This is going to be a bit of a long and rambling one, but please bear with me. I have some strong feelings and I’d like to get them off my chest, though this will be a bit of a stream-of-consciousness thing (again) and will not be edited.
There is a strong, age old relationship between chronic illness and guilt. No matter how we try to apply logic to the situation, the guilt creeps in, because logic rarely has any influence on emotion. There are many negative emotions associated with chronic illness, but once we get past the stage of denial (a stage many of us spend year in, without ever realising it is there), I think that guilt is the most common and pervasive one. At least, that seems to be the way it is for me, and guilt always follows a period of denial.
There’s a lot for me to feel guilty about at the moment. With everything that’s been going on regarding the coronavirus pandemic, it seems like the whole world is awash with seething, uncomfortable, and unprecedented emotion. Like many people, I guess I’ve just been trying to carry on as normal as I can, for as long as I can, but this week I have finally passed out of denial and into the stage of full-blown guilt.
This isn’t to say that it’s come out of the blue: this has been building up for a long time, and for an equally long time (it seems, at least), I’ve been trying to minimise it, to pretend it isn’t there. I guess that’s what I’m trying to do here, to distil all the complex emotion stirring around in me to some kind of sense. I don’t know if it’s an anxiety thing, an autistic thing, or just a plain human thing, but I’ve discovered that I don’t generally know I’m experiencing a particular emotion until it becomes too overwhelming to deny. It feels like, I’m okay . . . I’m okay . . . I’m okay . . . I’m okay . . . then all of a sudden, as if out of nowhere, I’m not okay. Very much not okay. It feels like it comes out of the blue, though in reality it’s been there for weeks, if not months, if not years, I just haven’t been able to register the fact. I don’t seem able to process my own emotional barometer in real-time.
I’ve known for some time now that I’m very much not a good fit any more for the job I do – the job I’ve done, basically, for over twelve years now. There’s been a lot of water under the bridge in those twelve years, and I know more about myself now than I ever dreamed of back then. Back then, in September 2007, all I knew was that I had some kind of condition with my knees that caused virtually constant pain, swelling, and intermittent periods of complete agony. I was twenty seven, just starting out on my nursing course at the University of Leeds. Things were difficult then, for sure: I had no pain relief that worked, no diagnosis, and no treatment for my condition, though I had started to take the first steps towards getting these.
My years at university passed in varying degrees of pain, but I managed to cope. The pain, also, was confined to my knees and hips: from the waist up I was pretty much fine and dandy. There were ups and downs over the years, but we were moving steadily forward in regards to getting to the bottom of my troubles. I was diagnosed, as I’ve mentioned before on here, with early-onset osteoarthritis in the knees, alongside a ‘benign’ condition known as lipoma arborescens. I coped, completed my diploma, and graduated into the workforce.
That was when the focus shifted somewhat. After graduation, I went through three years of what can only be described, in retrospect, of sheer hell. I struggled severely with the nursing, eventually shifting into working as a healthcare, my father died, and I began suffering with migraines (2011). I went through a traumatic time being investigated at work (2012). I had terrible pains in my ankle and feet, and eventually progressed to pains all over my body and constant stabbing pains (like broken glass) in my knees that restricted my walking to a short-distance, agonising hobble, with a side-order of panic attacks and incontinence that led to my being diagnosed with anxiety (2013).
Through all of this, I continued to work, though it was difficult-bordering-on-impossible in my pretty physical, stress-and-anxiety inducing job. Things started to look up, eventually, in 2014, both because I transitioned into bank work (meaning that I could control my hours and, to a degree, the places I worked) and because I finally found a cause for the increased pain (inflammatory arthritis, to go on top of the osteo), treatment, and relief in the form of methotrexate, my miracle drug.
