If I’m perfectly honest, I’m not sure if I’m a retired ICU nurse, or just one who is not working due to the necessity to care for loved ones—a journey that began in 2013 and continues to this day. I’m sure I’m not alone in feeling that a nurse can move away from nursing, only to find out nursing doesn’t move away from her. In my case, I went as far away from my nursing job in northern Virginia as I could, landing in the Hawaiian Islands, were I have lived since 2014.

Of course, it’s truly beautiful here, but did Hawaii make me happy, end my burn out, was it a panacea for all my problems? Ah….no.  Like this photo of my daughter, just before she landed on her head trying to do a handstand at the beach, my escape to Hawaii has ended in a rather uncomfortable thud, as I await for this child of mine to finish high school, so we can head home and, by home, I mean the mainland.  Anywhere on the mainland, but likely California, Florida, or the Washington metropolitan area (where I was born and raised).

Recently, while listening to a COVID room on Clubhouse, called “COVID does not discriminate,” a room moderated in part by physicians on the front lines of this crisis, the caretaker in me, the careful listener in me, soon became aware of the underpinnings of dark frustration and depression, just below the surface of these doctors’ voices.  They were trying to be professional and kind, in their attempt to beat back the disinformation out there, the vaccine hesitancy and fear and to explain the potential cataclysm of variant formation to our country and the world.  

Many stories were shared from the frontlines of this crisis, one doctor spoke of a patient he had just pronounced dead, moments before, a formerly health 27 year old man, who succumbed to COVID and the helplessness he felt that he could do nothing to save him.  The doctors spoke of hearing the same people in room after room on Clubhouse, spreading disinformation under the guise of asking the same questions which the doctors laboriously and repeatedly had answered in other rooms, were once again answering in this room, in a valiant effort to cut through the noise, to make their way through that blizzard of disinformation and shed light upon the science.  

Many who spoke, or pseudo-asked questions were actually selling herbs, or secret protocols for avoiding COVID (which they would reveal for a price), didn’t even understand the difference between a bacteria and a virus and were just so plainly and obviously ignorant, I too became really disheartened listen to this nonsense.  

The doctors’ frustration became my frustration as something deep inside me, that poor girl who went to nursing school in Jersey City (heroine capitol of the world at the time) all day, then took care of AIDS patients from 3-11 p.m. in Hoboken, ate unopened jello and graham crackers off my patient’s discarded trays because I didn’t have money for food, only to have to walk home sometimes to Jersey City because I didn’t have bus/train fare wanted to scream:  “WTF! Don’t you people understand what nurses and doctors have to go through just to become nurses and doctors and now you all are putting them through this sh_t on top of everything else?”  

Seriously, being a healthcare worker on the best day of your career is no cakewalk.  I can only imagine what it is like to slip into scrubs, mask up, put on your protective gear and kick, or elbow doors open, to once again enter those rooms, see that sadness, that misery, day in and day out for 18 months.  My God, doctors, nurses, first responders are human beings.  Don’t people realize what their words and actions are causing in these people’s lives….and the irony is, when you need them, when you show up sick and dying to the ER, they will not only do everything to save you, but they will neglect their health, their families, their lives to do so.  Maybe that’s why I am writing this, in the hopes that someone will hear.

My career in nursing began at St. Mary’s Hospital, working as a Nurse’s Aid during nursing school, in an unofficial AIDS unit called 6 north, which the Nursing Supervisors called “Vietnam.”  You’d head to the Nursing Sup’s office before your shift and she’d say, “You’re in Vietnam Kathleen.”  If you were lucky, you got North Korea, or South Korea (5-north, or 5-south), units that housed mostly your generic dying geriatric and/or oncology patients, sad still, but not as grueling as Vietnam.  What I saw there, just during my nursing training, the post-mortem care I did on a nightly basis, was enough to break most people.  But, this and the events of my nursing career that caused my own burnout are nothing compared to current and retired Military healthcare workers.  I can only imagine the level of burnout they feel!

Needless-to-say, I began to back channel messages of support to some of the docs, who had undergone the tragic strain of this crisis for 18 months, knowing that their life before COVID, was certainly no picnic and, much less, life after COVID was pretty much a day in day out disaster for their mental health.  One mentioned the ever-increasing rates of doctor suicides.  She wrote to me:  “I am not seeing patients in person right now.  Because of severe burnout.  I do non-clinical work and eICU.  Probably going back to ICU with the latest surge even though I am not mentally ready.”  

