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.

Covidisms: The Tip of the Sphere

There is a military term that you might be familiar with. It is “tip of the spear”. This term is used by military tacticians and historians to refer to a combat force that is used to puncture the enemy’s initial lines of defense, to be quickly followed by concentrated forces which destroy any remaining threat.

There is also a Coldplay song that I like very much called Army of One.

“Say my heart is my gun, army of one
Yeah my heart is my gun, army of one
Is my only weapon, army of one
Say my heart is my gun, army of one.”

These two thoughts merged and danced with each other in my dreams last night, as thoughts tend to do lately, and I woke up needing to write about them.

We are facing a Medusa of an enemy in our country and our world today. The coronavirus has no respect for race, color, creed, sexual orientation or geopolitical boundaries. Racism itself is another writhing snake that would bite us if we place our hand too close to its venomous mouth. Economic crisis, always a single paycheck away for some, threatens to turn us out of our homes, strip us of our jobs and leave us destitute and staggering. Some in power think that if we dare to look upon this triple threat of disease and hate and poverty that we shall surely be turned to stone and stand as still as the very statues that some strive to tear down. Powerless, impotent, beaten. So they look away. They ignore. They fabricate new myths that serve their own nefarious purposes.

You and I, my friends, are the tip of the sphere. We are the soldiers in this ravaged world who can go in fast and light, puncturing the Dickensian twins of Ignorance and Want, making the smallest hole, ripping the fabric of greed and power and reaching out to those who need us most right now.

“So I’ll never say die, I’m never untrue
I’m never so high as when I’m with you
And there isn’t a fire, that I wouldn’t walk through
My army of one is going to fight for you.”

I know that I will never singlehandedly cure this terrible disease. I leave that for the Anthony Faucis of the world who know how to do that kind of thing. I know that I will never singlehandedly be able to erase the pain and suffering that slavery and racism caused those long years ago in the South, my home and the land I love. I leave that to MLK and John Lewis and C. T. Vivian, who knew how to do that kind of thing. I know that I cannot singlehandedly, fundamentally change a broken economic system that favors the rich and keeps its knee on the neck of the perpetually poor. I leave that to the bedrock that the Founding Fathers put under us to hold us up at times like these, aided by the wisdom of those who know economics on a scale much larger than my monthly budget.

I know that I cannot change the world alone, but I can be an army of one, with my heart as my gun. I can be in the phalanx that is the tip of the sphere, the force that will change this world in millions of tiny ways, day in and day out. I can be the one that figures out how to look upon this Gorgon that would utterly defeat us.

For you see, Medusa was the only one of the three Gorgons who was mortal, and therefore could be killed. Perseus used a shiny shield that had been given to him by Athena and looked at the monster safely, reflected in his shield. In so doing, he was able to slay the killer without dying himself in the process. We do not have to destroy ourselves and tear down our society to make this world a better place, as some would have us believe. We have only to do as Mother Teresa admonished, “small things with great love”.

“Been around the world, universe too
I’ve been around flying, baby, there’s nothing I wouldn’t do
Dance with the stars, while I see the moon
I’ll be standing there besides you
Right when the storm comes through.”

Be the tip of the sphere today, my friends.

Change the world.

Covidisms: Thoughts on Death

I did something last evening that I have never done before. I wrote a serious and heartfelt email to the New York Times and those who make the podcast The Daily, one of my favorite ways to start each day. This podcast has a way of finding and telling stories that get to the heart of what we are all experiencing in the midst of our lives, especially in these days of pandemic and racial strife and economic crisis. There have been many episodes of The Daily that have been poignant, thought provoking and moving, but two of the most recent ones from this past week hit me hard. I would like to share the end of the email that I wrote before I go further with this post:

The episode revisiting the situation in Bergamo, Italy, through the wise, thoughtful and emotional perspective of Dr. Fabiano Di Marco hit home. I lived in Italy for two years as a teen and my wife and I had planned a trip back to Rome and Florence in April, my first trip back to the country in fifty years. Of course, it did not happen. I felt a deep sense of sadness for the Italian people and the medical staff members who are trying to serve in the face of this pandemic.