Things continued on, through 2015, 2016, 2017. Things were looking good: my work was stable and, thanks to the methotrexate, my pain was finally under control. There was a large degree of stress through late 2017/early 2018 as I bought my first house, but such stress was to be expected from such a large and momentous change. I can’t put my finger on exactly when things started to become more difficult again. Somewhere in 2017 or 2018 is my best guess. My knees were no different, but my feet and ankles were becoming worse (especially my left ankle: the bane of my life since the age of fourteen), as were my hands and wrists. I was permanently exhausted, a sensation I for a long time put down to anxiety and stress. In addition, participation in a remission research program where my methotrexate dose had been halved led to the worst pain I think I have ever experienced – and an upping of my dose by more than twice. I was also in that year diagnosed with hypertension (high blood pressure): a condition from which my mother had also suffered, though to a much greater degree.
The tipping point came, I believe, in June of 2019, when the pain in my hands and wrists escalated to such a point that I could hardly grasp anything, and feared to be able to do any part of my job. This was the point where I knew something was going to have to change. I had already been looking into retraining in bookkeeping, and was scheduled to begin my first course in October: this was a timely reminder that I needed out of this job, and as soon as I may at that.
We found some treatment for the inflammatory pain in my hands and wrists, a combination of steroid injections and sulfasalazine, but they never have gone back to where they were years ago. A period of several weeks where I did not work in 2019 (due to awaiting a delayed DBS check) confirmed that, when not working, I had little-to-no pain: it was definitely the job causing the problems. I threw myself into retraining with enthusiasm, whilst at the same time finding it more and more difficult in my current job. Moving patients was becoming difficult, sometimes impossible due to the pain in my hands and wrists. I was diagnosed with Vitamin-D deficiency, finally getting an explanation (if only partial) for my constant fatigue and exhaustion. I started on the second phase of my retraining in early 2020, all the while continuing to apply for jobs in my new field, increasingly aware that, work-wise at least, I was ‘living on borrowed time’.
Then March 2020 hit, and with it, the coronavirus, Covid-19. All of a sudden, work that had already been precarious was made even more so, because with my methotrexate treatment combined with my high blood pressure, I was classed as at increased risk. Working with Covid-positive patients or on ‘hot’ areas was going to be a no-no. For the first several weeks of the crisis, things went fine: in fact, as the hospital began to be emptied to make way for the influx of patients expected when the wave hit, work was much lighter than usual.
But throughout all this I knew what was coming: that there would come a day when the list of areas where I could safely work would shorten dramatically, and I would have to take a back seat. Where others would be rushing in, I would have to be backing out. Which is where, after all this convoluted preface, the guilt really kicks in.
People with chronic illnesses are no stranger to guilt. Every time we become unable to do something we used to be able to do – that others can do – the guilt hits. Every time we have to pass something up, or back out because we are no longer physically able to (or are able to, but not without dramatically increased pain), the guilt hits. For those with chronic illness working in healthcare, this guilt can really double down on you.
I don’t think we do ourselves any favours, and I do think that many of us with chronic illnesses continue to work long past the point where we should have switched to something else. It’s the same something that keeps healthcare people working when they’re sick and really shouldn’t be there, thereby making things worse for themselves and everyone around them, albeit unintentionally. It’s guilt – and a sense of being responsible for others and not wanting to add to their (our colleagues’) burdens. And that’s present even in healthcare people without chronic illnesses.
There will be many people, right now, who are continuing to work and put themselves at risk because of that guilt. People who should absolutely not be there, but either because of guilt or because of a denial of their own risk, they will be. Those who have heeded advice and either taken themselves out or been redeployed to safer, ‘cold’ areas will wake up every day with that guilt eating away at them. Guilt, a feeling of failure – even a feeling of being a coward.
It’s not permanent. It’s only temporary, because although we don’t know how long this stage will last, it won’t last forever, and we will be back where we want to be. But for many of us, the guilt will remain. I say we, and us, because although I don’t know anyone else personally in this situation (at least, I’ve never discussed it with anyone else), I know that I’m not the only one. If writing and blogging and reading others’ writing and blogging has taught me nothing else, it’s that if one person is feeling a particular way/has had a particular experience, others will also have. And those others will just be waiting for someone else to acknowledge it before feeling free to admit to it themselves.
We’ll get through this, and know we’re not alone but the guilt . . . I don’t know how that’s going to be solved.
And I’d really like to know.