Page 11 of Alarm Fatigue

I sit next to her and she leans her golden head on my shoulder. “Rachel, I would never intentionally lead you to anything that would cause you pain, I just want you to start living your own life again, instead of hiding out and watching other people live theirs. There is not going to be a way to guarantee that living a life outside your comfort zone will be entirely pain-free.”

“And I love you for wanting more for me. I have made great strides already, you have to admit, no?”

“I am so proud.”

With that we sip our teas in silence, the years of our friendship and history of all that we have lived through together wrapping around us like a cozy blanket.

Chapter 9

Later that night I wake with a start, a scream caught in my throat. Sitting bolt upright, I gasp into the night air as a sheen of sweat breaks out across my brow. It was just a dream, Rachel, I am relieved to remind myself, he cannot hurt us anymore. I shiver as the night air feels chilly against my damp face and I realize that I have tears running down my cheeks and into my duvet, which is balled up under my chin. I let out a slow, shaky sigh.

My God, it has been a very long time since I had a nightmare like this one. Maybe it is the dating that is bringing this particular recollection back to the surface? Of course, it could just be the challenge of interacting with people outside my typical comfort zone. Whatever it is, something has unearthed an old memory, rising up like a fire demon from the depths of hell. I used to think that the past was best buried somewhere outside of my conscious awareness, but that approach no longer serves me. I learned the hard way that the very things I try to avoid facing will come to haunt me in the present day, whether I want to address them or not. It is better to address them in the here and now. All of my old secrets are in fact a part of me and will be, as long as I am on this earth.

This was the lesson I was compelled to learn during the COVID-19 pandemic, about nine months into the first surge of the virus. When COVID first came to our area, it had already begun to create chaos for the medical community in New York. I heard so many horror stories from people living there, not to mention what was reported on the evening news. The lack of supplies, the devastation of dealing with personal losses while simultaneously struggling to continue to provide medical care without any true arsenal against the illness and its symptoms. The enormity of facing large volumes of patients requiring intubation without a logistical plan of where in the hospital they could be managed. The increasing number of deaths. Looking back, I think that the small respite we had here in the D.C. area gave us time to be better prepared than our colleagues up north could possibly be. Their anguish was sadly to our benefit. At the same time, for me, that calm before the storm served to ramp up my own anxiety, like being the last one in a group lining up to skydive out of plane.

By the time the patients started getting sick and presenting to our hospital, I was already as tightly wound as the steel cables of a suspension bridge. The most difficult part in our community hospital was how many nursing homes and assisted living communities we have around us. The virus had spread through these facilities like wildfire. While it may be said that many of these patients had lived full lives and therefore were not being cut down in their prime, each of them was somebody special to someone. They were a parent, a grandparent, a great-grandparent, an aunt or uncle. A friend. A partner. What really began to chip away at the careful shell that was my protective exterior was that these patients were in mandatory isolation and subsequently they were dying alone.

Bearing witness to these moments brought up my guilt and sorrow that Eli had died without me and our girls by his side. While I was aware that what had happened with him was a completely different circumstance, since he was on an operating table, that knowledge did nothing to prevent the fracturing of my psyche. Clearly, there was no way we could have been there at the time of his death. Understanding that did not save me from my emotional memories at all. I know it does not make exact sense, but every time I was with a patient in their last moments, I was triggered. Sometimes I would be holding up a smart phone, sounds of grief emanating from it as these patients’ families bore virtual witness to the loss of their loved one. Each time, and there were so many, I could feel the family’s pain as my own. After a while, I started to think that the universe was asking me to pay a price for not being with Eli when he passed away. The gap between what I intellectually understood and what my soul was trying to process was beginning to widen.

Somewhere beneath that sorrow was the deeper anguish that my mother had been alone when she died. Of course, she was with my father, but that would be no comfort in any way I could ever imagine. For me, as a child that was so affected by the violence in our home, I actually hoped with all my heart that she had died instantly. I recall having that conscious thought every day during shloshim. At shul I was quietly forming the words for the mourners’ prayer multiple times a day, but my broken heart was torn between a wish to be mindful of my devotions and a desire to beg God that her death had been swift. They told me it was instantaneous, but of course they would say that, wouldn’t they?

From that time to this, I cannot imagine a more horrible thought to have than that of my mother spending her last seconds on this earth with a man who had caused her so much agony. If her death was not immediate, she might have had a moment to reflect that her only child would be left alone with her abuser. The idea of this possibility was like a knife to my soul. Each patient that died alone during COVID started to bring all of those feelings of helplessness and unresolved grief back to me.

The reality was that I had been dealing with my childhood trauma on my own for years. Honestly I look back and it is a marvel that I survived and recovered as much as I did without any professional intervention. During the pandemic, however, it all caught up to me. It was as if I had taken everything that had happened in the past and tried to sweep it out of my consciousness. In actuality it was an enormous trash heap that had piled up just outside of my peripheral vision until it all came crashing in at once.

Some of what happened I do not entirely remember, because I kind of checked out. The things I do recall do not make much sense. My first clear recollection is that one day, I woke up in a psychiatric facility and I was aware of myself again. It was through a fog of medication but at least I knew who and where I was. I had lost a week or so of time.

Apparently I had sat down one day outside of a patient’s room, in my isolation gown and with my protective mask and shield still on. Instead of disrobing the gown in the vestibule, the way we normally do, I came out into the hall and sat right on the floor. I did not get back up again. The incident report, which I have since read, states that I was awake but not responding to verbal or physical stimulation. Some of my colleagues helped me and I ended up in the emergency department for an urgent evaluation. Once my colleagues in the ED figured out there was nothing medically wrong, I was transferred to a psychiatric unit.