Today’s episode about the grief felt by little Tilly for her grandfather hit me even harder. I am a grandfather of six kids, five in Chattanooga and one in Denver. I have not been able to see them for what feels like years, except by FaceTime calls. We are planning a driving trip out to Denver and back in late September, because I am not excited about getting back on planes, but we need to reconnect with our family and friends in other parts of the country. Hearing Tilly talk about her grandfather, coupled with the recent losses of one of our long time mental health center employees and another counselor whose clinic I used to consult with, made me very much aware that I could be that grandfather or that employee who contracts this virus and does not make it through the ordeal.

Your stories are powerful. For someone like me, who tries very hard to deal with the emotions by blogging, journaling, taking long hard bike rides or keeping up with the political craziness all around us, they force us to stop, to listen, and most of all, to feel. Ironic, isn’t it, that a psychiatrist would have a hard time feeling. Of course, the feelings are there, and when they are released by storytelling  and powerful emotions that you bring to life, the intensity of it all is almost too much to bear. It is so necessary though, and I know that full well.

Thank you, thank you, thank you, for getting the information out there, for telling the stories in such compelling ways, and for making us think, process, and feel. Yours is one of the first podcasts I listen to every day, and the ideas that come from it are some of the last ones I think about when I go to sleep at night. I appreciate what each one of you do. Please keep up the excellent work, knowing that we hear it, and we need it.

I wanted to express my thanks to the makers of this show because they provide a way for me to stay in touch with some very profound feelings during this time that I had simply rather not have. I feel frustration, I feel anger, I feel loss and grief, I feel elation, I feel dullness and boredom, I feel indignation, I feel sorrow, I feel pity, and I feel fear.

As I have mentioned in blog posts earlier this year and in followups afterwards, I will be sixty three years old on October 24th this year, God willing. At that point, I will have lived longer than my father, who died suddenly at age sixty two of a devastating brain aneurysm and cranial bleed. I never had much doubt that I would easily reach that point and that age, given the fact that I try to eat right, I exercise, I am trying to keep my weight and blood sugar and cholesterol and blood pressure down. All the right things that one must do to live a long life, barring catastrophe. I have been holding my figurative breath all the same, knowing that when I reach that milestone I will have a good cry, say a few words of thanks to my dad that I hope he can hear and go about the task of living productively until my sixty fourth birthday.

All of that held true until March of this year. Until the coronavirus upended all our lives, changed our daily routines, changed how and where we work, who we see, how we eat, how we travel, how we worship and how we connect with others. I have done what you have done, tried my best to make good decisions, protect myself and my wife from harm, continued my work to care for my patients the best I can given the circumstances, and kept my cool, for the most part. We have personally been so very blessedly insulated from the ravages of this plague. As far as I know, no one in my family has contracted this virus, no one I work with has had it, and only a few of my patients have, most of them doing well in spite of having the illness.

In the last couple of months, one of our long term mental health center employees, someone who was there when I started working in the center almost twenty nine years ago, contracted the virus and died. He left behind a wife and young son. A pharmacist friend of mine, who visited our offices every month to inspect our medication areas before her retirement, has just been released after a ten day stay with COVID-19. A counselor who once had a family clinic that I did medical consultation with in the early nineties recently contracted the virus, got very ill very fast, refused to be placed on a ventilator, and died quickly of COVID-19. The disease is starting to hit home.

I grieve these losses and setbacks for various reasons. I feel so badly for the families and loved ones of those who pass on. I rejoice over the victories of those who get infected but make it, all the while fretting over what long term consequences they may have to endure. I am sad that when someone like my counselor friend dies, not only because her life was most likely cut significantly short due to this illness, but because her death reminds me starkly that mine is coming too. She and I shared a slice of time, a set of circumstances, a place to talk and work, and a shared cause of promoting good mental health for the people we treated almost three decades ago. I sincerely hope that the work we have done together and that I continue to do goes on, but I am made painfully aware that we will not. We will end.

