I survived the mass shooting at Dawson College in Montreal, Canada, in September 2006 (1) . This single event turned my life inside out in deeper and more unexpected ways than I can describe in this short essay. I have lived with posttraumatic stress disorder (PTSD) ever since. Throughout the years, I have learned to manage my condition effectively through treatments which have helped me in different ways. Until a few weeks ago, I felt like the worst might be behind me. Then, the world became engulfed in the coronavirus disease 2019 (COVID-19) pandemic, which required people everywhere to make drastic changes to their lives in order to protect themselves and others against this novel virus. These changes, and the global malaise surrounding the pandemic, have heightened some of the PTSD symptoms that I had learned to cope with efficiently.
I have experienced varying degrees of a range of PTSD symptoms such as recurring intrusive memories, nightmares, night terrors, avoidance, persistent guilt, alienation, memory loss, irritability, hypervigilance, reckless behaviour, difficulty concentrating, and sleep disturbance, thus hitting all 4 clinical symptom clusters (2) . Over the years, these symptoms have felt anywhere between manageable and debilitating depending on my life circumstances. Similar to what is described in the literature about chronic pain, PTSD is my dance partner (3) . While it has certainly led some dances in my life, I have successfully managed to lead others. Cognitive behavioural therapy allowed me to develop skills to respond to triggering situations by grounding myself in the present and reminding myself that I am safe. "You are not back there, you are here, now," I tell myself. Most recently, eye movement desensitization and reprocessing has helped me de-escalate triggering situations by replacing a negative thought with a positive one. While these techniques may not be effective for everyone living with PTSD, they significantly increased my quality of life. Of course, my coping skills and mechanisms are not perfect. I still do not feel completely at ease in crowded spaces. I always look around to make sure I know where the exits are located and I still jump at loud noises.
In March 2020, particularly stressful circumstances emerged as the COVID-19 epidemic evolved into a pandemic. To be faced with the remote, yet real, possibility of me or my loved ones contracting and dying from the virus brought me back to the day I outran bullets. Intuitively, you might think that social distancing measures would be great for someone like me who dislikes crowds, and you would be right. It has been a welcome change to not have to take public transit and sit in crowded classrooms. However, the constant underlying feeling of danger has reignited a hypervigilance that I only feel at my worst. Hypervigilance brings sleep disturbances, which in turn bring tiredness that leads to avoidance. Just like that, within 2 weeks of social distancing measures being put in place, I found myself expanding considerable energy managing these symptoms. This means I have less energy to spend on my work, which I am expected to perform from home while caring for and homeschooling my son. Mental energy is a finite resource and I currently feel like I do not have enough of it to complete the tasks I performed fairly easily just a few weeks ago. I know now that this is not a personal failure. I am simply navigating my current life circumstance with a chronic condition. However, this acceptance came after living with my condition for over a decade; others with less experience may not be so gentle with themselves.
Another surprisingly challenging aspect to manage is the positivity that emerged in Quebec, my home province. Ç a va bien aller (It's going to be alright) gets drummed everywhere you go, on social media, and any news station you watch. While I understand that people need a positive outlook on the situation in order to keep hope, I cannot help but think about those of us for whom it is just not going to be alright. Some of us will lose loved ones and some of us will die. We don't know what our lives will look like in the coming months. A return to normal seems further and further away with social distancing measures being prolonged. We are worried for our loved ones. We will need to mourn our dead. We will need to mourn our pre-COVID-19 lives. Rainbows and positive talk will not change that. Words that are meant to be comforting can have the opposite effect on grieving people and can exacerbate feelings of alienation (4) . This is what I feel. As I mourn a period of my life that felt so sweet and accept this new chapter that feels so strange and uncertain, being bombarded with "It's going to be alright" is just not helpful. It dismisses my legitimate fears and concerns about the situation and closes the door to meaningful conversation. Through the trauma I survived, I learned that things can go dramatically wrong on any given day. This thought process still guides many of my behaviors and is why, even in my best state, I look for exits in crowded places and jump at loud noises.
It is difficult for me to share this perspective as the pandemic is ongoing and my symptoms are currently further away from "manageable with little effort" than they have been in a long time. It is challenging for me to focus on writing for longer than a few minutes at a time, and even more challenging to be writing about my condition-the simple mention of which reminds me of why I live with it today. I have the immense privilege of being a master's student in a health-related field, which has trained me to write about health and, more specifically, lived experiences linked to chronic health conditions. I can only imagine that it is just as hard, if not harder, for others to share their stories when their symptoms are heightened. I hope that this paper will help clinicians pay particular attention to those patients who are experiencing symptoms indicating a relapse of PTSD, acknowledge their pain and fears as real and valid, and, where appropriate, refer them to a service provider who is experienced with the condition. I also hope that sharing my experience will spark a conversation among health care workers about PTSD, as they are themselves currently dealing with immense stress and trauma.