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.”

Covidisms

  1. My wife and I took a brief automobile trip to Virginia to visit Monticello over the July 4th weekend. We stayed in a modern, clean, socially distanced and iPhone app-driven hotel where we wiped down each surface before we touched anything in the room, let ourselves in with a key-less entry system and checked in and out without having to speak to anyone at the front desk. We brought our own food, used some of our own cutlery and other implements, walked everywhere once we got to our destinations, and ate out only at restaurants where outside dining was available, staff wore masks, and proper social distancing could be maintained. At Monticello, many, many rules and procedures applied that one would never have dreamed of when I last visited there seven years ago. We felt safe, well taken care of, and learned a lot about how truly hot a Virginia summer on the mountain can be. Every staff member wore a mask. Surfaces were being sanitized in real time. Tours were metered, and without guides. We went to the Jefferson Vineyards and saw exactly the same thing and felt the same vibe: people who were very grateful to be working, happy to welcome us there, and eager to make sure that they and their customers were super safe during their visits. We then made our way back home by traveling through Mt. Airy, NC, the hometown of Andy Griffith and inspiration for the town of Mayberry. In that small NC town, walking up the town’s main street, we were hit with a very stark contrast. Only couple of younger families, plus the two of us, wore masks in the sweltering heat. Many older, overweight, heavily breathing, uncomfortable looking older folks, some sporting politically themed t shirts or caps, made their way past us on the narrow sidewalk, nary a one wearing a face covering. As we sat in a diner to get lunch, the very nice older gentleman who took our order and appeared to run the place pulled his mask up as he knelt right by our table at much less than the prescribed six foot distance. I quickly pulled mine back on as well. “Oh, you don’t have to do that for me,” he said, his eyes crinkling as he smiled behind the cloth. “I wouldn’t wear one either,” he said in a conspiratorial stage whisper, “but I don’t want to tick anyone off.” “Oh, I do have to wear one-for you!” I responded. Wear a mask, please. For me.
  2. We are obviously settling into this pandemic for the long haul, doubters and politicizers and skeptics magical thinkers and haters of science be damned. The coronavirus and COVID-19, the multifaceted disease it causes, have changed our world. No, they have rocked our world. To indirectly quote a very famous musical now on Disney+, we live in a world turned upside down. As I have told more than a few patients over the last almost four months, some of the feelings and symptoms and experiences that you are having are normal. They are normal human responses to a very, very abnormal situation. Tired? Yep. Not sleeping? Check. Anxious? Doh! Unable to concentrate? Right-o. Unable to plan past your own nose? Yeppers. As I read in one commentary this past week, when we let ourselves sit quietly with this whole deal, this pandemic, we are finally struck by the very concrete realization that we have lost our normal lives. They are gone. To quote another of my favorite musicals (thanks, Greer/Kate Monster), maybe they are gone only for now. The kicker, the sheer crap of all this? We simply don’t know. No one knows. We are in as uncertain a time as I have known in my lifetime. We must practice acceptance, pray for grace and know that grief, however deep, does not last forever.
  3. It will be fall soon. There may not be football. I can write little more of this paragraph because the tears fill my eyes, I lose my breath and I simply cannot fathom a crisp, blue-skyed fall in the South without SEC football. In the South, football is life.
  4. Work issues. Oh, where do I start? I have been working from home for the majority of my days since mid-March. My wife was on voluntary furlough for two months. We have been together at home, a lot. We love each other, so this was good. Great, in fact. Lunch every day together, sometimes on the front porch in the rockers. Bike rides along the river. Movies at night. Coffee and conversation in the morning. If you live with someone you really love, who is your best friend, this is kinda cool! She went back to work yesterday. She drove to Atlanta and got on a Delta plane for the first time in two months and flew away. To South Korea. Yeah, she is thirteen hours ahead of me (that really messes with my feeble brain). It bites, but she is back at work, the unemployment payments will stop, she will settle in to a “new normal” (Lord, I do HATE that term) and we will get back to our old routines. Waaaaaaait a minute, noooooo, no we won’t! I’m still taking my thirty five second commute up the stairs and back home again every day. I still sit on a back-breaking chair (a new one is on order and should arrive any day, probably just as I get called back to my office full time). I still have more connections and dongles and screens than any one person should have, just to connect with the patients I used see face to face PC (pre-COVID). Ironically, at least to me, I am the busiest I have ever been in this job. EVER. Fewer no shows, in that patients who have their phones in their hands at their appointment times and answer said phones are captured (Mwa ha ha ha ha) and cannot no show me. Genius! As my wife once gently pointed out to me, only a few weeks into this new arrangement, “I know you like at least some part of it, though, don’t you?”, obviously referring to my love of all things tech and gadget. Yes. I’ll admit it here. I love the tech part of it, the virtual management, the scans and emails and calls and video visits and e-prescribing of prescriptions. I do. I am quite sure that it will not all magically disappear (like the virus? Naaaaaah) once we are Post COVID. It simply is too efficient and works too well, and patients LOVE it. We shall see. That being said, I also love the autonomy, but I miss the socialization. The real kind, not the Zoom kind or the Teams or the Skype kind. They are cool and flashy and let you pick your own neat background, but they are not real. (One background I used for a staff meeting this morning was so realistic that one of the clinicians asked in amazement, “Where ARE you this morning, Dr. Smith?”) Zoom. Doximity. Google Duo. Google Voice. FaceTime. We knew or cared little about all of these less than four months ago. How’s your work? Do you work from home, or are you socially distanced in an office? Do you have that vague sense of un-ease, that flat “I’m out of gas” feeling some days? Is it hard to focus? Hard to get yourself motivated every day? See (2) above. What we have right now, what we are doing right now is not real, but it’s the best we’ve got.
  5. Vacation planning. I want to think about it. I want to travel again. We had to postpone a planned trip to Italy in April this year because of this pandemic. Italy was not, you might say, the safest place to visit this spring. I lived in Italy from 1970 to 1972. A couple of the best years of my young life. Learned a ton. Saw the David, the Pieta, St. Peter’s, the Tower of Pisa, climbed the bell tower of the Duomo in Florence, ate pizza from a real wood fired oven in a little village pizza shop. I had not been back in fifty years. My wife flies there (or did) several times each year. We can’t go there now. The EU does not want us around. Sucks. I also worry about how and when to go back out to Denver to visit my granddaughter and her parents. She is growing up. Kids grow like weeds even in a pandemic, did you know that? Should we fly? When? Should I take ten days and drive out and back? Will I be able to go back to Arizona next year for what I fully intended to be a yearly January pilgrimage to hike and eat good food? Not being able to plan is killing me. We must have patience.