I do not fear death so much as I am not ready for it. Like everyone else, I am sure in my own feeble mind that this illness, this worst illness of its kind in the last hundred years, is not going to be the way that I will leave this life. It is not aiming for me. I will live a long life and become a grump old man who still likes to read and write and fish and take pictures and take walks by the river. Or will I? The uncertainty of these times is the biggest stress of all.

In watching this pandemic and how it is affecting all of us, I am reminded of a few basic things that we must attend to each and every day, as if it was going to be our last. Things that tend to shine through and demand our attention when someone dies and passes on, leaving their legacies.

  1. Relationships are important. Make them. Enjoy them. Nurture them. Attend to them. Water them like flowers in your summer garden and watch them bloom and dazzle with bright color.
  2. Find something that you are passionate about, and throw yourself at it with fury. Write. Paint. Play music. Heal. Preach. Teach. Mentor. Parent.
  3. Put others above yourself. Whether this viral illness is your ticket off this planet or something else gets you down the road, you will inevitably leave others behind. They, like little Tilly on The Daily podcast, will remember you. They will remember what you said, what you did, what you taught them, but most importantly, how you made them feel.
  4. As the recently departed John Lewis of Georgia said, get into trouble. Get into good trouble. Do the right thing because it IS the right thing. Do not waiver in your resolve to do this, because it is important.
  5. Know above all else that your reason for being here on this earth is not to glorify yourself, embellish yourself, surround yourself with riches and accolades and awards, and make yourself the center of the universe. (You are most assuredly not.) Your mission, your assignment, your reason for being is to do all you can, everything you can, in every way you can, with everything you have at your disposal, to make the lives of those around you, those less fortunate, those who are downtrodden and oppressed and neglected and forgotten, those who the world despises, BETTER. You have the power and the obligation to do that. If you do, if you truly do, then at the appointed hour you can meet death, smile, close your eyes and know that your time here has been well spent.

Stay safe, do the right thing, and live long, friends.

Grief, Coronafied

You are all familiar with the five stages of grief, made famous by Elisabeth Kubler-Ross. They are denial, anger, bargaining, depression and acceptance. We have heard about these and thought about them in many contexts over the years, most commonly in the face of the death of a loved one or some similar loss that broadsided us, left us reeling, and engaged our brains in trying to find any way possible to reverse the course of the terrible events we were experiencing. We’ve all been there. Think back to a time that you suffered a major loss. Think about how you felt, deep down inside, how your thoughts organized themselves, and how you really did ponder the possibility of magical thinking.

A few things about these five stages before I get to my observations today. Read more detail about this subject at https://grief.com/the-five-stages-of-grief/. First, they are meant to be guidelines, or guideposts to the process of grief, not a rigid system of hurdles that one must jump over in a very specific way in a specific timeframe. People grieve very differently from their fellows. I have worked with patients who lost spouses and were truly happy and content after one month, and with parents who lost a child and never really finished the traditional grieving process at all before their own deaths. Next, not everyone goes through them the same way, in the same order, for the same amount of time.  We process things differently. That being said, many things have popped up over these past four months that have made me rethink these five stages in the context of the coronavirus pandemic.

First, denial. Must I get political here? No, of course I won’t, as that is not the reason for this blog post. Suffice it to say that none of us saw this coming, at least in real time. Yes, people like Bill Gates and others have made speeches and written books in the last decade that foreshadowed this event, but when the actual virus that causes COVID-19 burst on the scene in December of 2019, we were simply not prepared. We heard about it, thought about it briefly, thought about how far China is from where we live, and gave it little more thought. Government leaders, policy makers, medical professionals and ultimately all of us thought to ourselves, No, this could never happen here. We will be fine. Nothing can harm the greatest country in the world with the best healthcare system in the world. The greatest difference between the denial that defined us early on in this pandemic and the denial that happens when a loved one is suddenly lost is that we did not know enough about what we were about to lose. We could not see the horses of the apocalypse galloping our way. We did not know enough to be able to deny in the way that helps a grieving person, or nation, survive. We denied in a way that made us blind and lost us precious time, time that could have mitigated the fallout from the disaster. Coronavirus was so stealthy that early on, we did not even know what to fear.

