COVID emotions

Talk presented at #NotYoga2020 Symposium Dec 2020.

I have a question for us. What do you think is our greatest asset in this pandemic?

What is the most important asset that we need to protect during this pandemic? If you’re in leadership positions, you may consider that the team or the institution as something you need to guard. Today you will hear many brilliant ways of engaging the whole system for change. But for you personally, you probably know that the greatest asset in this pandemic is yourself.

Of course, your experience of this pandemic is dependent on where you are, when you are and probably even more importantly, who you’re with. We’re all experiencing different phases of the pandemic. How Melbourne feels right now is different to how Brisbane, London, New York or Warrnambool is feeling. How Melbourne feels right now is different to how Melbourne feels back in August when we were in lockdown. Perhaps most importantly, your team, your leaders, and your institutional authorities determine how you are feeling at this moment. You’ve heard it before: we’re in the same storm, but we’re in different boats, different waves and we’ve got different boat crew members.

In this day of big talks, we are not going to gloss over the little big people, or big little people. This is a private talk. We process this pandemic differently. My experience of this pandemic is very unique to me. I work in several institutions and teams. In one hospital I feel completely protected and appreciated. In another I feel lonely & lost. In one hospital, name tag lanyards are ok, surgical cloth caps are not. In another, surgical cloth caps are ok, but name tag lanyards are not. It’s wild. No wonder it’s been a roller coaster of emotions. I still remember the betrayal & anger I felt when I needed to justify a request for N95 mask for my aerosol generating ENT procedure. We experience & process this pandemic differently on a personal level.

A recent study published last month looking at “Psychological distress, coping behaviours, and preferences for support among 650 plus New York healthcare workers during the COVID-19 pandemic” reported that 57% screened positive for acute stress, 48% for depressive, and 33% for anxiety symptoms. And what were their biggest concerns? Lack of control, lack of testing and PPE, and transmitting COVID to family.

How are you feeling at the moment? You might well be feeling burned out, because this pandemic is a chronic occupational stress causing us to feel emotionally exhausted, depersonalised and less efficient. You could be feeling a sense of compassion fatigue: an emotional and physical exhaustion leading to a diminished ability to empathize or feel compassion for others, the negative cost of caring. Or perhaps it’s moral injury, moral distress, moral anguish, or moral conflict. In 1984, the term moral distress was first conceptualized by Andrew Jameton in his book on Nursing Practice, to describe the psychological conflict nurses experienced during, “ethical dilemmas.” He wrote that “moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.” I bet many of us here know that feeling.

You may not be able to accurately delineate where burnout, compassion fatigue and moral distress overlap, but I’m sure that you can recognise the primary emotions underneath. Those definitions are scientific, while our emotions are raw and real. Our emotional responses to this pandemic are native and inherent to who we are as human beings and health care workers. May I help you define some of those things you’re feeling right now? Can I confess that I have felt mad, bad, sad and scared?

I have felt mad. I was angry at the state we found ourselves in. I was mad at certain protocols. I was angry at some decisions made by our leaders. I have written emails I should not have, and tweeted thoughts I should not have. Has anyone else done this? Or is it just me?

Because of that and a few other things I also have felt bad. A sense of shame that I wasn’t good enough. A feeling of guilt that I did not do more for that patient who died or that colleague who got infected. I felt bad I did not advocate more.

Of course, I have felt sad. I’m sad that I see worldwide carnage from this virus and yet many who still deny its existence. I am sad that I have not seen some of my colleagues’ smiles for a long time or hug some of my patients and my family members. This sadness can explain some of the days when I just wake up feeling blue. When will this marathon end? When will this pandemic be over? When can I hug my patients again?

Perhaps the one emotion that has driven a lot of actions during this pandemic is fear. We are scared. The uncertainty of the future makes us feel scared. The words “toilet paper” has triggered some primitive emotions and actions. When I’m doing rigid bronchoscopies on my tracheostomy patients, I feel close to danger and I’m scared. When I’m holding the face of my patients and examining their noses and throats, I’m scared & anxious. It only takes one breath for the patient to pass on their covid to me when we are that intimate in an ENT examination. That’s why my psychological safety is strongly linked to my physical safety.

I’m not so good at writing cards. So you know when you look for a greeting card in the shops, you are looking for one that encapsulates how you feel about the recipient. Perhaps the emotional confusion you feel can be defined by one of these words? Am I feeling mad, bad, sad or scared? This is not an attempt to belittle these emotions or its impact on the individual. This is my way of simplifying and clarifying how I feel. I need simplicity to help my simple surgeon brain to comprehend my complex emotions.

Here’s the thing: are these emotions negative, positive or neutral? None of the above. These emotions are not negative, positive, or neutral. These emotions are human. These are human emotions in a pandemic. Feeling mad, bad, sad or scared is human in this unprecedented year we are experiencing together. The challenge is how we navigate and manage these fundamental emotions for positive impact. My anger is a trigger that something does not sit right me. I need to find a solution. My shame or guilt is a mirror to remind me to be humble and to accept that I am good enough where I am. My disappointment is a reminder that I do not have everything under my control. I should focus on things I can influence. My fear is a reminder that I need to redirect my excitement for advocacy work. Use these basic emotions to reorient your thinking and response.

When I look back carefully at the last 11 months, I admit that beside feeling mad, bad, sad or scared, I have also felt glad. I have changed. I learned new ways of doing things. I learned stuff I wouldn’t have learned. Listen to the speakers before me and the speakers after me. I am glad I get to learn from them. I have been impressed by many leaders. I have been touched by the resilience of many of my patients. I have seen the faithfulness of my colleagues. I have seen ordinary people doing extraordinary things. Librarians calling up the elderly in their membership books. Restaurants feeding frontline workers and the marginalised. Airline crew working in aged care facilities. The pandemic has shone a light on social inequities and broken systems, but that light that broke through the cracks mean that we can start fixing things. Like a mosaic art, light will shine through the cracks, and all those colourful pieces can be put together for a better vision.

This pandemic has decluttered my life and reorganised my values. I am learning the art of tidying my life. I have decluttered my possession, my profession and even threw out some friends in the bin. I am learning to focus on things that spark joy. You know, I basically Marie Kondo’ed my way through the pandemic. Marie Kondo says you need to touch every item in your life and keep it if it sparks joy, bin it if it doesn’t. The first thing my dear wife did after reading her book: she laid her hands on me. She said, “I’m just checking if you still spark joy.” For many of us, this pandemic year is a year of re-setting. Pandemic decluttering is good for you.

Feeling mad, bad, sad, scared or glad is not wrong. It is simply being human in this pandemic. Reorienting those emotions for positive effect is what we should strive for. Decluttering our lives, reducing the noise and focusing on things that matter will help us significantly.

One more thing. So by now you know how to don and doff your physical PPE. What’s your emotional and mental PPE? Your mental PPE will look different to mine. It could be exercise, books, meditation, art, spirituality or yoga. My personal PPE include humility, heart (empathy) and hope. To my surprise, one of the greatest emotional PPE I’ve discovered through this pandemic is other people. My colleagues help me debrief. My family helps me see purpose. My team mates make me realise that I’m not alone. We get through this pandemic together.

So perhaps my opening statement is incorrect, or at least, incomplete. Perhaps the greatest asset we have in this pandemic is actually each other. Jump into each other’s boats.

Stay safe. Stay connected. Take care.