Nursing moment of clarity:
Sometimes it’s the sick that heal you.
Nursing moment of clarity:
Nursing moment of clarity:
Sometimes it’s the sick that heal you.
“If healthcare workers can’t provide the care they typically believe is medically necessary for their patients, they may experience a phenomenon known as “moral injury,” says Dr. Wendy Dean, a psychiatrist and the co-founder of the nonprofit Fix Moral Injury.
Dean says that American healthcare providers are used to doing anything and everything to help their patients, but inadequate protective gear and triage procedures will force them to make “exquisitely painful” decisions, such as choosing whether or not to risk infecting themselves, their family and other patients in order to help everyone in their care.
Still, Dean says the scope of the mental health crisis among healthcare workers won’t come into focus until the more immediate problem has ebbed.
“When I think the real challenge is going to come is when the pandemic eases up and people start having time to process,” she says. “All that they’ve seen, all that they’ve done, all that they’ve felt and pushed away.”– Tara Law, Time Magazine
I’ve actually recently thought about stopping this blog because I can’t seem to write about anything except the Coronavirus. I don’t know about the rest of the U.S., but here in NYC it’s changed literally everything. At the same time I feel like it’s important to keep slogging away here if for no other reason than to see how I get out of it.
I mean, life doesn’t stop because of the pandemic, yet I can barely think of anything else. Really, who wants to read this shit? I know I don’t. It’s like I’ve painted myself into a corner and I don’t know how to get out.
Of course life goes on even with a novel infectious virus – it just won’t ever be what it was before. But how’s that different from the natural order of things? Isn’t each moment always different from the one before?
Change is part of life – sometimes it’s small, insignificant changes, and sometimes it’s big existential events. I guess the real question is: once you’ve wrapped your brain around a changed world, can you adapt and still find meaning and joy and beauty in it?
I’m still working on it.
So we know that for every action there’s a reaction, right? Of course this effect keeps rippling through time, our lives, and the environment. Each consecutive action begets another reaction, and on and on and on and on.
Impossible to predict, yet unstoppable.
Adapt or die – the law of nature, the essence of life.
There’s just no other choice.
If you’re lucky enough to get criticism from a respected source, listen to that shit carefully. Examine it closely, roll it around in your head for a few days, and sleep on it – ‘cuz here’s the thing: that person didn’t have to give you anything.
They chose, for no gain of their own, to offer you their thoughts. Only a fool would discard that without careful attention.
Now, you may or may not act directly based on their critique, but you need to appreciate this: you can’t get this from your friends, partner, family, or anyone else connected to you, because they’re biased. They know you.
But a respected third party?
That shit is gold.
Normally, when you go through something traumatic with a group of people, there will be a very specific human response. The people who went through this thing will get together in some sort of social setting, and the act of doing so will begin to heal them. This will happen even if the trauma itself is not directly discussed.
But for all of the frontline responders to the COVID crisis in NYC, this can’t happen. There will be no social healing because humans can no longer socialize. Speaking for myself, this can leave one feeling unmoored, as if you’re just floating around in the ocean aimlessly. How does one process taking a hands on role in all this death, grief and tragedy?
Even tele-therapy seems unsettlingly remote. I guess it’s better than nothing, but for me, it doesn’t seem to really work. I end up feeling even more disconnected from humanity. Perhaps the single defining quality of being human is our desire for social connection, yet the virus has taken that away.
I took an active role in a mass casualty event and it’s impossible to talk to anyone about it. Because I’m older and have lived through a lot, I know myself well enough to know that I’ll get through this. Apparently I was born resilient.
I am, however, also vulnerable in the adaptive phase, which can last years. But I know I’m somewhat unusual in my adaptability, which makes me wonder how others less resilient are going to deal with this.
And to be clear – at this early juncture, I’d be lying if I didn’t admit I’m struggling too.
