I was on my way to work for swing shift and had The Howard Stern Show on. Stern was speaking to an ICU doctor who was frustratingly describing the daily death toll in his ICU, which had become unmanageable for his team. As the doctor was wrapping up over the phone he became more impassioned about the state of his fellow first responders and said something to the effect of “once were out of this thing we will have to deal with the mental health of our first responders, many of them will quit their jobs and stop working on the front lines. Everyday of the job has become the worst day of my life.”
I began picturing a man whose calling was the ICU, who thrived in his role, and then like a match to gasoline Covid-19 hit and turned his strong sense of compassion, empathy, mental control and commitment into a tsunami of fear, anxiety and a loss of mental control. Several first responders have also had to manage protests and riots, causing PTSD on an unprecedented and complex scale in the first responder community.
It is likely that many first responders (who now see death and violence at a more alarming rate than ever) have thought about death (and likely suicide) more and more since the pandemic began and (despite media outlets and social media “cheering us on”) we obviously need more than cheering. The tricky thing about first responders is we don’t like to admit we are doing a bad job at anything, let alone taking care of ourselves, but here’s the thing, most of us suck at it!
We love the thrill of tragedy: being in it, treating it, thinking critically during it! But the pandemic is different- its not a shooting victim in the middle of the night that you saved by the skin of your teeth- it’s body bags in refrigerators the size of Mack trucks. Everyone is going through their own personal hell right now, but for first responders, especially first responders working in the ICU, everyday is a fight for sanity and control. Going to therapy is not always the answer and it often takes several tries to find the right therapist. It is also important to consider that the trauma is still occurring and when we are still living through a trauma, therapy is often not effective. Therefore it’s imperative that first responders and those in the helping community pay special attention to self care. I have compiled a list of self care tactics which have helped my clients and myself manage this crisis. The first one is probably the most important!
#1 Let go of your God complex
You are you and God is God. Many people struggle with defining who God is and I am definitely not going to do that here. I will however let you know that you are NOT GOD. Yes you save lives, but then you go home and clean the litter box just like the rest of us. When you let go of the God complex you are able to see what your’e true capabilities are outside of your work. A good example of this is overtime. God is able to work countless hours of overtime, you however cannot, especially if you plan on healing. Overtime often comes from two ingredients, a difficult home life and financial issues. Doing too much OT will often create a pattern of overspending (I can get that new iPad, I’ll just sign up for more OT!) and it almost always creates home life/ relationship (i.e. avoidance) issues. It is important to remember that you are a human who has emotions and you need to exercise those emotions in a realistic manner. When you let go of this particular complex, it will make it easier to follow the additional self-care guidelines.
*Consider a staycation – you need it!
#2 Only give attention to individuals who show you love and kindness: Begin Cultivating your Relationships
This is actually a pretty simple thing to do, the key is to start simply. Cultivate the relationships that make you happy, meaning those more “complex” less communicative relationships can and should go. Only give attention to individuals who show you love and kindness. A good example of this is neighbors. I never really spoke to my neighbors before the pandemic, maybe a “hi” here and there. Then I began to notice how nice my neighbors were. They had always invited me to outside movie nights and BBQ’s; post pandemic I began to accept their (socially distanced of course) invitations.
My neighbors (who ranged from 12 to 60) were not as cool or interesting as some of my friends but I was starting to figure out that they actually treated me better than some of my more lame duck acquaintances. The 12 year-old started to walk my dog for less than half the price of my dog walker and last month my neighbor across the street gave me Hanukkah candles because “you can’t find them anywhere.” These are the types of relationships you want to focus on!
Certain friends are good company for “the good times” and some are not. You may consider this a break from some of these friends, they do not have to be gone forever, like your devices and 24/7 news consumption, you may just need a break from them!
This will slowly start to trickle into your family and partnered relationships as well. You will notice a pattern of only seeking out the positive people in your life and you will therefore begin to show more kindness to others. Certain mental health issues including anger and depression will begin to fade to a more manageable baseline and you will be able to focus on bigger goals and issues that need to be addressed.
