This is what we do.
“When you bring yourself back to that day at work, what comes to mind? What do you see, hear? What picture represents the worst of the incident?”
“I am seated in a chair in the dining area. There are a number of residents at the tables behind me. My instinct, even in this fit of terror, is to not make a scene. My surroundings are out of focus, and I can hear voices but I can’t make anything out clearly. All of my senses turn inward to the alarm that is telling me I am not safe. Three or four of my co-workers hover over me as I try to catch my breath. A CNA takes my vitals and I hear an overhead call for a response nurse.”
My eyes are closed and my feet are firmly planted on the ground. My hands are gently crossed at my chest and I tap them, alternating at my own pace. This is the fourth eye movement desensitization and reprocessing (EMDR) session I’ve had with my therapist; it might also be the most vulnerable I have felt in the two years that we’ve worked together. This therapeutic technique requires me to access memories that are unpleasant at best, traumatic at worst. It was a recent panic attack at work that prompted this new method.
“When you bring up this picture, what negative beliefs do you have about yourself?”
After a moment I say, “I am weak. This place is better off without me. All of my efforts are futile and they will never be enough. I will never be enough.”
It is 8 a.m. on a Thursday in spring. The cherry blossoms have started erupting all over the city in bursts of pink, giving Seattle an air of hope. Before our 90-minute session comes to a conclusion, my therapist points out that these negative beliefs appear to be recurring. “It seems like we may have some work to do around that.” Although they have proven to be effective thus far, these weekly EMDR sessions have become increasingly draining. I pull myself together and head into work.
I was just hitting my stride at eight months into my first position in the healthcare field when the pandemic hit. I felt as though I had found my career; I felt like my expertise was needed and valued. The facility has a century-long history in the neighborhood with a daycare onsite, children and elders interacting regularly, putting on plays or making bag lunches for our houseless neighbors. Two cats roam the long-term care neighborhoods, purring in laps and instinctively curling up on the bed of those who need their company most. The two chapels onsite held daily mass attended by residents and community members alike. People spend the final years of their lives here.When people asked me how I liked my job, I told themI felt as though my family had grown exponentially.
The epicenter of the pandemic in the United States was at a nursing facility across Lake Washington, just under 15 miles away. We watched on local and national news as EMTs in HAZMAT suits removed body bags on stretchers from the building. There were a total of 34 deaths. The level of uncertainty grew each day as we learned new information, policies and protocols. Our Director of Nursing said it would not be a matter of if the virus entered our facility, but a question of when.
She was right. Despite our rapid preparedness, we had an active outbreak within a few months. We had gone into quarantine with the rest of the world, but every step of the process was heightened as our family-like setting transformed into one that felt institutionalized. Residents were relegated to their small, often shared, rooms. Work became less about quality of life and more about keeping people alive. Our priority became dispensing medications, providing meals and collecting vital signs. All of the activities that brought life to our community were cancelled indefinitely. The volunteers on whom we depended so greatly were no longer allowed in the building. Friends and family members were unable to see their loved ones unless it was through glass. Symptoms of dementia were accelerated, and worlds that were already small dwindled. It was damage that could not be undone and time that could not be reclaimed.
Some days I felt brave, like I could still be the bright spot in someone’s day even through all of the necessary layers of protective equipment. I did my best to validate their fears and hold space for their grief. My role called for me to be a resident’s connection to the outside world. And to their families I was a touchstone inside of the building, allowed daily contact with their loved one, albeit through a face mask, N95 respirator, and face shield. Wearing a clinical gown and gloves, I was still afforded the luxury of holding their hand.
In the mornings, I would deliver newspapers and refill coffee cups, opening blinds to let in the fresh morning light, a leisurely hour before the day’s activities took hold. But with the pandemic, my morning rounds became a task that I approached with trepidation, unsure of what I’d be faced with. PPE carts, a sign of a potentially positive patient, would appear in clusters outside rooms and you could almost see how the virus moved and struck, like a house fire or a flood.
I vigilantly monitor food and fluid intake, and note subtle changes in breathing and mood. I communicate as best I can to the families for whom I have also become an advocate, grief supporter, and reliable source of information. I promise myself that, if I can help it, a person’s body will not lie alone between the time of death and the arrival of the funeral home.
When a death occurs, a Chaplain leads employees in a procession to the hearse. We cover the body with a handmade quilt. We say a prayer or play a song. We briefly share stories and things that we loved about this person and hope to emulate in our lives and our work. Before the pandemic we would watch the funeral home drive away, pause for a moment, share an embrace or memories over lunch or a walk. The pandemic changed the spirit of this beloved ritual; we could not ignore the fact that we’re participating in this ceremony so often, bearing witness to such loss in a short amount of time that it’s difficult to fathom. We wipe our tears under our face shields and file back into the building, 6-feet apart, to go back to work. Still, we were grateful for the opportunity to provide a proper sendoff — many of our residents died alone at the hospital.
I return home mentally and physically exhausted, feeling as though I have run a marathon. If I spent any time on the COVID unit, which was multiple days a week, I remove my clothing at the front door of my home and shower immediately. I am barely able to name and meet my own needs, let alone fulfill my role as a partner in a relationship. My spouse makes sure I’m fed and gives me the space to do whatever I might need to be able to go to work the next day. I retreat inward; a tendency that has come naturally to me all of my life but now feels detrimental, even dangerous at times. Attempts to leave work at the door are unsuccessful. I cry often and sleep 10 or more hours a day. My body breaks out in rashes and my doctor doubles the dose of my antidepressants at my annual visit. Two weeks after my panic attack I give a presentation on the practice of self-care to social work graduate students at the University of Washington. The irony of this is not lost on me; I feel like a cautionary tale rather than a professional qualified to impart wisdom on new students.
Then, there is the work that doesn’t get applauded by neighbors every night at 7 p.m. Decades of coping mechanisms that I have fine-tuned fail me. Unforeseen and ever-changing, high stakes circumstances are dangerous for a person who habitually plays out every possible worst-case scenario in their mind’s eye. My nervous system refuses to be regulated, comfortably settled in at its new baseline of crisis mode.
The fear of losing others by burdening them with my heavy feelings is one that I have long carried, and it feels impossible to articulate the depths of my grief. Not just the anguish that I hold for others in my role, but also for that of our nation’s healthcare system and its deep failures and inadequacies, laid bare by a once in a lifetime event. I realize that my employer does not, in fact, value me. I am very much replaceable. Our healthcare system is a business, and on my worst days I feel like my sole job is to turnover beds so they can be filled.
One Friday evening, a Chaplain calls to let me know that a resident with whom I had become very connected has died. I want to attend the late night processional, but struggle with the idea of leading it. The Chaplain, hearing the conflict in my voice, offers to drive the hour back into work to provide the professional support to the family that she knows I am incapable of at this moment. I try to convey my gratitude and between sobs, apologize for the inconvenience. She replies, ‘this is what we do.”
“This is what we do.” She is not talking about our respective professions. She is referring to the need to serve, the pull we both have to attend to and make space for the people that are discarded by the rest of the world. Being a helper is part of my identity, but over the course of the eighteen months, I have kept my cup empty to allow others to pour their sorrow in. My body feels unrecognizable, like it doesn’t belong to me; a vessel for the grief of others. Sometimes I wonder if it was ever fully mine to begin with.
I long for a day when work won’t be so heavy, but my faith that it will come is waning. I know that sometime in the future, I’ll have to decide if I can continue. Until then I will keep showing up. Because in all of the chaos and uncertainty there is one indisputable fact — people will always age and die. The work will always remain.
