Diamonds in the Rough

According to the Smithsonian Magazine, diamonds are formed deep within the earth, about one hundred miles down in the upper mantle. As you might imagine, it is quite hot in that part of the planet, and there is a tremendous amount of pressure bearing down in that location. The brutal combination of pressure and heat is what it takes to form diamond crystals. Now, we can’t actually travel there or even adequately sample the earth at that depth, so how did the diamonds that we mine today get brought to the surface? The Smithsonian tells us that huge, violent volcanic eruptions, like none we have seen in our lifetimes, carried the newly formed diamonds upwards in channels that made cooled lava formations called Kimberlites, and that these conduits ran at twenty to thirty miles per hour. Why is that important? Because if they had transported the diamonds any more slowly to the earth’s surface, once they got here and the eruption cooled, all that would have been left was lumps of graphite. The diamonds had to be rushed from the fiery pits of hell to the coolness of the surface rapidly, and the changes that they endured created some of the loveliest crystals that man has ever seen. Formation may have taken forever, but transformation, ah, that happened very quickly. By moving quickly, these diamonds got locked into their crystalline structure, and there was simply not enough energy available at their destination to ever turn them back into graphite. Diamonds are made of carbon atoms that bind to each other extremely strongly, each carbon atom joined to four others. Once they have made the turn and become the diamonds that we know, there is no turning back.

I have heard many stories over the last ten months. I have heard the lamentations of those who feel downtrodden, alone, forgotten, with moods as dull gray as the graphite one hundred miles below the surface of the earth. I have heard the stories of the white-hot heat of grief as a loved one is lost to COVID-19 or another illness. I have heard the stories of the volcanic eruption that occurs with the loss of a job, the loss of income, the loss of a home. I have listened as someone describes the tectonic shift of being displaced, turned out, evicted, down sized. I have heard and witnessed the rapidity with which one can be faced with the loss of a business that took decades to grow. The people of our planet have been forced to deal with rapid, forceful, painful, monumental change in the short space of ten months. Ten months. We did not even know exactly what COVID-19 was this time last year.

Like diamonds, the most marginalized and ostracized and forgotten among us have been thrust upwards on a hot wave of change that threatens, if it goes on too slowly and too long, to reduce us to nothing but gray ash. The upside of the pandemic? We have been forced to change the way we see our world, our work and our worth as we think outside the box, learning to be teachers, learning to conduct meetings online, learning to find new income streams by learning new skills. We have been forced to change so rapidly that we have found new bonds, strong bonds, that no virus can break. We have been transformed into shining examples of resiliency. We have lived and loved and mentored and supported each other.

Some of you may even now think of yourselves as gray, sad, and worthless. No. As you have been carried along by this 2020 volcanic wave of change, you have been made stronger than you think. Those four bonds, six bonds, a dozen bonds that you have nurtured this past year have transformed you into something bright, shining and capable of surviving anything that COVID can throw at you. Use those bonds. Be strong for yourself and for those around you. Polish yourself any way you can so that when this ends, and it will end, you will no longer be a diamond in the rough. You will be clear eyed, look toward the future and know that you have survived the fastest and most challenging medical threat in a hundred years, and that you have emerged with a clarity that nothing can ever take away again.

It’s a Pandemic Life

I have had more than one patient tell me that although they have no specific plans to kill
themselves, they sometimes just wish that they had never been born. They are so depressed
and hopeless and have so little regard for themselves that they feel that anyone who lives with
them or loves them would be much better off without them. In this time of the coronavirus
pandemic, these feelings have been intensified. Losses mount for some. Loved ones grow ill and
die. Jobs disappear, and with them the ability to pay for food, clothing, rent and even gifts for
the children at Christmas. Think of it. The people who count on you for their very lives and
support are the ones who you think might be better off if you had never existed. Ironically, it is
the strong attachment to those people, especially young children, that often saves us from
ourselves and pulls us back from the brink of an irreversible act of self-destruction.
Have you seen the movie It’s a Wonderful Life? I highly recommend this 1946 film starring
Jimmy Stewart and Donna Reed. George Bailey, played by Stewart, has spent his whole life
giving of himself to the people of his hometown, Bedford Falls. On Christmas Eve, George’s
Uncle Billy loses an $8000 deposit from the Building and Loan that George runs, which is found
by the town’s villain, Mr. Potter. When Potter hides the money, George is in very real danger of
being arrested for bank fraud if an examiner discovers that the money is missing. Thinking that
his wife, his young children and others who love him will be better off without him, he
contemplates suicide. After crashing his car into a tree, he walks to a bridge and is planning to
throw himself off. The prayers of all those people reach heaven and an angel named Clarence is
sent to earth to help George, promised that he will earn his wings if he is successful. Clarence is
able to show George what the world would have been like if he indeed never had existed, and it
opens his eyes. He is able to see all the blessings that are his, the people who care for him and
the fact that love and togetherness and a mutual respect for each other can conquer any
problem.
No doubt, there are many people who are hurting this holiday season. There are those who
cannot take care of their families, who do not have a job, and who feel that life would be better
for those they love if they had never been born. Like George Bailey, they may be thinking of
suicide. But also like George, many of these people may have a Clarence just begging to help
show them that they matter. We sometimes feel that we can do little to change the course of
history or the arc of misery that the world seems to be on. Think about this holiday season and
how you can play the part of Clarence, Angel Second Class, for someone you love. Can you tell a
story and share a memory of a good deed done? Can you offer a smile? Can you send a note
thanking them for the influence they had on your life? Can you drop off a meal or Christmas
cookies or a small bag of toys for the children at the front door? Can you give a card and more
of those cookies to the postman who brings your mail every day?
Especially in this time of pandemic, in this holy season, it is important to count our blessings
and use our time and talents to help those who need it most. Who knows, if you are successful
in making the holidays bright for just one desperate person, you might just earn your wings.

