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.

Come Hither: Random Covidisms for Sunday 4-19-20.

  1. One of my superiors in the Department of Mental Health sent out an encouraging email to us the other day. One of things she said that really hit me was that in our current state of personal uncertainty, anxiety and turmoil, maybe we were all experiencing just a little of what our patients experience throughout much of their lives. That stopped me in any tracks mentally and emotionally. How right she was. Thanks, Deb, for making us take the time to exercise our empathy muscle.
  2. I am now working from home four days out of five, as far as my regular clinic job goes. I go into the office on Fridays, as part of the need to have a medical doctor on site for billing purposes for Medicare and other random reasons I suppose. After getting sort of used to being home and having a completely different physical and mental workflow, I went to the office this past Friday as instructed. I drove around to the portico for my pre-admission screening, passed that, parked, and went inside the building. There were probably a dozen people actually working at the office that day, most of whom I did not see the whole time I was there. I went directly to my office, mask in place, then closed my door (mask comes off) and worked most of the day without leaving that small space. I did walk to the medical records area to drop off signed items (mask goes on), left a couple of things under the doors of coworkers’ offices, but spent most of that time in my own space (make comes back off), physically and head-wise. Once, I was out in the hallway (mask back on) and saw another masked staff member walk around the corner and up the hallway. I gave them plenty of space, kept my social distance and only said hello. Nothing more. Odd this felt, in so many ways, this day at the office that felt like more of a punishment than a reprieve. I did not really want to be there. I am now used to working at home (funny how the new normal takes hold so fast) , I did not want to make obligatory small talk (I normally love the little random daily interactions that make up office life and relationships) and I was mentally prepared to just work by myself for that day. This was not a bad day but neither was it a fulfilling day at work. I miss the old way.
  3. I am not one to remember my dreams, if I dream at all. I know I probably do. There is more time lately to actually reach that stage where dreams may come, but I wake with that vague semi-remembrance that feels like wisps of cotton brushing my brain. Not so last night and this morning. My wife gets up earlier than me on most mornings that we are at home together, and so she did today. I decided that as I seemed to be dreaming, I would give myself a little more time to complete these elusive thoughts. As I am not a Freudian (even though I trained with mentors in a program that was hanging on to psychoanalytic principles with everything it had) I will let you interpret these as you will. In the first part of my dream, I was sitting at an airport bar, Dell laptop (yes, this is the work machine if that has any importance in your interpretation of my nocturnal strivings) on the bar in front of me, drink at the side (a no-no, of course!) struggling with some project or note or problem. Distracted by something that I do not remember, I turned back to face the mirrored surface and multiple bottles of booze only to realize that the laptop had been stolen. Gone, it was. Crap. So what did I do but of course go the bathroom to relieve myself, telling myself that I had my bag containing my personal MacBook at the foot of my barstool, and that I could continue my work on it when I returned. You guessed it, when I got back to my unattended bag of technology, it too had been pilfered. I went home. I then realized that my Lexus (I do not own a Lexus) was showing that its oil level was perilously low to the point of imminent engine lockdown. I went into the house and asked my wife where she kept the cases of extra motor oil, as one does, and she promptly brought out five quarts of Costco’s finest. I drank half of one bottle to make sure that it passed muster, which it did. I then went out and filled my Lexus (I do not own a Lexus) with motor oil, knowing that I was not going to be driving anywhere for the next God knows how many months due to the Coronavirus lockdown. I then decided, as the hour was unseemingly late in the morning even for a Sunday, that I could wake up and start the day.

Happy Sunday.

It is Sunday, right?

Or am I dreaming?

Lend Me Your Ears

Okay, so I made it clear in my last post that I do not like really big, long term change. That’s just me. That being said, I have been in a maelstrom of rapid, relentless, major, workflow altering change, much as many of you have, over the last two weeks now. Sort of like that frog in the pot of water that is unaware that the temperature is rising until he starts to boil, we have been the recipients of a slowly gathering storm, pushing a tidal wave of change on us from way out at sea, knowing that it is coming but not having a clue exactly when it will hit, how much damage it will do, or whether we will survive it.