It’ll take my brain quite a while to process this new reality. What did it mean to have so many patients die in a shift that there was no more room in the morgue? So many you stopped counting? I would just throw sheets over dead bodies and move them wherever I could, freeing up a room for the next one to die. To have discussions with the docs about which of my patients had the best chance of surviving if they got the last ICU bed? To see all these people die alone because family members weren’t allowed in? To see doctors struggle to understand how to treat a disease that had never been seen before? To know that I was vulnerable to the same virus that was killing all these people? To have my medical director, a brilliant, strong woman with no history of mental illness commit suicide at the height of the crisis? To see the faces of my loved ones on the dead bodies? To know that the only end to all this misery is a vaccine that is years away? To see the complete and utter inability of our government to manage this crisis? To see my highly rated hospital collapse under the strain of dealing with a pandemic no one had prepared for? To run out of basic supplies? To run out of protective gear for the frontline workers – including docs and nurses? To see your colleagues succumb one by one to this virus? To wear so much PPE that it’s impossible to recognize your coworkers, much less make human connections with patients?
That’s a lot of shit to process.
It’s impossible to comprehend, but somehow I made it through this without getting sick from the virus.
I always loved my job as an inner-city ER nurse, and I’m pretty sure I still do. But I’m shaken to the core, so I’m a little fuzzy on what exactly I’m sure of.
But I know I’m sure of this: I’m grateful to be alive and be loved, to have a job when so many others are without work and hurting.
I’m slowly working the rest out.
“In art, we can find a humbling sort of wisdom. We see themes and ideas repeat over many lifetimes. Those ideas don’t belong to any one person, and as they evolve, disappear and reappear, they remind us that regardless of what’s happening now, our lives on this earth will always be part of something bigger.
When I go to the museum and I look at a piece of art, I’m transported. I don’t know how, or where, but I know that it’s not a part of the material world. It’s beyond modern culture’s political, technological soul. We’re not here to live forever. Humans and materialism die. But there’s no dying in art.”– Sonny Rollins, from The New York Times article “Art Never Dies”
Let’s just call this a day. I’ve got nothing to say, except I know tomorrow will be better.
They can’t all be winners.
When everything else is falling apart around you, and you’ve lost all faith in the institutions that were supposed to protect you and the society you live in, in order to keep going on you’ve got to get small and very simple in your goals.
Just help one person, and you can call that day a success.
That’s how many days you’ve got if you make it to 80.
I’ve already lived 23,100.
That gives me 6,100 days left, assuming I get there.
So what do I want to do with this rapidly shrinking chunk of time?
Well, if you step back and look at the big picture, in the grand scheme of the universe, a single life means nothing. Hell, an entire species probably means nothing – or even a planet for that matter.
But maybe that’s the wrong perspective – maybe the right way to look at it is that I’ve won the lottery already. I’m alive, I have a good life, and somebody loves me.
Everything else is a gift.
“COVID-19 has been a life-altering experience. No amount of schooling or training could have prepared us for the psychological toll of this pandemic. A few days ago, I cried so much for a loved one fighting for his life that I began to question how much fluid our tear ducts can make. We each cope with the trauma in our own way. My own attending physician and a recently minted 23-year-old emergency medical technician both reached their emotional breaking points and tragically took their own lives.”– From “I am an ER Doctor in NYC,” by Vineet Kumar Sharma, a third-year emergency medicine resident at New York-Presbyterian Hospital
It’s too soon to say that COVID surge number 2 is here, but it was the first busy day with multiple intubations in a while. So much for the ER slowdown – but there’s good news.
Approximately two months after NYC’s COVID apocalypse, the hospital is offering testing to staff.
So there’s that.
It seems as though we live in a post-truth era, as if there is a smorgasbord of truth where you get to pick the one that suits your sensibility.
This idea probably always existed on the fringes of society, but it took the internet to provide the global scaffolding that really allowed it to become mainstream.
To recognize this catastrophe is to realize the limits of free speech. Or at least it seems that way to me. Back in the days of print media, there was no confusing The New York Times at the newsstand with the National Enquirer at the checkout line of your grocery store.
No one saw the headline “Bigfoot Keeps Lumberjack as Love Slave” and actually believed it – and if they did, they kept it to themselves. There was no pretense that this was “the truth.”
But those days are long gone – now, any idea, no matter how outrageous or ignorant or hateful will have a cult of thousands of very loud people enthusiastically posting about it on the internet.
Harmless, you say?
Not when it affects public health.
So let’s say you’ve worked on this thing for a considerable period of time; it might be a piece of music, narrative fiction, a movie, software, an invention of some sort, a process improvement for work, anything really. You keep chipping away at it, looking at it from different perspectives, trying to make it as good as you possibly can.