Fatigue

Words are interesting, aren’t they? I love to use words to convey meaning, to educate, to enlighten and to try to persuade. We all use words that we are familiar with, that we understand and that are part of our normal vernacular. We get used to these words as ways to express a familiar thought or idea that we hold dear or that comforts us. The interesting thing about the English language is that many of our words have nuanced definitions and can be used to express many similar or related meanings.
Fatigue is one of the words that comes to mind for me lately. When we look to the Merriam Webster Collegiate Dictionary definition of fatigue, we find several aspects of this word that pertain to our current situation as we struggle with pandemic life.
First, a definition that was certainly not top of mind for me. “Manual or menial work, such as the cleaning up of a camp area, performed by military personnel.” There is also a corollary definition that goes with this, being “the uniform or work clothing worn on fatigue and in the field”. Think about many households now as young families struggle with educating their children at home, cooking and eating many more meals at home than usual, and having one or more adults working from home at the same time. This scenario has created home landscapes akin to domestic camp areas, staging areas for vocational, culinary and educational missions that were often outsourced and performed far away from the home just a few months ago. We are constantly “cleaning up the camp area” while wearing the new uniform of 2020, shorts, tees, sweats, and Allbirds, trying our best to be efficient and productive while staying as comfortable and low key as possible. For the most part, I think we are succeeding admirably in spite of all the odds against us.
The second definition is more the traditional one that we think of when we think of fatigue. “Weariness of exhaustion from labor, exertion, or stress.” We have all felt this in one way or another over the last seven months. We are working hard, sometimes in vastly different ways or in different places than we are used to. We are caring for families, our coworkers, and others at the expense of caring for ourselves. Some of us have fallen ill with COVID-19 and that has given an entirely new meaning to fatigue for us. Physical weariness that precludes meaningful activity and productivity wears on one’s body, mind and soul. Even if you want to get up and actively engage the world, sometimes a physical illness like COVID-19 stops you in your tracks and says, “not today”. This fatigue, unlike the camp that can be tidied and cleaned, must be managed until it has passed. It is insidious, long lasting and debilitating.
The third definition that caught my eye was the one describing “a state or attitude of indifference or apathy brought on by overexposure (as to a repeated series of similar events or appeals)”. Now, this definition encompasses several different aspects of our current lives in the time of COVID-19. Not only are we feeling extremely overwhelmed by the pandemic and how it has disrupted our daily lives for months now, but we have been dealing with racial tensions, economic stresses and political dissent and strife as we approach one of the most contentious presidential elections our country has held in our lifetimes. When there were fifteen cases of COVID-19, the threat felt small. When there were one thousand deaths, we felt that this was something terrible. Fifty thousand deaths were almost unfathomable. One hundred thousand deaths were unbelievable. Now, we have had eight million cases of COVID-19 in our country and well over two hundred thousand deaths. We have been seeing and hearing these numbers for so long now, and in such quantities, that we are numb to them. We are fatigued. It is harder and harder to muster compassion, much less hope that things will eventually get better. On top of the ongoing pandemic and its stresses, add the civil unrest, the political intrigues and countless ads on television and in the news, and we are simply bombarded with negativity that further numbs and chastens us.
What to do?
See things as they are. We have already found that one cannot wish away a viral pandemic. It will run its course, relentlessly, until we either achieve immunity overall or we have a workable vaccine. We cannot make the government attend to our financial needs. We have had to be creative to find work and put food on the table. We cannot fix racial unrest and social inequalities overnight. These changes can come, but it will take much time and much work by all.
Limit negative exposure. Keep up with the news, but only in prescribed amounts and at certain times. Constant exposure to negativity and stress will only increase social, emotional and physical fatigue.
Act. Plan. Work. Vote. Talk. Collaborate.

One final definition of fatigue that Webster’s offers us? “The tendency of a material to break under repeated stress.” We do not want to let ourselves get to that point, do we?

Gimme Shelter

Gimme Shelter

Ooh, a storm is threatening
My very life today
If I don’t get some shelter
Ooh yeah, I’m gonna fade away

The Rolling Stones

Shelter. It’s a safe sounding word, a comforting word, a good ending to the story word. We have all needed shelter at one time or another in life, if just to lay our head on a pillow for the night and sleep to be able to face another day. What is shelter, exactly? Well, Merriam-Webster tells us that a shelter is something that covers or affords protection, or an establishment providing food and shelter. There are shelters like lean-tos in the open forest, homeless shelters in inner city neighborhoods and animal shelters that care for strays until they might be adopted. Remember Maslow’s Hierarchy of Needs? Shelter fits right into those bottom two sections of the pyramid that talk about basic needs like food, water, rest, security and safety. If you do not have these basic needs, safe shelter being one of them, then it is very difficult to focus on the more complex, higher needs like relationships and self-actualization. 