On top of that, we are now seeing reports of people actually dying from this COVID-19 infection and disease, not just getting sickened or inconvenienced by it. A young lady. A middle aged media executive, a child, an infant, a renowned neurosurgeon, a country music artist. In other words, people like us or people that we love and care about. Ouch. Much too close to home. Anxiety, More stress. Worry. Paranoia. Enforced isolation which leads to functional isolation which leads to real isolation even at home. Not good for the psyche. Not good at all.

I can handle this, I tell my bad self. I will not get sick. This could never happen to me. I’m too young to die. I’m in my prime. My brain, smart as it is in the area of fact assessment and reality testing, is also super duper good at deception. The person it is the best at deceiving is me. I do not feel sick, therefore I cannot get sick. I am able to handle this stress, and even more stress, without feeling it physically. I will not notice a thing, not one little thing that will give me a clue that maybe my physical or emotional systems are overloaded. Right.

A couple of weeks ago, my left ear started to feel a bit stuffy. Annoying, but not terribly debilitating. I chalked it up to the myriad allergens in the air in the southern United States at this time of the year. I had felt this before, sometimes saw it turn into a mild cold, and had developed a way to cruise through it. Daytime and nighttime cold medicine at the very start of this syndrome, plus nasal spray to keep me breathing enough to work and be productive, all for about a week or so, had always worked before. Dutifully, at that first little feeling of stuffiness and discomfort, I embarked on my standard regimen. I thought little more about it.

A week later, things were worse. The ear was more stopped up, I could not hear well on the left side, and there was an uncomfortable feeling of having one side of my head in a barrel. I knew best, I told me, and I continued to doggedly prosecute my tried and true regimen. More liquicaps, more spray, more time. Nothing doing, my ear said, we will not budge. The left side of my head, down onto my neck, around to my cheekbone, got numb. When I would talk to colleagues, albeit from six feet away, I felt that I was shouting. Conversations at the island in the morning with my wife were unsatisfyingly one sided unless I turned my head towards her and practiced a mixture of something like torticollis and lip reading. “This is one bad allergy season!” I pontificated. All the while, this was really starting to drive me nuts, with the changes at work, schedules upended, my wife getting back on planes to fly germs, I mean passengers, around the country.

Then I remembered an episode a few years ago when a similar thing happened, but a time that I felt that I lost ALL the hearing in the same ear. Total hearing loss. Nothing. Scary. I ended up going to an urgent care center that time, and as you may have guessed by now, I had a monster, hard, obstructive impaction of cerumen, that’s ear wax to you and me, in that ear canal, completely and utterly obliterating any path for air or sound to travel one way or the other down my ear canal. A little soaking and a splashing shower of irritation, I mean irrigation into a small metal pan, and I could hear! I had never felt that happy in my entire life.

Fast forward to this week. No hearing, numbness in my face, unsteady on my feet, oh my God do have a tumor somewhere kind of angst running amok among the COVID-19 particles , I finally remembered that episode. I go to Walgreens, buy some ear wax nuking stuff (No, they still don’t have hand sanitizer), and get to work. I won’t bore you with the tedious details, but after three nights of this intervention, one evening in the midst of a showering royal flush, out came an ugly piece of wax that had bugged me for days. I could hear! I was no longer numb! It was a miracle!

Funny thing, though, the right ear, the one that had felt pretty normal through all this, felt a little stuffy itself once the left one was crystal, drive a gondola down the ear canal clear. Oh, no, migratory aural tumor, I thought to myself, and had to smile. Really? Really? More wax nuking drops, two more days, then blessed relief. I am virtually normal now, if I ever was.