There is more, but this kind of writing is a painful recognition that the struggle is real, the stress is real, and the virus is real. We will make it through this. In the meantime, I will watch movies, listen to audiobooks (including The Great Influenza: The Story of the Deadliest Pandemic in History, just to see how all this turns out). Stay safe, wear a mask, wash your hands, and stay six feet apart.

Resilience in the Time of COVID-19

I first published these thoughts on 9-11-09. I thought I would share them with you again today in 2020 in a different context that is no less serious, traumatic and important to us and our mental health as Americans. In the first iteration of this column, I reflected on the tragedy of September 11th and how it had affected all of us. In 2001, we suddenly lost our sense of safety on our own soil. We lost two thousand nine hundred seventy seven American lives. My oldest daughter and namesake, now a young woman with five children of her own, rehearsing to perform in a show that did go on in spite of the hate extended to us by our attackers, was to turn seventeen years old the day after the attacks. It was a time of fear, grief, and pain, but also a time that saw Americans rally around and support each other in ways that we are still struggling to regain today.

It was a Tuesday in 2001, late summer/early fall in South Carolina. Bright blue sky, wonderful smells in the air, and just a hint of the changing season. Enough to make you wish for pumpkins and turkey and pan dressing and kicking piles of leaves and smelling smoke. Enough of all this to make you feel safe, free, and wonderful. Enough to make you proud to be an American. This time around, it was early spring of 2020, March, more bright blue skies and warming temperatures and the hope that this season always brings.

I was working in the mental health center that Tuesday morning, doing what I have now done every Tuesday morning for over twenty-nine years. I was talking to people with psychiatric illnesses, some of whom had been hospitalized against their will for reasons of dangerousness or potential for self-harm. In other words, my job that morning involved making sure that the most vulnerable among us were given a fair shake by the mental health system and the court system, and that if they had improved sufficiently, that they would be released from the hospital that day. How American, yes? In 2020, I was working a normal week, using my office in the mental health center to welcome patients, read emails, enjoy my coffee, all the normal things that I had been doing in that very space for years.

After the second interview, if memory still serves, a staffer ran into the room and told us that the patients and hospital staff waiting their turns to see us in the adjoining room were all glued to the television. It seemed that a small plane had just had a terrible accident, crashing into one of the World Trade Center towers in New York City. How terrible and sad, we all thought vaguely, going on about our work for the next few minutes, not thinking more about it at least at that instant. In 2020, we got wind of a viral illness that had originated in China, but that now appeared to be spreading to other countries. We learned that we had a small outbreak of illness caused by this novel coronavirus, way out on the west coast in Washington state, affecting a handful of people. How sad, we thought, not having any idea what was about to happen to us.

