Plandemic

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

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

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

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

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

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

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

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

Costco-vidisms, and Other Musings

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

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

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

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

 

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

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

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

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

 

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

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

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

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

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

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

 

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

 

 

 

 

Coronavirus and Mental Health

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

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

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

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

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

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

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

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

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

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

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

Boredom

We have been in this pandemic for months that feel like years. Have you reread all the books from your childhood and college years? Have you put together every jigsaw puzzle from the storage closet under the stairs? Have you binge-watched every Netflix series that caught your fancy? If you have, then you have probably hit that emotional, physical and temporal wall that is boredom. I don’t have anything to do. I just want to go to sleep. Maybe I can find a snack in the kitchen. I should be cleaning or cooking or…
I think we’ve all felt it, experienced it, and dreaded it, but boredom is not something that is to be feared or even endured. I read a January 4, 2019 Time article by Jamie Ducharme recently called Being Bored Can Be Good For You-If You Do It Right. Here’s How. It made some good points and made me think more about how we can embrace boredom and even use it as a jumping off point for creativity and productivity if we just open ourselves up a bit.
Why is boredom, and the act of being bored every once in a while, so important? According to the Time article, boredom “is a search for neural stimulation that isn’t satisfied”. I believe that we sometimes panic when we have nothing to occupy our minds or stimulate us or provide novelty, but being bored pushes our own brains to create the novelty and stimulation from nothing. It forces us to be creative. I love to write, and some of my best ideas to explore have to come to me in such unlikely places as the hot shower on a cold morning, on a steamy trail walk by the river, or when sitting drowsily in the early summer sun in my front porch rocking chair. These down times can be a resting period, a respite from the daily grind that we sometimes do not realize we need. They can happen spontaneously. That being said, can one plan to be bored?
Absolutely. Now, I should say here, as did the author of the Time article, that one should not confuse boredom with relaxation. Acts that require concentration like yoga, meditation, or even putting together a puzzle, do not lead to boredom, even if they are relaxing. Boredom requires that one let the mind wander. No stimulation is necessary. Another crucial aspect of allowing yourself time to be bored is that you must unplug. Having a phone in your hand keeps you from ever reaching true boredom, while it paradoxically fails to truly entertain most of the time. What do I mean by this? Endless scrolling keeps our brains from working out their boredom and coming up with novel stimulation and creative thoughts. At the same time, the quality of entertainment we get from such unstructured time is nowhere near the quality of entertainment that we might get from diving into a good book with characters we truly care about and invest in.
Sandi Mann, a senior psychology lecturer at the University of Central Lancashire in the UK, says that we can become addicted to the tiny dopamine hits we get every time we pick up our devices. “Our tolerance for boredom just changes completely, and we need more and more to stop being bored.”
Planning for times that you will be bored may lead to increased creativity, new ideas to explore, and thoughtful reflection about the things that are important to you but that get pushed back by technology and busy schedules. Being bored may help you become more resilient. You may even find that this new creativity and idea generation gets you outside your own head and thinking about doing something that might benefit others. Read, doodle, listen to familiar music, doze in the sun, anything that will free your brain to be quiet, attentive and open to new things. You may be amazed at what you come up with.

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. 

Marking Time

Is it just me, or has time felt different in the last ten weeks? Do you feel that time has sped up, giving you a decreased ability to accomplish the things you need to get done, or does time feel slowed down to you, making each day feel longer and harder to fill with constructive tasks? Do your protracted days feel full of dead space that is buffered by countless hours of Netflix? I have been doing some thinking about time and schedules and orderliness and routine lately and thought I would share some of that with you this week.

Time is measured in several different ways by us and for us. First of all of course is our natural, biological circadian rhythm. According to the National Sleep Foundation at sleepfoundation.org, your circadian rhythm is basically a 24-hour internal clock that is running in the background of your brain and cycles between sleepiness and alertness at regular intervals. It’s also known as your sleep/wake cycle. A few important things about this cycle. It’s pretty regular, but it can be altered or disrupted if you are a night owl or a morning person, or if you are caught up on your sleep or sleep deprived. Light and dark tend to coincide with this cycle but shift work or other alterations in usual patterns of activity also can make things interesting. Lastly, your circadian rhythm may change as you age. You may not have the same sleep cycle as your partner, children or parents.

How has this affected all of us during this pandemic? We tend to get into a pattern that involves going to bed at about the same time every day, getting up at the same time (albeit prompted by that dreaded alarm that always goes off earlier then we like), having a relatively fixed commute time, and eating meals at the same time. We mark time during our days by these fixed events and behaviors and we can almost set our clocks (internal and external) by them. Now that many of us are working from home, or might have even lost our regular jobs, these temporal signposts have been disrupted. We might get up an hour later. We might have more time for lunch at home. We have a shorter commute, or no commute at all. Light and dark might not be the biological bookends that they were before, in that we get up and go to bed at different times that before the pandemic. Our internal clocks, our circadian rhythm, has been slightly altered just enough to make us feel odd, tired, irritable and out of sorts.