So, I quipped to my wife at breakfast the next morning, sitting at the island, and NOT turning my head as I could already hear her replies, I wonder if increased stress and anxiety can cause one to create more ear wax? Ever at the ready to end wanton ignorance in our little world, she snatched up her iPhone and searched for an answer.

I’ll be damned.

Turns out, increased stress and fear can cause the body to produce more cerumen.

WHAT?

PRODUCE MORE CERUMEN!

SEASON WITH CUMIN? WHAT?

NO! EAR WAX. EAR WAX!

Oh……

We are all overloaded right now. We are frogs in a pot. The temperature is rising, and we are in jeopardy of boiling if we are not careful. We think that we have seen it all, done it all, figured it all out because we are smart, successful, resourceful people. We have all the answers. We are large and in charge.

Wrong.

This is bigger than us. Tiny viral particles, too small for us to see, have brought our world to its knees. Our economies are reeling. Our social institutions are paralyzed. Some of us are sickened. Some of us are dying. Our bodies know this, the ancient parts of our bodies and those cells and systems that really HAVE seen it all and survived, they know this, even if our younger, smarter, more resourceful brains cannot accept it.

Listen to your body. It will tell you when you are maxing out your biological credit line. It will tell you when to slow down, when to meditate, when to eat, when to rest. If you do not heed it, it will find a way to get your attention.

Thanks for lending me an ear while I waxed eloquent.

Yes, I really went there. Be well.

COVIDISMS: Change

I don’t like change. Never have. Never will. That is, big change that impacts me in big ways for long periods of time. Little changes, maybe okay.

That being said, this COVID-19 crisis sucks.

As soon as we knew at work that this was a real disaster, that it would almost certainly affect us locally and all of our coworkers and patients, we began to plan and to act. Almost immediately, we began to scheme how to put at least six feet between us, how to open doors with door stops so that no one would have to repeatedly touch them to go in and out of the various hallways in our buildings. How to sanitize fixtures and other touchable surfaces multiple times each day to keep us safe. The physical cleaning and distancing and separations came almost naturally as a first step to keep us healthy and safe. I dealt with that okay. Wash my hands even more times than usual. Don’t cough or sneeze openly. Use Kleenex, handkerchief, sleeves. Don’t touch stuff and then touch your face. Got it.

Next came how to distance ourselves from each other while all working in the same building, and how to keep patients from coming in and out, potentially cutting down on exposures for all of us. Six feet of distance. No staff meetings. All info exchanged by email, text or other non personal ways. Screening tent set up outside, signs diverting folks coming to the property to that area for the now ubiquitous interrogatory. Injections given outside in the tent by scrubbed, bescarved, masked nursing staff. The first ever, to my knowledge, management team meeting at our place that was completely done by Skype for Business. Most of us were still in the same building, but we were not dropping by to stand in each other’s doorway to chat, we were not doing sidewalk consultations, and we were not having routine meetings in the mornings or any other time. This was a major departure from business as usual for mental health types, who are used to presenting cases, asking questions, getting feedback and working in a team model.

The next step, pressure from the governor’s office to work from home. Not just a few of us. All of us, or as many as practically possible. This meant rapidly, and I mean in a matter of days, prepping everyone to pull up stakes, take everything needed home, learn to connect with a laptop, cell phone or tablet and access all the tools that we use to do our jobs every day, but in a completely different setting with completely different hardware. In addition to that, to speak with patients by video chat or phone (video encouraged) instead of face to face. This changed in less than a week. Hard to describe in words how monumental this is for many of us, who have sat face to face with patients for decades, looking for clues from odors, mannerisms, movements, gait, speech, expressions and other ways of assessing people and their behavioral problems. Suddenly, our world jumped online. Almost totally.

