Exposure Therapy

High risk of exposure to the coronavirus may also cause high risk of post-traumatic stress disorder. One such individual, a nurse, provided the following insight into a typical day in an intensive care unit:

I have worked the COVID ICU for several weeks now. Here is what I have seen so far. I start my shift changing into hospital scrubs and getting my assigned PPE for the day. When you enter the ICU, all patient room doors are closed and each patient is alone in their room. The patients are all on ventilators. Because they are on ventilators, they cannot speak. Under normal circumstances, patients in the ICU can develop delirium from sensory alterations and medications used for sedation. In this delirious state, patients are at risk of injury that can result in their death. This risk is elevated by the fact that it takes me several minutes to put on all my PPE before I can come to their rescue. If a patient accidently pulled out their breathing tube, we might not be able to put it back in before they die. Because of this safety concern, all patients on a ventilator are restrained. Yes, we tie you to the bed. We don't want to do this, but if you accidently dislodge your breathing tube, it could be game over for you. My patients are so sick with this virus that our usual treatment protocols to get your oxygen level up aren't working. When this happens, we chemically paralyze you. Why? Because muscles use oxygen. If we paralyze you, you need less oxygen. When that fails, we put you on a heart lung bypass machine.
 So let's paint the picture so far... You are alone... No family, no friends. You have a rigid tube down your throat into your lungs. You cannot speak. You cannot eat. You are sedated and delirious. You are tied down and possibly paralyzed. You will have a feeding tube inserted in either your nose or mouth. You will have a urinary catheter. Many patients have persistent diarrhea and will need a rectal tube. If you have a fever, which most do, we may need to use an ice cold blanket to cool your body down to a safe level.
 Now imagine, this is your new reality for weeks. Yes, weeks. We are seeing patients on the ventilator for 2-3 weeks. Imagine this is your reality for the same amount of time we have had stay at home orders. After you fight for several weeks on a ventilator, your chance of survival is less than 20%. If you have diabetes, hypertension, cardiovascular disease, chronic renal impairment, or liver disease, your chances go down significantly.

Exposure to sources of anxiety also happens to be a form of therapy. It is a technique used to treat anxiety disorders. It is tempting to imagine whether or not that work in this case. It is more tempting to conclude that no one wins, that there is no way out.

My mentor once told me that he once faced his fear of the dark by sitting in his basement, with no lights on, until he was no longer afraid. I confess that I have taken this method to extreme lengths in my life, but I have never taken a job where it is part of the daily routine. At most, I can only respect those who are doing it right now, because I know I could not do it myself.

Anxiety is my pre-existing condition, along with bipolar disorder. These conditions have often been confused with momentary setbacks. In the era of the coronavirus, each day is now filled with symptoms that are so familiar, aren't they? Self-care is vital for all, but what about those of us who have been working hard at it, in therapy. Are we at high risk? Or are we in a rare position of leadership? We know the answer.

Coronavirus Coping Skills

My heart goes out to the mental health professionals and patients and the affect this is having on their lives. Only they may truly understand just how much this all sounds eerily familiar, while continuing to suffer symptoms once invisible to others, yet now experienced by many. It is with them in mind that I will attempt some of what I learned, to life in quarantine:

• Map it out.

There is nothing you cannot map out, nothing you cannot plan. Get the notebook, journal or piece of paper of your preference. I prefer a hardbound sketchbook with plain white paper. Only recently, there were days where my ability to record a day's events ended up being crucial in my recovery. Once I committed to writing out exactly what I was going to do the next day, or the next week, I began to make progress. Now, like everyone else, that routine has been upended. BUT, I promise you that simply mapping out your days will make them more bearable.

• Group therapy.

Are you holed up in a small space with the same people day in and day out? Welcome to group therapy! It's time you learned what you are made of. I know I did.

• Be mindful.

Mindfulness for someone like me, with bipolar disorder, puts things in order. It allows the unstable to feel more stable. Paying attention, pacing myself and taking my time. Blobs of time with countless distractions start to form a clear picture. Take a look at what you're doing. Break it down into steps. Repeat.

• Catastrophizing.

I believe this word was invented in therapy. Everyone knows what a catastrophe is. Only some of us start to see catastrophes everywhere we look. Sound familiar? There are so many places to look that are not catastrophes. You need to look in those places.

• It's not happening now. (Zen)

The word 'zen' is included in parentheses because I have used my understanding of the practice to create one of my own in the early days of this crisis. No matter what I saw or heard on the news, or from others, I would go to my window and observe. Once or twice, I went live on Facebook and began to report on the nothing I saw. I take things too far. The point is that all of it was happening but none if it was happening outside that window. Feel like the world is collapsing? Head over to the window.

• You always have tomorrow's end of the world to look forward to.

This is a daily reminder when you are in group therapy. Remember the end of the world that started you on this journey? Worry about today's. Did you have one to talk about from yesterday? Focus on the one that just happened. There will always be another one.