Peekaboo, the ER Sees You!

Peekaboo, I see you!

Any of you who have children have played this game over and over with your young ones. At a certain age, they love to pull a blanket over their heads, or better yet, to have you hide behind that same blanket, and then squeal with joy when you emerge. It’s always as if you went far, far away and then miraculously returned to be with them again, much to their delight. The repetitive interaction teaches your child that you are always there, that if you appear to be gone that you will return and that you are a constant in their lives. They learn that you are there for them, and that you will keep them safe.

In mental health, we try to see and evaluate children in many contexts. We see them for who they are in a family unit, in their school environment, with their friends and in other social settings. In pre-COVID-19 times, we might have seen a child in the office, with input by a therapist, nurse and child psychiatrist. We might have had a school based therapist see the child in his or her natural environment in the classroom, the lunchroom, or the playground. We most likely would have wanted to get collateral information from other family members, several teachers, court systems, pediatricians, probation officers, or anyone else who might know something about that particular child and their presenting problem.

Since the pandemic began and lockdowns of various types began to be commonplace last spring, a lot of this normal information gathering has been curtailed. Clinics are closed and onsite, face to face interaction with mental health professionals is severely curtailed. School based therapists have been deprived of their most fertile diagnostic and therapeutic ground, the school itself, because so many children have been placed in virtual learning environments, often from home. If mental health providers cannot see the kids, they cannot do an adequate assessment and provide timely treatment. The result is the very real possibility that more depression, academic failure, physical, mental, or sexual abuse or neglect may be happening but never seen. Where do children and their parents turn when care is needed, but normal avenues of assistance are cut off?

The CDC tells us in their Morbidity and Mortality Weekly Report (MMWR) for the week of November 13, 2020, that emergency departments are often the first point of care for children’s mental health emergencies. As a community telepsychiatrist who has seen folks in the emergency rooms of South Carolina for the last ten years, I can attest to the truth of that statement. An interesting point here: during the first few months of the pandemic last spring, ER visits for all sorts of problems for adults and children actually went down, not up, at least at first. Why? Everyone was so afraid that they would contract COVID-19 at the ER that they stayed away, even if they had legitimate emergency health issues that needed to be attended to right away. Starting in April 2020, the CDC tells us, the proportion of children’s mental health related visits among all pediatric ER visits increased and remained high through October. Compared with 2019, the proportion of mental health related visits for children aged 5-11 and 12-17 years increased 24% and 31%, respectively.

We know that the coronavirus pandemic has had a negative effect on the mental health of children. If other services as outlined above are not available, children end up in ERs. These resources are invaluable when the going gets tough and there is no other option, but by virtue of their very nature, rapid assessment and evaluation of the sickest among us and triage to admission or discharge to further outpatient assessment, it is impossible for ER staffs to do a really thorough assessment of a child with serious mental health needs, even with telemedicine and other services there to assist.

Monitoring indicators of children’s mental health, the CDC tells us, promoting coping and resilience, and expanding access to services to support children’s mental health are absolutely critical during the COVID-19 pandemic. With the launch of vaccinations and continued use of masks, handwashing and physical distancing, we will get through this pandemic and back to some semblance of normal. In the meantime, we must not let even one child who needs us slip through the cracks and suffer from mental illness that can be assessed, diagnosed and treated.

Peekaboo, we see you.

Multiverse

I bought a Leatherman tool a few months back, thinking that having one multi tool in my bag or fishing tackle box would solve all the problems of finding that perfect screwdriver or pry or opener that always seems to hide itself from you when you need it the most. I have already used it to cut down cardboard boxes for recycling, to put together a pair of Adirondack chairs for the porch upstairs and to fetch an embedded hook from the throat of a largemouth bass. It is built well, it’s rugged and it’s complete. What more could you need, right?

I have also used other multi tools, including a laptop and desktop computer, an iPad, a multi pen, and others that claim to make life easier by having everything you could possibly need in hand at any time. They deliver on their promises,but are they as satisfying to use as single tools made for a single job?

