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. 

The Next Two Weeks

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

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

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

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

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

My preparatory years were measured in four-year increments. 

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

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

I used to look forward to the next four years.

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

Covidisms: Grudge Match

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

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

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

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

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

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

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

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

Grudges? I have ‘em.

What the pandemic has taught me?

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

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.

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.

Insomnia in the Time of COVID-19

I have talked about it before, but it bears revisiting this week. In the last three weeks that I have worked at home, I have heard several complaints repeated over and over again. One that is on everyone’s lips is this: “I can’t sleep.”

Now, I see a lot of folks who have depression, anxiety, trauma, grief and many other issues in my work, but there are certain kinds of symptoms that seem to be common across the spectrum of mental health illness or stress. When people get upset, their mood changes. They eat too little and lose weight, or they eat too much and gain weight. They notice changes in interest, motivation and energy levels. They isolate and have trouble connecting with those they love. They have a hard time focusing or paying attention to things that matter. Many of these symptoms might be present in anxiety disorders, mood disorders or even psychotic disorders. Still, the one thing besides a vague sense of anxiety that almost everyone is feeling, and complaining about in the midst of this pandemic, is the inability to get good, restful, restorative sleep. 

First, some normative data. What is normal sleep latency, the time that it takes most of us to drift off to sleep? Eight minutes is a good yardstick. How much sleep do we really need? One can read about numbers that vary wildly, but it still seems that most people do better with an average of seven to nine hours of sleep per night. How much of this needs to be REM (rapid eye movement) sleep, that stage of sleep where we actively dream? Well, if one gets nine hours of sleep and REM cycles repeat every ninety minutes or so, one could expect to have at least two good REM cycles per night. Twenty-five per cent of your total sleep time given to REM is about right for most people. 

Next, why is this important? Why do we need this much sleep anyway?  We think that sleep is important to maintain both good mental and physical health. While we sleep, our bodies repair and maintain organ systems and muscles and immune systems, and manufacture hormones. Memories and newly acquired information may also be cemented during sleep, so that this information can better be used later during waking hours. Getting the right amount of sleep may also be protective in guarding you against development of diabetes, weight gain, and heart disease. 

Why has sleep, or the lack of it, been such a constant complaint in the last few months as we navigate this COVID-19 pandemic? Many people are experiencing anxiety, which tends to make settling down, getting relaxed and falling asleep at night very difficult. This anxiety is low grade and chronic for many people, hard to describe but always there, and it tends to affect our ability to fall asleep, leading to what we call initial insomnia. This kind of anxiety and inability to fall asleep can build on itself night after night, becoming a chronic problem. 

Others may be battling depression, with superimposed grief over all the things that we have collectively lost because of the virus outbreak and its impact on our physical, emotional, vocational and financial lives. Depression sometimes leads to what we call early morning awakening. You are able to fall asleep just fine, as you are sometimes absolutely exhausted, but you find yourself waking up almost every night at four AM, not able to go back to sleep. 

Everyone wants to sleep. The quick fix, taking some kind of over the counter or prescription sleeping pill, seems to be the best answer. Not always so, I’m afraid. Sometimes one has to deal with the underlying anxiety, depression and grief that is depriving us of sleep in the first place. Sleep hygiene is also very important. You know, the steps that your doctor has told you to try, including not exercising in the evening, limiting late night eating and alcohol consumption, avoiding screen time for several hours before you go to bed. Regular bedtimes and awakening times are also crucial, as these rhythms tend to lead to more consistent and restorative sleep. 

During this pandemic, we are all a little out of sorts, our usual routines have been disrupted, our moods are different and our ability to relax is strained. Knowing what is normal, what is not and how to maximize our chances to sleep well each night will go a long way to help us not only weather this biological storm, but thrive as we get to the other side of it.  

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.