My heart cried out for these docs who bear so much of the weight of this crisis, putting themselves and their families at risks, while so many spread conspiracy theories and disinformation.  A part of me wants so much to return to nursing, to be the silent partner at the bedside by my colleagues, doing what I can to assist, elevate their mood, listen, support….but taking care of a disabled loved one is my current and necessary focus, as well as finishing the job of raising my child.  Still, my heart aches for all the frontline workers who will, largely, remain silent and isolated in their depression.

I wondered about the suicide rates of nurses, had they gone up, as the doctor said her colleagues’ rates had?  Nurses make up the largest percentage of  healthcare workers in the U.S., about 3 million and, no surprise, 85% of them are women.  What I discovered is there is an epidemic of suicide inside this pandemic:

“Female nurses are roughly twice as likely to die by suicide than the general female population and 70 percent more likely than female physicians, according to a University of Michigan study examining suicide among physicians and nurses…. What is also true is that Nurses have potentially, increased access to…drugs and the knowledge necessary on how to use them to overdose, thus increasing the risk of suicide. “

Think about it.  All the stress you and I have experienced dealing with COVID as Moms/Parents (the daily special precautions, home-schooling, fear and anxiety for loved ones…), all that is placed on the shoulders of these women, who (as any hospital worker knows, are profoundly and fundamentally the backbone and heart of any hospital) now must also bear the full brunt of this crisis, while being the primary caretakers of kids and the home, or (as was my own case) the caretaker for an aging parent with dementia.  In addition, female nurses (and nurses in general) do not have the agency and autonomy doctors have within the hospital settings.  

The article goes on to report:

“More than half of all suicides among the general population are the result of gunshot wounds. Among nurses, however, overdose is more common. And both nurses and physicians are more likely to have antidepressants, benzodiazepines, barbiturates, and opiates in their system, which suggests a need for greater behavioral health awareness among health-care professionals, the researchers say.”

When I worked as an Advice Nurse at Kaiser and took suicide calls, the First three questions were:  1).  Have you thought of harming yourself or someone else; 2). Do you have a plan to harm yourself or someone else; and, 3). Do you have the means to harm yourself or someone else?  If the answer was no to the questions, the triage could proceed so long as the patient committed to safety.  If the answer to any of these was yes, I would continue the call, but contact the nursing supervisor to call 911 and keep the patient on the phone until the police arrived.  Of course, suicide is the more serious end of the spectrum when it comes to depression in nurses and healthcare workers, in general.  

Here are some of the reasons I believe Nurses isolate in their depression during COVID:

1).  To Keep Suicide as an Option.

It is sad, but true.  If they are serious about ending their suffering through suicide, they have the means, the knowledge of what not to say and to whom.  Even if they never act upon the desire, nurses might keep their thoughts of suicide and their depression quiet, because it gives them the fantasy of ending their sufferings, without going through with it.  Sometimes, thinking about the possibility of a time when suffering ends may help them to cope with the present.

2).  No one will understand

The feeling that no one will understand what you are going through is profound, leaving you with a “why bother” attitude.  Nurses know that the general public have no understanding of what their lives are really like.  The public are often plaintive, unappreciative, ventilating and even abuse the nursing staff.  Perhaps because of the fact that society, as a whole, looks away from the abuse of women could play a role in this female-dominated profession.  In my time as a nurse, I’ve been cursed at, spit on and hit by my patients. ( It’s no wonder I veered towards and was blessed to work in Neonatal Intensive Care.)  

According to a 2018 Bureau of Labor and Statistics report:

“…20,790 workers in the private industry experienced trauma from nonfatal workplace violence in 2018. These incidents required days away from work.¹

Of those victims who experienced trauma from workplace violence:

• 71% were female
• 64% were aged 25 to 54
• 73% worked in the healthcare and social assistance industry
• 20% required 31 or more days away from work to recover, and 21% involved 3 to 5 days away from work

It’s clear, nursing was one of the most dangerous professions before COVID.  I can only imagine what the statistics might show in the coming years!