I had so much to unpack from my childhood. From the sudden loss of my mother, the tumultuous life we led with my father, not to leave out the verbal and physical abuse I witnessed and experienced. Then there was everything to off-load from the sudden loss of my dear husband.

When I was taken from my father’s home, which was a while after my mother had died, Ami’s parents took me in. They did try more than a few different therapists for me when I first came to live with them. Those people were nice enough but the truth was, I was not ready to talk about anything of significance back then. I was so young and I had spent my life up until that moment entrenched in a lifetime of keeping secrets. I know now that I did the best I could. Actually I probably could have lived peacefully the way I was for the rest of my life. That is, if I had not picked the most stressful job I could find and then found myself on the front lines of the most devastating infectious disease event to happen in modern history.

So I learned the hard way. It is best to try, with help, to cope with the leftovers of the past when they arise. A little procrastination may serve my mental health well on occasion, but evading and avoiding could risk a dismantling of my psychological and emotional wellbeing somewhere down the line.

Now I sit in bed, taking in the safety of my room in the dark, and the sweat that broke out is starting to dry. Getting up and out of bed to wash my face with trembling hands, I continue to work on calming myself.

This bad dream is an old nightmare, a memory from long ago. It used to be recurring, but I realize with gratitude to God, that it has been years since it last came to me. More accurate would be to say it is a memory-ish type of dream. The reality of my past fusing with the emotional echoes of what it was like to be in that life as a helpless child. My therapist taught me first and foremost, even if my recollection is not entirely accurate, the effects of the trauma are trying to reach my consciousness and be seen. This is what is of real value in healing for me. It was not my job as a child or now to sort out facts from feelings. My position here in the present is to process what I can recall as I recall it. The rest is between my parents and God.

I pull out a dream journal from my nightstand and begin to write. The first thing that comes to me from the nightmare is a memory of my father as he was pulling my mother by her hair, and dragging her across the living room floor. She was attempting to hold onto his hand to try to keep him from pulling her hair completely out, but he was swatting at her attempts with a wooden spoon that he was gripping in his other hand. Her red hair was cropped very short to enable her to keep it covered, and he had a handful of it, close to the scalp.

In real life, and in this nightmare, she had just tried to get me away to the safety of the back door of our home, so I could make a run for it if I needed to, but he caught her doing that and dragged her back through the house. He knew I would follow her anywhere and by doing this he could keep me from running away, without even acknowledging that I was there. His voice is low, more frightening than if he was screaming. He tells my mother that she is garbage, that everything she does is only fit for the trash. He is calling me a piece of shit born out of garbage. He accuses her of being unfaithful. He says my real father was one of her brothers or her own father. He reminds her no one in her family wanted her because they all knew she was worthless and a whore.

By then he has already started to hit her, with closed fists except when he would pause from that and kick her with the toe of his shoes. He lands all his blows in the places that will be hidden by her adherence to tzunit. I am watching this from under a coffee table as I realize again that her choice to be modest will be keeping her in a prison of abuse and pain. My mouth starts to form a scream, and that is when I wake.

I do not remember in real life what happened next. I lost time, as I did sometimes back then. I do not know where I would go in my mind, but wherever it was, this is what kept me from going completely insane, so it was probably for the best. I do recollect that when I woke up the next day, I had bruises on the front and back of both of my legs. The bruises were long and thin, like from the handle of a spoon or maybe a hanger. I will never know what it was, and I am at peace with not having this information.

I remember in graduate school an instructor for our pediatric course spoke to us one day about the look some children will have in their eyes. A guarded look, he called it. He even brought his own third grade picture as a reference. He said that was the year he was abused by a priest at his church. I could see it, even in the grainy photograph with faded color that was a typical school photo from the early 1980s. That look was there in his eyes. It was the look that says, ‘I wish this was not my life, but if I tell anyone what is happening to me, then things could go from horrible to much worse.’ The look also says, ‘Please save me but could you not rock the boat when you do it? Maybe you could just help me magically disappear.’ This look is both desperate and terrified with a dash of hopelessness that no child should ever feel. I had that look in all my school photos before the age of fourteen.

The professor then explained what to look for on physical examination. Signs of sexual trauma, signs of bruising that cannot be explained away. He talked specifically about bruises on the back of the legs and other places that should raise red flags as they would be incredibly difficult to obtain innocently. I guess that was not required learning for the rare pediatricians I saw when I was a child.

I take a shaky breath and put the journal away. I go into an app on my phone and make an appointment with my most recent therapist to see when she may have availability. I do not even bother trying to go back to sleep. I head to the living room and the promise of escape into a comedic movie. Of course, I have a selection of safe choices for just such an occasion. The cats seem to sense my distress and join me to snuggle up by my hips. They are such a Blessing beyond measure. At least the dream was easier to transition from than the reality. I say a prayer of thanks and then zone out.

Chapter 10

One can always hope. At least, that seems to be the typical mantra in which I approach the nightshift. I suppose if each time I went to work I was full of trepidation or pessimism, it would be less likely that I would remain in the unpredictable field of medicine. Not to mention that despite every example of contrary facts in my own personal experience, it is still in my nature to approach life with optimism combined with wishful thinking. That is why I began my shift, as I usually do, with the expectant notion that maybe tonight would be an unusually quiet evening.

Driving into work with this aspiration in mind, I imagined I could take a few cat naps as needed, and maybe I would have a handful of interesting patients with plenty of time to spend on each of their cases, providing the best medical care I possibly can. Of course, nine times out of ten, it turns out that I should have just expected complete chaos and that would have been closer to reality. I do not think I am asking for much, really. A reasonable number of admissions, moments of humor with my work friends, perhaps enough extra time to eat my food while in a seated position. I always do this; I arrive hoping for the best. Invariably, I am disappointed.

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