Frontline Trauma

The Long Road to Social, Emotional, and Physical Recovery

Frontline Trauma: The Long Road to Social, Emotional, and Physical Recovery

There is something we’re not talking about: how crippling frontline worker trauma was at the beginning of the pandemic and how it continues to fuel emotional pain for some people. Trauma is an invisible mediator of well-being: you carry it with you but there is no physical weight, it activates from your subconscious when you’re not expecting it, and it compounds with cumulative stress, psychological distress, and physical health in ways that you cannot understand. For some, the trauma of hospitalization, near death experiences, and unexpected recovery continues to haunt them to this day.

I’ve interviewed many people who present with symptoms that are much like ME/CFS and there are estimates that more than half of people living with Long Covid present in this way. However, I was struck by the emotional residue of hospitalization when I spoke with Sam (pseudonym).

Unsplash.

During those first days of the pandemic, when so many people were hunkered in their homes avoiding contact with others, people like Sam went to work every day and worked with the most vulnerable among us. Sam worked in a nursing home in Atlanta and describes the horror of that experience by, “everyone was dying all around us.” Many of her patients got sick and went to the hospital; most didn’t come back and those who did were on oxygen and barely living. The emotional trauma of that work was stark: people were getting sick and being removed regularly, leaving the nursing staff heartsick and exhausted. While many have documented how these experiences caused extraordinary burnout, rarely have we heard stories about how COVID-19 infections of frontline workers have caused persistent emotional distress and social upheaval. 

Sam’s Story

Sam was infected with COVID-19 first in April but her symptoms were flu-like. Everyone told her she couldn’t get it twice so she persevered, even taking care of the sickest patients because she’d already weathered one infection and felt confident that she wouldn’t face another one. (Her confidence was based on the fact that most people believed you couldn’t get sick twice.) She got sick again in May of 2020 and this time it was really intense.

Sam called her mom when the symptoms got bad and she wanted some company. She lived alone in an apartment she first rented in Atlanta as a traveling nurse, but she liked it so much she signed a long-term lease. When her symptoms got worse, she was managing her symptoms alone and her family in Illinois. Even though Sam thought she was doing okay, her mom became extremely worried when she could tell over the phone that her daughter was having trouble breathing. “Take your oxygen levels,” her mother told her. She did, and had a hard time believing that the levels were true. Her mom said, “wouldn’t you be concerned if you measured those numbers in one of your patients?” Sam eventually agreed with her mom, who then, from Illinois, called an ambulance to pick up her daughter in Atlanta: she described to me the relief she felt when the oxygen set in. It scared Sam a bit to realize how much she was struggling to breathe and wouldn’t let herself admit it. By the time she got to the hospital she was barely conscious; she went into a coma and was hospitalized for 36 days.

During that time, Sam had a near death experience that has changed the way she sees herself, and the world. She had fever dreams and an intense spiritual experience that worked through living and dying, staying and going, being and moving on. She explained that time to me:

“I remember some things when I was in a coma. One of the first things I remember was this voice—I don’t know what she said but I understood it was my body—do you want to stay or do you want to go?  I was confused—stay or go, and the next thing I remember I was on stage and I was singing because I was a theater person. I wanted to be an actress and stuff. For any reason I was singing All that Jazz, and as I was thinking I was repeating All that Jazz, and I thought, all I know is All that jazz—is that all I remember?  I couldn’t see my family but I remember hearing them. I was telling them I’m right here.”

She felt she was outside of her body, looking down and deciding whether to leave her corporal life. She said: “I was talking to the virus, and it was telling me, I just want to survive. And I was just like, yeah, you should live. And my ancestors told me, what are you doing here? You shouldn’t be here. For any reason, I was saying my lineage, I am Sam, daughter of…”

Unsplash

Sam’s hospitalization was at the same time George Floyd was murdered. She doesn’t know if it was because of the constant televisions in the background that her physical body observed, or a deeper spiritual experience, but she feels deeply connected to that time. It’s not only because she’s Black and losing Floyd was so emotionally and politically important – but also she had a spiritual connection to his death because she too felt she had died when his body left this earth. This continues to move her deeply. She remembers saying, “stay here, we matter. We deserve to be here.”

Here is the memory in Sam’s words:

“I think they have the TV on because I was seeing the other people, and I was telling them, just appear and show people that we that we exist, and that we matter. This was before Black Lives Matter like literally, I went in a coma, and when I woke up it seemed like the world was at war, cause it was like the Black Lives Matter, George Floyd thing. At some point later on, like a year or 2 later, I looked up exactly that when he died and I was still in a coma when he died. I think I was in the coma like one or 2 days, and he died, and then I started hearing that. So I think that's why in that state, I was like, we matter! Cause that didn't happen until then. I remembered telling these beings just to show up and appear and show people that we matter that we exist. And I don't know. It's weird. I think I heard whispery noises, and I remember thinking, What is that noise? And the whispering kept busy louder, and then I realized that they were praying. and I kept getting closer to it, and I was like, what are they praying for? And I remember at one point I realized they were praying for me. I don't know if there was somebody in the room praying for me.”

