But as days went by and spring turned into summer, Alderfer's fear transformed into exhaustion after months on the front lines of the COVID-19 pandemic. The toll of caring for the sickest patients of the crisis, of being unable to connect with them through layers of protective gear, and of watching so many of them die, was only just beginning to show.
And by fall, as the deadly third wave of the pandemic arrived, the 28-year-old critical care nurse became angry that she would have to go through all of it again.
"You try to protect yourself by not forming as much of an emotional connection because it's very likely that they will not do well," said Alderfer, a cardiac ICU nurse at UCHealth's University of Colorado Hospital in Aurora. "So I was angry. I just knew that I hadn't processed this thing yet and I wasn't emotionally in a strong place to go through all of it again."
Health care workers were hailed as heroes with nightly howling when the worst pandemic in a century arrived in Colorado. But a year later, several Denver-care health care workers who spoke to The Denver Post said they feel forgotten and let down by the government and public's response.
Health care professionals have spent a year enduring trauma — and it's still not over. They've faced an unprecedented amount of death through their jobs as more than 6,000 people have died from COVID-19 in the state.
They've cycled through a variety of emotions: fear, uncertainty, grief, exhaustion and anger. They've felt isolated as their jobs marked them as potential spreaders of the newly arrived virus — a concern that they, too, struggled with as they feared making their loved ones sick. They found hope in the arrival of COVID-19 vaccines, but still some wonder how they can remain in their chosen profession after this past year.
Overall, more people are experiencing heightened anxiety, depression, insomnia and post-traumatic stress disorder during the pandemic. But mental health professionals worry that the worst is yet to come, especially for health care workers who have experienced even higher levels of stress and bore witness to the most tragic moments of the pandemic.
"There's some concern... that the more significant mental health needs are going to kind of appear and emerge over time," said Steve Fisher, director of outpatient expansion and special projects at the Mental Health Center of Denver, adding, "It may sneak up on them in a way that they don't realize."
Health care workers also are at risk of experiencing compassion fatigue and moral injury because of their jobs. The latter occurs as their values are violated by decisions on the job that conflict with their beliefs, such as when nurses and doctors have to decide who get life-saving treatment when there is a scarcity of ventilators and other resources.
"You're overwhelmed by the nature of your job basically, which is exposure to so much trauma that now you are starting to experience it yourself and It's overwhelming you," Fisher said.
An unprecedented amount of death
Treating patients with COVID-19 is particularly challenging because medical employees have found that the coronavirus can affect the body in different ways. It can also be physically taxing as staff often turn patients on to their stomachs so they can breathe easier. And when a patient has severe enough symptoms that they are in the intensive care unit, it's possible that could stay there for weeks with little improvement.
"It's exhausting to come in and put 12, 13 hours into somebody and come back the next day and they're worse or better or nothing," said Justin Racine, a critical care nurse at Denver Health. "It seems like nothing you're doing is helping."
Health care workers have faced an unprecedented amount of death in their jobs as thousands of people have died in the state from the coronavirus, and some also have lost loved ones. So far, 6,191 people have died from COVID-19 in Colorado and 547,630 people have died across the United States.
"That's just not comprehensible that it's gotten this far," said Dr. Amy Olson, associate professor of medicine at National Jewish Health in Denver.
She has lost patients to the coronavirus that she treated for years before the pandemic. One such patient, who Olson had treated for at least 10 years, had an underlying lung disease but was stable before contracting the virus. The patient became sick after moving Texas, where hospitals ran out of resources during a surge in COVID-19 cases.
"We didn't have enough beds at that time to transfer her down," Olson said, adding, "It's really tough. Again, it's not just people I just met. These are people that I have known for a really long time."
Then, a month ago, Olson lost a close family friend who died from dementia and pneumonia. She was unable to go to his out-of-state funeral because of the pandemic and instead had to watch the service virtually.
"That was kind of icing on the cake," Olson said. "It's so disheartening not to be there."
During the fall surge in cases, hospital employees said the number of patients they cared for continued to increase as more of their coworkers became sick with the coronavirus. And even when hospitalizations from the virus decline, it can be difficult as people with other conditions come in sicker after putting off care.
"You're kind of getting hit harder by someone who is just as sick in another manner," Racine, 28, said. "And then, the second time around there's no 'thank you' signs. No hero signs."
He described the mental exhaustion that occurs each time he enters a COVID-19 patient's room, saying he took out a life insurance policy last spring when the pandemic began and discussed with his wife the possibility of her living elsewhere as she was pregnant. She gave birth to their daughter early, and he said he doesn't know if it was the result of stress from the situation.
"I do my best to not take it home with me, but there's days when that just doesn't happen," he said. "There's opportunities at work for some counseling and stuff like that, but it's difficult with the night schedule to coordinate that."
Alderfer, who is a charge nurse, remembers losing five patients in her 24-bed intensive-care unit in a single day during the spring surge. But, she said, she is one of the fortunate ones as UCHealth brought family members into the ward to say goodbye to dying relatives.
"I was in the place a lot less often where I was the only person in the room with a dying stranger, " she said.
Racine described a different scene, saying that when people are still positive for the coronavirus they are unable to visit with loved ones in the hospital..
"It becomes difficult to set up and arrange for some type of video chat,' he said. "Then try to tell them that their loved one is not doing well through a computer screen is a tough ask."
How health care workers are coping
Late last year, Olson began having trouble sleeping and started feeling anxious. She couldn't fall asleep until 4 a.m. and would wake by 6 a.m. to get her kids ready for school at home before going into work. She struggled to focus.
"I wasn't caring as much as I should and I was like, 'This isn't me,' " Olson said.
She thought it would get better after she took time off during the holidays, but when she returned to work she was still struggling with burnout and grief.
Mental health is still heavily stigmatized in the health care industry, and it is difficult for physicians to say they need to take time off of work, Olson said.
But, she said, that is what she had to do. Under the Family and Medical Leave Act, Olson has taken weeks off and altered her work schedule. For example, during February, she worked from home reading studies and did not directly treated patients. (Even when she's on leave, Olson still fields phone calls from her coworkers updating her about patients, such as when they pass away.)
"Overall, yes, it has helped me," Olson said, adding, "There are still days that are going to be rough and I'm learning how to get through those days."
Health care workers are facing a huge amount of grief and loss, but the longevity of the pandemic means people are having a harder time finding healthy coping mechanisms, said Fisher, with the Mental Health Center of Denver.
"The way that they were able to manage is not sufficient in many cases and now they have to figure out how can they manage this new stress and create a lifestyle of wellbeing," he said.
In December, the emotion Alderfer had stored away for nine months "leaked out" after losing someone she knew to COVID-19. She took a week off and spent the first couple days in bed, crying and journaling. Eventually, she returned cooking and walking her dog.
"I felt like I had coping mechanisms again," Alderfer said. "For the first time in nine months, I wasn't just shoving all of this emotion down in a box to deal with later. And since then, I've been trying to deal with stuff in real-time"
Her anger last spring made her uncomfortable; it was unlike her. She's heard from other nurses who have felt the same
Alderfer doesn't feel that way anymore. It's been replaced by apathy and exhaustion.
Now, before she goes to work each day, she stops in her car and tries to summon a positive attitude.
"I'm definitely been feeling burned out," Alderfer said. "It's hard to even consider staying in the nursing profession after everything that we've gone through."
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