What it’s like to try to fall asleep when you are a health care worker during the COVID-19 pandemic

Dedicated to everyone whose job is putting them at risk in these frightening times

It’s 12:08am and I can’t sleep. I only really sleep every few nights now. The rest of the time I scroll and worry. Hopefully what I’m about to say is common knowledge at this point, but it it still worth stating: It is a scary and disorienting time to be a health care worker.

I will lay all my cards on the table. I’m a pediatric hospitliast. I take care of kids who are admitted to the hospital. My COVID-19 risk is less than that of health care workers in adult medicine, especially those in high risk areas like the emergency department and intensive care units, though kids are more likely to be silent carriers so there is an X-factor there: many of the COVID-19 patients I end up caring for may not be billed as such. I may not know which children are exposure risks. I live with my 8 year old and with my immunocompromised spouse and I’m terrified of what COVID-19 would mean for him — as it is he has lung infections frequently and recovers from them slowly. To a lesser extent — these virus seems to be kinder to children — I’m worried about my child getting it. And to an even lesser extent, but with more mental load attached, I’m worried about what illness for me, my spouse, or both of us would mean for the functioning of our household. Through a fluke of scheduling, COVID-19 hit at the beginning of a rare stretch in which I was not scheduled to take care of patients for three weeks — one of those weeks was to have been a vacation — so I have been working from home. During this time I have been attending meetings remotely and trying to be productive but I am also homeschooling a very active 8 year old, trying to keep the entropy at bay in my household, standing in line at stores, trying to stay current on the medical and lay news, and trying to stay connected with colleagues, friends, and family members. I feel like I’ve never been more exhausted, but I know so many people are so much more exhausted by infinite multipliers. So those are my credentials, my own personal cocktail of risks and life circumstances. Everyone in the health care field has their own coronavirus cocktail these days.

So I lay in bed at night and worry and the worry has become a predictable but inescapable loop. The first stop on the loop is: What if going to work will result in the death of my immunocompromised spouse? How do I balance my promise to take care of sick people against my promise to prioritize and protect my spouse? Maybe I should move out of my house for awhile? But what if this goes on for months? Do I want to be separated from my child for months? Is that even good for her? Maybe I’m being selfish, imaging that my absence would be somehow harmful to her, imagining that matters in the grand scheme of things. I think of men going off to fight in World War II. I should be willing to sacrifice everything. I remember that my spouse’s job is at risk because of coronavirus, so I need to keep working so that we can continue to pay our bills. Well, unless I die. But then I remember that I have pretty good life insurance. Is death by pandemic covered in my life insurance policy? I should check on that. This particular thread, the “What if I kill my spouse” thread, and it’s closely related cousin ” Other negative familial consequences that could befall us if I contract coronavirus” never feel fully resolved, but my ultimate decision is to continue working, the equation of which goes something like this: this is what I promised I would do when I became a doctor x don’t want to let my patients and colleagues down x strategies to mitigate risk x panic about finances.

Then on to the next loop: What if I die? A sizable percentage of COVID-19 cases and deaths in China and Italy have been health care workers. If the numbers have become hazy in my mind — was it 5000? 20%? — this is the part of the loop where I look up the statistics again, because what harm could come to me of spending 20 minutes reading about health care worker deaths again at 12:20am? I should write a will, I think. Add that to the mental list — maybe I’ll do that tomorrow, the day before I go back to work. Actually, that’s already today.

The idea of not seeing my kid grow up and her growing up without her mommy is just the worst. That’s the darkest place in the loop. I try to be kind to myself by not dwelling there so much but every loop passes through it.  Should I not go to work so my kid can continue to have a mommy? I land back in the “yes, I will go to work” folder. (see above re: this is what I promised I would do when I became a doctor x don’t want to let my patients and colleagues down x strategies to mitigate risk x panic about finances). But then I wonder, how bad would this have to be for me to opt out? Cue guilt and imposter syndrome. Am I a bad person or a bad doctor for even contemplating this option? And then I wonder why have I not been saving more money so that we have more of a cushion if I decide to opt out? Then I reflect on how much luckier I am than most other people in this moment. I remember all the workers — grocery store workers, postal workers, public transit workers, so many others — who are absorbing these same risks for much less financial reward, and all the people who have lost their jobs. Cue self-flagellation about how often my anxieties are reflective of blindness to my own privilege. I should just be grateful for my job.

Then I remember that my parents are actually at much higher risk than any of my immediate household members and I worry about them and the idea that I would not be able to see either of them again in this life if they died of coronavirus several states away. But they are staying inside and being really rigorous about it. I allow myself to fantasize that they will be ok and this feels like a break from the loop.

All of this feels a bit abstract, until at some point, I remember that I will be going back to work on Monday, in two days which is actually now only one day. I wonder how many COVID cases there are at my hospital now. I spend some number of minutes planning, like a champion skier about to jump, how I will decontaminate myself after working on Monday so that I can protect my spouse. And yet, no matter how many layers I add into the hypothetical routine, there is a moment in the chain of actions where it is impossible to be fully sterile. Where should I keep my shoes? In my car? At the hospital? In the basement near the washing machine? Tomorrow I should sew a few head coverings for myself, I think, that could be washed with my scrubs each night. Add that to the mental list as well. Sew head coverings. I read and re-read my hospital’s protocol on universal masking. How will I eat and drink while I’m at work? My shifts can last 11 or 12 hours. If I only have one mask, how can I safely remove it to eat and then replace it? I imagine getting an energy shake and slipping the straw carefully up under the mask and into my mouth. Surely, that fails every rational approach to infection control, I think. I’ll just eat a really big breakfast. I scour Facebook for recommendations from other health care providers — it turns out health care provider groups on social media are the most reliable source of information these days. I am so proud to be a member of the global community of health care workers — I bear witness everyday on these forums to more ingenuity and bravery and sheer force of will to serve others than I can possible describe here.