Back when I was in medical school and residency, pens and paper were the lifeblood of medical charts and orders and notes. Cross pens (remember those?) were easily recognized in pockets and hands. They were given as gifts, singly or in little blue felted lined boxes with equally silvery shiny mechanical pencils. Mont Blancs were a step up, and of course I had a maroon one that I loved. Perfectly weighted, felt good in the hand, wrote smoothly. What more could you ask for, right?

Reading used to be accomplished by holding things called books, (You remember those too, right?), a single target use device that was made to entertain, impart knowledge or provide in hand research after rifling throughout wonderfully musty card catalogues at your local library. More recently, we have iPads, Kindles and a host of other electronic reading devices that may or may not do fifteen other things that distract you from that primary goal of reading. (Check Twitter! Check email! Order from Amazon.com!) Better, or not?

I often had a good natured argument with several friends and coworkers about the actual existence of multitasking and whether or not it could actually be accomplished in any meaningful and productive way. Our brains are made to focus on one thing at a time, and we do not do multiple tasks well all at one time. Is it better to be a jack of all trades and a master of none, or…

So, now that I have had access to laptops, iPads, multi use audio devices, multipens, and multi tools, I have come to the realization that I love the thought, feel and process of using one tool at a time for one job at a time most of the time.

Give me my book, my superbly weighted pocketknife, a throwaway Uniball Signo DX pen, and a good notebook anytime. I will be satisfied, productive, and happy.

Eras

I was talking with my wife the other day about different times in our lives and asked her this question: “What is the period or era in your life that you feel most impacted or influenced you?”

I guess the fact that we have been living through a time of such upheaval in the last year has had me thinking about such things. We have seen the worst medical crisis in one hundred years, political unrest, economic instability for millions and racial tensions that have been escalating and boiling over with the deaths of black men in multiple cities. Now in my early sixties, I am at that point in my life that I know there are fewer years ahead of me than there are behind, and I am trying to make sense of who I really am and why.

I think back to the grammar school years, with the early crushes and football practice and idyllic days of riding bicycles exploring nearby woods on a hot summer day. I remember the many visits to my grandparents. My mother’s parents had a farm in middle Georgia, a wonderful place for a small boy to grow up in the bosom of a loving family. I will never forget finding box turtles in the sandy ditch in front of the farmhouse, swollen with runoff after a monster rain storm. I remember spending hours in the porch swing on the front porch of that same farmhouse, back and forth and back and forth as I traveled in my mind to foreign lands, piloted a plane, captained a ship. Many, many dreams had their origins in that rhythmic motion at the far end of the porch. Butchering hogs, gathering watermelons, fishing at the pond, and taking rides in the back of the old truck to the country store to fetch small paper sacks of candy are indelible memories. Christmases were magic, with the floorboards on Christmas morning so cold that your feet would be numb after jumping out of bed before the gas heaters were lit for the day. Food, so much food, and visits by all the aunts and uncles and cousins, light and laughter and love through the ages.

I have been many places and done many things since that time on the farm as a little boy. I navigated the treacherous waters of the teenage years and high school, went to college, lived overseas with my family in Italy for two years, and then achieved my dream of admission to medical school, with residency to follow. I have had many different groups of friends and associates, professional partners and teachers and mentors. All have shaped me, taught me, buoyed me up and at times torn me down (albeit for my own good, I suppose). I have loved it all. But which time in my life has had the most influence on me, given me the most fuel to move forward, taught me the most about moving through the world and being a productive citizen of the planet?

I think you can see by virtue of the structure of this musing that the time that was most important to me was the early times, the formative times, the times that a young boy learned how to be a teenager then a young man. The time that pulls at the man the most is not the college years, the medical school training time spent in the anatomy lab or the first time I treated a patient on my own as a young doctor. The time that has stuck with me the most is the time that I spent with family before I knew about racism,economics, pandemics or politics.

I have a swing at my house today. It waits at the far end of the front porch, and I sit in it only sporadically. It means a lot to me, not because I spend hours there flying planes or captaining ships and sailing to foreign lands, but because I could do that if I needed to. It is a bookmark in time for me, a stained wood reminder of my past, a clear and present comfort in these uncertain times, a place that I can always retreat to any time I need to feel a connection to those who who have gone before, those who have molded me and shaped me in ways that no other periods in my life could have.

