A Year As A Nurse In The COVID ICU Gave Me PTSD. Now It’s Happening All Over Again.

“Every nurse in America right now is staring down this summer and this fall like it’s the barrel of a gun. “
AlenaPaulus via Getty Images

It’s hard to admit to needing help when your concept of self revolves around being strong for others: assessing critical patients quickly, making life-and-death decisions, and communicating effectively with people on the phone who may have just experienced the worst day of their lives ... but for you it has to be just another Tuesday.

Even before last year, roughly 4 million nurses across the nation were burned out. Our jobs are intellectually demanding, emotionally exhausting and physically laborious. Pre-COVID our post-traumatic stress disorder rates were 1 in 5 or 1 in 4 depending on the study.

I guarantee you they are higher now, and I know, because it happened to me.

I don’t think most Americans realized what it was they asked of nurses last year. It was easy to call us heroes, but far harder to understand what we were put through at the bedside. Nursing in COVID times, both then and now as it continues, is being forced to bear witness to a cavalcade of preventable tragedy.

People who die of COVID die the worst deaths imaginable. (I used to be a burn nurse, so please understand that when I say that it means something.)

Most Americans will never understand what it is like to look someone in the eyes as they pant in increasing terror, forced to choose between talking on the phone to a loved one they know they might never see again and breathing enough to survive. To hear their distant loved ones shrieking over FaceTime, trying to tell your patient that they love them as they die.

How would you feel if you were forced to watch this every day for up to 16 hours? Every single shift of yours, over the course of an entire year?

***

There’s a certain amount of braggadocio in health care.

Because the consequences of any of our mistakes can be so dire, many of us have a hard time admitting that we have ever made any. And thus, because we want to think ourselves infallible, it is often hard to recognize the signs when we are not.

When we go home, unable to stop thinking about what happened on a certain shift.

When we have recurring nightmares about being trapped or unable to help.

When we have trouble regulating our emotions because for so long to have even acknowledged their mere existence would have been the difference between functioning another day versus ceaseless weeping.

A photo I took of my morning notes of a COVID patient. You'll see at the top I wrote "will pass today."
A photo I took of my morning notes of a COVID patient. You'll see at the top I wrote "will pass today."
Courtesy of Cassie Alexander

I cracked at work in late April, in the middle of a shift.

I told my closest friends I wanted to die, started crying, and didn’t stop for about three weeks. I wound up being placed on temporary leave and diagnosed with PTSD.

At the time, it felt incredibly shameful to be having problems. We didn’t have any COVID patients anymore.

But I actually think that’s what triggered it. The fact that, for the first time in 13 months, I had a chance to breathe.

To rest.

To reflect.

And when I looked back at what I had “accomplished” last year as a COVID ICU nurse, which was mostly nothing, through no fault of my own, I couldn’t bear it. Being forced to witness so many absolutely needless deaths, hearing so many family’s hopes dashed on the phone, and listening to people at the highest levels of government lie without consequence?

I had given my all, for a whole year, and I’m used to succeeding, dammit.

And yet for most of 2020, and the beginning of 2021, I couldn’t.

No matter how hard I tried.

And it broke me.

I am still working on coming back. I’ve come to accept that recovering and keeping my mental health is not something I can count on, but instead a lifelong goal.

It is frustrating, though. When someone is physically ill, you have metrics to judge their progress with ― have they recovered mobility, are their labs now good? But when you’re newly mentally ill, while you can hold up the image of the person that you used to be, there comes a time when you realize that you might not get that person back.

I so dearly want to go back to the time when I thought that my government was invested in the health of its citizens ― and when those citizens themselves seemed to care about one another.

But now I have seen truths that I cannot ignore nor put away. I am learning to cope with them, via therapy, and to desensitize myself to the most intrusive images, via eye movement desensitization and reprocessing, the therapy modality they use on combat veterans, which is great.

I wrote a book about my experiences, at my therapist’s urging, because she knows I like to write, and that helped too ― it gave me a chance to honor the version of myself that was trying so hard last year.

But I still grieve her loss, knowing that the “me” that I once was is not a “me” I can attain again, not until ― unless ― America changes its heart, soul and mind.

***

If someone came to your house and told you to take all the batteries out of your fire alarms, you’d report them to someone, right? Because that’s literally insane. We all know that fire alarms save lives, no questions asked.

So why do we tolerate anti-vaccine conspiracy theorists moving among us? Or any political figure that decries wearing a little scrap of fabric on their face because of “freedoms!”?

Knowing what we do about COVID now, how quickly it transmits, and how lethal it can be, allowing either of these groups any foothold in American society is the same level of insanity as someone who sabotages fire alarms on purpose.

Every nurse in America right now is staring down this summer and this fall like it’s the barrel of a gun. All of our hospitals are seeing COVID cases rise again, and with the rare exception of immunologically compromised patients for whom the vaccines are less effective, none of these deaths had to happen.

Each of us is being forced to be a handmaiden to atrocity.

And ... for what?

Why?

I mean it, really.

Why?

If you tell me it’s because “God knows when it’s your time,” I just want to tell you from the bedside, none of my patients looked peaceful dying, nor did their families find one whit of comfort in their deaths.

Each time you say that phrase you are spitting on over half a million graves ― and the time, attention, care, love, respect and dignity of the 4 million nurses whom you are forcing to keep watch.

I know this essay’s going to piss some people off, and I know I don’t 100% speak for all nurses.

But if it does piss you off, know this ― the real emotion you should be feeling right now is shame.

Because for some soulless reason you are OK with wanton, needless carnage. You are OK with people dying. There is no in between.

***

To be a good nurse you by definition have to care ― and truly caring requires making oneself vulnerable.

So here America is, asking us to step up to the ledge again, to open up our hearts and souls and minds. Some of us are going to step back to protect ourselves, and some of us are going to step over. (Nurse suicide rates are more than double the non-nurse female population.)

You deserve the best of us, but I am here to tell you that we don’t have much more to give.

So please. Change. Do better. Get vaccinated. Wear a mask. Tell your neighbor to wear a mask.

Help us help you this time, or we will not be around the next.

Cassandra Alexander is a registered nurse with experience in burn, critical care transport, and ICU. Her book, “Year of the Nurse: A Covid-19 Pandemic Memoir,” is her attempt to come to grips with suicidal ideation and PTSD after having been a COVID nurse in an ICU in 2020.

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If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.