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. 

 

 

 

 

Covidisms: Balance

I was standing there at the door, looking out the windows at the green space that fronts our townhouse, taking in the serenity and glad I was not out in the heat of the day just yet. Then, I saw him.

Our little green anole, who I have affectionately named Alvin, was sitting on top of one of the (to him and really, to me too) towering leaves of our elephant ear plant that stands just at the front of the house off the porch and threatens every day to block the dawn peregrinations of my neighbor. He was on the top leaf, not the largest but certainly large enough to make a nice platform for a few ounces of scaly green lizard.

He turned and saw me (he always sees me, sometimes before I see him, especially when he is hiding in the cucumber vines in the courtyard), gave that little sideways cock of his head and the side eye that says “Whaaaat?”, then turned away. He was splayed out on the top of this giant leaf, front legs lightly grasping (do anoles grasp?) , hind legs straight out in that “Oh, my God, if I did that I would rupture myself!” kind of way that lizards do. Then, he did something that cracked me up. He pulled himself up to the large notch that elephant ear leaves have, pushed his head through the notch slightly and scratched his chin! Not once, but three times. Like a small green bear grinding against a tree in a national park to scratch his back, but not.

I watched, now entertained and hooked. Alvin began to maneuver across this anole-green leaf (you just thought the lizard changed colors to match his surroundings…) sidling up to the edge, backing up slowly, finding that perfect balance between “ahhhhh….” and “AHHHHHHHHHHH!” He would inch up, further, further, further, until his Lilliputian girth would begin to bend the delicate tropical appendage down just a hair, just a a smidge, then back to let it spring back again to regain the post-summer-shower turgor that keeps these unwieldy leaves somehow upright. He was playing, was Alvin. Back and forth, almost to the point of no return and a slide down to the pine straw below, but recovering just in time to slither back toward the spine of the leafus pachydermous. He was playing, I tell you.

Alvin weighs about 4 grams. Not much of that is brain matter.

I weigh (considerably more than Alvin). My brain weighs three pounds on a hot summer day if I am reasonably hydrated.

I used my brain a lot today.

Alvin took time away from foraging to experiment with the turgor, tipping point and elasticity of elephant ear leaves.

I think Alvin had more fun playing today than I did.

Is there a lesson to be learned here?

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.

Covidisms: The Tip of the Sphere

There is a military term that you might be familiar with. It is “tip of the spear”. This term is used by military tacticians and historians to refer to a combat force that is used to puncture the enemy’s initial lines of defense, to be quickly followed by concentrated forces which destroy any remaining threat.

There is also a Coldplay song that I like very much called Army of One.

“Say my heart is my gun, army of one
Yeah my heart is my gun, army of one
Is my only weapon, army of one
Say my heart is my gun, army of one.”

These two thoughts merged and danced with each other in my dreams last night, as thoughts tend to do lately, and I woke up needing to write about them.

We are facing a Medusa of an enemy in our country and our world today. The coronavirus has no respect for race, color, creed, sexual orientation or geopolitical boundaries. Racism itself is another writhing snake that would bite us if we place our hand too close to its venomous mouth. Economic crisis, always a single paycheck away for some, threatens to turn us out of our homes, strip us of our jobs and leave us destitute and staggering. Some in power think that if we dare to look upon this triple threat of disease and hate and poverty that we shall surely be turned to stone and stand as still as the very statues that some strive to tear down. Powerless, impotent, beaten. So they look away. They ignore. They fabricate new myths that serve their own nefarious purposes.

You and I, my friends, are the tip of the sphere. We are the soldiers in this ravaged world who can go in fast and light, puncturing the Dickensian twins of Ignorance and Want, making the smallest hole, ripping the fabric of greed and power and reaching out to those who need us most right now.

“So I’ll never say die, I’m never untrue
I’m never so high as when I’m with you
And there isn’t a fire, that I wouldn’t walk through
My army of one is going to fight for you.”

I know that I will never singlehandedly cure this terrible disease. I leave that for the Anthony Faucis of the world who know how to do that kind of thing. I know that I will never singlehandedly be able to erase the pain and suffering that slavery and racism caused those long years ago in the South, my home and the land I love. I leave that to MLK and John Lewis and C. T. Vivian, who knew how to do that kind of thing. I know that I cannot singlehandedly, fundamentally change a broken economic system that favors the rich and keeps its knee on the neck of the perpetually poor. I leave that to the bedrock that the Founding Fathers put under us to hold us up at times like these, aided by the wisdom of those who know economics on a scale much larger than my monthly budget.

