Reflecting on Mental Health and Resilience -Lost & Found in the Time of Covid

Many of my colleagues experienced the unending stress of being locked in, far away from home with no end in sight, or the prospect of the relief staff flying in, to offer some respite and a way out, to get back home. The days, weeks and months working alone, unsupported, and without physical, family and or intimate contact, during COVID. Missing out on so many of life’s small wonders that those back at home working during COVID had the opportunity of experiencing. The smell of being at home, sleeping in one’s own bed, spending time with family and loved ones, even if social distancing. The small luxuries and pleasures that you encounter when staying in your own space back home. I salute all my brothers and sisters in the medical profession caught, who were caught in this predicament, who have unselfishly soldiered on, against all the odds.

I was one of those “unfortunate’s”; at times I was not sure if I was stuck in Dante’s first circle of Hell; Limbo, or one of Poe’s 7 rooms in "The Masque of the Red Death” or in some strange sick way stuck with just the 7 dwarfs, or one of them, on any given day ….

COVID kept me trapped or should I say locked in and locked out – locked in Saudi Arabia and locked out of South Africa, in a perpetual state of limbo. The pandemic is so representative of Poe’s writings – representing the typical attributes of human life and mortality, which would imply that COVID could be an allegory about man's futile attempts to stave off the inevitable, death. Yet, as we might expect, there is no locking out or blotting out death. By the end of the outbreak, it will have broken down the walls of each castle, despite our best efforts to hold it at bay.

But this is no allegory, this was real life, and its effects on so many; the infected, the cured, the healthy, the untouched, the medical teams; is significant, life changing and life ending. Some of us are still processing those after effects.

I had been on the road for almost 15 months by the time I made it back home to South Africa. Starting in Iraq in late 2019 (which also had its challenges – in a bunker locked down at times) and ending in Saudi. I arrived in Saudi in early January and then it got interesting with COVID hitting us in late February, moving to lock down in early March. Home awaited, when flights and countries unlocked, until then it was working in a medical environment where COVID dictated so much of what we had do on a day-to-day basis. All the rules changed, be it treating day to day primary healthcare patients, the traumatically injured or medical emergencies. COVID sat at the back and kept rearing its head asking the awkward questions. I was on 2 different projects, and exposed to the ways of COVID, from overseeing an outbreak from afar with lock-down and curfews and then to being at the coalface of one, albeit a small outbreak. Experienced the loneliness of 14-day isolation on my travels, and the ongoing sense of being alone and disconnected during a “normal” workday.

The pressure was continuous and relentless, what with all the above and then at times, wearing full medical PPE, double gloved, double masked with a face shield in plus 40? C heat, doing PCR testing, monitoring and treating patients. Yes, you can breathe quiet well in a double mask (surgical and N95) with a face shield in plus 40? C heat for a few hours. Rather that, than to be intubated and ventilated.

One of the challenges which stayed at the back of one’s mind, is when do we detach from this dystopian nightmare and get the opportunity to go home, or just have a few days’ rest. Working 6 to 7 days a week, week in and week out, some days were quiet while others dragged into 18 or 20-hour marathons. The answer is the same as the “how long is a piece of string” conundrum.

Compare it to running a race with no defined finish line, you have no way of knowing how to pace yourself mentally and emotionally, as one would on a “normal” remote site roster. How much must be kept in reserve for the last lap and sprint across the line, or the portal into your far away home? Truth be told; it is an ultra-marathon, but just a never ending one.

So now that I have spoken about being lost, what did I find/witness/see during this time? I had found friends in places I never thought I would, tapped the reserves of resilience I never? knew I had, saw (once again) the banality of corporate deceit and greed, impacting on staff and supply chains (this is not a new experience for me, but it’s just depressing to witness it in times of need and in a disaster situation), saw the compassion, commitment, support and care of dedicated medical professionals working with limited resources in the most challenging of environments.

Personally, and professionally I had to stretch the boundaries of my knowledge, patience, and energy levels; to keep pace with the ever-changing environments, locations, working hours and unimaginable stress from unexpected quarters. I had had to rely on my tried and trusted coping mechanisms, and then find new ones. Some of the usual suspects are not available or do not function as well, during these times. The journey dragged me to revisit my inner self, look inward at my resilience and emotional state. I had to explore new ways of releasing stress and seeking counsel and revisiting old coping mechanisms (running) to get through the long grind away from home and my safe place.

No matter how bitter, maudlin, depressing, challenging and even stimulating the journey was, I must focus on the good that has come out of it (both professionally and personally), and that will be my guiding star.?

“Midway along the journey of our life I woke to find myself in a dark wood, for I had wandered off from the straight path. How hard it is to tell what it was like, this wood of wilderness, savage and stubborn (the thought of it brings back all my old fears), a bitter place! Death could scarce be bitterer. But if I would show the good that came of it I must talk about things other than the good.”

Dante Alighieri

or in the words of Eros Ramazzotti from his song, Lettera al future/Letter to the future – loosely based around "The Masque of the Red Death”

I am writing all this to you

who will be born someday in the future

and who knows how things will be

if this wind will have left the cities...

I don't know the world you'll find

I just hope you'll be

the son of a new

and more fair humanity

I eventually made it home in Dec of 2021 – I was locked out for almost 15 months – 10 of them during COVID, working nonstop with limited resources and staff. How I rested up and coped when back home is for another article, although I did dive into working front-line in ICU when the call went out in SA for assistance during the second wave in January of 2022.