Diamonds in the Rough

According to the Smithsonian Magazine, diamonds are formed deep within the earth, about one hundred miles down in the upper mantle. As you might imagine, it is quite hot in that part of the planet, and there is a tremendous amount of pressure bearing down in that location. The brutal combination of pressure and heat is what it takes to form diamond crystals. Now, we can’t actually travel there or even adequately sample the earth at that depth, so how did the diamonds that we mine today get brought to the surface? The Smithsonian tells us that huge, violent volcanic eruptions, like none we have seen in our lifetimes, carried the newly formed diamonds upwards in channels that made cooled lava formations called Kimberlites, and that these conduits ran at twenty to thirty miles per hour. Why is that important? Because if they had transported the diamonds any more slowly to the earth’s surface, once they got here and the eruption cooled, all that would have been left was lumps of graphite. The diamonds had to be rushed from the fiery pits of hell to the coolness of the surface rapidly, and the changes that they endured created some of the loveliest crystals that man has ever seen. Formation may have taken forever, but transformation, ah, that happened very quickly. By moving quickly, these diamonds got locked into their crystalline structure, and there was simply not enough energy available at their destination to ever turn them back into graphite. Diamonds are made of carbon atoms that bind to each other extremely strongly, each carbon atom joined to four others. Once they have made the turn and become the diamonds that we know, there is no turning back.

I have heard many stories over the last ten months. I have heard the lamentations of those who feel downtrodden, alone, forgotten, with moods as dull gray as the graphite one hundred miles below the surface of the earth. I have heard the stories of the white-hot heat of grief as a loved one is lost to COVID-19 or another illness. I have heard the stories of the volcanic eruption that occurs with the loss of a job, the loss of income, the loss of a home. I have listened as someone describes the tectonic shift of being displaced, turned out, evicted, down sized. I have heard and witnessed the rapidity with which one can be faced with the loss of a business that took decades to grow. The people of our planet have been forced to deal with rapid, forceful, painful, monumental change in the short space of ten months. Ten months. We did not even know exactly what COVID-19 was this time last year.

Like diamonds, the most marginalized and ostracized and forgotten among us have been thrust upwards on a hot wave of change that threatens, if it goes on too slowly and too long, to reduce us to nothing but gray ash. The upside of the pandemic? We have been forced to change the way we see our world, our work and our worth as we think outside the box, learning to be teachers, learning to conduct meetings online, learning to find new income streams by learning new skills. We have been forced to change so rapidly that we have found new bonds, strong bonds, that no virus can break. We have been transformed into shining examples of resiliency. We have lived and loved and mentored and supported each other.

Some of you may even now think of yourselves as gray, sad, and worthless. No. As you have been carried along by this 2020 volcanic wave of change, you have been made stronger than you think. Those four bonds, six bonds, a dozen bonds that you have nurtured this past year have transformed you into something bright, shining and capable of surviving anything that COVID can throw at you. Use those bonds. Be strong for yourself and for those around you. Polish yourself any way you can so that when this ends, and it will end, you will no longer be a diamond in the rough. You will be clear eyed, look toward the future and know that you have survived the fastest and most challenging medical threat in a hundred years, and that you have emerged with a clarity that nothing can ever take away again.