Soon, that same staff member came back with astonishing news. It seemed that the plane that had hit one of the twin towers was a much larger plane, maybe even a jet airliner. No, we all thought, at least to ourselves, how could that happen? Huge planes don’t just lose control and crash into skyscrapers. It just doesn’t happen. We soon went from fifteen cases that we were told would go away to dozens, then hundreds, then thousands of cases of the illness that were caused by this new virus, now called COVID-19.

The next few moments, really the next few hours, changed all of our lives forever. When we understood what was happening, as the first tower smoked and burned and helicopters began to buzz as did television commentators, we stood riveted to the floor, all of us standing up, restless and vaguely afraid but not knowing what we were afraid of, not knowing whether we should just go on about our days or wait to see if we were going to get new marching orders. Do we rush out and buy supplies, do we wash our hands, do we wear masks, do we stay at home? The crash of the second plane into the second tower, with the graphic video footage that almost all Americans have seen, was surreal. We were being attacked. The United States was being attacked. The coronavirus began its relentless march across our nation. We were again being attacked by something that we did not fully understand, to an extent that would only become clear later. I have always loved history. I thought to myself, if there had been the real time coverage we have now in 1941, this is what Americans would have felt like as Japanese planes bombed Pearl Harbor. Just like the Gulf War and other incidents in recent years, we were all witnessing history being made, terrible history that would affect everything from how we traveled to how we looked at neighbors who didn’t quite look like “us” any more. This time, we would shelter in place for many weeks, rarely venture out from our safe zones and fear even those who did look exactly like us.

We went through the rest of the morning in a fog. All of us wanted to make sure our families were safe. As crazy as it feels today, I believe that we all thought that attacks could happen anywhere the rest of that day, even in South Carolina. We made plans to attend church services that night, most of which had been cobbled together as prayer services for the victims as well as for the safety of all of us who remained in America that night, shocked, afraid and angry. My family did something else that a lot of other families did. We met for a meal of comfort food, harkening back to that age-old tradition of gathering around a table and breaking bread together, offering solace and strength to each other. In 2020, we gradually began to understand that these ways of comforting and supporting each other were potentially deadly.

One of the most symbolic things we did as the next few days and the real tragedy of it all became so apparent was to display American flags everywhere. We put them on our cars, on our office doors, on our windshields. Today, we wear masks, gloves and protect ourselves and those around us by these outward signs of the current pandemic. We follow arrows on the floor of supermarkets and stand six feet apart in checkout lines.

In 2001, we remembered that tragic day, September 11th, when so many innocent Americans died. We remembered and honored a new crop of American heroes who rose to the occasion in service to their country. We remembered when the American spirit, so often dampened, burned brightly at ground zero in New York City through dark days and even darker nights of digging, searching, rescuing, and recovering. We remembered the fear, the anxiety, the terror, the anger and the relief when we knew that the worst of the initial attacks was over, though the aftermath was just beginning.

In 2020, we remember the day we heard that the virus was coming for us. We honor those men and women who have worked tirelessly on the front lines, caring for the sick and the dying, exposing themselves to the risk of illness and death. We see the American spirit around the country in the nightly banging of pots and pans and ringing of bells that acknowledge healthcare workers. We once again deal with the fear, anxiety, terror, anger, grief and loss that have accompanied the first wave of this pandemic, even as we know that the second wave, the aftermath, may be coming again.

We remembered. We honored. We grieved. We remember. We honor. We grieve.

In 2001, we were not just fighting a war on terror. We were all struggling and fighting to regain a lost sense of humanity and brotherhood and common cause. We were fighting to be a global people who could live together and celebrate our differences as well as our commonalities. We were fighting not to be isolative and separate and exclusive in the global sense, for if we did so, we would all surely die one day, all of us the world over.

Today, we fight not just a war against the invisible enemy that is COVID-19, but against another assault on our humanity, our global brotherhood and our ability to support our survival. We once again see the stark contrast between our differences and our similarities, knowing that attention only to the former will kill us, and nurturing the latter will ensure our continued residence on Earth. We are learning that to live, to defeat this enemy that does not discriminate in its desire to infect and kill us, we must separate from each other. In separating, we bind ourselves tightly together to insure that all get the best chance at life.

I will ask that you take some time to reflect today. Take some time not to grieve just the losses we have endured due to COVID-19, but to consider the loss to humanity as a whole. As I write this, 7.7 million people around the world have been infected with the coronavirus. Four hundred thirty thousand have died. When many of us die, each of us dies just a little right along with them. Be vigilant. Be resilient. Do what you can, where you are, with what you have. Get help for physical symptoms, emotional trauma, sadness and grief. Be strong. Just like September 11th, this is a watershed moment not just for the United States, but for the world. We will survive it, and we will be the stronger for it.

Patience, Grasshopper

Another thing this pandemic has taught some of us? 

Patience.