3.  The Culture of Silence

Nurses who vocalize any weakness are often bullied by their colleagues:

“Nurse bullying is a systemic, pervasive problem…NURSES in the profession call it ‘eating our young.’ Some consider it ingrained in the culture, a rite of passage, or an unavoidable fact of a nurse’s life. But no matter how it is explained away, nurse bullying takes a heavy toll…The nurse bullying phenomenon is well-documented in the clinical and leadership literature. It starts early and is present from the classroom to the bedside to the boardroom. One study showed that over a 6-month period, 78% of students experienced bullying in nursing school.2 In another study, over half of nursing students reported seeing or experiencing nurse-on-nurse bullying during their clinical rotations.3 Within the first 6 months, 60% of nurses leave their first job due to the behavior of their coworkers.”.2.

4.  The Foundations of Nursing

The origins of nursing predate the 19th century, often existing in unwritten human history.  But the formal origins of the Nursing Profession began, as many of you know, with Florence Nightingale – – a member of the wealthy, educated British elite, she was somehow motivated to make a radical departure from her station in life, to help in the cause of the Crimean War, one that at least, in part, was a religious conflict between the Roman and Eastern Orthodox church.  

During that war, wounded Russian soldiers were fairing better than the British, under the care of various religious orders.  The British Government sought to imitate their success and train women, under the auspices of Nightingale and the St. Thomas Hospital (one of the oldest hospitals in London, which was founded in the 12th century as part of the Augustinian Priory of St Mary Overie).  

While there were some applicants from the wealthy classes who sought to model themselves after Nightingale by volunteering in the war effort as sober and Christian nurses helping the soldiers overseas, many women from the lower classes applied to be nurses, as a means to elevate themselves economically, or free themselves from abusive marital situations.  Applicants were required to be sober and of sound moral character (the thought was that if you were a drunk and a loose woman, you would divert the attentions of the soldiers away from the cause at hand, to win the war.)  And thus, the notion of Nurses being saints that walk among us, who must bear their cross of suffering without complaint in imitation of Christ, was born.

For lower income women, the Nursing Profession was then, as it is now, for many, a means to an end, a way to elevate oneself out of poverty, so long as you are moral enough and hard-working enough to tolerate the strain of the profession.  It is no wonder that many immigrants to the United States become nurses.  Since women entering the profession often lacking agency to begin with, this fact combined with the religious and military foundations of nursing, often predetermines a culture where the ideas of service to others and duty dictate the culture of quiet stoicism associated with the nursing profession.  

5.  When the Nature of Coping is the Problem

The mind sees tragedy.  The mind shuts down.  Plainly and simply.  But all that is seen and goes underground does not disappear.  We do what we have to do to get through what is in front of us.  But, then, we suffer the consequences later, in the form of depression, anxiety, PTSD, an inability to really relax/sleep well/experience joy….to name just a few consequences of the miracle of the brain and its coping mechanisms, that allows us to get through stuff that is truly horrible.  Because the mind walls off the parts that are too hard for us to feel, we become detached from ourselves, our feelings.  We forget how to feel.  A callous forms.  It thickens.  It thickens some more.  What once helped us, becomes the problem itself.  

This is not, of course, solely the problem of healthcare workers.  Society, as a whole, is experiencing this as a result of the pandemic.  Can you imagine if YOU feel this way, how a nurse must feel, or a doctor, who has undergone eighteen months of this?  Be kind to them, whenever you can.  Maybe get your vaccine, so that they don’t have to spend the rest of their lives, dealing with the emotional impact of this Pandemic.  

It’s possible, if something doesn’t change sometime soon, when you are in need, there may not be a doctor or nurse to help you.  The reality is that, behind closed doors, they are suffering.  Some may live and some may die on the frontlines of this pandemic.  Just don’t expect there to be an infinite supply of nurses and doctors, if you refuse to wear a mask, or get a vaccine.

 

Epilogue

It is the afternoon.  I sit in my house in Wailuku, having spent the morning surrounded by my poodle family, drinking too sweet and too cold coffee, thinking and writing about why nurses isolate in their depression, why I isolate in my depression, the ways we seek to escape our past traumas.  

Let’s face it ladies, you all are #Badasses!  But, that doesn’t mean you are invincible.  Whether you’ve left nursing, or are still in the game, you are a part of a very special group of people in this world.  You may not be a saint, but you are pretty dang close to being one.  You deserved to be treated a whole lot better than you were, be it from an employer, your patients, or the general public.  That’s the real deal truth of the matter and we all know it.

