“Every day begins with an act of courage and hope: Getting out of bed.” — Mason Cooley

While reading an article by a US physician about COVID-19, I happened upon the term “Pre-TSD”. Pre-Traumatic Shock Disorder encapsulates what so many healthcare professionals are feeling in the lead up to the unknown trauma many of us are preparing to face in the weeks ahead. As I heard this term, I realized what had been plaguing me recently. Having worked regular 36-hour shifts for much of my career, I have acquired the skill to fall asleep almost anywhere, at any time, when required. My husband of 32 years can attest to the fact that I generally fall asleep with in seconds of my head hitting the pillow. 

Lately, I am not sleeping well at night. I lay awake and worry about my family and friends, my elderly and frail parents, my mid-20’s children who think they are invincible, and my husband, whose support I rely so heavily on to get through my days. We plan everyone’s grocery needs, medication refills, and outside activities to ensure healthy nutrition and good mental health. They know the PHO messages on how to stay safe and well, but, there is always a chance.

We are usually such a close family, and celebrate at any opportunity, but I now maintain the 2-metre physical distancing requested to ensure that I don’t infect them with anything I bring into the house. My shoes, medical bag, stethoscope, computer, even my Apple watch and cellphone. The instruments I use to heal have become potential vectors. My clothing is dropped directly into a hot wash when I arrive home, and I head immediately to a soapy shower to eliminate any viral particles that may have settled on me, despite my use of personal protective equipment and hand washing practices that have aged the skin on my hands so much they look like Yoda’s. My husband is limiting his contacts as he may be at higher risk, simply because he lives with me.
 
Despite all these practices, solid, peaceful slumber is elusive. How will I support my children or my parents if they fall ill when I myself am at risk of carrying the disease? At 57 years of age, am I at higher risk for a more severe version of disease? I watch families saying goodbye to their loved ones at a distance on the evening news and my heart breaks. At the moment, my mother-in- law is having an emergency surgery without the close support of her family, and we all feel the grief of not being there for her. We simply can’t risk the lives of more family members than is absolutely necessary. 

I know I am not alone in my insomnia. My patients describe this also. They tell me of their fear of the unknown, and difficulty accessing the activities that usually allow them to manage their daily worries. Too many are self-medicating with alcohol or other substances, and I worry about their future health consequences.
 
My office staff who deal with the patients who need face-to-face care fear that they that may become infected, even when the patients are not currently unwell. The nurses, midwives, other allied health colleagues, and essential hospital support staff all describe the same apprehension. We are doing our best to maintain the strictest protective procedures and protocols, but intrusive thoughts persist. Did my mask touch my chin as it fell into the garbage bin? Did I remove that gown carefully enough? Was that really 20 seconds hand washing with enough soap? Did I just touch my glasses? What am I carrying on my shoes?

I am certain many of us would rather simply cover our heads, stay safe in bed, and not put ourselves or our families at risk. However, every day in a simple act of courage and hope, we do get out of bed and head to work to care for those who can not care for themselves. Each of you are truly heroes. Perhaps the fact that we are all in this together in the service of others will help us sleep a bit more soundly tonight.

- Dr Kathleen Ross