Hello my name is Joan, I am a senior nurse currently working at the NHS. I am also, according to the nursing times, a well-known activist.
During the pandemic I left my office desk and I went back to the frontline. During the first and second wave I worked in ITU.
Both emotionally and physically has hit me very hard. On a daily basis I went from joy to grief in a matter of seconds. It has been a rollercoaster. Anxiety, fear, insecurity, guilt, anger, loneliness… These are a few of the emotions that I needed to deal on a daily basis.
You realize your mortality. Inside your head you always have a little voice that constantly tells you that you can be next.
After a year I am very tired physically and emotionally.
Tired of the pain on the phone, of the daily tears, of the only visit for the last goodbye, of the pain in loneliness, of the broken lives, of the eternity of the constant mourning and of seeing people die every day.
Tired of waking up in the middle of the night. Tired of having nightmares. Dreaming of the terror in my patient’s eyes. The tear running down his cheek. Tired of patient saying goodbye to their families on facetime before they are put down to sleep knowing that probably that will be the last word the patient will ever say because 50% of them they will never wake up again.
Similar scenes are repeated every day, it is very hard.
They are not numbers ... Each death leaves a scar on your heart, imprints an image on your brain that you remember during your dreams.
Psychologically, you are not prepared to withstand the pressure that means that every time you open the doors of the ICU you are risking your life, that any small mistake can mean that death comes knocking on your door. Also, the work is often bleak.
Even I, who am not religious, found myself praying as I closed my eyes and took the hand of my patient as if trying to channel my energy to recharge him and that I could continue to fight COVID. As I passed the sponge through every corner of their skin, I prayed that my patients would get better, even if only a little.
As nurses we take care of the functioning of each patient’s body. We monitor heart rate, blood pressure and respiration. The patient’s life is in our hands and it is a huge responsibility. We need to monitor patients constantly because change can happen very quickly. Any fluctuation in blood pressure or breathing may require an adjustment of treatment or may be a sign that the constants are deteriorating. This is why, hospitals usually assign a nurse for each intensive care patient. But with COVID this has often not been possible and in some ICUs, especially in London, a single nurse may have to monitor the care of up to four seriously ill people. Normally, the nurse caring for the patient notices the signs that predict an impending crisis, but this perception becomes much more difficult when more than one patient needs to be monitored and cared for. If we cannot maintain the ratio of one nurse per patient, the pressure on caregivers will get worse. Nurses cannot provide the level of care that is expected of us and very often this makes us feel guilty. You often come home with your head spinning: "If I hadn't gone to see that other patient, my first patient could have been better." You feel responsible when things don’t turn out the way they should, but what other option do you have?
You need to be constantly on the alert. You can't lower your guard for a moment. A mistake can cost a life. On top of all this emotional pressure we also have to carry a complete PPE protection kit and this makes the job very difficult.
We wore the PPE constantly. All you can see are people’s eyes. It is very hot and sweaty throughout the twelve hours that the shift lasts. And you can't lift your visor to dry your face or take a sip of water. Instead, you should plan your breaks so that you can eat and drink regularly. You can't go to the bathroom without carefully removing the entire kit and then putting everything back together.
I am not ashamed to say that I needed help.
I was not prepared or able to cope with the large volume of deaths and the intense pain we experienced every day.
I often worried about the decisions I had made during my shift. Sometimes I was so worried, that I even got to call the unit to talk to the work colleague who was caring for my patient. to check to know how my patient was doing. The broken nights were accumulating and little by little the fatigue was taking over your body. But keep going trying to do the best you can.
At the end of May, I had an anxiety attack. I had not slept well that night. I woke up in the middle of the night and couldn't sleep anymore. The day before, I had lost a patient of a similar age to me who had no serious illness. Statistics said he should have gotten out of it but COVID took him in the blink of an eye. I still remember her daughters saying goodbye to their father through an I-Pad. Daughters the same age as mine. The death of this patient affected me a lot and I couldn't get the idea out of my head that it could happen to me soon.
