID-19. She states that working through it with someone else allowed her to be present every day.

[5 Mental Health Tips for PA Students]

Tova Hecht with her mother
Tova Hecht, PA-C, right, with her mother.

Tova Hecht
Tova Hecht is an emergency medicine PA working at CityMD. In February 2020, she was on the front lines treating COVID-19 patients when her mother was diagnosed with stage IV breast cancer. “The biggest struggle I had to deal with on a daily basis was the emotional aspect of suddenly having to care for my mom. My mother cared for me, nourished me, supported me and provided for me my whole life and abruptly, the tides turned,” Hecht said.

“One of the hardest moments for me as a caregiver during the pandemic was when I wasn’t able to accompany my mom to her appointments. She was diagnosed right at the start of COVID and no one was allowed to enter the facility with her. The inability to provide moral support to my mom, and to hold her hand while she was going through a life-altering journey was frustrating, aggravating, and emotionally difficult. I couldn’t bear the sight of watching her enter the hospital building alone to attend her medical appointments, and oftentimes I would drive home crying, wishing I could be by her side.”

Tova Hecht with her mother and sisters
Tova Hecht, PA-C, with her mother and sisters.

Hecht did find that being a PA made it a bit easier for her to communicate with her mother’s treatment team. She had a good understanding of what was happening and could explain it to her mom. She was also able to advocate for the best possible care for her mom. Hecht had the emotional support of her sisters and other family members, whom she leaned on during the challenging time.

Hecht’s mother passed away in September of 2020, four weeks after attending one of her daughters’ weddings.

Hecht says her experience as a caregiver ultimately gave her entirely new perspective for treating patients. “Cherish every moment and every person in your life because you never know when it will be the last time you see someone. Life is fragile. Take nothing and no one for granted.”

To other caregivers
Caregiving is not easy. Some days, I do feel like quitting PA school because I’m tired of dealing with so much. However, my family is my source of constant encouragement. My advice to PA caregivers is to develop a strong support system. Reach out to people if you feel like things are getting too suffocating. It helps. If you are a PA student, reach out to your program faculty and preceptors to discuss your situation. My program director and faculty were incredibly supportive after I revealed my mom’s diagnosis in November.

Caregiver burnout is real. It’s a topic discussed and witnessed in both PA education and practice. Self-care is something I still struggle with to this day, but my best advice is to try to prioritize your own health. Find a day for yourself. Catch up with friends. Take a walk. Organize a Zoom party. Do what you need to do to be your best self, because at the end of the day, you matter too.

These days, I feel more hopeful, now that vaccines are available. My sister and I are vaccinated and my parents just got their first doses. When my sister sent me a picture of my mom getting her shot, I felt an incredible sense of relief. I’m cautiously optimistic, and I can’t wait to be a practicing PA.

Sara Naeem is a second-year PA student at Wagner College. She can be reached at [email protected]   

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