International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By: Hope Morrow
After the earthquake that hit Haiti in 2010, I spent time providing mental health support to the medical staff at Project Medishare’s hospital on the airport property in Port au Prince. Supplies were limited and patients died there who would not have died had they been treated in a hospital in the United States. Medical staff were faced with knowing they could help, but not being able to do so. As in Haiti, our medical professionals have had to deal with depletion of supplies that have put their lives in danger and affected their ability to care for their patients. In addition, we have another issue that I think is more acute in this pandemic: caregivers’ inability to heal a large numbers of COVID patients.
Medical professionals enter their roles to heal the patients they treat. In the beginning of their careers, they may also have rather unrealistic exceptions of themselves and their ability to heal every patient they encounter. Life and death issues can confront new medical and nursing staff very quickly with the reality of their own human limitations… their powerlessness to heal every malady. That can be a hard lesson to learn, especially when one finds oneself in the middle of a pandemic where patients are dying at a rate higher than even the most seasoned professionals have experienced in their careers.
Let’s face it, feeling powerless and out of control is tough in any situation, but it is extraordinarily intensified when someone’s life is at stake, especially when you believe you should have had some ability to control the outcome. Powerlessness is likely to be a common theme in defusing, debriefings, and face-to-face communications with medical personnel; and, CISM responders should be aware of these issues and ask about them if they aren’t brought up by participants.
First, there are tell-tale signs that someone is struggling with these issues. First, an individual experiencing this emotion may look for ways to make the event(s) controllable so as to rescue themselves from feeling powerless. There’s two ways that this struggle can be expressed:
Unfortunately, in mental health settings, it is not unusual for mental health professionals to respond to clients’ feelings of powerless by urgently trying to find ways to empower them. These efforts also result in a missed opportunity to help a client confront and eventually accept their own human limitations. It is really difficult to be confronted for the first time with one’s inability to control a life and death situation. Efforts to make the situation controllable again persist in frequent thoughts about the event. These repetitive thoughts can be seen as the brain’s effort to try to come to terms with one’s human limitations. It can be helpful to instruct the individual that there’s no way to know if doing XY or Z would have helped or doing XYZ could also have made things worse. It’s important to understand that one’s responsibility is to show up, do the best you can, and stay out of the results. We ultimately don’t control good outcomes any more than we can prevent the bad ones. We have no say over the patient’s genetics, pre-illness stress level, prior risk factors, or the strain of COVID-19 that infected the patient. The only thing we can control is our efforts to come to terms with our human limitations, our efforts to provide patient care and our efforts to engage in good self care… so that we can continue to provide quality patient care.
For some, this can be summed up this way:
God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the power to know the difference.
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