I know that I cannot change the world alone, but I can be an army of one, with my heart as my gun. I can be in the phalanx that is the tip of the sphere, the force that will change this world in millions of tiny ways, day in and day out. I can be the one that figures out how to look upon this Gorgon that would utterly defeat us.

For you see, Medusa was the only one of the three Gorgons who was mortal, and therefore could be killed. Perseus used a shiny shield that had been given to him by Athena and looked at the monster safely, reflected in his shield. In so doing, he was able to slay the killer without dying himself in the process. We do not have to destroy ourselves and tear down our society to make this world a better place, as some would have us believe. We have only to do as Mother Teresa admonished, “small things with great love”.

“Been around the world, universe too
I’ve been around flying, baby, there’s nothing I wouldn’t do
Dance with the stars, while I see the moon
I’ll be standing there besides you
Right when the storm comes through.”

Be the tip of the sphere today, my friends.

Change the world.

Covidisms: Thoughts on Death

I did something last evening that I have never done before. I wrote a serious and heartfelt email to the New York Times and those who make the podcast The Daily, one of my favorite ways to start each day. This podcast has a way of finding and telling stories that get to the heart of what we are all experiencing in the midst of our lives, especially in these days of pandemic and racial strife and economic crisis. There have been many episodes of The Daily that have been poignant, thought provoking and moving, but two of the most recent ones from this past week hit me hard. I would like to share the end of the email that I wrote before I go further with this post:

The episode revisiting the situation in Bergamo, Italy, through the wise, thoughtful and emotional perspective of Dr. Fabiano Di Marco hit home. I lived in Italy for two years as a teen and my wife and I had planned a trip back to Rome and Florence in April, my first trip back to the country in fifty years. Of course, it did not happen. I felt a deep sense of sadness for the Italian people and the medical staff members who are trying to serve in the face of this pandemic.

Today’s episode about the grief felt by little Tilly for her grandfather hit me even harder. I am a grandfather of six kids, five in Chattanooga and one in Denver. I have not been able to see them for what feels like years, except by FaceTime calls. We are planning a driving trip out to Denver and back in late September, because I am not excited about getting back on planes, but we need to reconnect with our family and friends in other parts of the country. Hearing Tilly talk about her grandfather, coupled with the recent losses of one of our long time mental health center employees and another counselor whose clinic I used to consult with, made me very much aware that I could be that grandfather or that employee who contracts this virus and does not make it through the ordeal.

Your stories are powerful. For someone like me, who tries very hard to deal with the emotions by blogging, journaling, taking long hard bike rides or keeping up with the political craziness all around us, they force us to stop, to listen, and most of all, to feel. Ironic, isn’t it, that a psychiatrist would have a hard time feeling. Of course, the feelings are there, and when they are released by storytelling  and powerful emotions that you bring to life, the intensity of it all is almost too much to bear. It is so necessary though, and I know that full well.

Thank you, thank you, thank you, for getting the information out there, for telling the stories in such compelling ways, and for making us think, process, and feel. Yours is one of the first podcasts I listen to every day, and the ideas that come from it are some of the last ones I think about when I go to sleep at night. I appreciate what each one of you do. Please keep up the excellent work, knowing that we hear it, and we need it.

I wanted to express my thanks to the makers of this show because they provide a way for me to stay in touch with some very profound feelings during this time that I had simply rather not have. I feel frustration, I feel anger, I feel loss and grief, I feel elation, I feel dullness and boredom, I feel indignation, I feel sorrow, I feel pity, and I feel fear.

As I have mentioned in blog posts earlier this year and in followups afterwards, I will be sixty three years old on October 24th this year, God willing. At that point, I will have lived longer than my father, who died suddenly at age sixty two of a devastating brain aneurysm and cranial bleed. I never had much doubt that I would easily reach that point and that age, given the fact that I try to eat right, I exercise, I am trying to keep my weight and blood sugar and cholesterol and blood pressure down. All the right things that one must do to live a long life, barring catastrophe. I have been holding my figurative breath all the same, knowing that when I reach that milestone I will have a good cry, say a few words of thanks to my dad that I hope he can hear and go about the task of living productively until my sixty fourth birthday.

All of that held true until March of this year. Until the coronavirus upended all our lives, changed our daily routines, changed how and where we work, who we see, how we eat, how we travel, how we worship and how we connect with others. I have done what you have done, tried my best to make good decisions, protect myself and my wife from harm, continued my work to care for my patients the best I can given the circumstances, and kept my cool, for the most part. We have personally been so very blessedly insulated from the ravages of this plague. As far as I know, no one in my family has contracted this virus, no one I work with has had it, and only a few of my patients have, most of them doing well in spite of having the illness.

