Finally

I love to read about, think about, and practice new productivity methods. I am always on the lookout for that wonderful new notebook, calendar app, pen, pencil or gadget that will make me more efficient, help me get more work done, and help me to feel that I have reached a new goal or accomplished a big task. Do you ever feel like that? Do you search for that one thing that will help you get where you want to go? Better yet, in the time of COVID-19, do you ever wonder when you will get to the finish line, to the end of some project, or to the end of this new world that none of us likes that much anyway? Do you hope that, finally, this pandemic will be over, and we will be there, wherever there is?

 

Shawn Blanc writes about productivity and teaches some crazy good classes at his website thesweetsetup.com. Check it out if you have the time and the inclination. Now, he also sends out inspirational and instructive emails once or twice a week that drop a little knowledge, tell about a cool gadget, or offer some productivity hack that us mere mortals might find helpful. He sent an email out this week that hit me at exactly the right time in exactly the right way, and I thought I would share what I learned with you.

 

He started the email by telling the story of his journey to earn a black belt. The training was mentally, emotionally and physically exhausting. When he got to the testing day as one of twelve who were going through this rite of passage, he thought that finally earning the black belt would be the goal that all aspired to get to. After completing this and coming back to the studio just two days later to continue his training, he quickly realized that the black belt had been a goal but not the goal. He learned that when something in life is important, you don’t simply show up every day until something happens. You simply show up every day. As Shawn said in his email, life is lived in the day-to-day.

 

He made the point that there is a great deal of “satisfaction (to be gained) in the small daily wins and the joy of consistently choosing to do the the things that are meaningful, valuable and important.”  We all seem to think that if we strive for the huge goals and the big flashy wins that they will somehow come faster or easier. In fact, says Blanc, “if you’ve got a habit of showing up every day then I guarantee you that along the way you’ll pass milestones and accomplish big goals.”  Milestones are wonderful things, but once you reach them, “you get back to living your life”.

 

During this past eighteen months, we have all felt that if we could just get though to Easter, to the summer, past the holidays, to the next summer, or to the next fall, that somehow we would have arrived and everything would be okay and back to normal again. We are fooling ourselves. We may be looking at a normal that bears little resemblance to the one we had in 2019. Is that bad, tragic, depressing? No, it just is. If we are committed to showing up at work, for our kids, for our spouse, or for others just until the pandemic is over and we can go back to our own lives the way they were, we are going to miss a lot of nows, a lot of our life in the present that we are squandering while waiting for that elusive “normal” that may never return. If we are waiting for the until, the finally, we are destined to be disappointed.

 

“If you are doing something that matters”, says Shawn Blanc in his email, “ there will always be resistance. Distractions, excuses and challenges will always be right at your doorstep. Don’t wait for the fear to go away, because it won’t. Don’t wait for the risk to disappear, because there will always be risk.” He admonishes us to “show up every day when it’s frightful. When it’s risky. When it’s tense. When it hurts. Because it will always be that way. The finally moment never comes.”

What are you doing during this terribly stressful time? Caring for an elderly relative? Teaching your kids? Working two or even three jobs to make ends meet? Learning to spend more time with your spouse? Trying to figure out how to take better care of your own body, mind and soul? I hope that whatever it is that you are doing, that you are not just showing up until. When the pandemic is finally over, I hope you will see it not as the end but as the beginning of your new life, with all of the joys and challenges that time will bring.

So Much Is In The Doing

My wife and I both work in service industries. We both do a lot of listening. She is a flight attendant who travels all over the world, walking up and down the aisles of Boeing and Airbus airplanes at forty thousand feet, listening to stories and responding to requests. I am a psychiatrist who is usually found sitting behind a desk, tapping away on a laptop, listening to stories and responding to requests. We have have many conversations about how people interact with each other, how they talk, how they ask questions, how they respond to demands and rules, and especially how they function under stress. I know you have seen the various YouTube videos of enraged, unruly passengers who have attacked cabin crew members over issues of mask wearing or alcohol consumption or some such. My wife has never been on the receiving end of one of those attacks, thank goodness, but she is aware of the possibilities every time she signs in for a flight. I have been hit twice and lunged at several other times but never seriously injured while doing my job. We do realize, as I am sure you do, that the last eighteen months has brought out the best and the worst in all of us, and part of that is the lack of attention to the social graces and the simple interactions and courtesies that we once paid each other as a matter of course.