I have worked in and around shelters run by the Red Cross and other organizations in times of need, and maybe you have too. The traditional shelter layout that most of us envision is a very large, somewhat open space like a church parish hall or a gym, with room for the cots and belongings of hundreds of people who for some reason need to be there. These people are very close to each other, sleeping just a few feet apart. There is usually some kind of communal eating, with shared tables full of foodstuffs and community coffee pots. There are often common bathrooms, albeit cleaned and monitored to the extent possible. Helpers and volunteers often work in very close proximity to those in need. There were some days during my deployment for Hurricane Katrina in Mississippi and Louisiana that I would talk to literally hundreds of people a day, some for one minute, some for fifteen or thirty, depending on need. We worked, ate, comforted and rested in very close quarters. There has been the need for this type of sheltering and aid during Hurricane Laura and now during the catastrophic wildfires in California, some of the worst ever. 

Shelter has recently become a concept and an operationalized idea that is fraught with challenges. The age of the COVID-19 pandemic has turned on its head the idea of getting many dozens or even hundreds of people in the same large room, living and eating and breathing in the same vicinity, for days if not weeks at a time. This is virtually impossible. Or is that the key word? Virtual?

We have all been asked to shelter in place for varying lengths of time since the start of this pandemic. We have found ourselves staying in our homes for days, weeks, or even months at a time, with little contact with the outside world or even with others in our own extended families. We have made makeshift home offices, set up school environments for our children, ordered our groceries and meals from companies who will deliver to our door, and driven by for curbside pickup of everything from internet purchases to communion. We have found that parking by school busses that are reconfigured to be WiFi hotspots might be the most reasonable way to stay connected while still sheltering in place, that place being the family vehicle. Our concepts of normal work, education, and providing for our families have been significantly challenged, altered and modified, some perhaps for the foreseeable future. 

What is the new meaning of seeking or providing or benefitting from shelter? There are several aspects to this new pandemic-inspired concept. 

First, there will always be the physical component. The facts as we know them now mandate that we continue to exercise caution in the form of physical distancing at least six feet from others any time we are outside our safe zones, which for most of us is our own home. This physical distancing, combined with wearing face coverings, gives us the ability to essentially “shelter in place” no matter where we are, so that we can roam a little more freely to get groceries, fill up the car with gas, or make short trips as needed. 

Emotional support is going to be an ongoing need. This is hard. No question. I talk to people every day who are tired of being cooped up, tired of not seeing their loved one and friends and tired of basically being on house arrest. We are human animals, and we crave social and emotional togetherness, closeness and community. That is never going away, but it must be tempered until this pandemic goes away for good. Connectivity that leads to communication is key. As discussed before by many others, use FaceTime, Skype, messaging apps, email, phone calls and even good old fashion letter writing to keep in touch with those you care about. The need for connection does not go away just because physical distancing is necessary. 

School has been a huge issue for many families over these last many weeks. How do we go back to school? When do we go back? For how many days each week? Virtual versus hybrid versus online versus paper versus-you get the idea. Kids must be sheltered and protected even as they learn. This may be in the classroom with plexiglass and masks, or it may be at home with Chromebooks and headphones, or a combination of both. Education is paramount, but safety is on the hearts and minds of everyone who has ever taken on the wellbeing of a child as a primary responsibility. 

Daycare and the ability of parents to work is another major component of this new sheltering in place idea. Are parents able to supervise kids while still doing their own jobs at home? Must in home childcare and supervision be obtained in order for parents to go back to the office? Are kids sent back to school rooms that have been modified based on current knowledge in the hope that teachers and kids will all remain healthy? 

Almost by definition over the last six months or more, we have been physically and socially distanced, but we are still very much emotionally connected. That connection and common purpose are the only way that we will survive the stresses of the pandemic, social upheaval, climate change, and an economic downturn that has impacted so many in our country. Educate yourself. Challenge suppositions that seem spurious or nonsensical to you. Protect yourself and your family in the ways that you feel are scientifically based, logically thought out and that are in the best interest of all. 

Rhythms

My mother buried her husband this past week, the second man she had to say a tearful goodbye to after her had endured a protracted illness. The first was my father, who passed away suddenly, almost violently, from a brain hemorrhage twenty five years ago. It got me thinking about a lot of things, as these events and times do. I began to think about them in the context of the rhythms that they settle into.

We are born into this world, we hope, the objects of joyful celebration, welcomed to the world with open arms and warm fuzzy blankets and the kootchie-cooing of adoring parents and grandparents. If we are lucky, we are loved. Undeservedly, unequivocally, unabashedly, unconditionally loved. We are cared for and nurtured. We grow and learn and succeed. One day, we head out into the world, adults who know nothing ready to control everything, only to finally realize that our true education has just begun. If we are smart and savvy, we learn even more about how things work, how to live and love in a harsh world that owes us nothing, nothing at all. We create, we procreate, we work, we amass, we collect, we build, we inhabit, we settle in for that delicious part of life which is the “we made it” part. We expect that “we made it” leads to “we earned it” leads to “we deserve it” which gradually morphs into “it will always be this way” and “no one can ever take this away from us”.  The train is heading down the track at a dizzying speed, wheels singing on rails and billows of black smoke trailing behind to darken the other fellow’s sunny skies, not ours. Not ours.

