Caring for everyone except herself
Ashley has been an ICU nurse at a Denver hospital for sixteen years. She’d seen death before the pandemic. But COVID broke something in her that didn’t heal when the crisis passed.
“Between March 2020 and the end of 2021, I lost count of how many patients I watched die alone because their families couldn’t visit. I held iPads up to dying faces so people could say goodbye over FaceTime. I went home and couldn’t hug my own kids because I was terrified I’d infect them. And then the world moved on and I was supposed to be fine.”
She wasn’t fine. Major depressive disorder, diagnosed in 2022. Her psychiatrist noted probable compassion fatigue layered on top of it — the emotional exhaustion specific to caregivers who absorb too much suffering for too long.
Her PHQ-9 was 17 at diagnosis. She started duloxetine, which helped for about seven months before the effect faded. Switched to venlafaxine — similar trajectory. Added bupropion as augmentation. Marginal improvement. Tried aripiprazole. The akathisia (restless, jittery feeling) was unbearable for someone who needed steady hands to place IVs and adjust ventilator settings.
“I’m a nurse. I know what all these medications do. I know the pharmacology. That didn’t make it any less frustrating when they didn’t work. If anything, it made it worse. I’d read my own chart notes and think, ‘This patient has failed four adequate medication trials. What’s left?’”
What was left was TMS
Her psychiatrist brought it up. Ashley had heard of TMS — her hospital had a behavioral health unit that referred patients for it — but she’d never considered it for herself. Nurses are notoriously bad at being patients.
“My first reaction was, ‘I don’t have time for that.’ Five days a week for six weeks? I work three twelves. When am I supposed to fit in brain stimulation?”
Her clinic in Denver offered early morning and late afternoon slots. Ashley scheduled sessions at 6:30 AM on her days off and at 4:30 PM on days between shifts. It wasn’t convenient, but it was possible.
Insurance through the hospital’s plan covered TMS after prior authorization. The documentation of four failed medication trials made approval straightforward. Her out-of-pocket cost was a $30 copay per session.
The protocol and the process
Thirty-six sessions, standard high-frequency left DLPFC protocol. The clinic used MagVenture equipment. Sessions lasted about 20 minutes with the accelerated protocol her doctor selected.
“I understood what was happening better than most patients, which was both helpful and unhelpful. I knew the mechanism of action. I knew the statistics. I also knew that understanding how something works doesn’t mean it’ll work for you.”
First session: the motor threshold calibration startled her. The involuntary thumb twitch felt strange from the patient side. The treatment pulses were uncomfortable for the first three sessions — a persistent tapping that gave her a tension headache each time. By session four, she’d habituated and barely noticed.
She kept working through treatment. Twelve-hour ICU shifts on top of TMS sessions. It was exhausting, but Ashley is used to functioning while exhausted.
“My coworkers didn’t even know I was doing it at first. Nurses don’t talk about their own struggles. We’re the ones who are supposed to have it together.”
The morning she didn’t dread going in
Week three. Ashley was driving to the hospital for a day shift. She realized she wasn’t clenching the steering wheel. She wasn’t running through a mental catalog of worst-case scenarios for the day ahead. She was just… driving to work.
“That sounds so small. But for two years, the drive to work was thirty minutes of dread. Wondering which patient would crash, who I’d lose, whether I had anything left to give. That morning, the dread was just gone. I turned on the radio and sang along to something stupid and cried because I hadn’t done that in so long.”
Her PHQ-9 at the midpoint check: 10. Down from 17. By end of treatment: 6. Not quite remission, but close — and a world away from where she’d been.
The compassion fatigue symptoms improved too, though she attributes that partly to the therapy she started alongside TMS. With the depression lifting, she had enough emotional bandwidth to actually engage in therapy for the first time in months. She could process the trauma instead of just surviving it.
Back to the bedside with something left to give
Eight months post-TMS, Ashley is still nursing. She considered leaving the field — a lot of her colleagues did. But the depression and burnout had been stealing her ability to do the work she loved, not the love itself. With the depression managed, she found the vocation was still there.
She’s mentoring new ICU nurses now. She talks openly with them about mental health, about the toll of the work, about seeking help early.
“I tell every new nurse the same thing: this job will break you if you don’t take care of yourself first. And if the standard treatments don’t work, there are other options. I’m proof of that.”
Her PHQ-9 at her most recent psychiatry appointment: 4. She’s on a low dose of bupropion and sees a trauma therapist monthly. She’s discussed maintenance TMS if symptoms return, but so far hasn’t needed it.
Ashley’s advice for healthcare workers
- You are not exempt from needing help. Knowing pharmacology doesn’t protect you from depression. Stop treating yourself like you should be immune.
- TMS fits around shift work. It takes creative scheduling, but early and late appointment slots exist. Ask your clinic.
- Your hospital insurance likely covers it. Ashley’s copay was manageable. Check your plan’s TMS coverage before assuming it’s too expensive.
- Tell at least one colleague. Ashley eventually told her charge nurse, who helped cover scheduling gaps. The response was support, not judgment.
- Compassion fatigue and depression overlap. Treating the depression made the compassion fatigue treatable. Address both.
Names and identifying details have been changed to protect patient privacy. This story is based on composite experiences reported by TMS patients and is presented for educational purposes only. It is not medical advice. Talk to a qualified specialist about whether TMS is right for your situation.