We were all on hyperdrive seventy days ago. Work, church, school, lessons, clubs, dining out, vacations to schedule, family visits to make, shopping runs, gas fill ups, oil changes, clothes to buy.

Now, we’re not.

Working from home, some of us not working at all.

Not able to go to church, at least in the physical sense of the word. 

Kids homeschooled. All of them. All the time. 

No dining out, at least not in the same way it was just three months ago.

No unnecessary travel. 

Filling up with gas every two weeks, three, once a month?

Family visits by FaceTime. 

Nobody buying dress clothes anymore, as Zoom meetings require nothing more than shorts or sweatpants. 

Over the last few weeks, I have learned to be a little more patient. What has it gained me?

I have made friends with the most wonderful little fellow, a ruby throated hummingbird that loves the salvia by our front porch, in front of our rocking chairs. Before this week, I had never been as close as one foot to a hummingbird. Now, I have. 

I got up early and went into the kitchen to make coffee on one of those mornings that I didn’t really have to. I looked out the kitchen window and saw an Eastern box turtle under the bird feeder. He (she?) seemed to relish the coolness of the pine straw that had just been hit by the sprinklers minutes before. I watched the turtle walk off down the straw bed, a little faster than I thought he would! 

I have been able to watch at least two doves on the nest on the brick wall by our courtyard, sitting stock still over several weeks, never moving, always watching, never being startled by our comings and goings. 

The pandemic has changed our lives in many ways. If we let it, it can make us sad, disillusioned and irritable. If we practice a little patience, we may just see some things that we never even knew were there. 

The Next Two Weeks

I lived my life in four-year blocks of time for a long time. 

I went to high school for four years, enjoying the studying, the teams, the football Friday nights, the dances, the classroom experiences, the crushes, my first real love, and the teen years. A small mill town in the south. A big fish in a little pond. A girlfriend. A handful of dreams. 

I went to college for three years (yeah, I got credit for four years because I CLEP tested out of a year, but that’s a story for another day). I lived in the organic chemistry lab visited by my professor’s Great Dane, studied late at night at the local Krystal eating chili and cheese Krystals, agonized over making enough As to get into medical school, then took the MCAT to make that dream a reality. 

I went to medical school for four years. I endured the hell of year one, when classmates drop out after two weeks because it’s just too fucking hard. Most of us made it to year two. We made it past professors that told you no matter how you tried you would never get more than a C (then gave you a B if you were lucky). We made it past anatomy, microbiology, pathology “pot cases”. (No, those were not studying people who smoked marijuana, but looking at the diseased tissues of those who had donated their organs to be placed on carts in formaldehyde filled pots for medical students to study in detail.) We enjoyed electives after enduring the compulsories. We graduated, doctors in name only, not knowing how little about life and medicine we actually knew. 

I did a four-year internship/residency/chief residency in psychiatry. I learned just how little Freud knew about people who I now treat who have real psychosis, real depression, and who really kill themselves. I learned more about how to manage and navigate the future systems in my life than I did about the medications available at the time, which is good really, considering that people and systems don’t change that much over the years, but medications become obsolete and get recalled. I learned to work ninety hours a week on very little sleep. I learned who I could trust to have my back, and who would stab me in it. I learned to love my patients for what they would teach me, real things about life and love and sickness and death that no two-hundred-dollar medical textbook could ever show me. 

My preparatory years were measured in four-year increments. 

Now, we are all gathered on the battlefield of a great pandemic. 

There is a virus out there that can infect me, make me sick within fourteen days, and kill me in just a few more. If I am exposed, I must count fourteen days. If I make it that far, then I will likely make it farther. If I don’t, who knows. 

I used to look forward to the next four years.

Now, I count myself among the lucky who make it through the next two weeks. 

Covidisms: Grudge Match

I was listening to the Chill Mix that comes up on my Apple Music every week, because, you know, COVID-19.  

One song that got me thinking today was To Have and Not to Hold, from Madonna’s album Ray of Light. What do I have and hold, right now, that I should let go of in this time of pandemic and uncertainty? 

I hold grudges. There. I said it. Out loud. On the internet, of all places. 

Yes, I have sometimes caught myself thinking about things from the past that have hurt me, people who have done me wrong, situations I was in that were negative and hurtful and poisonous to me and others around me. Instead of letting these go, processing them and moving on, I have held them to me tightly, jealously, letting them suck the life and light out of me. I have collected them, displayed them, if not to others, then to myself in my own mind and memory. Up there on their little wooden shelves like the cheap golden plastic trophies of my youth, reminding me of things that happened, yes, of course they happened, but things that no one else cares about, no one else even remembers. 