It’s a Pandemic Life

I have had more than one patient tell me that although they have no specific plans to kill
themselves, they sometimes just wish that they had never been born. They are so depressed
and hopeless and have so little regard for themselves that they feel that anyone who lives with
them or loves them would be much better off without them. In this time of the coronavirus
pandemic, these feelings have been intensified. Losses mount for some. Loved ones grow ill and
die. Jobs disappear, and with them the ability to pay for food, clothing, rent and even gifts for
the children at Christmas. Think of it. The people who count on you for their very lives and
support are the ones who you think might be better off if you had never existed. Ironically, it is
the strong attachment to those people, especially young children, that often saves us from
ourselves and pulls us back from the brink of an irreversible act of self-destruction.
Have you seen the movie It’s a Wonderful Life? I highly recommend this 1946 film starring
Jimmy Stewart and Donna Reed. George Bailey, played by Stewart, has spent his whole life
giving of himself to the people of his hometown, Bedford Falls. On Christmas Eve, George’s
Uncle Billy loses an $8000 deposit from the Building and Loan that George runs, which is found
by the town’s villain, Mr. Potter. When Potter hides the money, George is in very real danger of
being arrested for bank fraud if an examiner discovers that the money is missing. Thinking that
his wife, his young children and others who love him will be better off without him, he
contemplates suicide. After crashing his car into a tree, he walks to a bridge and is planning to
throw himself off. The prayers of all those people reach heaven and an angel named Clarence is
sent to earth to help George, promised that he will earn his wings if he is successful. Clarence is
able to show George what the world would have been like if he indeed never had existed, and it
opens his eyes. He is able to see all the blessings that are his, the people who care for him and
the fact that love and togetherness and a mutual respect for each other can conquer any
problem.
No doubt, there are many people who are hurting this holiday season. There are those who
cannot take care of their families, who do not have a job, and who feel that life would be better
for those they love if they had never been born. Like George Bailey, they may be thinking of
suicide. But also like George, many of these people may have a Clarence just begging to help
show them that they matter. We sometimes feel that we can do little to change the course of
history or the arc of misery that the world seems to be on. Think about this holiday season and
how you can play the part of Clarence, Angel Second Class, for someone you love. Can you tell a
story and share a memory of a good deed done? Can you offer a smile? Can you send a note
thanking them for the influence they had on your life? Can you drop off a meal or Christmas
cookies or a small bag of toys for the children at the front door? Can you give a card and more
of those cookies to the postman who brings your mail every day?
Especially in this time of pandemic, in this holy season, it is important to count our blessings
and use our time and talents to help those who need it most. Who knows, if you are successful
in making the holidays bright for just one desperate person, you might just earn your wings.

Empathy

I have always tried to understand what my patients are feeling. Why are they depressed? Why are they anxious or afraid? What keeps them from getting out in the world and working or traveling or visiting with families or going to church? It is very hard to put yourself into someone else’s body or mind, or to walk a mile in their shoes, but the practice of mental health treatment almost demands this thing called empathy. Since March of this year, our mental health center has been sorely tested, forced to rearrange schedules, send people home to work, see patients for injections outside under a tent in the open air, and really think outside the box to continue to provide socially distanced, medically safe, efficacious treatment to those who suffer from mental illness in Aiken and Barnwell counties.

So what is empathy? The ability to understand and share the feelings of another. I alluded to the first part of the definition in the first paragraph, but did you catch the second part? To share the feelings of another. Now, I would argue that understanding and sharing the feelings of someone who is hurt, ashamed, fearful, depressed, angry, or suicidal would normally, at least in my field, be a voluntary action. It would be something that I would choose to do, as I care about my patients and what they are feeling and want to figure out how best to help. I would go so far as to set up regular appointments, ask questions, learn about family history and listen to the hopes and dreams of the person, all in the service of understanding and trying to feel just a little of what they feel.

The coronavirus pandemic has forced us all into an involuntary state of misery. The CDC tells us that stress during an infectious disease outbreak can sometimes cause the following:

  • Fear and worry about your own health and the health of your loved ones, your financial situation or job, or loss of support services you rely on.
  • Changes in sleep or eating patterns.
  • Difficulty sleeping or concentrating.
  • Worsening of chronic health problems.
  • Worsening of mental health conditions.
  • Increased use of tobacco, alcohol, or other substances.  

We stay isolated from each other, but we try our best to connect through Zoom, Teams, FaceTime, and Skype. We communicate in real time but we cannot hug or touch or shake hands. We work together as teams, but do so virtually, knowing each other only from the neck up. It is very hard to be empathic if you sit in a locked office, maybe somewhere out of state, talking to a person who is hurting as they walk around their back yard swinging an iPhone that gives you an intermittent view of first their face, then the ground, then the sky.

One would think that this pandemic era would be extremely hard on anyone with preexisting mental health issues, and as plenty of evidence has shown, you would be right. However, I was amazed to learn something new from one of my patients a few weeks ago that made me rethink how empathic I had really been over the last few months. I had asked him how the pandemic had affected his life and if he was more depressed or upset because of it.