Then, a once in a century, a once in a lifetime event happens for the second, third and fourth time. The hurricane leaves nothing but concrete slab and green slime-infested pool at the edge of a sunny shore that once heard the laughter of children and now hears the wails of retirees who find that their physical address, what is left of it,  has moved over three streets. The lingering siren that warned of the monster heralds a dawn in which the rubble is piled three stories high, the muddied teddy bear and the family album strewn across a neighborhood that no longer has landmarks of any kind after the wrath of the mighty winds visited. A casket is lowered into the ground, a tiny one, and is covered with earth, covering hopes and dreams and sleepovers and play dates and senior proms and trophies that will never be displayed, all because of a stray bullet that was stopped by the innocence of a child.

We are born. We grow. We dream. We work. We love. We die.

The virus creeps in on Sandburg’s little cat feet. Yes, I can’t get that descriptor out of my mind in the past few months because it seems like everything that hits us, hurts us, kills us comes in that way nowadays, gliding on silver airplane wings to knock down buildings, hissed in a a quiet string of expletives designed to hold us down, or breathed quietly towards us, inhaled death. Quiet. Stealthy. Deadly. The rhythm of death.

I’m home. I work every day. I talk to everyone and yet touch no one, shake no hands, pat no one on the back, proffer no gifts except my words. The rhythms of this daily pandemic grind are cold and mocking. Upstairs to work. Listen to music that used to soothe but now just bores. Hear the rumble of the construction workers’ trucks and trailers heading into the area to work. FedEx truck by for the first of one, two or three routes that day, always before ten. UPS truck (What can Brown do for you?) close on his heels before noon. Construction guys to lunch, sans trailers. USPS truck chugging out and back, albeit later than usual these days. Rhythms. The daily grind of good coffee and hard work and tedium and our inexplicable complacency with mediocrity of leadership and one thousand deaths per day.

And yet, we do it.

And we do it again.

And we do it again,

until,

one day,

we understand

why.

The masks come off,

and we smile.

Covidisms: Does It Pass the Smell Test?

  • I think I have washed my hands more times in the last five months during this pandemic that I did the entire time I was in medical school, including my surgery rotations. I work most of the time in my “new” home office that is in the guest bedroom, seeing as how we have very few guests just wandering through this year looking for a place to lay their weary heads. There is of course a bathroom a few steps from my desk, so I am usually washing my hands in there at least a half dozen times a day. Now, we have various soap dispensers around the house upstairs and down. The one that I have been using most recently has the scent lemon verbena. I have never had the pleasure of washing my hands using lemon verbena scented hand soap, being a lavender/mint/rosemary kind of guy usually, so this was an eye and nose opener for me. The smell is sort of pungent, acerbic and brisk, which is not to say pleasant but not altogether unpleasant either. I just decided after a few days that if I was going to have to make my way through an entire bottle of this stuff, I might as well make the best of it. I taught myself to appreciate hand washing time in the upstairs bath with the lemon verbena, because if I could still smell the stuff, it was highly unlikely that I had caught the COVID. Instant daily testing at home!
  • Another way we take the COVID challenge a couple times a week is to ride our bicycles up what we now have affectionately dubbed “COVID Hill”, an undeveloped street that seems to go almost straight up for a quarter mile and is enough to make you wheeze and gasp for breath on even your best days. This street is so steep that we often have to zig zag all the way up to the top, instead of pulling it in a straight line. Much like lemon verbena scented hand soap, if you make it up this particular hill, ain’t no way you got the COVID.
  • I got my second pandemic haircut the other day, because I just can’t stand it when things get shaggy and unkempt. I wore my mask, sat in the car until my appointed time, went in and was taken back by Carlene, who has cut my hair for years now, and proceeded to get cleaned up. There were two other people in the shop at that time, Kim, the co-owner who had cut my hair all the way back in medical school times , and one other stylist. As I was getting clipped, I heard a loud, drawn out, almost ecstatic moan of pleasure from across the room behind us. “It feels soooooo good to take this thing off at the end of the day!” the employee said as she removed the mask she had undoubtedly been wearing her entire shift. Without missing a beat, Carlene turned towards her and replied, “Yes! Just like taking your bra off at the end of the day. I don’t know which is better!” Now, I am not usually one who is shy about throwing down and adding my own quips or jokes or whatever, but I was so stunned by this that I just sat there and smiled. I think in this day and age, that was probably the right decision and the smartest move.
  • It is close to September, which is close to October, which will be my 63rd birthday. I have almost made it. I was talking to my brother about the latest worldly stresses, and I said that if the COVID didn’t get me, I was going to live to be older than our father was when he died suddenly of a brain aneurysm at age sixty two, just a couple months shy of his 63rd. “I think about that every day”, said my brother soberly. Come to think of it, so do I. I told my wife about this little exchange at the end of a very long, very hard week, and I burst into tears. “It makes me so sad. I can’t help crying.” Being the wonderful woman and loving wife that she is, she softly said, “I love it. It makes you human.”
  • I had one other little episode the other day that was weird. My wife was gone to Europe, flying a work trip, and I was alone at home. I was watching TV, doing the usual stuff, when all of a sudden I was overcome with a brief, fleeting feeling of doom/panic/dread/fear/hopelessness/anger all rolled up into one. It lasted mere seconds, I made a little gasp, took a couple of deep breaths, and it was gone. I was fine. Has this happened to you? COVID angst I guess. It has to find a way to come out sometime, somehow.
  • Lastly, it is almost sunset at 8:15 PM as I write this. Though in some ways this has seemed like the longest summer ever on record, it is already starting to wane, and fall is coming. What will it hold? More COVID? Flu? Both. Working at home? Football or not? Will the holidays be anything like normal? Fall is my favorite season and time of year, but this one will most assuredly be different. I guess all we can do is keep working, riding bikes, having birthdays, getting our haircut, and living life as it comes to us.