I think of all these incredible healers and innovators and I quickly enter the part of the loop that I am most ashamed to describe, the part where I feel like I haven’t done anything or nearly enough to help in this crisis. You would think that the death of my loved ones or my death would be the most prominent part of the loop, but the “I’m ineffective and powerless and somehow some piece of this mass suffering is my fault” is where I spend most of the long, sleepless nights these days. Doctors across the country and the world are injecting patients with convalescent sera, writing ethical guidelines about allocation of resources, opening drive-thru testing clinics, and just plain seeing patients, I have been…. attending meetings and trying to move long-range projects forward but feeling very unfocused, reviewing vocabulary words with my second grader, doing the dishes, and reading COVID-19 articles. I have started a daily zoom meditation which is attended by 15-30 people each day and perhaps there is some positive impact there. I have been helpful to my institution’s response to the crisis in some small instances. I have been trying to be as present as I can to the communities I belong to in remote ways. But I feel like I haven’t done enough, by a mile, by a long-shot, by any means. I haven’t 3-D printed any masks, convinced a biotech company to start making cheaper ventilators, created online courses for first responders on protective equipment, or volunteered to test people at homeless shelters. How are people doing these things, I wonder?! Do they have high energy children at home with them?! And because I haven’t been on service with patients in so long, I haven’t even done my usual amount of service to others in the form of good old regular medical care. Cue the brutal self-judgmental thoughts. If there is a championship in self-judgment, I assure you that I would be the winner. “That’s about the only thing you’d ever win,” says the voice. See? It’s really, really good at its job. I remind myself that I’ve been trying to stay at home at all costs to spare my spouse from whatever risk I can. I remind myself that we’ve been splitting childcare. I remind myself that this is a stressful time. “Pitiful,” the voice says. “No one cares about your shitty little excuses. Stop whining.”

Now its 12:46am. I should really try to go to sleep, if for no other reason than to bolster my immune system. Even insomnia feels like a transgression against some larger humanitarian purpose these days.

But wait, I think. All this was preventable! The virus was not preventable, but the shortage of personal protective equipment for health care workers most certainly could have been averted with some foresight and effective planning. Not enough ventilators? Preventable! People gathering for parties in parks despite clear guidance not to? Totally preventable! The guy who blew out his cigarette smoke at me as I flattened myself face first against a building to avoid him while walking my dog. There’s a special circle of hell waiting for you, buddy, and news flash — there aren’t enough ventilators there either! I hear from friends about administrators forbidding health care workers to wear masks, even those they brought in themselves, because it might be perceived as scary by patients. I read about doctors being fired for speaking out about the shortages in personal protective equipment at their institutions. I read tweets from the president about how critical medical equipment supply for the states is a quid pro quo situation and I think to myself: Hell. F-ing. No. Here I am lying in bed for 2-3 hours per night worried about exposing my loved ones to risk by going to work and society is showing me and my colleagues in small and big ways that they just don’t care about us at all. I appreciate all the people clapping on their balconies, but the government could have been funding pandemic preparedness and it didn’t. Test kits could have been made widely available in time to given containment a chance. Our leaders could be invoking mechanisms to force private industry to manufacture needed equipment and they aren’t. Government at the state and federal level could have imposed shelter-in-place orders sooner given what was already known about the spread of disease in China and they didn’t. It feels like the lives of health care workers are invisible and disposable, their bodies instrumentalized to compensate for a system that has been overstressed for years under the false guise of resource scarcity and is shockingly underprepared to meet this challenge. Is a patient’s sense of fear really more important than a nurse’s life? I read my social media feed from friends debating whether to allow their kids to play with other kids and I know everyone is doing their best but I think: I’m about to maybe expose my loved ones to a disease that could kill them. The least you can do is not host playdates! This is the anger part of the loop, and it feels much better than the other parts of the loop — it can really generate some warmth on a cold night — but it’s just as toxic, because now it’s 1:32am and the best case scenario for me at this point, if my kid sleeps as late as she ever does, is 6 hours of sleep, and that’s not enough for the night before the night before I put on the N95 respirator my father mailed me — one of the last in a box he has in his woodshop from before COVID — and suit up for work.

I was an anxious child and an anxious young adult and it took a decade of meditation and therapy and another decade of medical training to turn me into someone who, until very recently, was basically no longer afraid of anything. I’ve held a patient’s intestines inside his surgical incisions with my own hands so his loved ones wouldn’t have to see them popping out while he received CPR. I’ve sat in rooms with parents and their dying children for hours as they gasped and drew their last breaths. I’ve seen severed body parts and absent eyes and drowned children and gunshot wounds and suicide victims. And I have never been as afraid or unsettled as I am now.

Because of my history of anxiety, I have always been hypervigilant about any signs of anxiety in my kid (hypervigilance — another competition I could win!). From the time she was old enough to walk, I have encouraged her to climb and explore and touch things and look at life with her eyes open. When she expresses fear about trying something, I sit quietly with her and talk about her worries and then we go together and do the thing. “You have to face your fears.” I tell her. “That’s how you get strong.” Now that she’s older, I overhear her saying it to her friends sometimes, when they don’t want to try the monkey bars or climb to the top of the dome. She’s even said it to me a few times — the instance that comes to mind was in San Francisco, when I was seized with fear at the prospect of driving down one of its dizzying inclined roads. Now, as I imagine leaving my house for work on Monday morning, I hear her little voice saying it: “You have to face your fears, Mommy.” And just maybe, it will feel like a good enough reason to do it.

2 thoughts on “What it’s like to try to fall asleep when you are a health care worker during the COVID-19 pandemic

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