In the last couple of months, one of our long term mental health center employees, someone who was there when I started working in the center almost twenty nine years ago, contracted the virus and died. He left behind a wife and young son. A pharmacist friend of mine, who visited our offices every month to inspect our medication areas before her retirement, has just been released after a ten day stay with COVID-19. A counselor who once had a family clinic that I did medical consultation with in the early nineties recently contracted the virus, got very ill very fast, refused to be placed on a ventilator, and died quickly of COVID-19. The disease is starting to hit home.

I grieve these losses and setbacks for various reasons. I feel so badly for the families and loved ones of those who pass on. I rejoice over the victories of those who get infected but make it, all the while fretting over what long term consequences they may have to endure. I am sad that when someone like my counselor friend dies, not only because her life was most likely cut significantly short due to this illness, but because her death reminds me starkly that mine is coming too. She and I shared a slice of time, a set of circumstances, a place to talk and work, and a shared cause of promoting good mental health for the people we treated almost three decades ago. I sincerely hope that the work we have done together and that I continue to do goes on, but I am made painfully aware that we will not. We will end.

I do not fear death so much as I am not ready for it. Like everyone else, I am sure in my own feeble mind that this illness, this worst illness of its kind in the last hundred years, is not going to be the way that I will leave this life. It is not aiming for me. I will live a long life and become a grump old man who still likes to read and write and fish and take pictures and take walks by the river. Or will I? The uncertainty of these times is the biggest stress of all.

In watching this pandemic and how it is affecting all of us, I am reminded of a few basic things that we must attend to each and every day, as if it was going to be our last. Things that tend to shine through and demand our attention when someone dies and passes on, leaving their legacies.

  1. Relationships are important. Make them. Enjoy them. Nurture them. Attend to them. Water them like flowers in your summer garden and watch them bloom and dazzle with bright color.
  2. Find something that you are passionate about, and throw yourself at it with fury. Write. Paint. Play music. Heal. Preach. Teach. Mentor. Parent.
  3. Put others above yourself. Whether this viral illness is your ticket off this planet or something else gets you down the road, you will inevitably leave others behind. They, like little Tilly on The Daily podcast, will remember you. They will remember what you said, what you did, what you taught them, but most importantly, how you made them feel.
  4. As the recently departed John Lewis of Georgia said, get into trouble. Get into good trouble. Do the right thing because it IS the right thing. Do not waiver in your resolve to do this, because it is important.
  5. Know above all else that your reason for being here on this earth is not to glorify yourself, embellish yourself, surround yourself with riches and accolades and awards, and make yourself the center of the universe. (You are most assuredly not.) Your mission, your assignment, your reason for being is to do all you can, everything you can, in every way you can, with everything you have at your disposal, to make the lives of those around you, those less fortunate, those who are downtrodden and oppressed and neglected and forgotten, those who the world despises, BETTER. You have the power and the obligation to do that. If you do, if you truly do, then at the appointed hour you can meet death, smile, close your eyes and know that your time here has been well spent.

Stay safe, do the right thing, and live long, friends.

Grief, Coronafied

You are all familiar with the five stages of grief, made famous by Elisabeth Kubler-Ross. They are denial, anger, bargaining, depression and acceptance. We have heard about these and thought about them in many contexts over the years, most commonly in the face of the death of a loved one or some similar loss that broadsided us, left us reeling, and engaged our brains in trying to find any way possible to reverse the course of the terrible events we were experiencing. We’ve all been there. Think back to a time that you suffered a major loss. Think about how you felt, deep down inside, how your thoughts organized themselves, and how you really did ponder the possibility of magical thinking.

A few things about these five stages before I get to my observations today. Read more detail about this subject at https://grief.com/the-five-stages-of-grief/. First, they are meant to be guidelines, or guideposts to the process of grief, not a rigid system of hurdles that one must jump over in a very specific way in a specific timeframe. People grieve very differently from their fellows. I have worked with patients who lost spouses and were truly happy and content after one month, and with parents who lost a child and never really finished the traditional grieving process at all before their own deaths. Next, not everyone goes through them the same way, in the same order, for the same amount of time.  We process things differently. That being said, many things have popped up over these past four months that have made me rethink these five stages in the context of the coronavirus pandemic.