I hold these truths to be self-evident, that all grudges were created equal, with equal power to hurt the person who holds them, wanting things to be rectified, wanting things to be fair, wanting things to be as they were. Wishing that the things and the people and the situations that created the grudges in me had never been a part of my life in the first place. Wanting things to go back to being as they were before the injuries, to be normal again, to be happy again, to be free and easy and without conflict again.

But you know what? You know what this pandemic is teaching us, if we will listen? Nothing was ever as free and easy and happy as it seemed to be. It was an illusion. Nothing can ever be the way it once was, because we cannot go back and change the past any more than we can predict the future. What happened, happened. What we feel, we feel. What made us, made us. We are who we are now. We feel what we feel now. We love who we love and do our work and try our best to make the world a better place, COVID-19 and politics and famine and pestilence and volcanoes and tsunamis and hurricanes and all of it be damned. 

I am responsible for how I feel. No one else is. I am responsible for the baggage I choose to carry, no matter how heavy it is. I am the only one who can put it down, leave it behind, travel lighter and freer and at peace. 

In this uncertain time, in this time when a man who is almost sixty-three years old, who has almost lived longer than his father did, who could conceivably contract a deadly virus that could actually kill him quickly and without fanfare, isn’t it important, isn’t it mandatory, that we see the positive, celebrate the joyful, and live life free of the things that weigh us down and keep us wallowing in emotions that are fleeting as puffs of air? 

Grudges? I have ‘em.

What the pandemic has taught me?

They may be to have, but they are no longer to hold. 

Flattening the Emotional Curve

I am one of those weird people who have always enjoyed responding to disasters. One of my mentors in this field from Columbia many years ago was talking to me about this topic as we sat in the bright, non-disastrous sunlight by a lake during a springtime work picnic.

“It’s hard to explain to other people. You and I know what it feels like, the rush of adrenaline, the ability to work long hours in the heat or the cold, the decreased need for sleep and food, the drive to help people at any cost, the sheer exhaustion that paradoxically gives you more energy than you’ve ever had. Try to explain that to other people, to tell them how good it feels, how exhilarating it is to be in the field in the middle of a disaster response, and they look at you like you’re crazy.”

I have done this work in various ways over the years, and it has been some of the most rewarding work I’ve ever been privileged to participate in. I have worked with disaster groups within the framework of the Red Cross, been a part of our local disaster response teams through work, and been a part of what we affectionately called the “DIRT Team” in the SC Department of Mental Health years ago. I have hunkered down in bunkers in downtown Columbia and Aiken, SC, I have slept in freezing cold church Sunday school classes on hard cots with scratchy blankets, I have felt the wonderful cleansing power of a portable shower in the hot Mississippi summer after a hurricane, and I have cried softly to myself when the homesickness and the hurt and the pain were transiently too much to bear. It has been a true privilege over the years to give time, physical labor, emotional support, a listening ear, technological support and medical expertise to those in true, dire, raw need. There is no work like it, though my mentor was right when she said that it is hard to describe it without folks thinking you’re a freak.

The COVID-19 medical disaster is an animal that many of us less than one hundred years old have never had experience with. It is a disaster like few others we have known personally, or as a planet, a slow roll, tsunami-like wave of death and destruction that we could see coming from days and months and thousands of miles away but were almost powerless to stop. That was the first half, the front end of this disaster. We knew it was coming, and it got here soon enough. Now, it is here to stay for who knows how long. So many uncertainties. We just don’t have enough data, enough experience, enough time to know the answers yet. I have had conversations with my wife about how this is a disaster that is terrible for those of us who see things in black and white, who like to assess, evaluate, operationalize and fix. There’s so much gray here that it makes my brain hurt. I do not like gray, though as I have more of it on my head I can tolerate more of it in the world around me.

This is not a disaster that is quick and dirty. It is not fixable, at least not yet. It does not come up on you, slam you to the ground, then move on, allowing you to pick yourself up, dust yourself off and get things back to normal again. There is no normal right now. There is the “new normal”, not one of my favorite phrases, something that represents a normal that is not now and never has been normal before. See, doesn’t your brain hurt now?

I deal in emotions every day. It’s my stock in trade. It’s my life’s work. It’s my bread and butter. It’s my vocation. All that, but damn, it’s hard living it while you’re helping others deal with it.

I have been working at home at least four days a week for the last month. I go into our main clinic on Fridays, but I may as well be at home then too. Isolation is a very real issue right now for many of us. We may talk to others (again, my MO every day, as that is my job) but we do it in our own little spaces in the guest bedroom or the garage or a corner of the dining room. We work alone. We pat ourselves on the back and keep ourselves going. We reach out to others by email and Skype and Zoom and FaceTime, but we all know it’s not the same.

What emotions have I had during this disaster?