What about our self-imposed schedules, our calendars, alarms, reminders and other ways that we mark time during our days and nights that helps us make sense of our world and our place in it? These have always been the ways that we choose to structure our days. For example, my wife is a very analog person who has a calendar in the laundry room, another in her art room, several ongoing Post It note lists for groceries, phone calls and projects that live between the bathroom, bedroom, kitchen and art room. I choose to structure most of my life digitally, with a to do program called Things, a digital family calendar for our stuff and Outlook for work related time, and reminders that are pre-programmed for months and years to pop up and tell me what to do when it’s time to do it. Both of these methods of marking time work very well, depending on the person and their needs. Even in the time of this pandemic, these ways of controlling our day and the time allotted to various events and projects maintains a fair amount of integrity.

That being said, even these physical manifestations of our time have been altered by COVID-19. How? She is going to the store less. I am ordering things online as I always have loved to do but finding that I need fewer things now that I am home the majority of my time. Seeing and visiting our families has become an entry to FaceTime on the weekend to catch up. My routine management team meeting with my coworkers is now done on Skype for Business, instead of around a table. Church is at ten AM, but we now go there via Facebook Live. The events on our calendars are exactly the same, but the way the events happen is vastly different.

How about the big external ways that we mark time or have it marked for us? I’m thinking about birthdays, graduations, holidays, sports seasons and events, changes in the seasons, and other major delineations of time that we experience collectively and socially. What has happened to these during the pandemic? We know that we have not been able to travel to visit with parents, siblings, children and grandchildren. The joy of a hug and blowing out the candles on a birthday cake has been tempered by the possibility of being an asymptomatic carrier of the coronavirus and inadvertently infecting a loved one. Easter came and went with virtual celebrations, family Zoom calls and personal egg hunts. As I write this, a NASCAR race will be held at the speedway in Darlington, SC, but no spectators will fill the stands to watch it. Seniors are graduating without public fanfare. Baseball will play a shortened season starting in July, without fans. The celebration of summer will start as it always does on Memorial Day, but pools will not open and beaches may still be closed.

We count on our internal clocks, our personal calendars and the changing of seasons to guide our behaviors, set our moods and keep us connected as we celebrate the moments of our lives. We mourn the loss of these tangible ways to measure time. It is not the same today, and it may not be the same next week or next month or even next year. Will we get back to the security of a routine, a calendar filled with events and being able to celebrate life’s many milestones?

You can bet on it. Mark it on your calendar.

Certainty

“Have you ever heard a story like mine before?” she asked me, a pleading look on her face that both begged me to say no, making her special, and to say yes, alleviating her fear that she was so unique that there was no help for her.

“Why, yes, I have, many times,” I answered.

She slumped, her body releasing the tension of years of not knowing, of fearing the worst, of thinking that she was beyond help.

“Please, tell me. Tell me. What do I have? What is my diagnosis? What is wrong with me? I just want to know that someone knows what this is called, what my symptoms mean. I want to know. To be clear. To be certain.”

I told her what I thought, while at the same time telling her that not much in the field of mental health is absolutely certain. The brain is a fascinating organ, but when something goes wrong deep inside it, it may neither be as easily diagnosed as a fractured femur, nor as easily repaired.

Many of my patients come to me with anxiety, with fear, with uncertainty. They feel things, they experience things that frighten them and make them feel that their world is out of control. They are hesitant at first to uncover these feelings and thoughts and impulses and changes in mood and thought that they think will label them as crazy or weird or not normal. Can we blame them? Absolutely not. We all want to appear, to feel, and to be normal, at least in the eyes of our family, friends and peers. We crave normality. We crave the usual, the mundane, the predictable. Of things that can be known and explained, we crave certainty.

Now, these past few weeks have been different, wouldn’t you say? We are told to distance ourselves from our loved ones and coworkers. We communicate via FaceTime and Doxy.me and Zoom and Skype. We wear masks. We wash our hands many times per day. We look askance at the person approaching us in the aisle at the grocery store. We have developed an intimate relationship with Netflix. Some of us have lost our jobs, and with that has come a rise in anxiety, insomnia and fear that I have not seen in my patients for quite a long time. All of this is stressful enough, but it is bearable, at least for the short term.

Enter the lack of certainty.

Humans can bear almost anything for a finite period of time. Think of previous pandemics, the fall of empires, the great wars, and natural calamities. We have faced much, and we have survived much. We are able to bear the most painful hurts and atrocities, as long as we know there is an end in sight. As long as we know there is an end to the suffering, the pain and the uncertainty. This is one of the reasons that our current situation, battling the unseen enemy that is the coronavirus that causes the illness COVID-19, is so difficult for us to bear. We simply do not know exactly how and when this is all going to end.

