'Grief is Not Allowed:' Navigating Mental Health as an HCW During the Pandemic

(This Mental Health Week, a doctor writes about navigating her mental health and accessing therapy as she worked the frontlines during the Pandemic)

No weekends, no timely salary, no division of labour- no problem! If someone dies on your shift, there are several others on the brink so you just finish the paperwork.

Grief is not allowed.

Empathy is a burden.

Anger at a broken system is best not acknowledged.

A good doctor understands that there are problems and decides to tolerate them. That is the legacy of doctors, apparently. As a house surgeon trying to make sense of the medical world, this was one of the first things I had to wrap my head around.

I felt guilty for every hour of sleep I managed on a 36 hour shift and for every meal I had on time.

This was even before the pandemic truly hit India.

The pandemic only precipitated all the inadequacies of the healthcare system. No PPE, no protocol, no donning-doffing areas after the supplies were improved, overcrowded hospitals- we were spectacularly vulnerable to COVID. Amidst this chaos, there were voices valourising healthcare workers(HCWs).

Turns out, the conditions were miserable enough for politicians and voters to laud us and light lamps for us but not enough to get protective equipment.

I wasn’t alone- world over, healthcare workers were suffering.

Constant exposure to a potentially fatal disease that you are not adequately equipped for is bound to be overwhelming. Many expressed fears regarding the impact on patient care, too. Eg: last year’s slogan for World Patient Safety Day was, “Safe health workers, Safe patients”. Later, the WHO declared 2021 as the International Year of Health and Care Workers to protect, support and invest in health and care workers. It is well documented that the HCWs were, in fact, not okay.

Still, there was no time to dwell.

Or so we felt.

"If not us, then who? People only had us."

The One Who Helps: Accessing Therapy

I was determined to help fill in as many lacunae in my immediate surroundings as I could.

No mask supplies? Crowdfund. No blood stocks? Organise blood donation camps. People not wearing masks? Educate. No protocol in the hospital? Create one and circulate it!

The strain was undeniable but it was validating that I got to play a role, however tiny, in such difficult times.

I understood that it was a lot to deal with so I tried everything that had worked for me previously- I wrote, I sang, I watched movies, I spoke to friends, seniors and family. Conversations with batchmates often led to similar stories on their end, I ended up feeling guilty about complaining to them.

Seniors reminded me of how much worse they had it. Family worried when I shared things so I ended up consoling them.

Often, I received variations of, “be positive”. I felt I was not being heard.

Despite being a vocal mental health advocate most of my college life, I hadn't considered accessing therapy. I was checking on a friend regarding his mental health when he asked me how I had been doing considering I was on the frontlines.

I said something like, “Sometimes, I feel like the city’s COVID situation rests on my shoulders, but I am fine otherwise.” My friend told me to get the help I kept pushing him to get.

It was easier telling other people that their problems were valid.

"Even after I decided to seek therapy, I had to find a therapist who was flexible with timings because I barely had a diurnal rhythm anymore, let alone a schedule."

There were helplines meant specifically for healthcare workers but I had heard too many stories of therapy being more of a nightmare than the issues themselves, so I was apprehensive.

Plus, I felt I didn’t have any issues I could easily pinpoint so I wasn’t sure that emergency helplines would help.

In retrospect, it could have helped, but going via recommendations even if they were from fourth degree acquaintances, felt safer to me. I think, more than anything else, it allowed me to delay the actual therapy session.

Safe Health Workers, Safe Patients

Eventually, I started therapy. I realised that I did not have an answer to how I felt most of the time. I resorted to reading out my old and new writing to express myself. I would also write down the things I wanted to cover.

Even as I navigated therapy, I observed that my colleagues were often at the brink of tears, yet crying was a sign of weakness. It was considered a sympathy-seeking, manipulative tactic.

Every weeping resident or intern would be told that this was part of the job so they needed to suck it up. Most of them did.

Anger was a more acceptable emotion, but it was always directed to those with less power- juniors, Group D workers, patient bystanders, sometimes, even patients. In the first piece I wrote to discuss with my therapist, I said “...You know that apathy finds its way easily through burnouts. And you wish you didn't care.”

Over the months I started to titrate my efforts. I took a step back where possible and once I felt ready, I worked towards reconciling with my need to work for change, on my terms.

I learned to ask for help although it still makes me uncomfortable sometimes.

I began navigating my own boundaries without guilt. I started to acknowledge my anger, sadness and helplessness as normal and valid responses to my situation.

Through the safe space therapy provided, I learnt how important it is to empower a person to allow them to be vulnerable. My therapist would always seek consent before opining on something I said and cross check with me if she understood correctly.

Any approaches she suggested were open to discussion. She kept the power dynamic nearly balanced while also enforcing her boundaries. Perhaps the amount of time she could give me was much more than a doctor can usually afford per patient.

Still, I tried to emulate some aspects from this experience.

I found, the kinder I was to myself as a caregiver and as an individual, the kinder I could be in my work, too.

I started having conversations with colleagues regarding mental health and recommended therapists via my own, where necessary. These conversations, both online and offline, often circle around to the core issue being a crumbling healthcare system.

It's true. It would be a good preventive measure to fix Healthcare structures that currently perpetuate exploitation and power imbalances. In my case, therapy helped me navigate that fact and my role in this without feeling naive.

"We forget that HCWs don't exist in silos. They are as affected by social determinants of mental health as they affect it."

The pedestal healthcare workers are often put on harms people on both ends of the stethoscope. We, too, need “mental, physical and social well-being and not merely the absence of disease or infirmity” to be healthy. This year, when we discuss the WHO theme for World Mental Health Day, “Mental health care for all: let’s make it a reality” let us include healthcare workers into the ambit of “all”. Mental health care, after all, is a human right and healthcare workers are, after all, human.

(Dr Shivangi Shankar is a modern medicine doctor who writes in English and Hindi. She uses her art as a medium for catharsis as well as for making health and care more accessible for all.)