“No, Doc, not at all. And you want to know why?”

I did.

“Because now everyone else knows how I feel every single day.”

You see, this man had felt loneliness, social isolation, anxiety about being in close proximity to crowds in stores, fear about getting ill or dying, worry about being able to find and hold a job and pay his bills, lack of transportation, and most of all, the stigma that is associated with an illness that is completely out of his control. He had been living with these very difficult issues for many years. We had just been dealing with them for a few months at most.

“You know, Doc, staying at home, playing with my dog, playing a game on my phone, watching TV, listening to music, it’s not so bad really. It relaxes me.”

Profound words from one of the folks who teach me more than any expensive textbook I ever bought. We have all been forced by the coronavirus to feel what some of our most vulnerable feel and live with every day. We have experienced the social isolation. We are anxious about our health, or jobs, keeping our homes and putting food on our tables. Maybe one positive effect of this pandemic is that we will learn to be just a little more empathic towards our fellows, knowing that only in staying together even as we are apart is the only way we will survive this.

Masks

Masks are the talk of the town lately, are they not? To wear them or not to wear them. Cotton or synthetic. Single layer or multilayer. Inserts or not. Mainstream or rebellious. Republican or Democrat. Individualistic or conformist. Surgical or fashionable. How did a little piece of fabric with ear loops rise to the level of cultural totem for the various groups that see it as medical savior or condemn it as heresy in 2020?

According to Wikipedia, a mask is an object normally worn on the face that may be used for protection, disguise, performance or entertainment. Masks have been used for various purposes since antiquity. The word “mask” appeared in English in the 1530s, from the middle French masque “covering to hide or guard the face”. How have masks been used throughout history? Well, there are funeral masks, life masks, death masks, ceremonial masks, performance masks, ritual masks, religious masks, healing masks, and political masks. Masks may be used in festivals, carnivals, burials, plays, and stories.

Now, all of these are similar, but they differ a bit from the functional masks that have as their purpose the protection of the wearer. We are a bit more familiar with these in the year 2020. There are oxygen masks, surgical masks (including the N95 that has been in the news off and on since March of this year), face shields, and even pocket masks that can be used by a good Samaritan who happens upon someone who needs CPR. Protective masks filter the outside air in some fashion to make it safe for the breather. Other functional masks might include the kind worn by robbers and thieves to keep their identity safe from their victims or security cameras that might capture them as they go about their dastardly deeds. Plague doctors in Europe wore beaked masks that contained herbs in the beak to attempt to ward off the Black Death.

Do you get the point here? Masks have been around for literally thousands of years and have served every purpose from identifying the wearer to hiding his identity to celebrating his life to commemorating his death to punishing him to keeping him healthy. According to Stephen E. Nash writing in Sapiens Anthropology Magazine, the earliest well documented masks came from the arid Judean Desert in the Middle East about 9000 years ago. They may not have been the earliest ones, but they were certainly among the earliest preserved ones. Masks have been important cultural phenomena for thousands of years.

How about the medical aspect of mask wearing, which confronts us now in 2020? A bit of history is informative here as well. A July 27, 2020 piece in The Conversation said that during the 1918 flu pandemic, cities around the world passed mandatory masking orders. In the United States, the American public at that time embraced mask wearing as “an emblem of public spiritedness and discipline”. Mask wearing was widely unpopular in Canada during that time, but was embraced by the public in Japan. To the Japanese, mask wearing symbolized “modernity”. The Japanese continued to wear masks to protect themselves from the flu, and later against SARS and avian influenza. In a country that takes etiquette very seriously, wearing masks has become a form of politeness. Controversies over mask wearing continue in the United States and other countries as well as the coronavirus pandemic rages on. To some, masks represent control, are uncomfortable, unnecessary, and possibly even harmful to their own health. To others, seeing people wearing masks is a tangible reminder that the pandemic is real, and is frightening to them. Some have an “optimism bias” and believe that the coronavirus will not affect them.

