Former medical director in Saudi Arabia, now living in Sweden

Today, as coronavirus is sweeping the world, people react in different ways. Many people are afraid. Others are indifferent. Some seem to be striving to save themselves first, perhaps at the expense of others. Some people are showing extraordinary humanity, spontaneous compassion and genuine care.

This brings back memories for me. Coronaviruses have directly impacted me. In 2015, during the Middle East Respiratory Syndrome (MERS CoV) outbreak in Saudi Arabia, I was working as the Director of Nursing in a large university hospital in Riyadh. At the time of the initial MERS outbreak, I was the Senior Nurse Director on-call and had to lead a team of around 3,000 nurses through those extraordinary times.

It was 3 am when I got a call; the phone call that nobody ever wants to get. Three patients had died in the last couple of hours in one of the surgical ICUs. My presence was needed at the hospital immediately.

At the unit, I was greeted by ten pairs of eyes. Panicked, scared, exhausted, tear-filled eyes. I had never seen nurses and doctors so afraid. They were terrified of what had killed their patients in a matter of hours. The unit was in a state of chaos: surgical drapes on the floor, the defibrillator and crash carts at the bedsides, equipment everywhere. Three bodies in black body bags were waiting to be moved to the morgue.

The patients had not died as a result of their surgeries. Something else had caused it, but at that time it was unknown to us. My imagination went wild. At first, I thought maybe the drugs had been mixed up. Or perhaps something had happened with the anaesthetic. It even crossed my mind for a split second that somebody was deliberately harming the patients. My imagination made up all sorts of scary worst-case scenarios. But, it was worse than I imagined.

Soon, another two patients in the unit had taken a turn for the worse and were deteriorating rapidly. There was seemingly nothing that modern medicine could do to save them. I panicked too. All my experience as a nurse was of no use.

But what happened next was as startling as it was welcome. My mind cleared. I thought: OK Fee, the last thing you want to do in this situation, is to empower fear and let that fear make the decisions for you.

Panic was replaced by what you might call ‘real-time responsive intelligence’. It was a feeling of great relief. Even in the midst of chaos, I realised I could be clear, focused, decisive and peaceful! Within minutes I had sorted out what needed to be done, what I had to do and what the next steps were.

This was the beginning of our MERS CoV journey. The epidemic lasted nine weeks in Saudi Arabia. It changed our lives in so many ways. During these nine weeks, we all experienced a roller coaster of emotions: frustrations, fear, courage, hope and love. I witnessed compassion, caring and true professionalism. I also witnessed death, suffering and tragedy, and tragedies sometimes turned into miracles when the sickest of the sick recovered.

At that time, MERS CoV had a death rate of 42%. That means that almost one in two people with the virus died.

The virus ripped through our hospital with over 220 patients in hospital infected in a matter of days. At the peak of the epidemic there were over 50 MERS-positive patients in our ICUs. With these numbers, it is easy to understand the palpable fear and panic that the frontline healthcare workers experienced. In addition, the workload was unbelievable; we all worked 18 hours a day and still not everything got done.

All this is to achieve one thing: keeping our people safe to care for others. Not just physically safe, but emotionally safe too. At the end of a shift, our healthcare workers were physically drained and emotionally exhausted. Hours in Personal Protective Equipment is insufferable. It’s unbearably hot and our staff were dealing with the sickest of patients. Some days were just horrific. But there was always hope.

Naturally, I felt the pressure from time to time. As it turned out, I became my own teacher during these war-like days. What I learned in the trenches that made a real difference was the importance of maintaining my own equanimity. We all do really well when we are not caught up in our fearful, worried thinking. As humans, we are beautifully made for responsiveness in the moment. It made a crucial difference to physically be with staff as they worked in the units. As department heads, we invited them to share their experiences. Allowing staff to speak freely and with compassion made the biggest difference. I cannot tell how many times I heard nurses say: I don’t know how to do this; I am afraid I may die here; nobody really cares about me here; I can’t take any more’. Although this was not always easy to hear, I also know that if we just listened and cared for them, they’d come back to that centred, grounded place in themselves. And time and time again we saw it happen. When staff had shared their real feelings and concerns, most of them would take a deep breath and say, ‘You know… I am OK.’

We set up ‘social support’ for every nurse or doctor taking care of a MERS-infected patient. One of the ways we did this was through a ‘spotter’ system where every member of the team had a partner. Qualified nurses and doctors would observe each other as they put on their PPE (personal protective equipment). This ensured they were safe and fully protected. Similarly, when staff were doing high-risk procedures with patients, the spotters would observe to ensure that the staff member didn’t inadvertently contaminate themselves.

This support started out as a safety net. However, the effect of people caring for each other in their team was unforeseen. Staff members felt deeper connections. They fell in love with each other – In a platonic way. Team cooperation and respect for one another soared. I am sure this saved lives too.

I am both humbled and grateful for this experience. And I would not trade it for the world. These were daunting times, where mostly everything felt like it was out of our control. Yet I witnessed doctors, nurses and the front-line teams showing great courage in the face of personal danger. I also saw the vulnerability of human beings, the breakdowns, the tears of frustration, the anger, the fear – all that is humans in crisis. Yet there was compassion, inner strength, resilience and love for each other in those moments. There were days when I cried, got frustrated, angry, and my body was achingly exhausted. Moments later, I was back home; settled, grounded, making a joke, in a freer mind, with clarity, resilience and hope.

During those 9 weeks of the outbreak, the sun would still rise every day, the birds in my backyard continued to sing, our hearts continued to beat, and our lungs continued to breathe. Life was still fully alive.

We got through to the other side, back to ‘normality’, if there is such a thing. For many of us, we did not only go through the experience, we grew through the experience. We are wiser too. But what still moves me is how life throws up leaders and heroes in moments of crisis.

We can be so responsive in the moment. We are designed to respond in the moment using our wisdom, insight and clarity. When in ‘scary’ situations we can easily lose that presence, clarity and balance if we believe our uncomfortable feelings, reacting rather than taking things in our stride. We learned to be comfortable with uncomfortable feelings. We were all there in it together.

It is absolutely possible to have peace of mind and clarity in the midst of chaos. In fact, that is what keeps us safe, focused, helps make the right decisions, and allows us to be there for others with compassion and care. It boils down to one question: in challenging times do you know how to find your way back home to yourself?

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