I am a senior nurse in the NHS. I am also, according to the Nursing Times, a well-known activist. During the pandemic, I left my desk and went back to the frontline. During the first and second wave, I worked in the intensive care unit (ICU). The work was often bleak, and the experience hit me hard both emotionally and physically. It taught me hard lessons about myself and about the crucial importance of looking after our mental health.
I am not a hero. I am not an angel. I am human, and a nurse.
Mental health and wellbeing: each covid death leaves a scar on the heart
Working as a frontline health worker can be a rollercoaster, both mentally and physically. You go from joy to grief in a matter of seconds, dealing with a huge range of negative emotions – anxiety, fear, insecurity, guilt, anger, loneliness. You become very aware of your own mortality, knowing that one small mistake can bring death to your door.
Even I, who am not religious, found myself praying as I closed my eyes and took the hands of my patients as if trying to channel my energy to recharge them. As I passed the sponge over every corner of their skin, I prayed that my patients would get better, even if only a little.
But I became very tired, physically and emotionally.
Tired of the pain on the phone, of the daily tears, of the single visit for the last goodbye, of the pain in loneliness, of the broken lives, 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 patients saying goodbye to their families on Facetime before they go to sleep, knowing that probably that will be the last word they will ever say.
For medical staff, patients are not just numbers on daily updates. Each death leaves a scar on your heart, imprints an image on your brain that you remember during your dreams.
Intensive care nursing during covid: compromises and pressures
As nurses, we take care of the functioning of each patient’s body. We closely monitor heart rate, blood pressure and respiration, because change can happen very quickly. The patient’s life is in our hands and it is a huge responsibility. You need to be constantly on the alert. You can’t lower your guard for a moment, as a mistake can cost a life. This is why hospitals usually assign a nurse for each intensive care patient.
But with covid, this has at times been impossible, especially in London ICUs, and a single nurse has often had to monitor the care of up to four seriously ill people. Noticing the signs that predict an impending crisis becomes much more difficult when more than one patient needs to be monitored and cared for.
If we can’t maintain the ratio of one nurse per patient, we can’t provide the level of care that’s expected of us and this makes us feel guilty: “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?
On top of all this, we have to carry a complete PPE kit (personal protection equipment) and this makes the job very difficult. In the first and second wave, we wore the PPE constantly. All you can see are each other’s eyes. It is very hot and sweaty throughout the 12-hour shift. And you can’t lift your visor to dry your face or take a sip of water. You can’t go to the bathroom without carefully removing the entire kit and then putting everything back together.
Nothing in our training prepared us to cope with the large volume of deaths and the intense pain we experienced every day. I’m not ashamed to say that I ended up needing help.
Overwhelmed by pressure
I worried so much about the decisions I had made during my shift, that sometimes I would call the unit from home to check on my patient. The broken nights were accumulating and little by little the fatigue was taking over my body.
At the end of May 2020, I had an anxiety attack. 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 underlying illness. Statistics said he should have recovered but covid took him in the blink of an eye. I still remember his daughters saying goodbye to him through an iPad. 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.
When I arrived at the hospital the next day, I was exhausted. As I rode the elevator up to the ICU I started sweating and my heart was pounding. I sat in the handover room and a feeling of panic suddenly engulfed 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 didn’t go to work in the ICU. Instead, my boss sent me to the hospital psychologist.
Acceptance and recovery
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. I thought people would judge me and condemn me. After all, I had always given an image of strength. For 45 years I had learned to pretend I was fine.
I started face-to-face therapy and gradually regained my balance. With the help of the psychologist, I came to understand that mental imbalance is nothing to be ashamed. 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. I realised that stress and anxiety are 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.
The most important learning I’ve done is knowing that mental health is as important as physical health. You need to allow yourself to recognise your feelings and learn to share. I’m still learning from it; I still often feel uncomfortable talking about feelings.
Breaking the taboo around mental health
Mental health is similar to physical health. You have to take care of it every day. As with love, so with stress and anger – if you don’t take care, it goes wrong.
From a very young age, we’re taught to take good care of our physical health. We learn to exercise to improve our fitness and to go to the doctor when something hurts. Similarly, we should be learning to do mental and emotional exercises to improve our mental health. And we need to break the taboo of going to a psychologist when something goes wrong.
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.
It’s okay not to be okay
We are on the road out of this pandemic, but another one will be 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 okay not to be okay.
Here are five tips that I learned from a good friend Lisa Rodrigues:
- When something goes wrong and you make a mistake, try not to be discouraged. Take time to process what has happened. Apologise wholeheartedly. But don’t rush into quick judgements or decisions. Making mistakes, and learning from them, is part of life on the road to success.
- When someone criticises you, try not to take it personally. It’s 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.
- Don’t pretend to be someone or something you are not. It’s exhausting
- 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’s the first sign that your mental health is unbalanced.
- 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.
A longer version of this article was originally published on We Communities on 21 March 2021.