First, denial. Must I get political here? No, of course I won’t, as that is not the reason for this blog post. Suffice it to say that none of us saw this coming, at least in real time. Yes, people like Bill Gates and others have made speeches and written books in the last decade that foreshadowed this event, but when the actual virus that causes COVID-19 burst on the scene in December of 2019, we were simply not prepared. We heard about it, thought about it briefly, thought about how far China is from where we live, and gave it little more thought. Government leaders, policy makers, medical professionals and ultimately all of us thought to ourselves, No, this could never happen here. We will be fine. Nothing can harm the greatest country in the world with the best healthcare system in the world. The greatest difference between the denial that defined us early on in this pandemic and the denial that happens when a loved one is suddenly lost is that we did not know enough about what we were about to lose. We could not see the horses of the apocalypse galloping our way. We did not know enough to be able to deny in the way that helps a grieving person, or nation, survive. We denied in a way that made us blind and lost us precious time, time that could have mitigated the fallout from the disaster. Coronavirus was so stealthy that early on, we did not even know what to fear.

Anger. It’s here. How on earth did it get through our borders and start to move across the United States? Who was responsible for this growing fiasco? Who can be blamed for this? Anger is usually an anchoring emotion, one that gives pain and hurt and loss some structure that makes it helpful. Not so for this scenario, when the thing that invaded us and started to make us sick is so tiny that we cannot even see it. How do you get angry at something you cannot see, touch, confront, look in the eye? So what do we do? We find a surrogate. We get angry at the politicians, the healthcare policy makers, the manufacturers of goods that are in short supply, the people who do not look like us. Our anger is righteous and mighty and backed by allegiance to religion and party and ethnic group and geographical section of the country. The problem with that is that the coronavirus does not respect any of those things. It is happy to infect and spread in those who are angry just as easily as those who are still in denial, maybe more so.

Bargaining. If only I could get my loved one back, I promise that I would wear a mask twenty-four hours a day and respect social distancing and wash my hands twice an hour and … When we know we are stuck, that things have happened that we have no control over, we will often go back before the event and try to reconstruct it in our minds. What could we have done better, sooner, faster? What did we miss? If just given the chance, we would “get it” this time and make the right decisions, perform the correct actions that would prevent the grief and heartache that we now deal with. We want to make it right, make it disappear, make it hurt less, and at least in that moment we are willing to consider almost anything that would accomplish that for us. Why is it so hard to bargain in the time of COVID-19? Because we are in the middle of a pandemic that has no well-defined parameters. We do not know the end game or what this is going to look like when it’s over. Even if we figured out what we could have done differently or better, it’s much too late. Sometimes, when we realize this, it can lead us right back to anger, or…

Depression. When we realize that the loss is real, that the new normal is not anything we would have voluntarily chosen for ourselves, we go numb. We feel empty. We are sad, at everything and nothing at all. We are truly grieving now, realizing that this situation is here to stay, perhaps for a very long time. In this pandemic, we have suddenly been thrust into a situation where we are distrustful of others, where the things that normally give us solace might now be dangerous and where we get conflicting information that makes it almost impossible to know what to do to keep ourselves safe. Some of us might get quite depressed and even suicidal , but it is very important to know that what the vast majority of us are feeling, the confusion and fear and sadness and lethargy, are normal responses to a very abnormal set of circumstances. Circumstances that have not really existed in similar fashion for over one hundred years. This will end, as all pandemics end, but our lives may be affected in profound ways that persist for a very long time. Once the sadness starts to lift, the realization that we must find new ways to cope, to love, to learn and to socialize will drive us to make positive changes in our lives that will see us back to some sense of normalcy.

Lastly, we will enter some sort of acceptance. This does not mean that we like what has happened to us. It does not mean that we accept it wholeheartedly with a whimper. Not at all. We can go kicking and screaming into the rest of 2020 and on to 2021, but into that time we must go. We may lose some of the things or people we loved. We may not be able to do things the way we did in 2019. We may have to change the way we experience our relationships. Once we allow time for the grief over the losses that we all surely feel right now, then we can begin to heal and grow again and experience joy.

My daughter stated it very well in a recent post to social media that she gave me permission to share with you.

“How do I use this time, or at least sit in it without feeling sorry for myself, waiting on a normalcy that may never return? I exercise some control over the controllable, I will try to change what I can, I use creativity to stay connected and move forward when it may feel easier to be isolated and stagnant. I will love my friends and family fiercely and extend grace freely, to others and to myself. And while I may not mean it every time I say it, I’ll keep saying it… everything really will be fine.”

Covidisms

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

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

Resilience in the Time of COVID-19

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

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

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

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

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

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

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

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

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

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

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

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

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

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