There are still a few of us literally in the building. I am still doing my Telepsychiatry emergency room work at the office since I have all of my technological rig in place there to do high quality video, etc. I am not set up to do that from home. I do, however, have a new laptop that is about halfway set up to do everything I need to do to run my clinic job from home, bolstered by video access that I can get with my MacBook or iPad. I have about sixty patients scheduled for the clinic this week, so I am not sure where the time is going to come from to make these major changes in workflow while work is flowing, but it will come to pass somehow. Soon, I may be asking for permission to share my wife’s art room studio space for a makeshift office in the corner for me, my Dell, my Mac, my iPad, my iPhone and my virtual patients. Major. Major. Major. Change.

Are there changes outside work? Are you kidding me? As I settled in to do my Telepsych shift in the EDs this morning, I got a FaceTime request from my daughter in Denver. Did not have to think twice about answering it immediately. There was my granddaughter, with a smoothie popsicle breakfast in her little hands. She has been in the habit lately, according to her mother, of calling someone that she wants to check on. Today, she wanted to call her Papa. Well, melt me and wipe me up with a Quicker Picker Upper. This is radical. This is heartbreaking. This is fabulous. This makes me laugh hysterically and sob at the same time.

So. Much. Change.

Such a short time to take it all in.

Has this changed my relationship with my wife? Not fundamentally, not in the least. She is my rock, my confidant, my support when I need it most. I try to be hers and return the favor. So are we both stressed? Absolutely. I work in health care. She works in the airline industry. Enough said. Might one of us be exposed to this little particle and infect the other? Of course. Might we get sick? We’re both over sixty. Yep. Might we have to quarantine? Yep. Can she work from home? Nope. We are okay, but we have had conversations. We will have more.

How am I dealing with all of these fundamental and profound changes?

On the negative side, by obsessing way too much (I do that anyway, on a good day!), by updating, organizing, re-reading, trying to concentrate, trying to stay focused on the task at hand and actually finish it in a timely way.

On the positive side? Listening to music, lots of music, uplifting music. Listening to podcasts. Writing. Journaling. Sleeping when I can. Eating good food. Connecting with family by email text, FaceTime and phone calls. Trying my best to be supportive of my friends and my staff at work. Getting advice and help and guidance when I need it. (I still need it.) Making time for my marriage and my relationship with my wife. Noticing that it is indeed a beautiful springtime outside and marveling at the beautiful colorful flowers in our courtyard, my Japanese maple that has miraculously resurrected itself from the winter doldrums to sprout dozens of delicate red feathery leaves, and the azaleas that are shouting at us, “Look! Look! We are gorgeous! It’s spring!” Watching the doves who sit patiently on their nests at the top of the courtyard’s brick wall under a marvelous cascade of tiny yellow roses. Sitting, blinking, soft and beautiful brown-gray and wondering what all the hullabaloo is about.

I do not like change.

I do not like it in my house.

I do not like it for my spouse.

I do not like it at my work.

Out of my routine I am jerked.

I do not like this viral spread.

I do not like the many dead.

I wonder when it all will end.

I wonder if our paths will bend?

I wonder if we all will learn

That viruses our worries spurn.

They set their own trajectory

And care not one small whit for me.

How has your life changed in the last two weeks? How is it likely to change this next month? How will you cope and stay happy and healthy and productive until this pandemic ends?

Stay safe, isolate, wash your hands and we’ll get through this together.

Updates

Well, as often happens, it takes a while for the dust to settle on a new idea or project to really find out what you were thinking in the first place. I was going to have a spin off blog about growing older that would be separate from my longstanding blog Musings. I realized a couple of things. One, it is as difficult to multi-blog as it is to truly multitask. We fool ourselves into thinking that we can do it, but in reality we only find ourselves ping ponging back and forth between competing ideas and projects, half doing both, completing little and feeling frustrated. I found that as I was growing older I was simply musing, and in the time I was musing I had indeed grown older. The solution? Merge the blogs. Done. If you missed any of the first dozen and a half posts on Growing Older, they are here to be found and enjoyed. Now, back to musing, the thing that I like to do and most likely do best in this space and format anyway.