In her recent 8-14-21 article “COVID Anxiety and Fear of the Base”, Wall Street Journal columnist Peggy Noonan addressed some of this. Now, my own column is not political, so some of her writings in the beginning of her piece are beyond the scope of what I want to discuss with you. However, she does start out by stating that people now have mask fatigue and other associated side effects of living through the first serious global pandemic in a century, and that issues such as mask wearing are pushing people to pick a side. Moderation, which in my book went hand in hand with politeness and social grace and simple courtesy, has now become only “for the gutless and insincere”. My wife and I have both noticed, in our very different but very similar worlds, that moderation, patience, respect, and tact have all become signs of weakness. As Noonan put it in her piece, “nothing has been so damaged by the pandemic as what had remained of American tact”. We pick sides of an issue or an action, then demonize and vilify those with different opinions. Noonan suggests that we “make a decision, then encourage, persuade and and exemplify helpful behavior” to win over our fellows who may have opposing views. We all tend to talk and rage against one another, but she says that instead of emphasizing the verbosity, “so much is in the doing, especially in a crisis”. Why are we this way? We are tired. Very tired. We are irritable, and we are much less confident than we were even a year ago because we simply do not know what is coming at us next. We cannot predict the future of this pandemic, and that now makes us gun shy about predicting anything that has meaning in our lives.

Now all politics and divisions aside, the part of her column that I liked the most was the part where she asked, “What rules of the road might help us…….what general attributes?”

First, she challenged us to “regain a sense of give”. We should stop pushing each other around. We should strive to have a generous and sympathetic sense of who our fellow Americans are. Those people that you so vehemently disagree with? Have you ever thought, asks Noonan, that they might be thinking about things that had not even occurred to you? We should be patient. I am always looking for signposts in my own life and work. Two recent events assured me that patience was a virtue that I sorely needed to pay attention to. First when my seven year old granddaughter stayed with us for five days, we learned that operating on her schedule and living life with her level of energetic intensity requires planning, stamina, and yes, patience! The other was when a patient told me the story of living with an incurable and potentially fatal disease, while caring for an elderly relative with their own serious health issues, and how this had lead to a major upheaval in schedules, vigor, and enjoyment of life that was not as it used to be, but as it now was.

Second, Noonan challenges us to stop picking on each other. Does it help to ostracize others? To demean or fight or assault? No. Once again she asks us to empathize, teach, educate, and lead by example. Third, we should admit that there most likely reasons that people do not trust the experts. (This could hold for virologists, and psychiatrists and flight attendants too, I suppose!) If you are ever in a position where you are the designated expert, and believe me, almost anyone who reads my column is more than likely in that camp at some point, play it straight, says Noonan. If you don’t know, say you don’t know. (It took me years after I finished medical school to get comfortable with this very simple but extremely difficult act) Do you like your fellow Americans? Are they “other”, “imbeciles”, or dare I stray into the political quicksand and use the term “deplorables” to you? Or are we all Americans, with different ideas and beliefs and values, and through our differences, embody e pluribus unum? Noonan tells us that if we do not like and respect each other, no matter how hard we try to hide it, “nothing is more obvious than a lack of affection”.

Lastly, she says we must “adjust our sense of proportion”. Put quite succinctly, “COVID now is part of life; it’s not life.” There are so many pressing issues in the world right now, war and famine, and climate change and heart disease and cancer and poverty and mental illness and we focus just on this pandemic and lose sight of all the others at our own peril. We will be dealing with emotional stress of these times for the foreseeable future. Life is hard. Illness is hard. But as the WSJ column concluded, “Life has to be lived.”

Taking One for the Team

Simone Biles knew that something was wrong. She had pulled herself out of the team gymnastics competition at the Tokyo 2020 Olympic Games after she developed a case of the twisties. This condition severely impairs a gymnast’s ability to know their position in the air and relative to the ground, something that could lead to serious injury if not addressed. She also decided not to compete in some of the individual events in the days afterward, citing mental health issues. Rather that find herself lost in the air, unable to add to her team’s scoring and possibly injuring herself, she decided to withdraw. “I knew they could do the job.” She wanted her teammates to medal, and she saw herself as a stumbling block. In an interview, she said, “We aren’t just athletes or entertainment. We are humans too. We have emotions that we don’t tell you about. I felt embarrassed at first. You have to put your mental health first. It doesn’t matter if you are on the biggest stage.”

There was mixed response to this turn of events from around the world. Some mental health advocates were very supportive of Ms. Biles. Some of her peers, such as Michael Phelps and Naomi Osaka, called her to offer their support, in that they had also struggled with mental health issues that affected their performance at times. They applauded her decision to put self care first and to keep herself safe. Others, not very sympathetic to her struggles at all, said that she should have “taken one for the team” and pushed on to compete in all the Olympic gymnastic events.

“Taking one for the team” means willingly undertaking an unpleasant task or making a personal sacrifice for the collective benefit of one’s friends or colleagues. It derives from baseball in the 1970s, when a player was asked to take a pitch on the body to get to first base for the benefit of the team.

The path that Simone Biles chose was self care.