The next day, the road to the hospital was exhausted. I parked my car and took the elevator to the floor where the ICU was. I started sweating and palpitating in the elevator. My heart was pounding. I sat in the room where we were given handover before entering. A feeling of panic suddenly engulfed me. My head was filled with thoughts that I would enter the unit that day and that the virus would attack me. I was convinced that if I entered the Unit I would be the next to die.
I lost track of time. Next thing I noticed was that the shift manager had put her hand on my shoulder and was asking me if I was okay. For the first time in 45 years I said NO.
That day I did not go to work in the ICU. My boss sent me to the hospital psychologist.
However I felt like a failure, I was ashamed to have had problems with my mental health. I thought this only happened to weak people and at the beginning I didn’t tell anyone. For 45 years I had learned to pretend I was fine.
I started my face-to-face therapy with a psychologist and gradually regained my balance. With the help of a psychologist, I realized that having a mental imbalance is nothing to be ashamed of. That my mental state was the result of the situation I had found myself in and many years of neglecting and not taking care of my mental health.
The most important learning I’ve done is knowing that mental health is as important as physical health. You need to allow yourself to recognize your feelings and learn to share. I’m still learning from it; I still often feel uncomfortable talking about feelings.
Mental health carries a great negative stigma. At first I thought people would judge me and condemn me. After all, I had always given an image of strength. I realized that my stress and anxiety were illnesses that could affect everyone.
My sense of guilt began to fade. I have learned to detect the first symptoms of anxiety and stress and instead of ignoring them I recognise them and, from what the psychologist has taught me, I apply techniques to control them.
Mental health is very similar to physical health. Every day you have to take care of it as you do with feelings and emotions. As with love, so with stress and anger, if you don't take care, it goes wrong. From a very young age they teach us to have good care of our physical health. We learn to exercise to improve our fitness; going to the doctor when something hurts us. Similarly, we should do mental and emotional exercises to improve our mental health. But this need is never discussed. We need to break the taboo of going to the psychologist. No one had taught me how to take care of my mental health until I first went to a psychologist when I was 45 years old.
Before I used to hide my problems, my anxieties, I did not share my doubts. I did not to accept my limitations. I have learned that I am no less of a man or a worse father or nurse because I had mental health problems. Taking care of mental health is not a weakness, quite the opposite. The bravest thing a person can do is ask for help when they need it. The problem is that for many years society has made us believe that having ups and downs in your mental health is a sign of weakness.
He had the absolute belief that in order to be a leader he had to have certain qualities: honesty, integrity, trust, being able to inspire others, being passionate and a good communicator. But I also believed I couldn’t let my problems show. But I have learned that this is impossible. I am not a hero or an angel, I am human. It was very difficult for me to show this more human face of mine and, when I was not feeling well, to recognize it in front of others.
All I can say is that for 45 years I became very good at pretending I was okay when I wasn't.
We are in the road out of the COVID pandemic but another one is on its way. The impact that COVID has had in our mental health has been tremendous and we will see the full impact in years to come. We need to start talking and supporting each other. It’s ok not to be ok.
To finish I want to give you five tips that I learned from a good friend Lisa Rodrigues, that hopefully will help you take care of yourself:
1.- When something goes wrong and you make a mistake, try not to be discouraged. Take time to process what has happened. Apologize wholeheartedly. But don’t rush into quick judgments or decisions. Making mistakes is part of life on the road to success. It’s important to learn what went wrong to try not to do it again.
2.- When someone criticizes you, try not to take it as a personal thing. You need to take it as it is: just an opinion, which may or may not be helpful. It’s important to listen to other people’s opinions so that you can improve as a person.
3.- Don’t pretend to be someone or something you are not. It's exhausting
4.- Exercise is important, as is eating well. But sleep is healing. We all need it otherwise we can’t function. If you have trouble sleeping, seek help. It is the first sign that your mental health is unbalanced. It’s a good starting point.
5.- Remember that being kind to yourself is not being selfish. In fact, it is extremely selfless. Because only when you are kind to yourself can you really be kind to others. To be able to take care of others you have to start taking care of yourself, if not totally impossible.