It’s now three months since the last time I wrote for here – largely because I felt that I had nothing to write about. But it turns out I do – a little – so I want to try and give voice here to something that I’m learning many people in my field experience, but which few talk openly about - Post Traumatic Stress Disorder.
MSF's own words are “We are not sure that words can always save lives, but we know that silence can certainly kill.” I’m pretty sure that my story in my own words will save no one's life, but the silence around this subject has certainly felt killing to me, so call it PTSD, call it burnout, breakdown, compassion fatigue, call it what you will – if my voice can add even a little to openness and dialogue and lessen the silence for even one person reading and identifying with this then it’s worth having written this.
We will talk openly about broken bones, why not broken hearts and minds too?
After all the events of Nepal and during my recovery from the malaria I suffered in June, for weeks my nights were punctuated by spells of wide-eyed heart-racing wakefulness in the small hours, alternated with crowded, confused dreams where the faces of the Nepal mission blurred past and Jessica's 1,000 kilowatt smile featured regularly.
In daylight hours I pushed myself to act normally and attempted to suppress the waves of anxiety that rolled through me every time a lorry passed by and the ground vibrated faintly beneath me.
From speaking to other MSFers I knew that I was not alone in having these feelings which helped to at least normalise them to some degree.
I availed myself of MSFs psychological support framework and spoke to their psychotherapist. Well, not so much spoke to, as wept copiously at. Repressed grief I'm told. Overdeveloped sense of responsibility for the helicopter crash.
The combination of the acute debilitating physical illness, emergency mission, sudden and traumatic loss of teammates, with the added bonus of a recent romance gone wrong leaving me with maybe more of a broken heart than I cared to admit, created a sort of superstorm of stirred emotions that was wearying to live with and even more wearying to sort through.
I'm advised to take it easy and be gentle with myself – that there is no way through this, but through this.
“Being gentle with myself” turned out to be the most impossible advice ever given to follow. After Nepal, I applied for and miraculously got a job at the MSF Amsterdam Operational HQ in the Learning and Development department. Goodbye nursing job, hello internationally flying trainer lifestyle!
So rather than a lazy, restful, restorative summer with my friends in Bath, I geared up to move countries in August and spent my days juggling relocation quotes, storage options and removal costs. I also had to find accommodation in a city I've only visited twice, where it seemed to rain perpetually, where I was so scared of the tram system that I caved and took a taxi to the airport after briefing once, and where the language makes me want to don a face mask and shove a phlegm pot under people's noses at the end of each sentence as every conversation sounds like the inmates of the TB ward in my old mission gearing up to give their morning sputum samples.
Daunted doesn’t begin to describe it.
As my departure date drew nearer the house was jumble of boxes and bags, all through which my housemate’s cat meandered with a disapproving air, eyeing me in a manner which suggests he knew full well I was to blame for all the upheaval. He occasionally tried to climb into whichever box I was trying to jam shoes and books into and sat squarely on piles of clothes every time I turned my back. Once, after being unceremoniously evicted from my bag for about the seventh time in one day, he sealed his displeasure of the disruption by weeing on my bedroom floor; a tactic I took a dim view of and banished him to the back yard while I aggressively febreezed the carpet.
For all that I knew that this job was indefinite – a couple of years minimum, longer in all likelihood. I avoided saying big farewells to people at home, ostensibly because after all, I’m close enough to fly back for weekends or have visitors. But also if I’m honest because I didn’t feel like I could handle saying goodbye to people. Or deal with them saying goodbye to me.
It was enough having too many of my own unchecked emotions ricocheting around without trying to handle other peoples too.
The big day finally came and the big move finally happened and I began to navigate my way through my first few weeks in a unfamiliar city and an unfamiliar job.
For all it’s many virtues Amsterdam doesn't feel like home, and won’t for a while yet; I miss the hills and warm honey-gold glow of the Bathstone buildings too much. And even the modern wonders of WhatsApp and webchat can't replace the comfort of being able to pop around to one of my many friends’ houses there for a cup of tea and a cosy natter.
I even miss the team living of being on mission; the intensity of life and work which bonds you to others faster than usual. I feel adrift, my usual anchors to life loosened.
That said, it’s hardly a social vacuum here. Within my first couple of weeks, several colleagues from previous missions have passed through the office, either for briefings or trainings; my new housemate introduces me to her circle of friends and a couple of uproariously drunken evenings ensue, during which I make the pleasant discovery that I haven't forgotten how to laugh, I'm just a bit rusty that's all.
I know I will make friends here, it’s just with my head as it is right now, I barely want to spend time hanging out with me, so it’s hard to believe that anyone else would do either.
Another former field colleague now also based full time in Amsterdam points me towards a reputable second hand bike shop and I vanish into the interior only to emerge a few minutes later and few hundred euros lighter, the proud owner of a true Dutch style bike, dynamo headlights, wicker basket and all. I christen her Godzilla (she weighs a ton) and after some brief disagreements as to which of us is actually in control of the steering I manage to wrestle her into a semblance of control and proceed to cycle in a cautiously delighted and somewhat zigzag manner home.
I'm green with envy of the female cyclists of Amsterdam, who cruise along skirtclad, bolt upright and elegant, sometimes casually texting with a free hand, confident in the knowledge that traffic will literally stop for them – hell, I think 747 would probably stop for them. Used as I am to Britain’s cycle blind drivers, I maintain a defensively hunched posture with a weather eye out for kamikaze cars. And even now six weeks later I still require a solid two handed death grip on the handle bars at all times to keep control, although I am more upright and slightly less wobbly.
