*3.3. The Contrapuntal Voices of Healthcare Workers*

Irrespective of the contrapuntal voices embodied in the narratives, all the HCWs who worked in the hospital's Corona Department stated that *the daily routine in the Corona Department was more complicated than that in the rest of the hospital*. The corona team concurred that the reasons for the differences were both physical and emotional and that acknowledgment should be given to the unique characteristics of the department. Sharon, a nurse, summed up this opinion very succinctly as: "*Corona—it is not extra work, it is completely di*ff*erent work.*" Against the background of this commonly held perspective, the third stage of the Listening Guide analytic technique nonetheless enabled us, the interviewers, to identify multiple voices that revealed different aspects of HCWs' experiences and needs, including their attitudes towards the coronavirus pandemic, the staff and the hospital, and their own needs. The Listening Guide analysis of the focus group and the interviews identified five different contrapuntal voices—Trauma and stress, Security, Knowledge, Attachment, and Meaningfulness—intertwined not only with one another but also with the "I Voice" and the "You Voice" (see below). The contrapuntal voices and examples of quotes from the transcripts that represent these voices are described below.

#### 3.3.1. The Voice of Trauma and Stress

The hospital workers' narratives reflected their direct exposure to traumatic events and the pervading presence of death in the hospital, as particularly manifested in the agony of seeing people dying without their families beside them and in the procedures for preparing the deceased for burial by special, double wrapping of the dead body as a precaution against contagion. For example, in response to the interviewer's question "but you are accustomed to the death of patients, what is the difference?" Golda, a nurse, shared her feelings about traumatic moments after a patient's death:

A deceased is a deceased but the separation from the family is extremely difficult, the wrapping process is a different from what you normally do in the internal ward. In addition to the regular wrap we put them in a nylon wrap and that is horrifying. A really unpleasant sight. It is like you put your patients in a plastic bag and you close it with a zipper. And then you cover with another bag but from the opposite side. An unpleasant wrapping of a patient since it is supposed to be isolated.

Similarly, Marina, a senior physician in the ICU, shared her difficulties in dealing with professional uncertainty and the absence of definitive information in the medical literature:

Look, the coronavirus is something completely new. A whole new disease that we do not have a clue how to treat, how to behave with it ... and the craziest thing [is] that no-one in the world has the knowledge how to treat this disease, no knowledge-based expertise, no medical literature. So, you are constantly calling your colleagues in the country and around the world. Then, you are planning how you will cope with your first coronavirus patient. And then you are planning your second patient and the third. The decisions [as the head of the ICU] are just on your shoulders. They said to me: you are crazy ... you are crazy; what are you doing? But I had to listen to myself, my instincts, and I said I have to go with my feelings and intuition. The decision is all yours. And what is most crazy is that you do not know what will happen next. Now it [the patient's condition] is fine and five minutes later the patient can die and there is no-one to consult with because no-one knows [anything] about COVID-19.

In discussing the traumatic nature of their work in the ICU and the Coronavirus Department, Marina and Golda used the personal pronoun "you" in the masculine form when they spoke about taking decisions about life-and-death issues. We note here that in Hebrew, this usage of "you" in the masculine form is a generic usage that does not refer to the gender of the user. According to the Listening Guide methodology, the use of the masculine "you" hints at Marina's and Golda's difficulties in connecting emotionally to their traumatic experience of treating corona patients in the ICU [12,45]. Harel-Shalev and Daphna-Tekoah [45] have defined this Voice as the "You Voice," a voice that enabled the HCW's to distance themselves from recurring exposure to traumatic and painful experiences. It might represent a symptom of dissociation from traumatic events, not as a dissociative disorder, but rather as a coping mechanism allowing them to keep functioning as professionals.

Experiences such as these during routine work in unfamiliar situations were balanced by feelings of competency and an ambition to fight and succeed in the mission to conquer the novel coronavirus.

#### 3.3.2. The Voices of Security and Knowledge

These two voices—Security and Knowledge—are presented together since they are intimately intertwined. At the beginning of the crisis, the HCWs expressed their need for security and safety, primarily physical safety, and their need for crucial information and knowledge as a means to help them to feel more secure. With the progression of the pandemic, the HCWs became less anxious about physical safety and medical protection, as the hospital management met these basic needs and as the HCWs acquired the knowledge about how to protect themselves against contracting the disease. However, they still expressed the fear that, in the future, there could be a lack of equipment. According to Maslow, the most fundamental human needs are physiological, namely, air, water, food, shelter, and sleep. For medical personnel, Hale and his colleges [28] extended this level to include the basic determinants of good physical and mental health and safety.

Orr, a nurse in the Corona Department, shared the following thoughts with us:

At the beginning of the corona outbreak, there was a lack of food, protective gear, and clothes and shielding eyeglasses to protect ourselves. We had to shower between the shifts, and there was a shortage of showers in the hospital, and we had to fight for the basic needs to be protected, especially during the weekends. It was horrible. Everyone was terrified. There was a lack of food in the Corona Department. At the beginning, I did not have what to eat during the day. I felt broken and choked ... . There were shifts that I did not eat for almost 12 h.

Similarly, Sara, a single mother who moved to the Corona Department and worked 12 h shifts, said:

I did not have a life except the work at the hospital these past few weeks. I did not have a private life at all. I did not meet my family. I am tired all the time, I just want to sleep like a human being, to eat, to be away from the hospital and from the Corona that is all over; these 12-h shifts killed me. I am a single mother and I have a daughter. My daughter was all by herself at our house. It is unbearable; she was all by herself for all those days of the corona, and I was here taking care of other people.

The fear of being infected and of infecting others inside and outside the hospital, especially family and friends, was expressed vividly by the HCWs, mainly those working in the Corona Department. Dorit, a nurse, said:

There was constant anxiety and fear that we would infect others; we [at the Corona Department] felt like lepers ... and then the isolation from my family since I was so afraid that I would infect them. I was isolated like a leper. My children could not go out to play with other children because I was terrified that I would infect my children and that they would infect their friends with coronavirus. At the beginning of the coronavirus, my daughter was so stressed out from this crazy situation.

The interviewees tied knowledge to the feeling of security and protection. Dan shared his feelings with us: "*The Head of the Department is constantly updating us* ... *I do not feel detached* ... *I feel secure, knowing where I stand."* In contrast, Avi, an administrator, shared with us that: " ... *a lack of communication and information about what is happening at the hospital at the general level and not at the sector level bothers me. I am worried*." In answer to the question, what helps you feel better? Yoav responded: "*Uncertainty concerns me—assessments of the situation and updates by my immediate supervisor would help me.*" And Ruth stated: "*I feel like I'm in the dark and don't know what's going on."*