The latest advice from the CDC and other groups maintains that the Three W’s (watch your distance, wash your hands and wear a mask when not able to social distance) are still the best way that individuals can protect themselves and others from infection with coronavirus.  Masks have been around for millennia, and they still appear to be one of the easiest and best ways to protect ourselves as we navigate this pandemic. Educate yourself, practice good social hygiene and stay safe out there.

Fake It Until You Make It

I have been talking with friends, family members, and patients over the last several months about our lives in 2020. We continue to try to describe what it feels like for each of us to live in the middle of the biggest pandemic in the last hundred years. We talk about the things that we have all been feeling: the sense of loss, grief over the changes in our normal lives, the lack of social interactions with others, the inability to participate in things that used to give us joy, and the lack of certainty that pervades every aspect of our lives. We talk about how these stressors have changed the way we work, play and interact with others. We talk of the longing for things to get back to the normal, the predictable, and the reassuring. Almost everyone I know feels less confident, less powerful and less able to influence his environment since the start of this pandemic. We have been shrinking into ourselves, staying at home more and shunning the very social interactions that make us fully human.

There is a phrase that I am sure you’ve heard before. Fake it until you make it. This idea probably goes back to at least Alfred Adler in the 1920s. According to Wikipedia, Adler developed a therapeutic technique that he called “acting as if”, which allowed his clients to practice alternative behaviors that would help them to change dysfunctional patterns. You may know this technique by its more modern name still used today, “role play”.  Fake it until you make it leads us to imitate confidence, competence and a positive optimistic mindset until we can actually achieve these things in our real lives.

Wikipedia offers another way to look at this, attributed to William James:

“Action seems to follow feeling, but really action and feeling go together; and by regulating the action, which is under the more direct control of the will, we can indirectly regulate the feeling, which is not.

Thus the sovereign voluntary path to cheerfulness, if our spontaneous cheerfulness be lost, is to sit up cheerfully, to look round cheerfully, and to act and speak as if cheerfulness were already there. If such conduct does not make you soon feel cheerful, nothing else on that occasion can. So to feel brave, act as if we were brave, use all our will to that end, and a courage-fit will very likely replace the fit of fear.”

— William James, “The Gospel of Relaxation”, On Vital Reserves (1922)

Another place that I have recently found reference to this ability to fake it until we make it is in the 2016 TED talk given by Amy Cuddy. In it, she describes how body language visually telegraphs our mood and state of confidence, and how our nonvisuals impact not only those around us, but ourselves as well.

One of her main points in her talk is that we can fake it until we become it, until we can tell ourselves, “I’m really doing this!” Tiny tweaks in our behaviors can lead to big changes in our lives.

We are living in very stressful times. We are dealing on a daily basis with social upheaval, political unrest and the possibility that we might contract a deadly illness. Even without being told, we have felt ourselves shrink from daily encounters with others, decrease our normal social interactions, and forfeit many activities that give us joy. We may not feel overtly afraid, depressed and defeated, but our body language and our actions may telegraph otherwise, both to others and to ourselves.

Can we fake it until we all make it? Yes, I believe we can. Listen to and act on the recommendations by the CDC. Wash your hands. Wear a mask when you leave your home. Observe social distancing recommendations. Be smart about how and when you interact with others both indoors and out. This pandemic is fueled by the spread of a tiny virus that will stop spreading when it is deprived of new hosts. Our behaviors, coupled with the eventual development of viable, effective, safe and reliable vaccines that we all choose to receive, will stop it in its tracks, and this medical nightmare will finally be history. Until then, even if you feel deprived, depressed and distanced from the people and things that make life worth living, fake it until you make it.