In an October 22, 2020 Harvard Business Review article titled “Serious Leaders Need Self Care Too”, Palena Neale PhD addressed this very issue. She asked questions such as “Why are so many leaders so resistant to taking a bit of time for themselves?” She found that “it usually boils down to misperception around what good leadership is, what self care is, and how self care actually works.” One thing that is often lost is that “self care is an investment that can increase overall productivity and effectiveness as a leader.” Ms. Biles had faced similar circumstances before in her career, and I am quite sure that she expected her competitive days to go forward as well, so getting past a temporary block in her overall journey just made sense for her at that time.

Diet, exercise and sleep are three components of a healthy life that we already know about. Then why is it so hard for most of us to eat right, exercise daily and sleep enough hours? One of the answers that Dr. Neale found was “I don’t have time for that!” The feeling of constant stress to manage a busy life, perform, always be on, and to juggle too many tasks is “sadly all too common.” “Taking breaks can prevent decision fatigue, renew motivation, increase creativity and improve learning.” Could Simone Biles have accomplished all of her key priorities, including tying Shannon Miller with seven Olympic medals after coming back to win bronze on the balance beam this year, without paying attention to her health and sense of wellbeing?

Another response found by Dr. Neale was that “leaders need to be strong. If I’m a good leader, I shouldn’t need self care.” This is simply incorrect. Leaders are often taught to not show any vulnerability. They feel that they should have all the answers. I think that many medical students and newly minted doctors feel that they know everything that is to be known when they finish their training. It is only later, when one has practiced in the real world for a time, that one realizes that learning never ends, and that the correct answers are constantly changing. Leaders sometimes feel that if they do not meet these criteria that no one will follow them at all.

How do we follow the example of Simone Biles and make self care a priority in our lives? According to Dr. Neale, we should integrate self care into our daily routine. Make it your own. Make time in your agenda for self care. Experiment with different things to keep it fresh. Share with others when you have found something that works for you that you think might benefit others. After all, Simone talked with Michael, Naomi and even Oprah! Your team will see these activities and actions and resolve and will follow you. Everyone wins.

What lessons can we take from the experience of Simone Biles in the 2020 Tokyo Olympics?

First, if you see that taking one for the team will lead to injury to you or disaster for the team, then stop and reevaluate. Biles stated in an interview that “it didn’t go like I wanted it to go, but it will open doors for bigger connections”. Pause for self care when you need it. Almost everything can wait. Model your decision making and share with others what worked for you. Encourage others to follow your lead.

Come back stronger and achieve even more because instead of taking one for the team, you decided to take some much needed time for yourself.

Mentors

My six year old granddaughter was getting frustrated. It was very hot as we played a round of nine holes of miniature golf under the blazing sunshine at Topgolf, the first such round for her. She was doing quite well, all things considered, until we hit one of those holes that required a tricky shot into one of two small holes at the end of a log which then allowed the ball to roll downward to the green and cup below. She lined up, struck her pink ball up the gentle incline, and down it rolled again. When she was finally close enough to attack the shot through the log, she stood with feet pointing in two different directions, putter head at a strange angle and an aim that was obviously going to send the ball upwards to ricochet back toward her and perhaps down the hill again. Golf that only Sisyphus could appreciate.

I approached her and gently asked that she let me help her with her stance, club alignment and swing. “No! I can do it myself! I want to do it myself!” I tried to remain calm but finally said, “No, you can’t, and I would like to show you what might make it easier for you to get this ball in that hole and down to the green.” After a little more bluster and vague noises of discontent, she allowed me to guide her hands. After a couple more tries, the ball entered the log, came out the other end as expected and a stroke or two later she had successfully completed the hole.

We all need a little help at times. There are things that we have never learned to do, things that we have learned to do incorrectly and things that simply require learning skills that we do not yet possess due to age, or training, or experience. As a young medical student, I remember thinking that I knew more things about more things than I had ever known in my entire life, but also having a vague inkling that most of this knowledge was absolutely useless without primary experience and the guiding wisdom of teachers that had my best interest at heart. Like my granddaughter, I wanted to cry out, “I can do this myself! I want to do it myself!” Fortunately for me, I was surrounded by learned men and women who were patient, skilled and who wanted to teach me how to be a doctor, an excellent doctor. I listened to most of them (I think!) and am the better for it every day of my working life now.

Over the last couple of years, I have lost several of those mentors. Some were ill and died too soon. Some were old and it was just their time to pass the baton along to my generation. One taught me general medicine mixed with psychiatric consultation, one taught me rheumatology, and one taught me how to approach problems in medical ethics, still one my all time favorite courses in any of the schools I have attended in my lifetime. I was shaped by these teachers, in ways that not even they fully knew, and they will always be a part of me and the way I approach medicine and patients who need my expertise. They not only taught me the facts, but how to think about the facts, and then how to take that thinking one step further and formulate a viable plan that would help my patient recover from whatever ailment they presented with. There are still times that I cannot do it all by myself, and I turn to those who can help when help is needed.