Take time to stop and smell the lemon verbena. It may let you know that you don’t have the COVID.

 

 

 

Plandemic

Remember when you first heard about the coronavirus? Were you watching the news on television, did you read a brief article in the newspaper, or did you have something served up to you via Google News? How did you feel? Perplexed? Anxious? Indifferent? Terrified? I know, trust me, it was probably a little bit of all of that rolled into one long, gaspy, chest-tightening, lump in the throat kind of fog that you found yourself in those first confusing days of what was an epidemic growing into a worldwide pandemic. It’s only in Washington state, we thought way over here on the east coast. It’s only a few people in a nursing home. It will be treated and contained quickly, and then it will “magically disappear”. Not so, I’m afraid.  As I write this, as of nine minutes ago, there have now been almost five million cases of COVID-19 in the United States, and one hundred sixty thousand people have died of the disease.

When you knew, really knew, that this pandemic was real and that it would eventually make it to your state, county, city and neighborhood, what did you do? Not what did you feel, but what did you do? My hunch is that on some level you began to plan. Maybe not even consciously, but on some level your brain started to play out scenarios that might happen, just like moves on a chessboard on the way to checkmate. There was, very quickly, the problem of finding and wearing masks. N95s, even simple surgical masks, were like gold. My wife, just like some of you, sewed a few cloth masks from an old Oxford shirt of mine, elastic at various lengths, some too tight on my ears, others just right. Bulky, blue-striped, sweaty, but effective. This very simple thing lead to other acute decisions that needed to be made: where and how to work, the potential for layoffs, how to help the kids finish up the school year, how to make sure that the bills were going to be paid, how to keep our families and those around us safe and well. We started to plan for a crisis that we thought at first would be like any other crisis. This epidemic soon to be a pandemic would sucker punch us in the gut, we would exhale, recover, and then move past the acute trauma, getting back to our old lives by Easter, Memorial Day at the latest.

When that did not happen, our brains, which had been humming in the background, running all those potential moves, went to the next step of our response. We had to come up with a continuation of our plan A, a more detailed, longer term set of reactions and actions that would get us through what looked to be a more involved medical and social crisis than we had dealt with for a long time. Some of us were laid off. Some of our businesses closed. We could not get a haircut. We could not go to the gym. We could not have a date night at our favorite restaurant. We could not visit. We could not hug. We learned the meaning of the thirty second commute and how to Zoom and work in Teams and find hand sanitizer. We were always planning, but to what end? How long? How so? For what reason, to what end? What next? What if? So many questions.

We have continued to plan. Now, we are facing not just working from home, but the very real prospect of working from home while educating our children. Six hundred dollars may have become two hundred dollars right before our eyes. Rent and mortgage payments are due. School supplies and books and pencils and possible laptops or tablets need to be bought. The internet access in our homes is not quite good enough for this whole distance learning thing. Assess. Analyze. Plan. Act. Repeat.

Are you overwhelmed yet? I know I am some days. What do we do in this, the worst pandemic in a century? Planning is key. A few pointers.

  1. Prioritize your obligations. Some things must be done. We know that. So just like the book Eat That Frog by Brian Tracy teaches, don’t leave the most stressful, most difficult decisions and plans to last. Do them first. For example, tackle how you will get your necessary bills paid first. All else can wait, right?
  2. Take care of those who depend on you. You know how stressed you feel? Your spouse or significant other knows it too. They might even feel worse than you. The kids? They are excellent little barometers of parental stress. They know. Don’t let them get overwhelmed but let them know some of what you are planning and doing and why. Work as a team.
  3. Make time for recreation and relaxation. I know, I know, there IS none. I hear you. We’re in Plandemic mode, right? We must plan, must schedule the time to do the things that are going to get us through this alive and healthy. I have learned one very hard but very important lesson over the years: no one is going to do this for you. You plan the time, you reap the benefits. Period. Do it.
  4. Reach out and connect to others. Call, message, FaceTime, Skype, fire up Teams, write a real letter! (Yeah, it will get there. This pandemic is going to last a while.)
  5. Get the facts about the pandemic. There is a lot of information and misinformation out there. You know that too. Don’t get embroiled in the religious, the political, the factional, the sectional, the cultural spins on this whole process. Learn about the science of this virus and the disease it causes. It is real. It exists. Don’t let anyone tell you otherwise. I have had people that I knew and worked with die from this disease. It’s no joke. That said, plan for how you can best keep you and yours safe and healthy until things start to go back to some semblance of normal. How long will that take? Truly, no one knows right now.

This is not an event that requires you to take a single punch, get up off the floor, and go back to your normal pre-pandemic life. This is a Plandemic. It is going to continue to require lots of rational thought, good decision making, and plain old common sense.

We cannot plan for an endpoint. When it comes, we will have one hell of a party, but for now, we must hunker down, learn all we can, make good decisions and wait it out. Stay safe out there.