#3 Consider switching your shift
One may have always thought that day shift Monday-Friday was the ticket! Especially if you have worked in a 24/7 facility as most first responders do, there is this idea that somehow a Monday-Friday shift is the gold standard and you have made it to seniority Heaven. In actuality Monday-Friday can and is the most stressful shift. Management typically works these shifts as do busy body (oh I just wanted to help) coworkers. Service providers, lawyers and family etc. often call during these hours.
Another thing to consider is how your body and mental health is reacting to your shift. You will want to pick a shift that is most in line with your circadian rhythm. Personally my body and mental health has always done better on swing shift and after Covid-19 it was the thing that truly saved me from going insane. I went from sleeping an average of 4 hours a night to 8 hours per night. Even when I got less sleep my body still felt better when it was able to wake up later, without an alarm. I also do better when I am able to do yoga/ exercise before work, and typically have a better outlook on the day. I enjoy taking my time getting ready for the day, not feeling rushed out of bed, greatly increased my ability to cope.
I know, I just wrote down that you need to exercise, it’s almost as obvious as telling you to get 8 hours of sleep each night. But cardio is free mental health treatment. Exercise affects the brain in many ways. It increases heart rate, which pumps more oxygen to the brain. It aids the release of “happy” hormones such as Serotonin, Oxytocin and Endorphins. Exercise also promotes brain plasticity by stimulating growth of new connections between cells in many important cortical areas of the brain. If your not at the very least going for a walk everyday / doing minimal exercise, you aren’t really living any kind of life!
Pick out routine that suits you. Adding in cardio does not mean you need to get a gym membership or start running down the block in Converse. If you hate running, don’t do it! Go for a hike, walk your poor dog longer than usual, do more yard work, play basketball with your kids!
Sorry! But this is everything. Diet is the best form of natural medication for your body and mind, period! In a previous post I have written about my stomach issues after working in the group home from hell! I had no choice but to completely change my diet and live a clean lifestyle. An easy was to start doing this is to embrace cooking to the fullest extent, like you would a hobby. Knowing the ingredients that go into your food is key! I’m not going to give you a diet plan to follow, your an adult, just stay away from processed sugar and carbs as much as you can, the best cook books for clean eating are as follows:
Against All Grain – you can eat just about anything! You just have to cook it yourself! I mean, I made bread out of cashew butter!
Clean Eats – This is pretty hardcore and for those who want to eat clean MD style, however it will truly change your gut!
#6 Give yourself time to cry and scream in your car
Don’t leave the screaming and crying for your co-workers, they have had to deal with enough! If you park in the car park this should be especially easy, if you park on the street, maybe during your break leave company property and have a good screaming and crying session! This however requires that (once again) you view yourself as a human being as opposed to God! Your body needs to detox the rage and sadness you have been enduring.
It’s not really OK to scream and cry in front of co-workers, but it happens, and when it does do a self-inventory of how and why you got to this uncontrollable state. Rage typically happens when we think we can handle everything or try to handle a number of complex tasks on our own. Taking more time off, cultivating your relationships and taking care of your body will all reduce your stress levels. If you are in a role of responsibility such as a supervisor, lead or a discharge planner etc. you may want to consider changing your role. After the pandemic hit I made the very wise decision to return to my line staff position where my only responsibility was seeing clients and writing notes, it truly saved me.
#7 Check your Empathy
This will go in line with Rule # 2, when you let the kind people in, the kind you will come out! The kind you also treats the individuals you serve with compassion. If your empathy is severely lacking this does not mean you need to quit your job, it likely means you need a reset. For me this meant a month long staycation, counseling and a stronger devotion to yoga. This likely will look different for you, either way you will need to some “digging in the dirt” to find out how to connect back with your empathy. This typically starts with giving yourself empathy and reconnecting to aspects of yourself that are not your job.
#8 Develop a Hobby
This will help you draw the line and create more of a work/life balance. Your mind needs a less stressful place to land so volunteering at your local homeless shelter is not the way to go here folks, you already dedicate your lives to the wellbeing of others. I would recommend picking a hoppy which is more removed from your job, painting, team sports, writing, photography etc.