And then the day comes where you realize it’s not going to get any better. In fact, if you keep fucking with it, it’s only going to get worse.
So that’s the moment.
You’ve got to let it go.
The really scary thing about all this is all internal though – because you can’t fail as long as you’re you’re “still working on it.” Its only once it’s done that it can be judged on its own merits. But here’s the thing: most people never even get to this point. It’s just too hard, and for what? To maybe see that no one cares?
Thinking this is a big mistake: failure is part of success. It’s not only how you get better, it’s your only chance at hoping to be great. Fail, fail, fail, fail, succeed. It’s the name of this blog for Christ’s sake.
Besides, one of the most common cognitive distortions artists have is not being able to separate themselves from their art. Just because someone thinks something you made is shite is no reflection on who you are.
Regardless, I just packed up a baby and sent it out into the world. Now it has to live or die on its own. Bon voyage!
You know those pictures of the ocean receding that precedes a tsunami? People playing and holding up their cellphones like it’s some kind of freakish low tide – and then the tsunami rolls in, its immense power destroying everything in its path.
That’s what it feels like in ERs all over the U.S. right now – it certainly does in mine. I’ve never seen the census so low, day after day. We still get our COVID patients, but nothing like what we experienced in March and April. And it appears that everyone else is avoiding us like the plague.
Here in NYC I kind of get it – the deaths were widely reported in the media, understandably scaring the shit out of the public. Who wants to sit in an ER surrounded by people dying from a contagious virus?
But it just feels weird. Where are all the heart attacks and strokes? They didn’t just stop – are people really staying home instead of seeking treatment?
To make the whole thing even weirder, my hospital hired a significant number of travelers – nurses who come in for a few weeks to support overwhelmed staff. The problem, however, was that they came in after the first wave had died down (perhaps a poor choice of words). So we went from Armageddon with no staff to a low census with too much staff in a short period of time.
And of course their contracts will soon end, just as the quarantine restrictions begin to loosen. So we know there will continue be a outbreaks in waves. What happens in the fall is anyone’s guess…
All I know is that it makes me feel uneasy. Maybe it’s because of what my ER just went through, or perhaps it’s a bit of PTSD beginning to rear its ugly head.
But I don’t like it. I don’t like it one bit.
Can now meditate for 20 minutes in the chapel of my hospital with my N-95 respirator mask on without feeling like I’m suffocating.
This must be some new uncharted level of TM…
It appears as though I am starting with movies I saw as a very young child, but hey, I’m not over-thinking this. In my mind, Toho studio’s 1954 classic “Gojira,” marketed in North America as “Godzilla,” is somehow inextricably connected to “King Kong.” This is probably because I saw them both at around the same age (4 or 5), and they both involved giant monsters that man was helpless against. Ok, that last part wasn’t exactly true – King Kong was shot off the Empire State Building, but not before wreaking serious havoc on NYC.
Godzilla, on the other hand, was way more frightening. Kong was a mistreated giant ape that actually liked a human (Faye Wray), while Godzilla was a true existential threat. Nothing could stop him – he seemed to have no purpose other than to destroy. And if his giant size and destructive power weren’t enough – he could exhale a concentrated beam of radioactive fire that burned everything in its path to a cinder. I couldn’t get enough of it!
Of course as a child the whole “monster as metaphor for the atomic bomb” thing went right over my head. But rewatching it as an adult makes the film much more interesting. It’s a fascinating post-WWII artifact made only nine years after Hiroshima and Nagasaki – a potent example of art as a response to trauma.
The fact that most of the film was shot in Japan and badly dubbed only made it weirder. Even as a little kid, it was clear that the Raymond Burr parts were added for the American markets. I didn’t know what film stocks were back then – all I knew was that the “American” parts didn’t look like they were in the same movie.
While Kong was created with stop motion animation, Godzilla was a man in a rubber suit. What made it work was two things: the graininess of the film itself, but more importantly the incredibly detailed miniature sets. Toho built models of Tokyo for Godzilla to crush and burn down, and they looked good – good enough to suspend belief and think this shit might be possible, at least if you’re a little kid.
See, my home life as a child was violent and unstable. I wanted Godzilla to come in and burn it all down. I spent many years fantasizing this would happen, knowing all the while it wouldn’t.
But it gave me some great daydreams.