What the Pandemic Has Done to My Mental Health as a Frontline Medical Worker

I posted on social media a few months ago asking my friends and followers what topic I would talk about if I was to make a TED Talk. Multiple topics were mentioned but one came to my mind often – mental health.

I was diagnosed with depression in January 2011. During the almost 10 years that followed, I have had my battles with my personal, internal demons. In addition to my depression, I have had constant or near constant feelings of anxiety and occasional suicidal ideations. Every day and night, it feels like an elephant is sitting on your chest and you have chest discomfort. You can hear your heart thumping in your chest and it’s beating as fast as a hummingbird flapping its wings or a woodpecker pecking a tree trunk. The constant roller coaster of emotions with the highest of highs and lowest of lows, and the high probability of Niagara Falls roaring from your eyes and down your cheeks. You lack the motivation of doing things that you once enjoyed doing. You would rather stay in bed instead of hanging out with friends and family. Plans that you have made long in advance are cancelled, postponed, or you do not show up without any explanation as to why. You rather be alone with thoughts and emotions.

I work in the Emergency Departments at a Level 1 Trauma Centers in New Jersey. Every shift, we would see traumatic events, but we would also see joyous events. We see people die, babies being born, lives being saved, and families and friends crying tears of joy and sadness in rooms separated by a thin curtain.

During the beginning of the COVID-19 pandemic, we saw patients come in via EMS with the same chief complaint – shortness of breath. Patient after patient came in with oxygen saturation of low-80 percent or less with some being in the 60s on supplemental oxygen of 6 liters on a nasal cannula and 15 liters on a nonrebreather. Patients, regardless of their age, came in and we had to intubate to help them breathe, and to attempt to save their lives by giving them a chance to go to the intensive care units (ICUs) or units converted to care for COVID-19 patients.

It did not matter how old they were. We donned our personal protective equipment (PPE) – face shield or goggles, first pair of gloves, gown, second pair of gloves over the gown and first pair of gloves, and N95 respirators – to protect us so we can continue taking care of everyone who came into the ED. Sometimes, we were fortunate enough to see the patients be transported to the ICUs or COVID-19 units. However, sometimes, we were less fortunate, and the decision was made by the families via telephone call to terminally extubate, or the patients went into cardiac arrest and not surviving our valiant resuscitative efforts.

Loved ones were not allowed into the ED during the peak of the pandemic in the hopes of limiting exposure to the public. That being said, patients passed away without their loved ones next to them to say their goodbyes, to pray, to hold hands once last time. We became their loved ones. I have held the hands of several patients as the physician, nurse, and I watch the cardiac monitor beep a monotonous tone and the pronouncements were done. I have cried gallons of tears with the nurses as the tone echoed in our ears, and my heart felt heavy in my chest.

These events happened every shift and our routine became second nature to us. We were robots — patient comes in, we don our PPE, we provide supplemental oxygen, intubate if needed, and we pray that the patient makes to the units. My hospital decided to play “Here Comes the Sun” by The Beatles over the intercom system after patients were discharged from the COVID-19 units and the hospital. My coworkers and I stopped what we were doing, if possible, and we clapped and cheered among ourselves while some sang along. I, however, stood still and I closed my eyes and felt heart become heavy and tears roll down my cheeks. Like hospitals around the world, we received generous donations and gifts from our community — food, PPE, shoes, etc. Children sent our posters and letters thanking us and calling us heroes and sending their love and support from afar. Messages of love, support, and encouragement were written on the sidewalk leading up the ED in chalk. Signs were placed in the lawn across from the hospital that read “Heroes Work Here.” We took pictures in front of the donations and gifts showing our appreciation to the community. I promise we were all smiling under our N95 and surgical masks. Despite all this, one feeling I had remained constant — I’m alone and afraid.

I should not be feeling alone and afraid given the outpouring of support and appreciation from our community, in theory. I am burnt out and overwhelmed mentally, emotionally, and physically during and after every shift. My anxiety and depression are on overdrive. I have palpitations almost every day and night. I cannot sleep for more than two hours when I get home from work or when I have the day off. When I do sleep, I would sleep for only 15 minutes before I’m awoken without intrusive thoughts and emotions. I am not my normal self, and I have not been for the past few months. Usually, I am outgoing, bubbly, talkative, sarcastic, and always smiling and laughing. Recently, I have been quiet or less talkative, I do not smile or laugh as much; I am in my own little universe.

