It's funny-I intended to write this column about vaccine-preventable illnesses. I wanted to talk about how our tendency to disparage risks we are familiar with and be alarmed about new or unique risks (Zika, Coronavirus) increases the chance of real and predictable harms to our communities. I wanted to express my concern that healthcare providers are not universally supportive of the science behind vaccines and herd immunity. The fact is that when someone refuses influenza vaccine because "I don't get the flu" or "It doesn't work that well," they put others at risk. When a clinician fails to encourage women to get influenza vaccine in pregnancy, we increase the chance that there will be a pregnant woman in the intensive care unit, struggling to breathe while the physicians debate whether to deliver her child early in an effort to save one or both lives. So that was what I had planned to say, in brief. And then, in January as the Covid-19 outbreak began, I shifted gears to write about self-care.

And now we are confronted with a healthcare emergency writ large, as the Covid-19 pandemic burns through our communities, overwhelming our reserves, and stressing our health care systems to the breaking point. Public health and infectious disease experts have warned for years that this would happen "someday," and now someday is today. Our lack of preparation for "someday" has left our health care professionals and all those who support them without essential resources.

So I listen to the news, and I think about the stress test our country is going through. I think about how, whatever one's political leanings, this has added yet another layer to the stress in the lives of many Americans. And though it does not touch on the added challenges of our current emergency, please accept the rest of my original column from January 2020 as my prayer for each of you to find strength not only to survive this challenging time, but to heal from the traumas it will inflict.

If you are reading this, the chances are you are a nurse or a midwife. You spend your days and nights, your weekends and holidays, caring for those who are giving birth to the future of our world. It isn't always easy, or beautiful, or happy. And then you go home to family and friends who value and benefit from those skills of compassion and empathy that you have honed at work. And who expect that you will bless them with your perfect support and understanding, because that is what you do, isn't it? And then you haven't slept, and your child and spouse need you, and your friend calls-and what do you have left to give?

We know that women (the gender of most nurses) are at risk for a doubled workload. It is widely reported that working women still "outwork" male partners in terms of responsibility for household maintenance and childcare.

We also know that sleep deprivation increases the risk of poor clinical judgment. How many nurses do you know who have chosen night shifts so that they can be available for their children during the day? How many physicians and midwives have you met who are working late in the office and then covering call all night or weekend, never quite catching up on their self-care? Are you a professional whose intention for career advancement requires you to work full-time and add school to an already overfull schedule? I lost count years ago of the women who came to me wondering why they never seemed to have energy and asking to be checked for anemia, and of those who sat and cried as they told me they felt overwhelmed. When I asked about their last day off, or most recent evening out with a partner, or a hobby they loved, or a mini-trip with their children just for fun-many couldn't remember when they had last had space just for themselves-at home or away. Many couldn't even remember the last time their family did something "just for fun."

I am not asking that anyone walk away from a career you love or step aside from new knowledge or experience that will enhance your professional life in the long term. What I am asking is that you sit down, now, and ask yourself what you are doing to keep yourself healthy. And then take one step toward health. I do not know what that looks like to you. It might be the commonly recommended and truly beneficial triad of exercise, healthy food choices, and sleep, although changing your life to fit those goals is a marathon rather than a single step. More manageable in the short run might be a massage, or a date night with no kids, or an afternoon off at the yarn store, or even a therapy appointment. What you choose doesn't matter-what matters is that it is your choice, and your self-care.

Take care of yourself. Please. Vaccinate yourself against stress and burnout with self-care. Do not let the world seize so much of you that you cannot love yourself, that you cannot rejoice in who you are and the skills you have gained. You cannot save even one other person in the world if you cannot care for yourself. Oh, and get a flu shot.

-Jan M. Kriebs, MSN, CNM, FACNM

Adjunct Professor

Midwifery Institute at Jefferson

(Philadelphia University + Thomas Jefferson University)

Philadelphia, Pennsylvania