Fatigue

Words are interesting, aren’t they? I love to use words to convey meaning, to educate, to enlighten and to try to persuade. We all use words that we are familiar with, that we understand and that are part of our normal vernacular. We get used to these words as ways to express a familiar thought or idea that we hold dear or that comforts us. The interesting thing about the English language is that many of our words have nuanced definitions and can be used to express many similar or related meanings.
Fatigue is one of the words that comes to mind for me lately. When we look to the Merriam Webster Collegiate Dictionary definition of fatigue, we find several aspects of this word that pertain to our current situation as we struggle with pandemic life.
First, a definition that was certainly not top of mind for me. “Manual or menial work, such as the cleaning up of a camp area, performed by military personnel.” There is also a corollary definition that goes with this, being “the uniform or work clothing worn on fatigue and in the field”. Think about many households now as young families struggle with educating their children at home, cooking and eating many more meals at home than usual, and having one or more adults working from home at the same time. This scenario has created home landscapes akin to domestic camp areas, staging areas for vocational, culinary and educational missions that were often outsourced and performed far away from the home just a few months ago. We are constantly “cleaning up the camp area” while wearing the new uniform of 2020, shorts, tees, sweats, and Allbirds, trying our best to be efficient and productive while staying as comfortable and low key as possible. For the most part, I think we are succeeding admirably in spite of all the odds against us.
The second definition is more the traditional one that we think of when we think of fatigue. “Weariness of exhaustion from labor, exertion, or stress.” We have all felt this in one way or another over the last seven months. We are working hard, sometimes in vastly different ways or in different places than we are used to. We are caring for families, our coworkers, and others at the expense of caring for ourselves. Some of us have fallen ill with COVID-19 and that has given an entirely new meaning to fatigue for us. Physical weariness that precludes meaningful activity and productivity wears on one’s body, mind and soul. Even if you want to get up and actively engage the world, sometimes a physical illness like COVID-19 stops you in your tracks and says, “not today”. This fatigue, unlike the camp that can be tidied and cleaned, must be managed until it has passed. It is insidious, long lasting and debilitating.
The third definition that caught my eye was the one describing “a state or attitude of indifference or apathy brought on by overexposure (as to a repeated series of similar events or appeals)”. Now, this definition encompasses several different aspects of our current lives in the time of COVID-19. Not only are we feeling extremely overwhelmed by the pandemic and how it has disrupted our daily lives for months now, but we have been dealing with racial tensions, economic stresses and political dissent and strife as we approach one of the most contentious presidential elections our country has held in our lifetimes. When there were fifteen cases of COVID-19, the threat felt small. When there were one thousand deaths, we felt that this was something terrible. Fifty thousand deaths were almost unfathomable. One hundred thousand deaths were unbelievable. Now, we have had eight million cases of COVID-19 in our country and well over two hundred thousand deaths. We have been seeing and hearing these numbers for so long now, and in such quantities, that we are numb to them. We are fatigued. It is harder and harder to muster compassion, much less hope that things will eventually get better. On top of the ongoing pandemic and its stresses, add the civil unrest, the political intrigues and countless ads on television and in the news, and we are simply bombarded with negativity that further numbs and chastens us.
What to do?
See things as they are. We have already found that one cannot wish away a viral pandemic. It will run its course, relentlessly, until we either achieve immunity overall or we have a workable vaccine. We cannot make the government attend to our financial needs. We have had to be creative to find work and put food on the table. We cannot fix racial unrest and social inequalities overnight. These changes can come, but it will take much time and much work by all.
Limit negative exposure. Keep up with the news, but only in prescribed amounts and at certain times. Constant exposure to negativity and stress will only increase social, emotional and physical fatigue.
Act. Plan. Work. Vote. Talk. Collaborate.

One final definition of fatigue that Webster’s offers us? “The tendency of a material to break under repeated stress.” We do not want to let ourselves get to that point, do we?

Random Covidisms: 63

  1. Yesterday was one of those days that gave me, as my three daughters would say, all the feels.

I had my sixty-third birthday, a day I had been anticipating with a sense of profound wonder, dread, longing, excitement and fear. As many of you know, I had already lived one day longer than my father back a few months ago, so that sigh of relief could be expelled slowly and softly and with gratitude. However, I had still not vaulted over the next hurdle, the official one, the birthday that would make me officially older than my father had ever been. He never celebrated his sixty third birthday. Yesterday, I did.