We are told to get out but keep our distance. We are told to go to work. We are told to stay home. We are told that we can work in a modified way, then we are unceremoniously handed a pink slip or a furlough notice. We are told that we must  stay in our homes for six or eight weeks, then we are told that the churches will be gloriously full of people on Easter Sunday.

How do we respond to this? We are anxious. We are stressed. We do not sleep. We hoard things that we think might be in short supply soon. We obsess over how we will pay our bills, care for our children, and check on our elderly relatives. We get depressed. We lose hope, that most precious of commodities that fuels recovery from any disaster. We worry needlessly, because as one of the nation’s top scientists said, we do not make the timeline. The virus makes the timeline. What to do?

How can we protect ourselves? The key is to recognize that we cannot be certain about this virus, this illness or the resolution of this pandemic. Even the medical scientists who know everything there is to know about these things are not in agreement about how this will all play out. We must let that go. What we can be certain about is how we live out our own life in the middle of this event, choosing to be positive and proactive instead of responding to the growing reports of illness and death.

Sleep. Sleep enough and rise and go to bed at the same time each day if possible. Eat healthy foods. Do not overindulge. Exercise. Meditate. Read things other than the news. Journal. Create. Connect with friends and family in any acceptable, non-risky ways you can. We are social organisms, and we do not do well with long term isolation and emotional and physical deprivation. We just don’t. Learn new skills that help you navigate this crisis. Do not expect to do things the same way because “that’s the way it has always been done”. Keep an open mind, learn new techniques and skills, participate and be a part of life as it is today, not as it was three weeks ago.

This pandemic will pass. I don’t know exactly how or exactly when. I just know that I am certain about a few things right now. I can still see my patients from a home office that did not exist until last week. I can get outside and take a walk and eat lunch in the warm sunshine on my front porch. I will go to the river and fish this weekend. I will read and listen to music. I will connect with my family in technological ways that were only vague dreams when I was my grandchildren’s age. This is the life that I can lead right now, and I am going to embrace it with everything I have. Of that, I am certain.

I hope you choose to do the same in your life. Be well and stay safe.

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.

Music Notes and Covidisms

Music is always a good thing, no matter the mood. If I am down, sad, angry, irritable or just flat, music can be the background that either confirms my emotional state or lifts me out of it.

I was pleased to open the music app on my phone yesterday to see that Apple had gifted me with a new curated music list called Get Up! I usually like to play my Favorites Mix, the Chill Mix and sometimes get wild and crazy and listen to the New Music Mix. The Get Up! Mix was especially welcome in light of all the stress I have been feeling in at work this past week. From the opening bars of Drivin’ With Your Eyes Closed by Don Henley (one of my favorite artists) to Elton’s John’s Sleeping With the Past to You Might Think by The Cars, I was immediately transported to a better, more mellow place.

Whether Dan Fogelberg is riffing on democracy or Chicago is making me smile, this music is a throwback and an anchor to times before middle age, viruses and crazy politics. I find myself singing along, tapping my feet, humming, and just letting a tiny bit of the stress flow out of me and back to wherever stress goes when it leaves us.

Like the bands tell me, If my Paper(is)late and I am stressing over deadlines, music can Take It Away. A look to the Western Skyline does Open Soul Surgery on me and, like Tom Petty (may God rest his soul) I Feel A Whole Lot Better. Amen.

What does COVID-19 do to you, even if you’re not infected? Well, from my chair at work, it makes me anxious, it has tripled my workload and it leaves me wondering when this will all end. Any good things, positive things it has done? Yes.

I am concentrating on communicating my needs and the needs of my staff and patients more succinctly. No time for mincing words these days. Formulate the thought, get it out. On to the next thing. It has made me appreciate touching base with my peers. A lot of decisions and plans can be made in a very short amount of time in a crisis situation. I knew this from having worked hurricanes and other natural disasters, but this is different. It is affecting everything from staffing to leave time to employee health to childcare to scheduling to clinic procedures to supervision to patient care to technology to time management. Boom. In a matter of days, the way we did things is no longer the way we DO things. You have to keep up. It’s exhilarating, excruciating and exhausting.

I have had more direct contact with my family members by phone and FaceTime in the last few weeks then in the last year. I checked on my uncle last evening after hearing from my mother that he had sustained an injury in a fall. He sounded the same to me on the phone. A little mischief and humor in his voice, an even tempered assessment of the world, a positive take on what had happened to him and how he was going to deal with it. It made me smile just to hear his voice. Why had I not called him sooner? There is no reason; there is no excuse. Just a loss of routine connection that a tiny virulent particle has prompted a course correction for.

Thanks to Tom Petty for giving me the right thing to say to you, Coronavirus.

I’ll feel a whole lot better when you’re gone.