As for me, I don’t know if I will return to nursing.  I do miss the camaraderie.   I miss the jokes, the teamwork.  Humor is one of the very serious ways people in healthcare cope behind closed doors, often dark and necessary humor.  I do know my heart goes out to every nurse, or doctor I ever worked alongside, the ones I didn’t get along with, the ones that hazed me when I was a new nurse, the ones who became my best friends, the ones I politically diverged from, the ones I was strong for when they couldn’t handle what was in front of us that day and the ones who were strong for me.  We knew how to work together, as a team, for the greater good of our patients.  It’s a shame society, as a whole, appears to be piss poor at doing the same.  We might be able to end this pandemic, if more people were like us in this world.

The stressors of our pasts come out on certain days.  We do have our “I can’t take it anymore moments,” and may explode in anger or tears.   Maybe we DO need special care and attention, like that kind we gave our patients on the many days we walked those hard hospital floors, that now plague our knees and hips so much!  Maybe institutions and society, as a whole, need to understand the kinds of stress we bear for them.  In the absence of that, may be we need to as women share what has worked for us, what has improved our lives, in support of one another.

Here is what has worked for me and might work for you:

1).  Don’t drink too much or medicate too much.  Your brain is already numbing you out.  Don’t give it any help.

2).  It’s okay to cry.   Find somebody to cry with, or cry alone, but let it the F____ out!

3).  Don’t be afraid of therapy (It’s not a marriage.  If you don’t like the person, change therapists, or stop, but get help if you need it.)  You may just find out that life is made up of three things (crisis, coping & living).  Sometimes a good therapists can help you navigate spending more days/hours/minutes in the coping and living phase.)

4).  Don’t expect anyone thing, anyone person, or place (hello Hawaii!) to be a cure for what ails you.  I learned that the hard way.  Vacations and, even, escapes to paradise are nice, but they don’t solve your problems.  Being in close proximity to family and friends can make all the difference when you are in crisis (P.S.-I miss you guys!)

5).  If you are gonna try to stand on your head in this life, you are sometimes gonna fall and hit your head.  Don’t stop trying, but also know when you need to stop, sit down and drink a cold one, eyeing that beautiful ocean in front of you.  Sometimes you just gotta be.  Don’t forget how to do that.

6).  Don’t forget music.  It can be amazing therapy.  Play something that speaks to you, helps to elevate or express your mood, but let it heal you.

7).  Don’t forget passion.  Whatever that means to you.  It could be a hobby, a love, anything that takes you away from it all, absorbs you…find those Calgon moments or people.

8).  Focus on what you can control.  Doing your laundry really well.  Cleaning the house.  Organize your books.  Decluttering your home.  Giving what you don’t need to those who need it.  Create space for the magic to happen.  Make room for new good things to happen to you.

9).  Call or visit someone.  Society is suffering from a crisis of loneliness, exacerbated by cell phone use (everybody texts, nobody talks), the pandemic, too much work, not enough play.  Prior generations had pandemics and tragedies.  Hell, they fought two wars, defeated Hitler, suffered through a pandemic, the crash of the stock market, the depression era….but they drank a lot of cups of tea and coffee and talked.  Have a good old fashion coffee break with someone you care about.  Play some checkers.  You don’t have to get into the serious talk, just make some cookies, sip and talk.  Rockers and front porches are vastly underrated in our society.

10).  Laugh whenever you can.  Sometimes the humor is silly.  Sometimes it may be a little dark.  But, laugh.

I recommend these folks on TikTok –

@tiffanymoonmd

When it’s time to leave but your boss is asking you to stay late #Madea #DoctorHumor #NurseHumor #whitneyhoustoniwillalwaysloveyou @archieparafina

♬ original sound – Shay G

@patrickloller

I can’t wait to hear all the intelligent well thought out comments #military #vaccineswork #vaccines #veteran #funny

♬ original sound – Patrick Loller

 

@steveioe

😌 #MuFKR #delta #covid #pandemic #goodluck #mask #strong #exam #F #wednesday #coronavirüs #face #50

♬ original sound – Steveioe

@elim_whatshername

you have my bank info and you can hear me. there’s literally no reason not to.#hospitaltiktoks #covidvaccine #covidvaccinefunny #healthcarehumor

♬ original sound – Elim

 

 

Stay healthy.  Please consider getting the shot.  

Abrazos con cariños,

Mrs. Sassy Pants