Getting about proves more challenging than I expected. I can’t pronounce any of the street names and neither can Google maps as it turns out (the iPhone routefinder app via headphones is either very helpful or just hopelessly misleading).
Add to which the picturesque canal system that Amsterdam is famed for follows curved routes, not straight ones, so every now and then I will end up pedaling industriously over endless cobbles in what I fondly believe to be a westerly direction, only for the canal to gently but inexorably curve around and lead me north instead.
More than once, I’ve given up on the app which appears to be talking gibberish into my ear and periodically instructing me to steer directly into the water and just checked the map itself and ended up having to backtrack for several frustrating (and bumpy) minutes.
Life working in an office is… odd. Just plain I-have-literally-no-experience-for-this-in-my-life-before-ever bizarre. It’s probably a perfectly normal office environment, but I’ve never ever worked in one. No one is wearing nametags, or stethoscopes, or talking about their patient’s blood gases, and it feels very strange to know that I’ve said goodbye to the nurse and carer identity that has been so much of me for the last 15 years.
My colleagues are great – and I mean genuinely great. I’m not just saying this because I think they will read this. And although it’s early days yet, I know I’m going to love the training job too when I have settled more and gained confidence.
I already did my first field management training in Ethiopia, prepping hard and relying on my innate ability to look and sound more confident than I actually feel, which astonishingly, worked better than I dared expect. But right now it’s still hard when everyday people ask me how I am doing today – such a kind, innocuous question – more often than not more greeting than enquiry – and although I try to respond with a “Good, how about you?” the honest answer is… tired.
Just so, so, so tired.
Dissecting why isn’t rocket science. Despite marked improvement the erratic sleeping pattern and unwelcome dreams I was having at home continue. Sadly your own brain isn’t something you can leave behind when moving countries no matter how much you wish you could.
The tiredness goes beyond broken sleep though. My concentration span is uncharacteristically abysmal – I have to read and reread every new piece of information presented to me – just what you want as you start a new job. Memory retention skills are also at an all time low; just remembering people’s names -which I’m usually pretty good at – even in just my small corner of the office is Herculean.
Everything, just everything, even the smallest of tasks seems to require gargantuan effort. Not just getting from A to B as already described, but getting a phone sim, finding wheat free food in the supermarket, finding a supermarket, opening a bank account, navigating internet banking, trying to take out health insurance, getting a social security number, getting a second passport, dealing with a broken boiler in my house back in the UK, going to Ikea, choosing furniture, trying to find socks in the huge heap of boxes that I still haven’t unpacked, trying to work the washing machine that only has Dutch instructions.
Every thing, every day, is astoundingly wearying to degrees totally disproportionate to the tasks themselves. And all through the knot of anxiety and frustration with myself is a constant pulsing presence in my solar plexus.
Even dressing for work requires a ridiculous amount of forethought and effort; I mean, I’m a nurse – I spent 10 years of my career mindlessly putting on a bog standard NHS polycotton uniform every morning, and the more recent years congratulating myself on having achieved an unusually “smart” look while on mission if I can find an MSF T-shirt that only has two holes in it. The MSF office is pretty casual but still… I mention this to a colleague in the canteen one lunchtime who blithely reassures me that I should just relax and wear whatever I would usually wear at home. Somehow I think even MSF would draw the line at oversize tartan GAP pyjamas though.
One evening while ambling vaguely round the flat trying to find a work outfit for the next day that doesn’t look like it has been rumpled up in a packing box for a month (that would be none of them) I belatedly register hunger, but can’t muster the energy to get out of the aforementioned tartan PJs to go shopping. Five minutes later I am industriously scraping the mould off a piece of cheese in the otherwise bare fridge and reflecting that when I once said I wouldn’t mind being Bridget Jones I meant it more in regards to hooking up with Colin Firth than this.
I have moments when I'm well aware that I'm my own worst enemy as far as high expectations are concerned – I have an Olympic worthy abilty to self criticise. But I know it in a cerebral and dismissive way, and tend not to remember it until I reach such a state of frustration with my lack of coping or slow uptake that it takes a friend or colleague (or writing it all down and reading it over like right now) to point out that I need to slow down and look at the bigger picture of how much has been thrown at me recently and how I'm well I’m doing in actually coping.
Uh, right... perspective. I remember that. Occasionally.
I think back to some of the things I've seen over the last three years – before even the Nepal mission – countries and communities broken through conflict, families broken by poverty, death and disease, and I wouldn’t take any of it back, not a single second, but it begins to feel less strange to admit to being a little broken myself after witnessing it all.
And that may well be the most important step towards healing. I have a renewed respect for those of my colleagues who keep mission work up year after year, and marvel that they are able to continue seemingly unbowed by the incredible weight of it all.
My heart is at best only halfway healed from this years events – and maybe that's as good as it gets really in humanitarian work. Maybe your heart can't ever really be whole when pieces of it break time and time again at your day to day work, maybe the willingness to do this job means just that; the cost of letting your heart be broken eventually at all the brokenness that you will see.
I’m not done with this healing process, not by a long long way. There’s more time, tears and counselling ahead I know.
I still don’t know whether tonight’s sleep will be restful, or whether I’ll be in a helicopter above the mountains of Nepal again.
The vibration from passing trucks still makes my heart pound.
And I’m damn sure I’ll get lost trying to find my yoga class in town later. But I’ll get on my bike and go anyway.
And that image of me right now, wobbling off slowly on my bike is about the best metaphor for how I’m doing at this moment. Not exactly moving fast, rather vague about the route I'm going to take, and not terribly steady as I go, but as always looking more confident than I feel, and gradually getting my balance back.
And remembering, when I can, to be gentle with myself.