Costco-vidisms, and Other Musings

I ventured out this week to get the tires on my car rotated and balanced at our local Costco. Now, I have been working at home most of the time since mid-March, with some time doing telepsychiatry and one clinical day on Fridays at the main mental health center office in Aiken. Other than that that, I have rarely ventured out at all, even to the grocery store, as my wife is the self-proclaimed “Food Lady” and does not require much of me in that department except for the occasional breakfast omelet making or steak grilling. I parked my Mazda 3 at the tire center side of the store, walked toward the entrance, donned my mask and got out my Executive Membership card, flashing it at the store employee as I made me way inside. So far, so good. What I saw shocked me, and at first I did not know why.

I could tell almost immediately that the store was different from the last time I had visited it, months ago. To my left, the wall made of fence-like material that usually held numerous, ads, signs and bolstered the stacking of merchandise, was free of any encumbrances at all. Clear. See-through, Airy, one might say. The height of the stacked merchandise on that side of the entryway was much lower than usual. To my right, the large screen televisions were socially distanced from each other. Granted as wide as these TVs are, they could be side by side and still be six feet apart from each other. Everything looked far apart, like one of those nightmares I used to have as a kid when everything looked over-sized and huge and menacing. I walked around to the auto service area, noticing on the way over that the rows of tables and chairs usually placed between the checkout line and the food court were all gone. Completely gone. I walked up to the auto checkin-checkout station and saw the high Plexiglas barriers that surrounded the desk and cash register area, little cutouts for exchange of paperwork and cards. After dropping off my keys, I made my way further into the store, back towards the seafood and wine and rotisserie chickens.

I was struck by the amount of merchandise that was NOT in the store. Granted, there was enough of just about everything you would come to Costco to buy, but there was not the excessive, pallet-driven environment of twenty four packs of everything, large bottles and over-sized boxes that made one frantic to overbuy while at the same time calculating available storage space back home. Huge fans whirred overhead. The entire upper third to half of the store itself was empty, clear, productive of good, proper airflow and circulation. I found the few items I needed, checked out, and walked towards the food area. My beloved vanilla-acai swirl, a treat reserved for tire rotation time, was no more! I was saddened by this loss in a silly, heartfelt way. Not having a seat to sit on or table to sit at, I stupidly walked towards the cardboard box corral, looked at my watch and figured that I could stand there for the remainder of my thirty minute wait time to get my car back. Which I did.

Why did this visit to Costco unnerve me? I got what I came for. I was not disappointed in the customer service at all. It dawned on me that this was the first time that I had decided to do out and experience the “normal” retail world in some time. At home, things are now routine. I work, eat, sleep, play, rest, relax and do almost everything else there. It is safe. I am healthy there. I do not feel threatened there. My world has not significantly changed there. Out in this new world, this world of distance and less stuff and six foot markers and Plexiglas everywhere, it is decidedly not normal any longer. I came to the realization, more vividly, that it may never be again. I went back to my home, calmer, more relaxed, feeling safe, but knowing that I will have to keep venturing out into this hostile landscape that some folks tell us will potentially get much worse before it gets better.

 

We have been attending church virtually for many weeks now. The Church of the Good Shepherd has learned, as we all have, to pivot with this virus, to use time and technology and virtual everything to stay connected with its parishioners and to try to keep us connected with each other. We have enjoyed “Good Morning Good Shepherd”, followed by a worship service that was at first quite traditional in its presentation, but that is now full of video and music and readings by parishioners and lovely tours around the summertime Summerville campus. We have even started having outside baptisms again, complete with baptismal font in front of the entrance to the church, masks and appropriate distancing and hand sanitizing.

Today’s service was especially poignant. The opening hymn admonished us to fight the good fight, run the straight race, cast care aside, and know that “Christ is all in all to thee”. Wise words of counsel in these very uncertain times, but oh so hard to do without much effort these days. Robert Lowry’s “How Can I Keep From Singing?”, sung in melodious tones by alto Rebecca Brune, was lovely beyond measure. Watch and listen to another wonderful version of this song here

Thro’ all the tumult and the strife, I hear the music ringing; it finds an echo in my soul-how can I keep from singing?

No storm can shake my inmost calm while to that refuge clinging; Since Christ is Lord of heaven and earth, How can I keep from singing?

 

Sometimes we need a little perspective. Watch this video if you feel that you are being put upon, that you are too stressed, or that we are facing more than any people have ever been forced to deal with and bear. It may change your mind, or at least put you into the river of time in the appropriate way and to appropriate degree. 

We rode our bikes on the Greeneway this afternoon in an attempt to get outside and do something physically good for us, as we love to do when we can. We ride this trail at least once a week now as times permits and always enjoy it. There are walkers, dogs, bike riders, in line skaters, singles and families using this wonderful community resource. It was very hot and humid today and we struggled on the uphill/out portion of the path, pedaling hard and getting a good workout. As the turnaround was in full sun, we rode a few dozen yards back up the hill and stopped to the side of the path, thought still on it and as out of the way as we could get, to drink some water and get ready for the trip back down to the start of the ride and the car.