We are still battling the coronavirus pandemic, like it or not. As we have discussed here in several previous columns, this illness has lead to both physical and mental illness in thousands of people. It has cost hundreds of thousands of lives. In this fight to better understand this illness, to learn how to treat it and to save lives, we have desperately needed mentors who could guide us in our endeavors. Whether it has been the pure science of the vaccines, the protocols involving ICUs and ventilators in acute care hospitals, or mental health and substance abuse issues we have sorely needed words of wisdom and tested treatment measures. Unfortunately for us, this is the first such pandemic in one hundred years, and no one alive has been able to act as such a mentor.

Now, we are at a crossroads where science and facts learned over the last eighteen months are in juxtaposition to fears, misinformation and rigid dogma. We must, like it or not, allow someone to come in and guide our hands. We need those with facts and tests and procedures that will help us to beat this illness modify our grip on our own fears, align us with solid scientific facts, and insure that our steady and confident swing is complemented by a fluid and smooth follow through. We need the mentors that this crisis has created in real time. Like my granddaughter, we can learn to make the shot, but we cannot do it alone.

Mercy

“Woah, ah, mercy, mercy me

Ah, things ain’t what they used to be.” Marvin Gaye

I have another podcast that I want you to know about in this week’s column, but first I have a few questions to ask you. Better yet, I want you to ask them of yourself as you read this and think about it today. We have been talking a lot, a lot, about the COVID-19 pandemic and how it has affected us physically and now mentally as we struggle to find the finish line of this biological disaster. Many of my family, friends, colleagues and patients have been dealing with issues of isolation, depression, anxiety and stress for well over a year, and the dilemmas that have come up have not been easy to resolve.The questions I have for you?

Has the pandemic made you reevaluate your associations and friendships with others?

Do you find that you have been carrying grudges based on old wounds that now feel just a bit trivial in the shadow of six hundred thousand deaths?

Do you struggle, amid the pandemic, with wanting to unburden yourself of hurt and anger but somehow find it easier just to keep carrying them after all these years?

The podcast suggestion I have for you this week is Hidden Brain, hosted by Shankar Vedantam. This is a wonderfully rich podcast that takes deep dives into emotions, motivation, relationships, stress, coping and everything in between. On a recent episode, Shankar welcomed Charlotte Witvliet, a psychologist at Hope College in Michigan. They had an in-depth discussion about grudges, holding them, dealing with them, letting them go, and the emotional stress and strain involved in all of that.

Dr. W, if I may be so bold, started out by telling us that we often go about our lives with a detailed ledger of all the wrongs that have ever been done to us, all the betrayals and hurts that we keep meticulous records of. Our anger over these can fester and grow stronger with time, not fade as we might think. It can feel both good and bad to hold a grudge. It is sometimes easier to keep it and nurture it than it is to let it go once and for all. Grudges, she says, may take the edge off of our profound sadness, and help us feel that we have a tiny bit more control over our emotions and lives.

We may always be on the lookout for clues that justify why we feel the way we do, clues that feed our anger. We sometimes dismiss things that might get us out of our destructive loop and actually make our lives better. Sound familiar as we navigate the treacherous waters of this pandemic? As we get more inflexible in our responses to a pandemic or an old grudge, we tend to get stuck in a do loop of bad behavior and anger that brings us further down. This rumination on negative emotions can actually affect us physically, according to Dr. W, in that our blood pressure rises, our heart rate increases, and our beat to beat variability ( a measure of healthy heart function) may be off as well.

Have you noticed that your response to that old friend or even a new acquaintance may sometimes be out of proportion to the thing that they said or did that set you off in the first place? Dr. Witvliet says that focusing on the humanity of the person, the fact that they are a person just like you, with a story, stress of their own, and their own baggage, may help you deal with them in a more positive way. The interesting thing about this to me was that even if you cannot completely give up the thoughts and hurts that might haunt you, if you truly try to understand the person that offended you and truly try to forgive and show mercy, your actual physical response will be very real, in a very positive way. She goes one step further (and you may or may not agree with her here) and says, “Forgiveness is a moral response to a relational breech.”

Now, you might tell me that in your case, you can just distract yourself with other thoughts, other activities, other pressing issues and that the grudge is dealt with in that way. You might be right to some superficial degree, but real forgiveness trumps distraction every time, says Dr. W. The real physical effects that I mentioned above, such as lowering your blood pressure, tend to be much more long lasting if the forgiveness, the grace, and the mercy are sincere and real.

Forgiveness is a process, says Dr. Witvliet, a journey. It unfolds over time. It’s like grief in that way, in that it is not a linear, A to Z process, but more a series of rolling waves. We have all had deep hurts from losses. All of us. That’s being human. Where we fool ourselves sometimes is that we tend toward decisional forgiveness, which is based mostly on our cognition, instead of the truer emotional forgiveness which involves a change of heart. The psychologist says that the two are not equal.