What did this mean to me and those who care about me? It meant that I am now older than the man who with my mother had a thought about me that lead to my being born and having time on this planet. I am sorry that he died young, but I am glad that he got to live at all. That is the reason I am here now. Unapologetically cosmic thoughts, I know, but you just can’t help having those thoughts about your place in the universe and what it all means at these monumental times. You just can’t. So, I am having them. I am sitting with them. I am thinking the thoughts and feeling the feels. I am sorry that my father never got to celebrate sixty-three. I am grateful and happy that I have been allowed to. In a sweet card that my mother sent me yesterday, she said ” I’m glad you reached 63 and can now look forward to growing older with Trina and enjoying many years of joy and happiness.” I think my astute mother summed it up for me while giving me permission as only mothers can. You made it. Now, move on and live your life. Don’t fear. Live. Thanks, Mom. You’re the best, and I love you.

2. COVID-19 is still rampant in our country, and the numbers are awful, but there are people out living their lives and being careful as they do. I drove to my office in Barnwell County in South Carolina on Thursday for the first time since March. It was very odd. The route I took was the same, but the landmarks were different. Timber had been harvested along one highway, leaving a broad vacant expanse that made me feel quite disoriented for a few seconds as I drove through it without my usual landmarks. Another stretch of trees and houses looked devastated, as if a bomb had gone off over them. I later found out that a tornado had touched down there, destroying most everything in its path since the last time I drove past that area. There were people in cars driving to their destination, stopping at stores, all along the route, and it all felt so normal, but not, sort of like being in a Stephen King novel. I just knew that the rabid dog or the possessed car or the Man in Black were going to come out of no where and undo my world.

When I got to the clinic I donned my mask, went inside, said hello to the few people who were physically working at that site, went to my office and closed the door. I came out only a very few times before leaving at five PM to return home. Meetings were on Microsoft Teams. Appointments were on Doxy.me or Doximity on my computer or my iPhone. Things at the office, my first time physically working there in seven months, were decidedly not normal. We are going through the motions, but the motions seem too scripted, too acted, too fake.

3. We voted yesterday, a very good way to start my birthday. The whole process took ninety minutes, was very smooth, professionally facilitated, and seamless. The wait in line in the already hot sun at 9:30 AM was something I have never had to do to vote before, much less voting this early. It was worth it. The sense of active participation in our government is palpable as you stand there with several hundred of your neighbors, all waiting to take part in this grand experiment that we call democracy. This is not a political blog, so I won’t go there, but let me just say this. We need to get back to decency. We need to get back to caring for one another the way we care for ourselves. (we talked about this is church this morning-see below). We need to get back to compromise. We need to get back to working for the things that benefit the majority of us, that lift and elevate all of us, not just the privileged few. If you have not voted, do so. It’s important. Exercise your privilege. Vote.

4. We watched a wonderful documentary last evening after an even more wonderful grilled filet mignon birthday dinner. The piece, Bruce Springsteen’s Letter to You, was an uplifting look at life, relationships, growing older and contributing to the world using your talents and your need to communicate with others. If you like rock and roll, you will love this up close look at how Springsteen and the E Street Band make their fabulous music together. Even if rock is not your cup of tea, watch this for its take on life and love, grief and loss, paying tribute to those who have gone before and carrying on traditions that are timeless. It will be well worth your time, then listening to the album itself will just mean that much more to you.

5. We went back to the Church of the Good Shepherd for in person worship for the first time since March this morning. Just like my drive to Barnwell this week, this trip to the sanctuary we love to worship with others was anticipated with joy. The services are limited to only forty eight parishioners (the sanctuary holds many times that in normal times), everyone is socially distanced (we sat in a pew by ourselves, at least six feet away from all others) and all are wearing masks. We were able to wave to friends at a distance and even spoke to a couple but it was nothing like normal times of meeting and greeting. Although there was wonderful organ music by Jim Nord, the congregation is not allowed to sing at all. Communion consists of going up one by one to the priest, receiving the bread and then exiting the sanctuary. No common cup is allowed. The service is short and sweet. Once again the pandemic has altered our day to day lives to the point that we are going through the motions and grateful for it, but we are certainly not getting the richness of experience that we got before COVID-19.

So, my friends, I have now lived sixty-three years on this planet and my mother has given me permission to move on and live many more happy ones! I intend to do just that, starting today. May our post-COVID-19 pandemic life continue to be filled with celebrations, music, worship, friendships, creativity, love and connections that enrich us, nurture us and give us myriad reasons to live life to the fullest. Happy Sunday!