COVID anxiety

Working in healthcare is never easy, but working through the COVID-19 pandemic takes all the usual stresses, strains, and anxieties, and amplifies them by a factor of ten.

The mood in my A&E department is very emotional. Above all, we’re worried about the impact of the coming (or already arrived) tsunami of COVID-19 patients, which feels like it’s been looming for months now. But we’re also affected by the uncertainty and the deferral of plans and hopes which had been the only things keeping us going in the ever-strained atmosphere of A&E. Two weeks ago, a nurse I’d never met before broke down in the changing room, after having a much-needed break canceled by an airline. “I really needed this holiday”, she said. “I’ve been saving up for a whole year”. All I could do was hug her, which didn’t feel like enough. Our most used methods of coping have been stripped from us, and we’re having to find different ways to manage.

Many people are worried about spreading the virus to others, and these fears are particularly acute for healthcare workers. A friend texted me to say that she’s so scared that she will kill people in her household. She’s constantly disinfecting surfaces and feels like she spends most of her free time cleaning. And she’s not the only one – I’m not looking forward to receiving my next water bill, given the amount of time I now spend washing my clothes and showering. There’s also the feeling that we should be constantly working, permanently manning the barricades. A colleague told me she feels “helpless” on her days off: she wants to come into the hospital to support. I feel the same way, but I know, if I’m able to think clearly about it, that preserving myself and taking the time to recharge is more important. We can’t afford to burn ourselves out. I’ve just canceled my bank shifts.

One positive thing that I hope comes out of this is a tightening of the bonds of solidarity that hold the NHS workforce together. Watching how the entire workforce is uniting to help patients during this time is inspiring. Every time I walk through our ‘clean area’ and see groups of people gathered together, teaching one another new skills, reminds me how much we are doing to ensure we are prepared for what is to come – or what has already come, depending on when you read this.

I’ve written in the past about the issue of night shift anxiety, and the sense of isolation and disconnect from the wider society that comes with working nights. Over the past few weeks, I’ve found these feelings are more acute than ever. And it’s not just night shifts that are causing this: as healthcare workers, we are now living totally different lives to most. The patterns of working life continue as normal for us, even as the world around us dramatically alters. The experience is jarring: it feels like I’m living in a different timezone to everybody else, or like I’m a ghost of the world we inhabited a couple of weeks ago. Some colleagues have even said that they feel guilty that they get to go to work, and that we should consider ourselves lucky that we’re able to get out of the house. And they’re right to an extent, we are lucky to be able to see our colleagues and friends face-to-face – but it’s small consolation for having to face this pandemic as frontline staff.

I have struggled with my own rollercoaster of emotions. Some of my non-healthcare friends haven’t been taking the precautions they should, insisting they have nothing to worry about. I know that I should be more understanding – the advice provided by the government has been confusing and ambiguous, so it’s no wonder that people have different opinions on what’s appropriate – but I find it hard to understand their mindset. A friend of mine feels the same way: “my ability to cope with other [non-NHS] people’s emotions is low”, she tells me, adding: “I feel extremely guilty about this”. For healthcare workers at present, it feels a bit like the world is a Rorschach test, and we’re seeing and experiencing things differently to everybody else.

Nevertheless, the generosity of others is extremely precious in these times – the organized clap last Thursday moved me to tears. But I feel guilty receiving such kindness: I don’t feel like I’ve earned it yet. The worst, we are constantly being told, is yet to come. The looming doom is hard to handle. Colleagues are also concerned that we’re letting our normal responsibilities slide, forgetting about our other duties as nurses and doctors. “What happens to everyone who doesn’t have COVID?”, a colleague asks, “I’m worried about all the social cases that are being missed”.

We also know that, as healthcare professionals, we’ll have to make difficult decisions that we haven’t had to make before. Horror stories from Italy, or from our own ITU wards, are spreading across hospitals. As recently discussed in the New York Times, we may be forced to take actions that go against our moral judgment, such as breaking bad news without present family or making agonizing calls on access to ventilators. As a result, we run the risk of ‘moral injury’ – harm to the conscience due to being forced to violate our own moral values. The kinds of decisions we’ll have to make are similar to those faced by soldiers/aid workers in warzones, and there are likely to be cases of post-traumatic stress when this is all over. I’m already all too aware of such scenarios playing out – just yesterday, faced with an adult COVID-19 patient crying because she was too scared to die alone, I could only smile behind my facemask and offer her a gloved hand to calm her down: giving her a hug was not an option, even though it felt like the right thing to do.

What can we do to keep ourselves functioning and healthy in these trying times? Many of the normal tricks, used to confront the usual anxieties associated with healthcare work, can’t be applied to COVID-related anxiety. Eating well, for instance: it’s hard to do when the only dried food left in the shop when you finish your shift is bulgur wheat. Seeing friends in anything but a virtual context is ruled out for now. And suddenly every film you watch has an unexpected pandemic-related subtext.

My sister Dr. Emma Waddington, a clinical psychologist, says that teaching your mind not to become preoccupied with “wandering” thoughts is important. She recommends making a concerted effort not to focus on the negatives, absences, and perceived failings: not to let your mind drift to the things you aren’t doing, the social bonds you aren’t able to maintain, the news and information you aren’t keeping up with. Instead, try to focus on what you are doing, which is, as she and many others insist, amazing. She has a simple message which she wants us to keep in mind: “You are doing enough. You are enough.”

Of course, focusing on our achievements and positive contribution to the fight against COVID-19 is easier said than done. One mechanism that Emma recommends to help with this is “thought stopping techniques”. These techniques help us to “pause, reappraise, and reframe”, to stop our minds becoming preoccupied with negative thoughts.

At work, finding new methods of coping has become key. We now cover our faces with masks and mostly work in cubicles on our own. Ensuring we take time to ask each other if we are okay is crucial. With expressions obscured by masks, it’s become a vital new healthcare skill to be able to tell what emotions people are going through solely by looking at their eyes. I’ve found out that no one can tell if I am smiling or not, I’m trying to achieve more expressions with my eyebrows now. Checking up on each other has been really important, and I’m particularly enjoying the new ways of being affectionate at work – elbow tap here, toe tap there.

With the help of friends and colleagues, I’ve added a few other techniques to the toolkit I’m using to help deal with COVID-19 anxiety. Firstly, I’ve bought an alarm clock so that when I go to sleep, I can leave my phone in a different room. That way I’m more fully disconnected from the world when I’m resting, and less tempted to catch up on things if I wake up in the middle of the night. And when I do get up, I don’t open my eyes to a bombardment of push-up notifications, emails, and frenzied messages. Secondly, I make sure I do some form of exercise once a day – even if this means following a pre-recorded boxing class via a choppy video stream. And finally, I make sure to properly relax during my time off by penciling in some time for indulging in my greatest passion (besides nursing): sprawling on the sofa and watching rubbish TV. Just make sure that the new Netflix series doesn’t have a pandemic-related sub-plot before you get stuck into it.

For some extra resources:

Watch out Clinician Care webinar

Managing mental health injury during pandemic

Podcast on moral injury

Good Netflix binges (not sponsored) that aren’t pandemic related:

• Stranger things
• The Stranger
• Sinner
• Sex education
• Good girls
• Frankie and grace
• Working moms
• The Fyre festival
• Russian Doll
• Ozark
• Call the midwife

Good Instagram workouts

• kobox
• The jab
• Melissawoodhealth
• Joewicks