The trick to dealing with these relationships that you are struggling with now that things are opening back up? The way to deal with the hurt, the anger and the wounds that have been allowed to fester for over sixteen months now? Generate positive, empathetic responses to other people, says Dr. Witvliet. Empathy is key. Think about the gift of grace, forgiveness and mercy that you can give that person, and then think how wonderful it would feel to receive that kind of gift. Commit to giving the positive, not committing the negative again.

The hardest relationship, hurt, offense or slight to deal with? One that is truly targeted, evil, or destructive. These kinds of hurts are not just subjective or a matter of having our feelings hurt, muses Dr. W. They are objectively terrible wrongs that are terribly hard to forgive. One example that hits close to home for us in South Carolina? The shooting of nine innocent churchgoers at Mother Emmanuel AME Church in Charleston, South Carolina. The tragedy that occurred there that day was unspeakable, but the responses from the families of the victims, a commingling of grief, sadness, anger and profound love and forgiveness towards the shooter, was almost unimaginable. But, as many of you might know more than I, it was about as real as it gets.

So, back to my questions. In this time of reentry into the almost normal of a post pandemic life, are you struggling with relationships, grudges, long ago hurts and injuries, or the inability to let destructive issues in your own life go? Were these magnified or made center stage by the isolation and stress of lockdown, working at home, more time with your family or wearing multiple hats between work and home and schooling your kids? Do you harbor and carry those heavy grudges towards someone and wish you could unburden yourself? As the psychologist in this podcast episode about the power of mercy instructed us, thinking about the humanity of the transgressor, truly forgiving them, and approaching the coming days with positivity and creativity will surely help you to experience less anger, stress and physical ills than you ever did before. Find this episode, listen to it, and ponder. You will be glad that you did.

Sleep On It

I love listening to podcasts, and one of the best new ones is Chasing Life, by Sanjay Gupta MD. Dr. Gupta is the chief medical correspondent for CNN, and he did a year long podcast before this one that gave us daily updates on the coronavirus situation as it unfolded. He is smart, well educated, insightful, and interviewed many different kinds of people who offered insights into the pandemic and our responses to it.

Chasing Life is the logical continuation of his first offering, looking at how we are trying to get back to our lives as the coronavirus pandemic winds down slowly. In the Tuesday, June 22nd edition of this podcast, he looked at sleep and how it has been affected by COVID-19 and related problems. He began this podcast by talking about Cliff Luther, a man who functioned quite well on no more than four hours of sleep routinely, and who had also managed to get three graduate degrees, start work on a doctorate, and coparent his children all at the same time. It was a mixed bag to Mr. Luther to be able to function well on so little sleep, knowing that it might be affecting his brain adversely in some way. It turns out that he did indeed have a rare condition that lead to his needing so little sleep compared to the rest of us.

In 2016, the CDC had found that more than one third of Americans got less than seven hours of sleep per night. As the coronavirus pandemic unfolded, it was noted that people on average were sleeping 14-20 minutes more per night in March and April of 2020, compared to the same period the year before. The pandemic seemed to throw sleep patterns off for many of us. Some people were sleeping more, some less, some got up earlier and some went to bed later. Someone during that period coined the term “coronasomnia” to describe these changes in normal sleep patterns. Some people who had COVID-19 infections have noted ongoing problems with sleep that have lasted varying amounts of time.

Rebecca Robbins, who is a sleep researcher at Brigham and Womens Hospital and has an affiliation with Harvard Medical School, told Dr. Gupta that sleeping less than six hours per night can cause a decrease in mood, increased irritability, brain fog, and decreased ability to focus. It might even cause us to make unethical or foolish decisions, or take risks that we might not otherwise take. One study in February 2021 hinted at a possible increased risk of Alzheimer’s Disease and dementia bought on in part by insufficient sleep.

If you trained in medicine like Dr. Gupta and I did, you remember being told something like “you can sleep when you’re dead”, meaning that you needed to be awake, active and doing something productive almost every minute of your day. But are there reasons that we should be sleeping, and sleeping the seven to nine hours that we hear is the prescribed amount for most of us? According to Rebecca Robbins, when we sleep our glial cells expand, allowing an increased flow of neurotoxins to flow out and away from our brains. Satiety hormones like leptin work the way they should, signaling when we are full and keeping us from overeating. One study found that when people slept less than five hours, the effect on the functioning of this satiety hormone caused them to eat two hundred more calories that they normally would have.

Who is at risk for poor sleep? Older adults, in that our best sleep habits and functioning occur in our thirties to forties and change for the worse after that. Women tend to have sleep issues more than men across the board according to Robbins. There may even be some economic correlation to quality of sleep, in that those who are in poorer socioeconomic groups might live in areas where unbroken sleep might be an impossibility.