Anger. It’s here. How on earth did it get through our borders and start to move across the United States? Who was responsible for this growing fiasco? Who can be blamed for this? Anger is usually an anchoring emotion, one that gives pain and hurt and loss some structure that makes it helpful. Not so for this scenario, when the thing that invaded us and started to make us sick is so tiny that we cannot even see it. How do you get angry at something you cannot see, touch, confront, look in the eye? So what do we do? We find a surrogate. We get angry at the politicians, the healthcare policy makers, the manufacturers of goods that are in short supply, the people who do not look like us. Our anger is righteous and mighty and backed by allegiance to religion and party and ethnic group and geographical section of the country. The problem with that is that the coronavirus does not respect any of those things. It is happy to infect and spread in those who are angry just as easily as those who are still in denial, maybe more so.

Bargaining. If only I could get my loved one back, I promise that I would wear a mask twenty-four hours a day and respect social distancing and wash my hands twice an hour and … When we know we are stuck, that things have happened that we have no control over, we will often go back before the event and try to reconstruct it in our minds. What could we have done better, sooner, faster? What did we miss? If just given the chance, we would “get it” this time and make the right decisions, perform the correct actions that would prevent the grief and heartache that we now deal with. We want to make it right, make it disappear, make it hurt less, and at least in that moment we are willing to consider almost anything that would accomplish that for us. Why is it so hard to bargain in the time of COVID-19? Because we are in the middle of a pandemic that has no well-defined parameters. We do not know the end game or what this is going to look like when it’s over. Even if we figured out what we could have done differently or better, it’s much too late. Sometimes, when we realize this, it can lead us right back to anger, or…

Depression. When we realize that the loss is real, that the new normal is not anything we would have voluntarily chosen for ourselves, we go numb. We feel empty. We are sad, at everything and nothing at all. We are truly grieving now, realizing that this situation is here to stay, perhaps for a very long time. In this pandemic, we have suddenly been thrust into a situation where we are distrustful of others, where the things that normally give us solace might now be dangerous and where we get conflicting information that makes it almost impossible to know what to do to keep ourselves safe. Some of us might get quite depressed and even suicidal , but it is very important to know that what the vast majority of us are feeling, the confusion and fear and sadness and lethargy, are normal responses to a very abnormal set of circumstances. Circumstances that have not really existed in similar fashion for over one hundred years. This will end, as all pandemics end, but our lives may be affected in profound ways that persist for a very long time. Once the sadness starts to lift, the realization that we must find new ways to cope, to love, to learn and to socialize will drive us to make positive changes in our lives that will see us back to some sense of normalcy.

Lastly, we will enter some sort of acceptance. This does not mean that we like what has happened to us. It does not mean that we accept it wholeheartedly with a whimper. Not at all. We can go kicking and screaming into the rest of 2020 and on to 2021, but into that time we must go. We may lose some of the things or people we loved. We may not be able to do things the way we did in 2019. We may have to change the way we experience our relationships. Once we allow time for the grief over the losses that we all surely feel right now, then we can begin to heal and grow again and experience joy.

My daughter stated it very well in a recent post to social media that she gave me permission to share with you.

“How do I use this time, or at least sit in it without feeling sorry for myself, waiting on a normalcy that may never return? I exercise some control over the controllable, I will try to change what I can, I use creativity to stay connected and move forward when it may feel easier to be isolated and stagnant. I will love my friends and family fiercely and extend grace freely, to others and to myself. And while I may not mean it every time I say it, I’ll keep saying it… everything really will be fine.”