ABSTRACT  PDF

COMMENTARY

The cacophony of emotions in a mental health professional from the isolation ward during coronavirus disease 2019 (COVID-19) pandemic

Mythili Hazarika

Associate Professor of Clinical Psychology, Department of Psychiatry, Gauhati Medical College Hospital, Assam, India

Abstract

This commentary is on the narrative of the thoughts of a first-line healthcare worker, and the psychological overview of the same while working in isolation ward and being in quarantine during coronavirus disease 2019 (COVID-19) pandemic.

Keywords: Healthcare Workers. Personal Protective Equipment. Therapeutic Alliance. Defense Mechanisms. Ventilation.

Correspondence: Dr. Mythili Hazarika, PhD, Associate Professor of Clinical Psychology, Department of Psychiatry, Gauhati Medical College Hospital, Bhangagarh, Guwahati-781032, Assam, India. hazarika.mythili@gmail.com

Received: 23 April 2020

Revised: 27 April 2020

Accepted: 28 April 2020

Epub: 5 May 2020

“I realised that the people in isolation are stronger than me and the mighty river Brahmaputra is my crisis manager”, said a mental health professional from the isolation ward (Fig. 1).

I always used to wonder about Dr. Bhupen Hazarika’s love for the “Lohit” (river Brahmaputra) in his evergreen numbers and after my discussion with her, I suddenly realised the deep significance of this river on people’s lives, in joy and in sorrow. The nature can be very uplifting and therapeutic is not an alien concept.

Freedom to go anywhere and do anything at any time is a privilege which we never realised before this pandemic. The deep agony of forced restriction while working in the profession one has chosen was not overt to the healthcare workers till this pandemic. They were never prepared for such an unprecedented event so the Hippocratic Oath never seemed so scary to them. But when the date of her duty in isolation ward in a tertiary center arrived, she was petrified.

Coming from a far off land to do her post-graduation (MD) was already stressful for her and suddenly the duty in the isolation ward with coronavirus disease 2019 (COVID-19) people - was something she dreaded. She had concerns of leaving her best friend, sharing her room with a stranger, wearing the personal protective equipment (PPE)-kit and getting infected by corona virus, as the disease transmission is very uncertain; and the probability of dying was though low but getting the infection was quite high.

She was immensely conscious the day she reached the institute for her duty as everyone seemed to be surprised by her presence and no one came forward to help her with her luggage. She felt lost and disheartened. She managed to console herself and dragged her luggage to enter her room on the second floor. She felt the confused emotions for choosing a job which was not given its due respect even at the hour of its indispensable need.

While walking up the ramp, the advice of her well-wishers kept pouring in over the telephone and she felt suddenly very calm. Reassurance by intimate people in crisis always helps, was an insight. But in the isolation ward, telephone was not allowed; so, she felt upset thinking about it as it was her only support. Her language and culture was different, and she being shy and introverted made things more complex to assimilate in the new environment. Personality matters in different ways at different times and learning to be flexible is a trait which everyone does not possess, was her deep regret.

The road became more complex for her when she had to wear the PPE kit without the Operation Theatre (OT) dress and when she found nobody to help her. She recalled the method to wear from a video that she was shown during COVID-19 training and became successful.

With full excitement, she went to visit the female ward accompanied by the nurse, ward boy, and the cleaner. Suddenly, there was no difference in the nature of their work though their status was different and she felt in unison with them because their lives were as precious as hers and they were risking for the sake of their duty which was very similar to her. She was surprised to see only one lady in the isolation ward who wore a black dress with white mask, praying to “Allah” and as soon as she saw them expressed her wish to go home. She had to maintain a physical distance from the patients to do supportive work unlike in normal circumstances. That was a hindrance to therapeutic alliance but somehow tried to establish some contact by allowing her to ventilate her concerns and issues. Such supportive work was new to her. Time and again, she had to distract her mind from the discomfort of the robe that she was wearing. She could not go to the washroom though she felt like urinating due to the PPE nor could she do it in her adult diaper that she was made to wear. She felt the extreme helplessness. She had mixed feelings and nothing seemed to be all black and all white as the situation did not permit her to feel likewise.