Two other riders, one a middle-aged man and one a young man, rode towards us soon after we had stopped. With plenty of room to pass us on the opposite side, the older man called out in what I thought was a jovial tone, “Don’t stop in the dance floor, now!” They went on their way, down the short hill to the turnaround, then he came back past us, not really acknowledging us at all. The younger man, after turning around further into the neighborhood just beyond the end of the Greeneway, came back up the hill towards us as well. On the opposite side coming towards us, a family of five was walking along the path. As they arrived beside us at almost the same time that the young man was getting ready to pass us, he had to slow and stop to allow them to walk a few more steps past us so that he could safely whizz past us himself. This might have taken ten to fifteen seconds. We turned towards him and quipped that we needed to cool down a bit more before starting back and were sorry that he had to wait a few seconds to let the family pass. In an exasperated and exaggerated gesture, he lifted his head and rolled his eyes several times, sprinting past us on his bike, not saying a word. 

Now, as far as I know, the Greeneway is a community resource that is available to all, kids, families, novices riders, older riders like us and more. There are expected rules of trail etiquette, including allowing users of all skill levels to utilize the trail, and not blocking access or ability to pass for other users. When we stopped for water, we certainly did not mean to cause any impediment in access to anyone using the trail around us this afternoon, and the family that walked past us and engaged in friendly conversation certainly understood that. The young man who so rudely rolled his eyes at us and then sped past without a work of any kind, did not. 

If you are that young man in an Andy Jordan bike shirt who was so inconvenienced this afternoon that we shaved fifteen seconds off your out and back time, I apologize. I would only ask that you remember these things:

  1. We are in a global pandemic. Everyone is stressed. Everyone needs an outlet. Ours today was riding our bikes on the Greeneway with a heat index of 105. We meant no harm to anyone as we enjoyed that activity today. 
  2. My wife and I are in our sixties. We are happy to be able to get out and physically challenge ourselves in this way for exercise. You are not in your sixties. I would ask that even when you are displeased, that you respect your elders when showing that displeasure. 
  3. Lastly, I would hope that in this time of great stress for us all that you would develop a little more patience and show grace to those who are navigating this time with you. 

 

Tomorrow is a new week. I wish for all the peace and good fortune and grace that we are all going to need continuously as we move forward through this global crisis. 

 

 

 

 

Covidisms: Balance

I was standing there at the door, looking out the windows at the green space that fronts our townhouse, taking in the serenity and glad I was not out in the heat of the day just yet. Then, I saw him.

Our little green anole, who I have affectionately named Alvin, was sitting on top of one of the (to him and really, to me too) towering leaves of our elephant ear plant that stands just at the front of the house off the porch and threatens every day to block the dawn peregrinations of my neighbor. He was on the top leaf, not the largest but certainly large enough to make a nice platform for a few ounces of scaly green lizard.

He turned and saw me (he always sees me, sometimes before I see him, especially when he is hiding in the cucumber vines in the courtyard), gave that little sideways cock of his head and the side eye that says “Whaaaat?”, then turned away. He was splayed out on the top of this giant leaf, front legs lightly grasping (do anoles grasp?) , hind legs straight out in that “Oh, my God, if I did that I would rupture myself!” kind of way that lizards do. Then, he did something that cracked me up. He pulled himself up to the large notch that elephant ear leaves have, pushed his head through the notch slightly and scratched his chin! Not once, but three times. Like a small green bear grinding against a tree in a national park to scratch his back, but not.

I watched, now entertained and hooked. Alvin began to maneuver across this anole-green leaf (you just thought the lizard changed colors to match his surroundings…) sidling up to the edge, backing up slowly, finding that perfect balance between “ahhhhh….” and “AHHHHHHHHHHH!” He would inch up, further, further, further, until his Lilliputian girth would begin to bend the delicate tropical appendage down just a hair, just a a smidge, then back to let it spring back again to regain the post-summer-shower turgor that keeps these unwieldy leaves somehow upright. He was playing, was Alvin. Back and forth, almost to the point of no return and a slide down to the pine straw below, but recovering just in time to slither back toward the spine of the leafus pachydermous. He was playing, I tell you.

Alvin weighs about 4 grams. Not much of that is brain matter.

I weigh (considerably more than Alvin). My brain weighs three pounds on a hot summer day if I am reasonably hydrated.

I used my brain a lot today.

Alvin took time away from foraging to experiment with the turgor, tipping point and elasticity of elephant ear leaves.

I think Alvin had more fun playing today than I did.

Is there a lesson to be learned here?

Coronavirus and Mental Health

What are the major ways that the novel coronavirus and COVID-19, the disease that it causes, affect mental health? To approach that question, we must break this issue down into several component parts. First, a review of some of the things we know about this virus and the pandemic. Statistics and other basic information for this column are obtained from Wolters Kluwer UpToDate, which updated this topic last on July 14, 2020 at the time of this writing.  

Knowledge and information about the coronavirus 2 (SARS-CoV-2) is evolving rapidly, and we must be vigilant to be as on top of this as we can. COVID-19 has been associated with multiple psychiatric problems in various groups, including the patients who get the disease, their families, and those who care for them. Psychiatric symptoms and disorders may occur in clinicians who are exposed to COVID-19. For health care workers in China and Italy, sites of the early phases of the pandemic, anxiety was seen in 12-20% of workers, depression in 15-25%, insomnia in 8% and evidence of traumatic distress in 35-49%. Interestingly, a survey of clinicians in Singapore revealed 5-10% of workers were at similar risk, possibly in part because of their previous experience with SARS in 2003. If anything has become more clear to me as I work with patients as well as speak with friends and family members, the uncertainty that this pandemic has caused has been one of the most difficult aspects to deal with. What you do not know can indeed hurt you, emotionally speaking.