Well, I can’t lie that the first thought that ran through this disaster junkie’s head was “wow, this is going to be fascinating!”. How will we face this threat to our society, our way of life? Do we have the coping skills, the resolve, the will to see this through and keep ourselves safe? Do we have the right stuff? It was all heady, at least at first. Kind of like the time that I saw Hurricane Katrina making the turn past the tip of Florida, watching the tracking change with the soon inevitable direct hit trajectory towards NOLA leading to the thoughts that I had back then. “This is the big one. This is the big game. I have to be a part of this. I have to go. I can’t sit this one out.” Go I did, and spent seventeen days in an environment of stress and vicarious trauma like none I had experience before or since. Life changing stuff, that. Acute stress, longing to be there but longing to go home where it was safe, wanting so badly to help but feeling so impotent. It was tough, but it got better in days, weeks. The end was visible, the rebuilding possible, the losses grieved, the destroyed assessed, catalogued and tagged for reconstruction. Emotional relief finally came when I hit the airport in Jackson knowing that I was headed home I knew I had done what I could do and that it was okay.

This is different.

That adrenaline rush that hit me at first, a million years ago in March, intensifying in April, is long gone. The excitement of my non-voluntary “deployment” to the upstair bedroom, my one minute commute being the new normal, the newness of signing onto services not previously used, and doing my job in ways that I had never done it before, has subsided. I am in a new groove now. A slow roll. A grind. A carefully choreographed series of steps and phone calls and video chats and typewritten notes that flow easily and mesh together pretty much as they should. I get the work done. I always have.

I miss my office. The first time I went back there it did not feel like my place at all. I miss my people. Last Friday, mask in place every time I set foot outside my space (which was exact twice in eight hours), I saw only three people. One of them walking by. One twelve feet away. One outdoors eating lunch by herself. We spoke maybe three words. This is not heady excitement. This is not adrenaline-fueled cooperative work in a hostile environment. This is not normal.

COVID-19 has flattened my emotional curve.

I do not have boundless energy for work when I get out of bed in the morning. Oh, I’m doing my job fine and still enjoying it as I always have and always will.

I do not feel joy, real joy, in my work every day. Again that does not impair my ability to do my job. It simply colors what was still bright and shiny two months ago a dull, consistent, predictable gray. I know it will be bright again one day. Just not now.

I am not depressed. I am not sad. I am not suicidal, like many of my aggrieved colleagues who have had to see the true death and destruction this virus has caused on the front lines in New York City and Washington state and New Orleans. I am not any of these things, thank God.

What I am is a black and white person living in a gray world surrounded by the Invisible Enemy.

An action oriented person who does not know exactly what to do, so keeps doing what he knows usually works until we know more.

A happy and very blessed person who is not sad or depressed, but whose emotions have been blunted by this pandemic, as I’m sure yours have, to the point that today I’m okay, today I’m okay, today I’m okay, at least for now.

In order for the vast majority of us to come out of this on the other side, we must flatten the emotional curve. We must resist the grandiose temptation to think that we know it all, that we have all the right answers, and that we can proselytize and cajole and intimidate others. We must be smart, compassionate and patient. We must be even handed. We must be kind. We must be even more expressive through the twinkling of our eyes and the bump of an elbow since big smiles lurk behind designer masks and hearty handshakes are no longer de rigueur.

The pre-dawn grayness often leads to the most intensely colorful sunrises.

It will be morning soon enough.

Random Covidisms for Saturday, May 2, 2020: What is Gone?

Thoughts as we continue this journey through the pandemic. 

What is gone?

We were riding our bicycles along the North Augusta, SC, Greeneway the other day when I noticed a somewhat disconcerting sight. There is a stop with restrooms and parking and so forth along the path. There is also a sand volleyball court that usually is being used by a half dozen or more people almost every time we ride by.  The net for the volleyball court was gone. Two poles stuck up out of the sand. No net. No people. Empty spot. 

We will most likely be bringing a few people back into the mental health center to be seen face to face by a skeleton staff starting in the next week or so. As part of the continued emphasis on social distancing to prevent the spread of the virus, the chairs in breakrooms and most likely on patios, will be removed to prevent congregating of staff. No chairs. No place to sit. No need for breakrooms. 

On that same bike ride the other day, we saw that one of our favorite little restaurants in North Augusta, one that usually has a lot of people eating meals outside on the sidewalk under umbrellas and sails, was empty. Tables and chairs stacked and locked. No outside dining. No people. Felt a little like riding through a movie set of a horror movie just before the bad creature comes out of the alley and starts to make weird alien noises. 

Should I grow a ponytail? 

I love my car. My Rosie, bought in the spring of 2014 before my seven thousand mile trip around the United States (which I think I might just have to re-create when this whole catastrophe is over). She has 175,000 miles on her now. Good miles. Surviving being hit by a deer in the middle of the night miles. Take me to the coast so I can ride my bike miles. Let’s go hiking miles. Listening to audiobooks and podcast miles. DAILY when I was commuting to work. My commute to work is now ONE MINUTE. On foot. No time for listening to podcasts or books in my car. I miss you, Rosie girl. Soon. 