Coronavirus has changed my life. Has it changed yours too? It seems like years ago since the first inklings of this unfolding tragedy hit out consciousness, but it’s only been weeks. In just weeks my home life, work life, travel, recreational time, and professional view of the world has changed. It’s here. I don’t like it.

Specifically, what do I not like about this virus-filled world? I do not like the fact that I now am sitting at my desk, isolated, cut off from my patients, all of whom I now communicate with by cellphone or video. I do not like the fact that my wife is unnerved, unsure, and at loose ends, not knowing if she will fly, where she will fly, with whom she will fly, and if she has a better then even chance of contracting this COVID-19 and then bringing it back home. I also worry that even though I see everyone artificially and sterilely now, that I may have had a chance or three to pick up that same virus in the weeks before we even knew it was stalking us. I do not like the fact that I spent many hours thinking about and working on a presentation for a conference that is now canceled. I do not like the fact that my wife and I were planning to go to Italy in April, the first time I would have been back to that country since I lived there as a seventh grader in 1970, and now that dream is many months if not years down the road. I do not like the fact that I cannot joyfully get on a plane and fly anywhere I want to seek adventure or excitement, because each trip is possibly contaminated and scary and potentially disease-ridden. I do not like the fact that I had to physically rearrange my office to better telepsych and type and talk and Skype and document. A little thing, but enough to make me not know exactly where to put my hands and at what distance to sit from each screen and how to best situate myself to hear and see and type and complete other tasks at hand. Just enough change to make me strain at the viral tether that now is attached to all of us, invisible and inevitable.

Which part of all this makes me the most cranky, feel the most sad, the most sorry for myself? None of it.

What hurts the most about this kind of game changing, world shrinking, mind blowing natural event is how it impacts the ones I love and care about. I already mentioned my wife. What hurts her hurts me and vice versa. Her confusion and questions are mine, my physical and emotional exhaustion are hers. We support each other the best we can and keep moving forward.

Our mothers, both in their eighties, should not have to worry about this. They are the young old, at least in our eyes, energetic and sharp and happy and smiling. They enjoy Silver Sneakers, volunteering at the hospital, spending time on the back deck, tending to flowers, watching the myriad birds they attract with feeders, visiting with neighbors, seeing pictures of great-grandchildren on FaceBook and living the life that the old should be entitled to without question. They should not have to worry about a cough, some congestion, a fever.

My children. No, they are not young anymore, I know that, strange as it still seems to me. They are courageous and daring and outspoken and informed and energetic as they attack this new problem that has decided to pop up in their lives at this particular time. They must handle relationships and jobs and raising children and sending spouses off to work. They have this newfangled internet and FaceBook and Twitter and Instagram stories and all the ways they can connect to friends and family, and they wield them like flaming swords, daring this little be-crowned viral particle to deconstruct their worlds. I marvel at their energy, their drive, their curiosity, their willingness to challenge norms and speak out and change their world. Virus be damned.

Yes, all the inconveniences are just that. They are not insurmountable. They may be fleeting. They are adaptations, mild kinks in the otherwise relatively smooth rope of time that we all cling to and slide along until we reach the frayed end that allows us to quietly slip off into history.

The big things, the important things, are how this little virus is changing our social fabric, our emotional, physical and financial security, our ability to reach out and touch each other, to comfort each other, to hold each other up. It is painful to watch, to experience, to feel. It is isolating. It is depressing. It feels almost insurmountable.

But it is not forever. The wonderful line in one of the shows that my oldest daughter starred in last season in Chattanooga, Avenue Q, says it best.

It’s only for now.

Wash your hands. Pick up the phone. Call someone. Wash your hands. Telecommute if you can. Cook at home. Have wonderful conversations. Wash your hands. Do it, because you must. We must all pitch in, if not for ourselves, then for our mothers and fathers and children and grandchildren,

It’s only for now.