Has the coronavirus itself, or COVID-19 the disease, caused mental health or emotional problems directly? Few data are available on this subject. Of course, biological and psychosocial factors are surely in play here. Coronavirus can affect central nervous system function. We have all seen the recent reports of sudden cerebrovascular accidents in persons with no such history previously. Alterations in behavior, cognition and personality have also been seen. Retrospective studies have also shown that the virus can affect the brain directly, as encephalopathies, inflammatory responses and physical impairments may lead to neurobehavioral problems. One study cited by UpToDate showed that past viral epidemics had lead to neuromuscular dysfunction as well as the above symptoms. The fact that many people who are infected and develop COVID-19 are admitted to intensive care units may in and of itself lead to symptoms that are related to that extreme physical and emotional stress.

Studies of previous coronavirus epidemics do suggest that those who suffer from COVID-19 may develop mental health sequelae. Previous looks at groups of patients with acute SARS or MERS infections showed that they did indeed suffer from delirium, with insomnia, trouble concentrating, memory impairment, confusion and depressed mood being seen. It appears that in a sample of self report surveys from January to April of this year, anxiety, depression, distress and traumatic stress were present in up to 36 per cent of adults. While no consistent predictors of mental health illness in adults have been identified yet, the presence of these symptoms has been unmistakable. In children, a Chinese sample of second through sixth graders who were quarantined  at home for an average of thirty four days showed reported anxiety and depression in twenty per cent of the kids and worry about becoming infected in fully two thirds!

How has the pandemic changed our daily lifestyle? Mental health illness may result from various stressors, including just being exposed to others who are potentially infected with the virus, fear of infecting family members, lack of access to testing, increased workload (think parents who are holding down jobs and educating their children at home), economic hardship due to layoffs or furloughs or loss of jobs, and the ever present feeling that our personal freedoms are being diminished.

How has it changed our ability to work and to go to school on a daily basis? All of us have been affected in some way by this pandemic and how it has impacted the economy and our ability to support ourselves and our families. Some of us have even been quarantined for fourteen days or perhaps longer. What mental health symptoms might be precipitated by these conditions? Anger, anxiety, depression, boredom, confusion, fear, exhaustion.

How has the pandemic affected those who had pre-existing mental health problems? On a very basic level, according to this UpToDate article, some patients with pre-existing mental health illness may be more at risk for infection due to difficulties with simple handwashing, physical distancing, and poor insight around these basic areas.  Many of these patients might live in close proximity to others and not be able to physically distance. Some might already be delusional, and this prolonged focus on physical illness and infection might become embedded into their delusional systems. The availability of routine appointments, injections, groups, and other support systems may vastly strain the ability of the mental health system to provide needed services to those with existing mental health problems. Lack of socially based interventions such as AA, NA and Alanon due to social distancing requirements may be detrimental to those trying to maintain sobriety and clean time. Patients who have a hard time getting refills of their medications may cut back on the doses or stop them all together, usually disastrous. Also, inability to get necessary lab studies and other testing done can derail treatment.

Exacerbation of the use of alcohol and other substances is a very real possibility with this kind of increase in stress without a corresponding increase in support. A survey of Chinese adults in March 2020 found that during the pandemic, use of alcohol increased 32% among regular drinkers. Recurrence of alcohol use happened in 19% of ex-drinkers. Regular smokers used 20% more tobacco, and 25% of ex-smokers fired up again. Eating disorders are another area that might be impacted negatively as levels of anxiety and uncertainty rise.

The risk of suicide is very real during this pandemic. Why? Folks are stuck at home, they have lost their jobs, income has shrunk, childcare is unavailable, there is social isolation and decreased access to church and other social support systems. The sale of guns has risen sharply during this pandemic, a huge risk for increased suicide attempts on its own. We have all read of the completed suicides of overwhelmed healthcare workers who simply could not give as much as they felt called to and could give no more.

Treatment and management of these mental health issues has been a major challenge for the health care system. Hospitals and emergency departments are stressed, some outpatient clinics and services may be physically closed, and availability of medicines may be severely limited. Novel ways to deliver services have sprung up literally overnight in many areas, and bolstered in areas where they already existed. Reminders about healthy routines (limit exposure to news, eat and sleep regularly, exercise moderately, participate in positive activities, etc) are a good place to start for all of us. For many, telemedicine services have been lifesaving during this time. As many of you know, I have been doing telepsychiatry for ten years, but never have I been as busy with the provision of telemedicine services as I have these past four months. No show rates have decreased, patient satisfaction levels have increased, and we have been able to provide many services that are just as high quality as they would have been if delivered face to face. There are some minor inconveniences and limitations to these services, but the ability to connect far outweighs most of them. The ability to electronically prescribe medications as well as deliver psychotherapy and various types of support has been nothing short of amazing.

These are just some of the issues that we are facing with the need to screen for, diagnose, treat and manage mental health symptoms, syndromes and illnesses during the COVID-19 pandemic. There are many more and the list will grow as we move through this time. Remember to educate yourself about COVID-19, wear a mask, wash your hands, and practice responsible physical distancing. Together, we will get through this.