Scientific and medical experts mentioned the possible effects of the COVID-19 pandemic on the mental health of frontline providers. What we saw and will continue to see is unprecedented. Our mental health can only take so much abuse before the dam cracks and breaks. I have said it before and I keep on saying this — we live in a continuous play and as performers, we wear masks during each act. Figuratively and now literally, these masks hide our true emotions and thoughts, and we maintain our characters in front others; no one knows how we are truly feeling and what we are truly thinking. Even though we wear masks, our eyes, our tone, and our body language often give hints to others about how we feel and what we are thinking. This pandemic affects everyone differently, and we cope with the effects differently.

Usually at work, I am talkative, outgoing, and bubbly. I love to smile and laugh, and I take pride in making other people smile and laugh. I am sarcastic and I use that to brighten everyone’s day. I am energetic and always moving around; I cannot sit still or not be moving around. Now, I find myself more reserved at work. I am less talkative, outgoing, and bubbles have left my personality. I do not laugh as much, and the level of sarcasm drops from a 10 to anywhere between a one and a four. My friends and coworkers tell me that I do not smile as much. They say that I am not as happy as I used to be. I wonder how they know that I have not been smiling as much and not as happy as I usually am. Do my cheekbones more move up as much? Do my eyes not squint as much as before? Is it the blank stares I give to everyone trying to talk to me? Do my eyes lose their shine and sparkle?

Two years since the start of the COVID-19 pandemic, my mental health still has not improved; actually, my mental health has worsened. I have fallen into depressive episodes almost every day and night, and multiple times each day. I often get “depression fog” and “depression tiredness” and I cannot seem to escape it. This usually happens in the morning when I wake up, during work at night, or when I am around family and friends. My mind would be flooded with negative thoughts of hopelessness, helplessness, loneliness, and that I am broken and not good enough. I cannot concentrate at work, I zone out or stare blankly ahead when friends or family are talking to me, I drink more than I should because I am more outgoing when I drink. I used to go to the gym every morning either at 5 am when I was off the night before or right after work at 8 am; however, I have not gone to the gym in a few months.

In the last two years, I drank more than I drank in college. I drank a bottle of red wine alone in my room one night while watching “Schitt’s Creek” on Netflix. I am more outgoing when I drink. I am an introvert and prefer to be alone more than being around people. When I drink, I am more talkative, and I laugh more; it feels like I am a different person. After battling these intrusive thoughts and feelings for so long, I do not want to lose this feeling of belonginess and feeling accepted by everyone. I am no longer an outsider, but rather I am one of them. I believe that people like me more when I drink because of how outgoing I am.

I have had more thoughts of suicide during the last two years than I did in the first nine years following my diagnosis of depression. These thoughts feel like dreams because they only arise when I am sleeping. I would have constant thoughts self-harm in my car or at work as an Emergency Department Technician. These are all dreams that I never want to come true.

I am more burnt out now than I ever was before. I am exhausted physically, mentally, and emotionally. I go home and I instantly fall asleep on the couch without even making it to my bed. I find myself dozing off behind the wheel when I drive home from work. Most of the time, feeling tired or exhausted is not always physical. I am more exhausted mentally and emotionally. My mind is constantly on overdrive. Thoughts and emotions are racing through my head. Even though I am tired after work, most days, I find myself laying in bed and I cannot sleep. I lay there and I stare at the ceiling, and I start to cry. I do not know why I become emotional almost every morning after work, but I cannot control the tears flowing down my cheeks.

The last two years have opened my eyes to what the COVID-19 pandemic has done and is doing to my mental health. My heart aches more now than in the past. My heart is racing more often now at work than before. I am more attuned to the world around me and everyone’s emotions. I am more empathetic and sympathetic at work and in life. I empathize and sympathize more with patients that come in with psychiatric complaints especially depression and suicidal ideations, especially the patients who are around my age or younger. I speak with them not only as a provider-patient but as someone who has walked and is walking in their shoes. I tell them my experiences and how I have overcome and am overcoming my obstacles. I offer to listen to their stories and a shoulder to cry on if they need to. I listen to people more when they speak.

The last two years have taught me that we are all human, especially superheroes. We all crash and burn, some more than others. The last two years taught me that it is OK to feel the way we feel, and to act the way we act. I learned that it is OK to ask for help because everyone is going through either the same or similar things as you; you do not need to be afraid. I learned that my feelings and what I am going through every second are valid and they happen for a reason or several reasons. I learned that my mental illnesses do not define me or my journey in life. Every journey is different, and some have more bumps, detours, roundabouts, and construction than others. Everyone is fighting a different battle with different demons than the person next to them. Most importantly these last two years taught me I have people in my corner who are always there for me and will drop everything to be with them when I need them. I learned that we are authors of our sentence, and we could have chosen to end our sentence but chose not to. Instead, we chose to pause our sentence with a semicolon. The author is me, and the sentence is my life.