#9 Rethink the Role of Social Media in your life
In many ways (especially during this time) social media can feel like a nice warm hug from a friend. We can reconnect and see photos of a baby’s first steps, food being prepared, real housewives memes and wait for our likes to pop up after a thirsty post. But staring at our devises all day also creates a sense of life that’s not being lived, but watched. We need to be bored, it creates inspiration and creativity, screen time tends to diminish the boredom which is necessary to create.
Obviously there are several negative factors to social media, particularly for first responders. We may want to post about the sate of our ICU, jail or ED. It’s never good to let ANY media outlet know about the state of your job and ultimately its grounds for being fired. You can purge this urge by deleting the facebook and IG apps on your phone. This means you don’t have to go through the process of actually deleting your profiles, this will lessen your urge to check social media continuously throughout the day. Another thing to consider is the emotional impact of digital friends and experiences and the genuine nature of these experiences.
As first responders we don’t need to see more images of burning buildings, broken glass, Karen videos, police brutality, riots etc. You are responsible for how you decide to manage your time and I guarantee turning off social media will allow you to heal, dig into your hobbies and connect with your loved ones. For some this may mean monitoring your use of screen time (several apps, including the settings on your iPhone can monitor your screen time). For others this may mean a complete lifestyle revision. Start out small and manageable. If reddit is your poison, limit this app to just the morning or evenings.
Personally when I find that I am in the danger zone of anxiety and depression I delete my instagram and facebook aps, even for just a week, and it feels like a cleanse! Replace device watching with other more inspired activities such as reading, going for a walk, playing with your kids, having a face to face conversation!
#10 Rethink your daily routine
Pre pandemic if you wanted to wait until midnight to workout, watch news all day or decided to have a nice cold beer after each shift, no one would really put it past you, but if you’re in survival mode, simple changes to your daily routine could save your sanity. Strongly consider moving your body before you start your day, even if its just a 20 minute yoga meditation, do it! Starting out your day on a positive footing, will improve your outlook throughout the day and you will likely feel more motivated. Along with screen time also consider the amount of TV you are consuming and consider what you are watching and how you could better spend your time. Obviously watching nothing but the news and murder documentaries, is not your best set of options, consider light and fun programming.
#11 Consider adopting a pet
This is only for the first responders who are interested in reducing their hours and who feel the need to reconnect to their social circle and home life. If you are not in a place where you feel like you can manage an animal, newly added stress is not a solution. When I got my rescue pup, initially it completely threw me and I had no idea what I was doing. Furniture, blinds, carpeting and shoes were all a victims of his wrath. However I loved being with my Rottweiler/ German Shepard boy! He taught me a sense of connection, how to love and be loved (for no apparent reason) and what caring for another being truly meant. Ultimately he made me want to stay home more, go on more hikes and ocean adventures and enjoy what life had to offer!
If you already have a furry friend cultivate that relationship, take him on more hikes and long walks. Take him to the beach or cook a nice treat from scratch for him. Caring for others (who are not your patients) will strengthen your sense of belonging and community. It will also take your mind off of the state of the world.
Yes this means less fighting and bickering, this part is obvious, but I would also recommend firming up your communication in terms of what you need from your family. Many of us have developed routines around preventative measures for Covid including showering after work before contact, setting up hotel rooms if we had an exposure etc. Consider developing this communication around your mental health. If you can’t form the words “Mental Health” you can use words like “stressed out,” “tired” and “really upset” to let your family know that you need support in certain areas. Try to communicate these issues before they come up in a fight.
For example if it’s looking like it’s going to be a tough month in the ICU (as numbers have suggested for the month of January), consider having a family meeting about how the state of your work may affect you and what you will need from your family (within reason of course). For example maybe your teenage daughter could be on grocery duty, or if you have a small child, your husband can be on small child alert throughout the night. If these arrangements can get sorted out before stress levels start to become unmanageable, you can save you and your family a lot of grief.