She comforted herself thinking about her therapy sessions with the patients in her hospital earlier when she used to say to them that “life’s experiences are not always black and white, they are mostly shades of grey”. Hence, she tried to look for the greys and then felt the cold wind from the Brahmaputra that touched her skin and she felt the soothing sensation. It gave her immense pleasure to see the birds from far off land on the bed of the Brahmaputra. Then a deep regret for the creatures of nature that everyone took for granted came to her mind and engulfed her thoughts. Life is indeed a mixture of emotions.

When thoughts of infection came to her mind, she immediately looked at the river and found solace. It was therapeutic to her. She tried to decipher her emotions and tried comparing them with the people in isolation. They were quite happy and healthy as some of them were not even bothered to wear the mask and took life as it came. The patients were very rude and dominating to her. She thought that they may be using defense mechanisms to cope up with this strange situation; so, appeared to be very dominant and strong suggesting reaction formation and minimisation.

She went back again to various thoughts and the experiences of her days in isolation. She felt good that she could do some supportive work by providing them with the basic essential item like the mosquito net and listening to their worries with an active listening stance. Earlier she never thought that just being there and listening could be as therapeutic for the patients as they felt calm, reassured, and less stressed after ventilating their emotions. The simple act of being there and giving time to them was considered a praiseworthy job.

The people in isolation was expected to have thoughts of dying and death, guilt and remorse, pain and humiliation, and rumination of good old days but it was not so rather she felt more miserable than them because the dress was very uncomfortable for her and the three-layered masks pained her jaws while talking. Telephone became the only partner after duty. She realised the importance of communication and connection by any means with one’s dear ones to be quite therapeutic.

She knew that life’s simple lessons are always learnt in crisis and pain but now she had experienced the truth of the statement. Nothing in life is ordinary and everything has special significance to one’s life was felt amidst crisis. After her duty in the isolation ward and getting applauds from the staff in the hospital, she felt relief from the difficult duty that she had to undergo but still was not happy. Though she was put in a five-star hotel she felt the discrimination between the staff as doctors and nurses were put in the five-star hotel for two weeks’ quarantine and others (ward boy and cleaner) in some other hotel. She felt that everyone’s status is same as all were risking their lives to take care of others. This discrimination pained her because she felt that the hierarchy was unnecessary and illogical when it comes to life and death situations. In the hotel, she felt like a captive. She missed the beauty of walking in the lawn, roaming on the streets, meeting people, being hugged, being touched, and being together with anyone and everyone appeared to be gifts of God to be treasured and not to be taken for granted anymore. Though her friends expressed their awe and joy about her spending two weeks in a five-star hotel, but she could not feel the pleasure. When any good or bad thing is forced upon us we do not enjoys its value. She sought for freedom and had longed for her near and dear ones. With one’s own people anywhere is heaven and alone anywhere it is hell, was her insight.

Many times in life she longed for such days when she could be all by herself in a wonderful ambience with world class food. Now that the dream had come true, its pleasure and value seemed lost, as it was no longer her dream. She understood the real meaning of life in adversity.

For her, the - exposure and experience - in the isolation ward made her learn some very important lessons like “life’s pleasures are in very simple things”, “close relationships matter the most”, “never take anything for granted”, “nature can heal the wounds in the same way as humans can”, “feeling weak and helpless does not make you a weak person”, “mental health professionals can also be shy, scared, fearful, anxious, and depressed”, and they are after all humans with the same emotions and sensitivity, and may be, this sensitivity was hidden and got unraveled. First time she could explore herself from deep within and know who she is and life’s real meaning, and that was her reward, her achievement!

ACKNOWLEDGEMENTS

Dr. Ammu Anil, Post-Graduate Trainee, Department of Psychiatry, Gauhati Medical College Hospital, Guwahati, Assam, India; Dr. Linda Cottler and the FOGARTY team.

Hazarika M. The cacophony of emotions in a mental health professional from the isolation ward during coronavirus disease 2019 (COVID-19) pandemic. Open J Psychiatry Allied Sci. 2020 May 5. [Epub ahead of print]

Source of support: INDO-US program in chronic non-communicable diseases (CNCDs) #D43 TW009120 (M Hazarika, Fellow). Declaration of interest: None.

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