“Please start by telling me your name and what you do,” the woman requests in a clinically-intoned, French-Canadian accent.
“Well, my name is Celia Sprague and I’m a rural family doctor, ” I reply hesitantly. “I primarily do maternity care and acute care in our ER. I work for mostly Indigenous families and am employed by a First Nations Health Authority here in Sioux Lookout …” I trail off.
“Right, and do you provide care for COVID patients?”
“Not directly. I mean, fortunately because of how isolated our community is, we are geographically protected. Our numbers are quite reasonable.”
The social worker continues. “This is a mental health program to support frontline workers affected by COVID. How do you foresee this service applies to you?” She sounds uncertain or perhaps I am fabricating the skepticism in her voice. Do I deserve mental health support? Presumably the focus should be on my southern Ontario care counterparts who are in the thick of the pandemic.
I falter. How do wrap up my clinical life, the stresses at home, the serrated edges of my ability to cope into a tight, clinical sentence that she can enter into the prescribed box on my intake form?
Weeks ago, when our Medical Director had forwarded around a flyer offering extra virtual mental health and psychiatry support services for healthcare workers amidst the pandemic, I had immediately signed up. In my six years of practice, not once had a similar offer been presented to me. Paradoxically, it was absolutely mandatory to maintain acute life-saving skills of various course acronyms: ACLS, ATLS, NRP, ALARM, etc. in order to be allowed to practice medicine, however, no one seemingly gave much consideration as to how physicians were to actually cope with the fall-out of these dire situations that we were being trained to manage. I always thought it quite bizarre that physicians weren’t similarly mandated to attend mental health sessions to shoulder the day-to-day burden of our clinical lives.
Into my iPhone, I exhale deeply and then launch into a description of the massive burden of social disparities that our patients face every single day: lack of running water, over-crowding, food-insecurity, sexual and physical violence. I tell the social worker about the pervasive addictions issues and disproportionate mental health diagnoses in our communities related to historical and intergenerational trauma. I speak of the social isolation of our patients and the multitude of challenges they face, exacerbated many-fold by COVID.
I can’t stop myself now.
I go on to describe caring for women whose charts are pock-marked with suicidal attempts and assaults throughout their lives. I describe the sleepless nights, haunted by the faces of women and their children stuck within the cyclical vortex of trauma and addiction. I share a recent story of a woman whose delivery had been high-risk, with multiple complications and her tiny newborn had required hours of life-saving intervention before being whisked off to Winnipeg’s NICU by medivac. I describe to the social worker how my patient had turned her pale face to the wall and had simply closed her eyes, shutting me and my words out when I had gently attempted to described how her little one was struggling to breathe. Freshly recovering from surgery, she hadn’t even had had the chance to meet her son before he was placed in an isoylet for transport to the big city.
Barely pausing for a breath, my voice is tight as I explain further that, no, I am not directly caring for COVID patients, but every single day myself and my colleagues bear witness to so, so much. Our job is an honour and I am grateful to be able to do what I do, but how can I continue, if I can’t even hug my colleague, console her with touch and care when carrying our patients’ stories in our heavy hearts?
I’ve finally run out of words and the space left hanging is filled quietly by the French-Canadian stranger on the other end of the line, worlds away in the nation’s capital. “Well,” she responds gently, “I do, in fact think you qualify for services. I can schedule you for your first session this week. It will be a series of six sessions of grief-focused therapy.”
Grief therapy? Not therapy for depression or anxiety? Grief. Presented matter of factly without any other option. I’m puzzled for a moment. In my clinical mind, I have always reserved bereavement or grief therapy for those who have been affected by loss of a loved one – my patient reeling from her second miscarriage in a row, a young man mourning the death of his grandfather, a family grappling with the end-of-life care of their mother. But me? Grief therapy?
“I’ve wondered if grief is transferable or whether, as physicians, we’ve witnessed and internalized so much secondary trauma that it simply takes a high-pressure situation (like a pandemic) and a slight nudge toward guilt and shock to completely undo us.”Lalita Abhyankar, M.D., M.H.S., AAFP
Yet, in the seconds that my mind processes this proposition, I feel a surge bubbling through my body, erupting inexplicably and suddenly, I begin to weep. I cry non-stop for what seems to be a long, uncomfortable time. Each time I try to pull it together, I can only manage to squeak out an “I’m sorry”, before sobbing anew. Thankfully, my intake interview was scheduled for a full hour and so I cry for a large proportion of that time. It feels good, a relief to have someone else give a name to what I feel.
Grief in the form of anguish that I feel for my patients and their immeasurable suffering and the sensation of utter hopelessness that I can do so little to change it. The pain, in turn, related to the secondary trauma that I am drowning in. Sorrow over the loss of the little things that shape our social existences that this pandemic has ruthlessly stolen. Heartbreak in the absence of visits with our extended family and close friends. Sadness at the loss of Holiday rituals. Despair over the state of our environment as political and economic priority lists are topped by the pandemic. Grief, so acutely, hangs at the corners of every aspect of life – not so fully that the view is obscured completely, but heavy enough to pull at the edges.
As we prepare for the holiday season, of course, I feel that it is important, maybe more now than ever, to celebrate what we can. I celebrate that each day, I am awoken to tiny hands on my cheek and sleepy hugs. I celebrate my health by moving my body, building strength and relishing in the power that that euphoric feeling brings. I celebrate that each day I enter the hospital, I am honoured with patients’ stories and access to the most intimate moments of their lives regardless of whether I have known them for five minutes or five years, all based on the privileged, inherent trust between patient and physician. I celebrate the resiliency of our patients, families and communities and hold on to those witnessed, simple moments of joy between partners, grandparents and siblings as we help welcome new littles ones every day to the world.
Yet, acknowledging our good fortunes will never fully ease that tension, tugging at the corners, threatening to pull darkness over our vision. The holidays, at the best of times, are often fraught with difficult memories and recognition of those who are no longer with us. So if you, like me, find yourself unexpectedly splashing tears onto cheery Christmas wrapping or are struggling to lean fully into the presumed merriment of this season, put a name to those feelings and reach out for help. As for me, there is hope – my first grief session begins next week.