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April 30, 2020
Sitting on the Sidelines of COVID-19: Survivor Guilt By Mary Peterson, MS, APRN, AOCNP®
We are only as strong as we are united, as weak as we are divided—J.K. Rowling
I am caught between the nurse who lives within my soul and pragmatist who lives within my head. The two are in constant turmoil as I sit and hear the stories of my fellow health-care providers asking for support for the simplest of things, such as PPE. Social media is flooded with stories of heartache and fear. The constant images invade my thoughts, and the reality that was life just a short month ago has changed in the blink of an eye.
Grief is a word those in oncology are all too familiar with. We have talked about it from a lot of different angles: the shoulda, woulda, couldas; regret over “what ifs”; the grief that comes from losing the fight. But this is a different
grief (some of my colleagues have used the term “survivor guilt,” and maybe that’s not quite the word to give it, but for now it fits); a pit in your stomach that won’t go away.
What Is Survivor Guilt?
On a basic level, survivor guilt is exactly what it sounds like: a sense of deep guilt that comes when one survives something. Survivor guilt was first documented and discussed after the Holocaust, and what has become clear in the decades that have followed is that survivor guilt is far more common than was initially understood.
A different form has been found among rescue and emergency services personnel who blame themselves for doing too little to help those in danger, as well as among other providers who may feel a form of guilt in the face of their
patients’ suffering. It is a concept associated with the interpersonal process of “surviving” harm while others do not, and it is appearing more frequently in nursing, medicine, and psychology literature (Hutson, Hall, & Pack, 2015).
Cancer Care During the Pandemic
According to the American Cancer Society, it was estimated that a total of 1,762,450 new cancer cases and 606,880 deaths from cancer occurred in 2019. In the world of oncology, patients don’t stop needing treatment, and in most instances, we discourage them from taking breaks or interruptions in treatment for curative intent.
However, in the current COVID-19 climate, how we provide and direct cancer care is changing. Providers will need to find a fragile balance between undertreating patients, resulting in more deaths from the disease in the
medium- and long-term, and increasing deaths from COVID-19 in this highly vulnerable population. These difficult decisions will have to be made with little evidence to support them on either side and will certainly
increase the survivor guilt even in those at the bedside.
Coping With Survivor Guilt
For me, it’s been about finding a way to cope with the new reality. How do I overcome deep guilt while continuing to support my colleagues at the bedside and understanding that there is a role that we all play. Maybe the simple answer is to stay home! (Yes, I agree.) But it goes deeper for those of us who are at our core, healers. A colleague, Jamie Mortellite, MSN, ACNP-BCNP, shared that “I would describe it as communicating with my colleagues on the frontlines but being separated by a glass divider. I can hear all their concerns and lend an ear and envision what it must be like, but do not have access to get to the other side to help them and be there for patients.”
Healing begins with a shift in my thinking, my faith, and without fail the support of my family and community of colleagues and friends. Acknowledging that right now, my job is not at the bedside, but is no less important.
Amid my guilt, I must remember that cancer care marches on and I must still be prepared for new diagnoses by staying up to date on critical changes, therapies, and guidelines in oncology. I must take time to mourn the
loss of bedside care, the heartache of those who we have already lost, and those we will lose in the days to come. It’s in accepting and embracing the circumstances that I can move forward. In sharing my grief, I not
only heal, but rebuild.
As my boss, Gayle Kempinski, MSN, APNP, ANP-BC, OCN®, kindly shared with me, “The hugs you gave, the hands you’ve held, the tears you have wiped away, and the words of encouragement you have given—you have given yourself in so many ways for so many years. Remember, although you are no longer at the bedside, you are now able to touch patients on a much grander scale in the work that you do now. You are mentoring, you are teaching, you are bringing knowledge.”
I can’t think of a more important time to salute all of you who are working at the bedside. Your passion, commitment, and unwavering dedication do not go unnoticed or unrecognized. For those of us no longer at the bedside,
we still impact patients. We are part of flattening the curve by working from home, social distancing, and most importantly, sharing our knowledge and education with families, friends, and patients.
As I sit here again tonight watching the evening news, I will continue to use the tools available to me and turn my guilt into positive action by sharing facts, not fiction; finding kindness in every interaction
while choosing hope, resilience, empathy, and love; and all the while remembering good things happen amid chaos.
Eleanor Roosevelt said it best: “You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I have lived through this horror. I can take the next thing that comes along.’ You must do the thing you think you cannot do.”
References
American Cancer Society. (2019). Information and resources for cancer. Retrieved from https://www.cancer.org/
Hutson, S. P., Hall, J. M., & Pack, F. L. (2015). Survivor guilt: Analyzing the concept and its contexts.
Advances in Nursing Science, 38(1), 20–33. https://doi.org/10.1097/ANS.0000000000000058
Read more from the APSHO Advance: Special COVID-19 Series
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