What helps us to get better sleep or learn better sleep habits? According to Robbins, cognitive behavioral therapy for insomnia can be very helpful. Relaxation training can be beneficial. She also spoke of the necessity of stimulus control. This includes using the bedroom only for sleep (or sex), only sleeping in the bed (not on the sofa or in the recliner), decreasing the temperature of the bedroom toward seventy degrees, and making sure that you are sleeping on a good quality mattress. Despite the holy grail of trying to get the most beneficial effects out of the least amount of slumber, conventional wisdom still tells us that most people do best if they get from seven to nine hours of sleep per night.

I would encourage you to check out this podcast, Chasing Life with Sanjay Gupta MD, for more interesting insights into the pandemic, our responses to it, and how we are entering the post pandemic phase and are beginning to figure out what is means to live normal lives again.

Flag Day

It was the Wednesday or Thursday after the worst ever terror attack on US soil. Our area, like many parts of the United States, was in shock. We did not know much yet, just the sketchy details of what lead to two planes crashing into the Twin Towers in New York City, another into the Pentagon in Washington, and another that was diverted downwards into a field by the brave passengers who learned that it was headed for the capitol rotunda. We were in shock, yes. Were more attacks imminent? Would something happen in our town? Were we safe? Were we at war? So many questions, and precious few answers to ease the anxiety we all felt that day and the days that followed.

What did we do to keep ourselves sane that week, to keep the thoughts from screaming inside our heads and the tears from flowing down our cheeks? We sought out home, family, and churches and other houses of worship. We went for comfort food, warm gatherings with friends and family in places and with items that made us feel safe, secure and more at peace. And we did one more thing.

We wrapped ourselves in the flag. The American flag. Old Glory. The Stars and Stripes. Flag stickers quickly sold out everywhere. No flag decals for car windows could be found in stores, but were displayed proudly on almost every car you encountered on the street. Those flag sets that you can buy at Lowes? Sold faster that they could restock them. Flags popped up everywhere. It was amazing.

At my house, we had a large flag that had been flown over the capitol, and it had never been displayed after that. I found it, unfolded it carefully, and then with great pride and great care managed to hang it on the front porch of the house, in front of the double set of French doors. It took up about a third of the facade of the house, and wrapped us like a red, white and blue security blanket for weeks if not months after that. We displayed it as a point of pride. We displayed it as a celebration that the country was still sound and running and cohesive and strong, even after those magnificent buildings imploded, sending showers of concrete and steel and glass and bits of paper, thousands of bits of paper, swirling into the streets of Manhattan. We displayed it as an answer, as a rebuke of terror and fear and hate. We displayed it as the embodiment of the American spirit, still strong even after losing so many of us on that dazzlingly bright blue September morning.

As Abraham Lincoln might comment if he were with us today, we are now met on another great field of battle, not one with planes used as bombs but one that sickens and kills the most vulnerable of us, a battlefield that starts with an invisible enemy and leads to the whoosh whoosh whoosh of a ventilator and the last FaceTime call a weeping relative will ever make. So many questions, still so few answers, though we are further along than we were just fifteen months ago. In this column, I have been talking for a year about the grief, the pain, the depression, the anxiety, the reentry, and the coping skills that have been involved with seeing us through this worst pandemic in a century in America. Many of you have been ill. Many of you have lost someone close to you.

Now, on this Flag Day, we are again in need of a rallying cry and a symbol or two that will help us go the last mile to make it through the last phase of this viral pandemic. We need to proudly display the flags of knowledge, good judgment, well thought out decisions, and good will. We need to wrap ourselves in the red, white and blue of science, teamwork and determination. We need, just as we did on those days after 9-11, to get the facts, grieve if we must, fight because we have to, and move forward in lockstep as only America can to see the dawn through the settling ash and mist of illness and death.

On this Flag Day, be proud, be compassionate, be helpful, be smart, and be resolved that there is nothing, given enough time, resources and indomitable will, that Americans cannot do. The end of the pandemic in our country is in sight. Carpe diem.

Reentry

Reentry

 

 

Did you watch any of the comings and goings of the Crew Dragon capsule as it went up and down from the International Space Station? It’s a sleek, slick, dazzling white, truly space age looking piece of hardware that has now ferried several astronauts to space and back as part of the partnership between SpaceX and NASA. I decided to watch a video on the You Tube channel Everyday Astronaut to learn more about how this tiny capsule gets back to earth once it has been in space and docked for a while. I would encourage you to check it out.

 

Spoiler alert: this last mission resulted in the first successful water splashdown since 1976. That being said, what were some of the most interesting facts about the timeline and process of bringing this little capsule and its human cargo home safely to earth? First of all, once the Crew Dragon backed away from its home away from home, it had anywhere from six to thirty hours until possible splashdown. That’s quite a range! As it entered  the atmosphere of our planet, its heat shield was turned to face forward in the direction of travel, having to withstand temperatures of 1900 degrees Celsius, and G forces of three to four times earth’s for the crew inside. The air that rushes towards the speeding capsule has little time to get out of the way, is superheated to half the temperature of the surface of the sun, and is compressed into what is called plasma, all of which puts tremendous pressure on the capsule and its contents.

