Beyond fortitude: COVID-19 nurses tap a hidden strength – “sisu”

Why We Wrote This

Sometimes, life and work can get so tough that it takes more than grit and perseverance to cope. Front-line nurses on COVID-19 wards have needed that quality in spades. The Finns have a word for it.

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Wendy Ariza (front), a registered nurse at Lenox Hill Hospital, listens outside the building as people applaud to show their gratitude to medical staff and essential workers on May 16, 2020, in New York City.

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How do nurses cope with the enormous pressures they face on COVID-19 wards, overwhelmed with work and fearful of infection?

They draw on a quality that in Finland they have a word for – sisu. It signifies the extraordinary courage and determination that surfaces in response to particular adversity and hardship.

Finnish soldiers drew on sisu during their brutal winter war to repel a Soviet invasion in 1939. Nowadays Erin Dean, a nurse in New York, says she is “drawing on a heretofore untouched well of strength and determination. The whole hospital is calling upon a unique type of fortitude that allows us to get the job done.”

Emilia Lahti, a world expert on sisu, thinks of it as the next gear beyond fortitude. It expands your sense of what you can do, encourages you to take action in the most daunting of circumstances, and opens untapped channels of power.

COVID nurses, she says, are “digging to reach layers of strength they did not know existed.”

I can see the banner atop the Space Needle from my desk at home. It reads, “We got this Seattle.” While I am grateful that my city is no longer the epicenter of the COVID-19 pandemic, my thoughts turn to my former home and my colleagues in New York City living in the eye of this dark storm.

I emailed a number of front-line nurses at Manhattan’s Lenox Hill Hospital, where I once worked, asking them to describe how they are able to maintain a constancy of care when they are running on empty.

Their stories are gallant examples of sisu: a Finnish word meaning the extraordinary courage and determination that surface only in response to particular adversity, suffering, and hardship. The word is 500 years old, but it was revived by the perseverance of Finnish soldiers who fought in the punishing cold of the 1939 Winter War. They defied a powerful Soviet army invasion and preserved Finland’s independence.

Since then, sisu has become a key element in Finnish culture, though it is a capacity we all share. At the core of sisu is the idea that, in each of us, there is more strength than meets the eye.

“No time to be sad”

Take Erin Dean, who details her evenings in the intensive care unit.

“Every night, when I take the elevator up to my floor, I call upon an inner strength to get me through one more night,” she explains.  “I became a nurse to help. I never believed it would require a special courage, but now I know that is true.  It’s not just me; the whole team, the whole floor, the whole hospital is calling upon a unique type of fortitude.”

Ms. Dean describes how this “horrifying disease has allowed me to witness acts of love on a scale I would not have imagined.” She recalls a loving, long-married couple – each fatally ill – in beds on separate floors. She ferried the wife in a wheelchair to her husband’s side so that they could die together. By the time Erin returned to her station, the wife’s bed had been assigned to another patient.

“No time to be sad.” Dean writes. “I had another patient to care for. As nurses, we have all developed the ability to compartmentalize illness and death, but not at this extreme, unprecedented level.  We are drawing upon a heretofore untouched well of strength and determination.”

I discovered the notion of sisu when I worked on a Fulbright grant at the Helsinki University hospital. There I encountered the work of Finnish psychologist Emilia Lahti, the world’s foremost authority on the phenomenon.

Ms. Lahti’s research details three key elements of sisu. Firstly, it enables us to move beyond our existing view of our mental and physical capacities. Sisu is also an action mindset that helps us to face up to fears, extend ourselves in moments of suffering, and take action in the most daunting circumstances. And finally, sisu is a second wind that allows us to draw upon a previously hidden, untapped source of strength.

Digging deeper

These three elements sing in the example of Lenox Hill front-line nurse Emily Fawcett, who describes working her fifth 13-hour shift in a row.

“I could probably sit here and complain about how my feet are swollen and throbbing, how I have a headache from the tight mask, how I have cried three times today already, or how I miss my family. But, I am choosing not to. And this is why: Today I had the honor and privilege to “send off” a Navy veteran – to give him the goodbye that he deserved.

“It was at this moment I had to call on my inner strength and courage. It no longer mattered that I was exhausted, that I had not eaten lunch, that I had charting to do. All that mattered was this patient and his family. They were my strength, my courage. If they could be strong in this moment, so could I.”

Ms. Fawcett describes her team jumping into action. They called the family in, gathered hospital workers who were veterans, got the music ready. “We all gowned up, the family said their goodbyes. We played the Star Spangled Banner and we all gave him his final salute. He passed away shortly after. It was beautiful and it is this moment that will carry me into my next shift.”

I ask Emilia Lahti how she views the exceptional responses of front-line health care workers.

“The sisu these nurses describe has appeared in a moment of extreme adversity,” she responds. “It is invoked by an experience that calls them to stretch and expand.” Ms. Lahti thinks of sisu as the next gear beyond fortitude. It begins where grit and perseverance end, a “friendly darkness of adversity” that sparks our “ability to channel a moment and open the pathway to a latent existing strength that resides within us,” she says.

The COVID-19 pandemic is such a moment, Ms. Lahti suggests. “We are witnessing a global expression of sisu. We see nurses and health care providers digging to reach layers of strength they did not know existed. They are stepping into their previously unpresented strength.”

Consider a final example of sisu as defiant bravery. ICU nurse Rose May Coma compares her first day on a COVID-19 unit to being “a civilian at war,” toe to toe with the enemy virus. She addressed it directly.

“That’s okay Corona, I was not ready today. Scoreboard: CORONA: 1 ME: 0. But tomorrow is another day. I’m made of tougher stuff than you, Corona. You won’t get me again. Enjoy your win; I’m in it in for the long haul. I will dig deep, deeper than I ever needed to. I will do it for my family, your family, my brothers and sisters at the front line, for me, for humanity.”

More than 100 years ago, the American philosopher William James wondered “what keeps our lights burning and our hearts hoping during the dark night of the soul?” When I listen to the stories of these valiant nurses, I hear eloquent answers. I can only express wonder and gratitude for the sisu that moves them to meet this unthinkable moment.

Barbara Mackoff is a Seattle consulting psychologist, senior faculty at the American Organization for Nursing Leadership, co-author of “The Inner Work of Leaders,” and author of the forthcoming “What’s in Your Just in Case Book?”

Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.

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