Chit chat. Checking in. Meaningless five-minute conversations. Man, I miss those. How are you? Read any good books lately? How’s the softball team doing? SEC football in four months! How’s your Mama and them? 

Church. I have gone astray many times in my religious journey, that I will readily admit to. I have experienced my faith, questioned my faith, logically skewered my faith, renounced my faith, lost my faith, and then had it come back to me with such force and clarity that it made me weep. I miss my church. I miss my people. I miss my friends, my acquaintances in the faith. I miss group study and the challenge it brings. I miss liturgy. I miss ritual. I miss music. I miss group worship. 

I miss family. Face to face family time. FaceTime is okay, but 1s and 0s are not family. I can’t remember the last time I thought about just hopping on a plane to Denver to see my family there just because I could. 

I miss flying. Really, with all the trials and tribulations of trying to get on planes and sometimes missing them and getting stuck somewhere, I miss planes and traveling in the air. Really. Could you pay me any amount of money to get on a plane going anywhere right now? Not likely. No, not likely. 

What is gone for you?

Covid Garden

Of course, this portion of the trip in May 2015 had to start with something Apple. Trina indulged me, as she is wont to do.

I entered the large store in Covent Garden, wowed as always at how the Reality Distortion Field, inspired by the ghost of Apple founder Steve Jobs, worked on me even in London. The store had all the usual Apple kit, plus a slick design including a wonderful staircase made of glass, a Stairway to Heaven, one might say if one were an Apple fanboy. I made the rounds through the store, marveling at everything, wanting one of each item, needing nothing. 

“Okay, I said, I’ve had my Apple store fix. Let’s keep going.”

We strolled through the streets full of shoppers and tourists like us, getting hungry and spying The Ivy, a place that looked busy enough, portending a nice lunch, just up the street from the juggler. We settled in at an outside table, fabulous, and indulged. Trina had a nice cauliflower and cheese soup and coffee. I tucked into the fish pie, alternating bites with sips of a Jubilee Julep with rye, sugar, fresh mint and a little maple syrup. 

The sights, smells, sounds, the whole ambience of the place, just being in London at this place at this time with this woman was so wonderful that the present-day memories of it almost make me ache with longing to go back and do it again. To do anything again, in Covent Garden, in London, at that table, with that juggler up the street and the men in gold and silver seemingly defying gravity as they bent backwards and sat on air above their boxes and shoveled and tipped their hats for gratuities. To pose by a red phone booth again. To snap a photo by a real cigar store Indian. To hear the haunting melodies of opera being sung by a blond beauty on her day off, filling the shopping space with lovely, lovely, sound. 

The sun warmed my skin, and the pleasant sweat of love-laced voluntary labor dampened my cotton t-shirt. She was watering her work, and I leaned against the fence, waiting to adjust the output from the hose as directed. The tomatoes were planted, Better Boys and Romas, the cucumbers guarded their newly constructed hills, the tiny village of a dozen pepper plants occupied the middle of the space. Free range zinnias and marigolds greeted us as we stepped from the outside world of the power line cut to the inside of the little plot of paradise we had just constructed of soil and rock and mulch and tender green plants. 

We paused for just a moment to savor this tiny moment of anticipatory joy in the midst of a world-wide pandemic. In the midst of so much organic death, there would soon be life. Bright, showy, colorful, edible life, metaphorically watered by the staggering number of tears that already watered the devastated nations of the earth. This plot of earth, this square of brown punctuated by green plants and red stakes and white stones, would soon make us smile as something new, something luminous, something sustaining, came up through the soil to delight us and entertain us and nourish us, a gift from the same earth that was bearing witness to the awful finality of death. We would say hello and smile even as many said goodbye and wept. 

“Should we name it?” I asked, suddenly.

“What should we call it?” she replied. 

I could already see the next piece of wood, the next post that we would have to place at one corner of the garden. You know the one I’m talking about. Just like the one in Key West. It would stand straight and tall, about six feet high, with brightly colored cross pieces and informative hand lettering. 

“Tower of London: 2.3 miles”

“Buckingham Palace: 1.2 miles”

“Shakespeare’s Globe Theatre: 2.0 miles”

“Big Ben: 1.2 miles”

“Evans, Georgia, USA: 4132 miles.”

“The only thing we could call it,” I said.

“Covid Garden.”

She smiled. 

We remembered. 

Can You Hear Me Now?