She remembers people praying for her but doesn’t know if people were actually praying for her in her hospital room, or if it was something her ancestors did to her spiritual body, or people in per subconscious, or if it was something that was protective in her mind-brain. Regardless, these memories from her coma have become central to her rumination and she has carried these memories with her since that time of extraordinary fracture.

Understanding the structural and societal realities of this time is crucial for interpreting Sam’s experience. The depth of her trauma or chronic pain is not linked to her genetic predisposition. Rather, more Black Americans work in essential worker positions, which escalated COVID-19 risk. For instance, 25% of employed Black Americans work in service jobs, which is significantly higher than the 16% of White Americans who do. Black Americans represent 30% of license practical and vocational nurses, and therefore, as Sam’s story illustrates, had very up close and personal exposures to pandemic grief very early on. This is especially troubling because so many people who experienced these earlier strains of COVID-19 infection have lingering and persistent symptoms that are preventing them from recovery.

However, not all pain and grief are medically-related. When Sam was released from the hospital, her parents drove down from Illinois to bring her home so they could care for her. Sam described the shame and regret she carried with her about leaving Atlanta. She earned her LPN and was working in a job she loved in a new city she’d discovered and enjoyed.  She had built a community, had her own apartment, and created a life for herself. She couldn’t live on her own anymore—at least for now, they thought. They left her stuff in her Atlanta apartment for several months until they realized there was no way she could return and subsume the life she once lived alone in Atlanta. They got a U-haul and moved her things to her parents’ house; however, over those months of paying rent and not working, she lost thousands of dollars.

Sam felt a lot of anger for a long time following her hospitalization. Part of this anger was linked to her trouble breathing—every day she would relive her trauma when her lungs caused her trouble and she was reminded of what happened to her. But it was in a pizza place with her family when she finally realized she needed therapy.  She “went off at a guy at a pizza place” because when she asked for more plates, he said: “you guys have plenty of plates.” She says he could have been speaking about her family but she felt he was talking about Black people more generally and this micro-aggression hit something deep and she went off. This type of micro-aggression was internalized deeply for Sam, as she wove together the injustice of her hospitalization with the race riots that were pervasive of the 2020 summer. She says that her anger was triggered by something “small” and she realized that she couldn’t live in this world this way. She needed to deal with her anger so she could find calm in the wake of the storm.

Sam was traumatized from this experience of observing so much death, nearly dying herself, and losing a life she had built for herself. Black Americans suffered especially from COVID, and have experienced elevated levels of trauma, psychological distress, and mental illness—not only from personal experiences but also through grief.

When Sam was really sick and couldn’t work anymore, let alone take care of herself, she started physical therapy and lung therapy when she was living in Illinois. She had a good primary care doctor but at first it was hard to establish specialty care for her breathing. Her pulmonologist first said her problems were that she was “fat” so that’s why she had respiratory problems. This type of fat-phobia is common in medicine: where fat patients suffer from discrimination and therefore their health conditions are attributed to weight as opposed to the symptoms they brought to the table. After the pulmonologist took x-rays and a lung function test, he apologized and said that her symptoms were real and her lungs were in bad shape. In some ways, he realized how out of line his discrimination was and how deeply it affected her. She is confident and was able to advocate for herself—he has become an important clinician through the past several years and now saws that he’s “amazing” and is very interested in her unique case.

She continues to need routine rehabilitation and care. For several months she would routinely seek care at the clinic but now she only sees her primary care doctor every four to six months. At the beginning, Sam would fall consistently—her legs buckling beneath her, causing apprehension and fear for herself and her family about her physical health. Moving helped the pain but was also awful and consistent; this muscular pain is one of the most pervasive and consistent Long Covid symptoms that she’s carried with her—apart from the emotional trauma. After she finished the physical therapy her insurance covered, she was worried because her recovery had only just begun and it was clear that she would need months of rehabilitation. Thankfully, Sam qualified for the Athletic Care program at her hospital, which as $100 visits for ten visits of physical therapy. Her family is able to pay for this so Sam has continued with her physical therapy (along with counseling) and it has been crucial for her recovery.

She said, “I think that’s something insurance companies need to realize. Therapy is needed much longer than what they offer. If I didn’t have this therapy, I wouldn’t be up to this point. I might be bedridden. It’s not just one person, you need support: mental support, financial support. If not for my parents, I’d be homeless or dead by now. People who are sick need support. At first, I felt like a burden at times and I’d ask my mom. She’d say, Sam, I’m just glad you’re here, you’re not a burden.”

Now Sam is doing really well. She’s getting back on her feet and enjoys her new job—it’s safe, pays okay, and enables her to engage with people (but from a safe distance). Sam’s family is incredibly supportive and has played a critical role in her overcoming her trauma. She still manages some deep emotions related to COVID, especially as she continues to try to rectify the fact that she lived while so many died and others rely on a trach or life support still today. She considers her covid experience a “near death experience” and still talking about COVID is triggering, especially when people like her cousin say it’s not real. But those days are less than they used to be, and online therapy groups have been essential to her healing.

Read The State of Black America and COVID-19: A Two Year Assessment to learn more.