 

Once the capsule did make it past the blistering heat of the atmosphere and was free falling towards the water, it had to be further slowed down, first with two small parachutes that oriented it for its final descent. Then, four main parachutes partially opened, then fully opened to help the capsule gently settle onto the surface of the water. The exact timing and manner of deployment of these chutes is critical. Too fast and they simply won’t open, too slow and they will not slow the craft enough to prevent a hard landing on the water. It was picked up, placed in a “nest” on the recovery ship, and saw the extrication of astronauts who had been in space so long that they could barely negotiate one atmosphere of pressure and could barely stand without support. As the host of the Everyday Astronaut video stated, “The entire system makes reentry safe.”

 

Now, think about where we are today in this pandemic cycle, which officially started in March of last year. We are battered, bruised, tired, grieving, and so ready to re-enter our prepandemic lives. We would like to think that we can just magically return to what we did, how we acted and talked and functioned in January 2020. The truth is, just like Crew Dragon, we have been docked for over a year, in one way or another, stuck in our homes, working out of closets and bedrooms, teaching kids at the dining room table, talking to coworkers, friends and family by Zoom, emotionally weightless. Now, we are ready to suit up, get back into the capsule, back away from being forcibly tethered to pandemic life, and head for freedom. What will it take to do this? What will it cost us to get back on the ground?

 

First, just like the crew leaving the space station, we must be protected. We cannot do this alone. We must orient ourselves in the proper way so that we can face the onslaught of heat that will be coming our way in the form of social gatherings, parties, dinners, school activities, sporting events, church gatherings, and family outings. It is going to be wonderful and brutal all at the same time. Is your calendar already filling up like mine? We need a heat shield. This may come in the form of a good support system, good self care and good habits like exercise and getting enough sleep. The events and obligations, like the air that cannot get out of the way of the capsule and is compressed into super hot plasma, will rush at us so fast that all we think we can do is say yes and hang on for the ride. I would counter with the fact that if we have learned only one thing in this time of pandemic, it is that we can say no.

 

What are your parachutes? What will gently place some directional drag on your descent back into the helter skelter that was your pre-pandemic life? What will slow you just enough so that you can take your time, pick and choose your commitments and activities and interactions so that they will make you stronger, not dash you against life in a rush? Think about that now as you get vaccinated, as your mask comes off in more and more places, as you begin to hug friends and family again, and as you feel more comfortable in your own skin outside your own home.

 

Like the Crew Dragon astronauts, we will miraculously come through the fiery descent, get ourselves oriented in the right direction, gently slow things down to a manageable speed, and come out of our confinement a bit unsteady, but ready to accept the support that will get us back to our best selves for the years to come.

 

Happy reentry!

Cast Off

It happened too many years ago to remember now, but I still do. It was a time when we who labored in mental health could be more real, could actually connect with our patients in meaningful ways and even let our hair down from time to time and have some fun. A group of staff members were playing a group of patients in a friendly softball game in Aiken, a few miles from the mental health center. I was old enough to know better but still young enough to think that the teen athlete still lived in me, and you know how that always turns out.

 

I was taking my turn at bat, connected with the ball and drilled what should have been a solid single to right field. I should have been more than satisfied with that, but of course I wasn’t. I rounded first, saw that the outfielder was fumbling with the transfer from glove to throwing hand, and made a split second decision to stretch a sure single into a maybe double. Getting to second was easy. I was still moderately fast in those days. The next decision I made was not a good one, however. Without a clear need to do so, I decided to slide into second in a blaze of dusty glory. Bad move.

 

I knew that I had really screwed up when my left leg made contact with the base, which felt at that moment like a concrete block. The snap was audible, the pain immediate and the shame followed close behind. When I tried to get up, I saw an acute angle between leg and foot that was not at all natural. Not good. A short ride and check in at the emergency room later, I was not at all comforted by the well meaning nurse who told me that “only really active people get injuries like these”. You know the drill. Ortho tech, clean it up, put it in a cast to the knee, get fitted for crutches, see ya in a few weeks.

 

The hardest part about being in a cast for those long weeks, besides not being able to take a real shower without wrapping my leg in plastic bags? I couldn’t walk with crutches and carry a coffee cup at the same time. This, my friends, is the definition of crisis. But, of course, like many weekend warriors, I made it through.

 

Fast forward to the doc’s office on the day that the cast was coming off. I had lost about half the muscle mass in my leg, and I was more than a little worried about taking away the plaster exoskeleton that had held me up for those weeks. Would I fall down? Rebreak the leg? Be able to do the things that I could before the injury? Getting the cast off felt so good in one way, with cool air on skin and mobility that I had missed terribly. But the worry about reinjury or weakness or worse still gave me fits for a few days, until I knew things would be okay again.