“I feel like a little girl at Christmas!” my almost eighty-five year old mother said, from an appropriate social distance, after she received her new iPad earlier this month.
My middle daughter, ever the organizer and planner, asked if her grandmother knew how to FaceTime or otherwise communicate by video in this new world of COVID-19 and social distancing. Her great-granddaughter is growing up in Colorado and she, like the rest of us, has not been able to see the little one, or any of her other great grandkids, for some time now. Something needed to be done to remedy that. My daughter had the marvelous idea that we should get her Grandma an iPad and teach her how to use it. I agreed and ordered one right away.
The look on her face when I saw my mother talking to me by video on the tablet was simply priceless. She quickly learned how to use this wonderful little piece of tech, and connected swiftly with her grandchildren and great grandchildren in Denver and Chattanooga. Something so simple lead to almost immediate joy. A silver lining in this dark gray Coronavirus cloud for sure.
We have found that we can all stay connected pretty easily to friends and family in this time of social connection crisis, but what about connections between patients and providers? What do you do when you have physical symptoms and have been told to stay away from doctors’ offices and emergency rooms? What happens when your depression deepens, your anxiety flares and the voices that were under pretty good control start to scream at you again? What happens when your resolve to stay sober is dashed by the fact that AA meetings are not meeting at all? How do you connect when mental health centers, doctors’ offices and clinics are not seeing people physically due to the worry about coronavirus transmission?
We have found that there are several very good apps and services that help us to do just that. Most of us in the local mental health center world are now working from home the majority of the time but we still have full schedules of people to assess, check for medications, and to do counseling sessions with. I thought I would share some generalities and specifics of this new world with you. It might help as you pursue your own mental health treatment, and you might find that it also goes for other medical care that you might receive as we navigate this new normal.
We communicate with you by phone call or by video calls of several kinds. This is a wonderful addition to our therapeutic arsenal, but it does come with some caveats. First and foremost, you must understand that while these ways of communicating with your doctor or therapist are quite private and secure, they may not be considered 100% HIPAA compliant. As you might remember, one of the primary jobs of the Health Insurance Portability and Accountability Act of 1996 is to safeguard your private personal and healthcare related information. Speaking with me in my office with the door closed and no one else around is about as safe as we can make things. Talking to me on our iPhones via FaceTime not so much, though it is a wonderfully vivid way to see and talk with each other in real time. You see the tradeoff there.
What are some of the other options for communicating in this new way that are being used by the local mental health community? Doxy.me is a video or audio telemedicine platform that is free to use, though it does have a paid tier with a little more functionality. I can send you a link that allows you to be in my “waiting room” until I call you for the session, which can be video or audio only. This service works well but the quality seems to be a little spotty at times, with freezes and restarts and other issues. If you have a Google or Android phone and have Google Duo, I have found that both the audio and video quality with that app are quite good. Google Voice is my go to for regular phone calls, as the connection is usually quite good and the quality of the call is quite nice as well. I have already mentioned FaceTime above, and some folks specifically asked to be contacted via that platform since they have an iPhone and trust it to be secure.
When we see you using these apps and services, we make sure that we tell you why we are doing this, that it is not the same as being seen in the office and that you give us permission to speak with you using these platforms. Most everyone I have seen over the last two or three weeks has been completely fine with these new ways of having a mental health visit. Some of the upsides? Patients do not have to waste time, gas money or effort getting to the clinic from their homes, paramount during this time of social distancing. When I call and you answer, we can get right to the point, cutting out much of the time walking to and from the waiting room, gathering paperwork for labs, etc (I can do most all of that electronically, as well as electronically prescribing most of your medication right from my laptop keyboard as well) and actually finishing many of these sessions in less time than at the center in person.
Lastly, may I leave you with some tips to help make this a smooth process on both ends of the phone screen? Understand that video or phone appointments are still appointments. They are set at specific times, and we expect to “see” you at those times. These are not casual or social calls. That means that you should be set up and ready to receive the call at the time specified, so that everyone may be seen on time for that day. I have called some patients this week, only to have a parent roust them from bed to speak with me, or having to wait for them to complete a task in the kitchen or bathroom before they can come to the phone. Consider your surroundings, as I do. I have had virtual tours of many backyards and decks, and met several cats and dogs on screen this week, which is certainly fun but may make it harder for us to really hear each other well enough to get our business together completed. Find a quiet, private spot for us to talk, just as we would if we were in the mental health center. One more thing. Remember to dress like you are going to talk to your doctor or counselor. I have been quite surprised and frankly startled a couple of times these last few weeks by what folks will wear while FaceTiming on the phone.
We are very unlucky in that we are all living through the first world pandemic in the last one hundred years. We are also quite fortunate to have at our disposal some of the most useful, easy to master technological tools for communication in our history. I am so glad that we still get to carry our work forward, maintaining our mental health even as we strive to stay physically healthy in these challenging times. Stay safe and thanks as always for reading.