 

Now, forward to March 13, 2021. The CDC decides that after more than a year, those who are fully vaccinated against COVID-19 can shed their masks indoors and out, around people who are also fully vaccinated and those who are not. This seems to come so suddenly that it catches us off guard.  After being so careful for so long to avoid exposure, protect ourselves against infection and illness, we are now told that all is clear and safe! To me, it almost instantly brought back memories of taking my cast off, something that I was more than happy to shed, but with the anxiety of what my health would be like after it was gone.

 

Protections, even if restrictive and painful in the short term, often make us feel safer in the long run. Removal of these restrictions is exhilarating but can be frightening at the same time.

 

When I was recovering from my broken leg, just as we are now seeing the beginning of the end of the COVID-19 pandemic in the United States, letting protections fall away was the only sure way to test ourselves and our safety going forward.

 

The second half of that lesson is also clear: testing ourselves is the only way to grow.

Languishing

How have you felt lately? Really?

Good? I am happy for you. Depressed and hopeless? I sincerely hope that you are seeking help and on the road to recovery. The rest of you? My hunch is that you may be feeling a little flat, not motivated, and “meh”. This is weird, right? Vaccines are here, many of us are back to work, things are opening up a little bit, and the warm sunshine of spring and the promise of summertime should be brightening our days. Why then, do we still feel a lack of motivation, have trouble concentrating and find it challenging to focus on the things that matter to us?

Adam Grant, an organizational psychologist at Wharton, addressed all this in his April 19, 2021 article There’s a Name for the Blah You’re Feeling: It’s Called Languishing. He pointed out that we are not depressed or hopeless. We are not impaired. We are functioning daily. We are not burned out. There is just little joy and we feel aimless at times. We lack anticipation for the good things that we used to look forward to.

According to Grant, languishing is a sense of stagnation and emptiness. We are muddling through, and as some of my patients have said in the past “existing but not really living”. Many of us who have had COVID and recovered or those who have not had the illness at all are struggling not with long COVID syndrome, but with “the emotional long haul of the pandemic”.

Think back to early spring 2020. We were all a bit frightened, unsure of what was happening in the world around us that was heading our way. Back then, according to Grant, our natural threat detection system was “on high alert for fight or flight”. We learned that masks were helpful, but we were still scrubbing surfaces and sanitizing our groceries. We developed crude routines that “helped ease our sense of dread”. The problem is that as time has gone by, our acute state of anguish “has given way to a chronic condition of languish”. As languishing is squarely between depression and flourishing, we don’t feel bad but neither do we feel back to our pre-pandemic good either. Grant says that “you’re not functioning at full capacity. Languishing dulls your motivation, disrupts your ability to focus, and triples the odds that you’ll cut back on work”.

The term was coined by a sociologist named Corey Keyes. According to the article, his research suggests that these who are languishing today are going to be at much higher risk of developing depression and anxiety over the next decade. That second great pandemic wave you’ve heard about? It may be psychological, not purely medical. Grant also says something about languishing that hit me: “You’re indifferent to your indifference.” You may not even realize how slowly you are sliding into the malaise.

So, what do we do with all of this? Grant says that one of the best ways to handle emotions is to name them. In the spring of 2020, we were all obviously experiencing acute grief, from loss of loved ones to loss of freedoms to loss of routine to loss of income. So many losses. Now, we learn that we are languishing, and naming it may be the first step in battling our way out of it. Languishing is “common and shared” and just knowing that may give us the ability to bestow a little grace not only on others but on ourselves.

What next? Focus. Relearn, if you must, how to pay attention to the things that are important to you. I am the worst when it comes to this, so believe me when I say I am not preaching to you. Grant says in his article that “computers are made for parallel processing, but humans are better off serial processing”. Simply put this means do not try to multitask! Again, I have five or ten or fifteen things that I must do, want to do, love to do, and I delude myself into thinking that I can do five of them at a time extremely well, but this is simply not true. Pick something, make it realistic and doable, and put your whole focus into it. You’ll feel much more accomplished and maybe even happy if you do!

Set boundaries and block out time for yourself. A colleague and I were talking about this by email just this morning. We need processing time, thinking time, planning time. I know it is hard to come by when you are working from home, taking care of the kids and responding to emails and Zoom invitations all day, but it is worth aiming for.

Grant tells us to focus on small goals. “Try starting with small wins”, because the pandemic was such a big loss to us all. Don’t be too easy on yourself though. Pick something moderately challenging sometimes. “The most important factor in daily joy an motivation is a sense of progress.” Do things that matter to you.

The article finishes up by acknowledging that “languishing is not merely in our heads-it’s in our circumstances”. “Not depressed doesn’t mean you are not struggling.” As one of my patients told me that other day (I told him I would steal this and he agreed), “Just because I am smart and can articulate what is going on with me does not mean that I can fix it.” Don’t let yourself languish, isolate and fall into the pandemic abyss. Use the tools outlined in this article, use your support systems, and get professional help if you need it. We are so close, and we will get there together.