Grief Coronafied, Redux

Grief Coronafied, Redux

This column went to print in its original form in July of 2020. Since that time I have been privileged to hear many heart wrenching stories of loss from COVID-19 and from other calamities, stories that my patients and friends have entrusted to me and that I will carry with me always. I love to hear about the triumphs my patients celebrate, but I also feel so very fortunate when they trust me to share their grief. As we ready ourselves to celebrate a joyous holiday season, I wanted to remind us one more time that for some, this time is hard, challenging and covered with a glittering veneer of deep sadness.  

 

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 twenty two 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 column. 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 attention. 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 physical 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 hope we are in the latter stages of a pandemic that has no well-defined parameters. We still 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. It has been twenty two months and counting. 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 become 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 embrace it wholeheartedly with a whimper. Not at all. We can go kicking and screaming into the rest of 2021 and on to 2022, 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 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.”

 

 

Who Was That Masked Man?

What do the Lone Ranger, the Mandalorian, the surgeon who performed my surgery a month ago, and I all have in common?No, I cannot ride a horse, at least not very well, and I don’t think I would want the Mandalorian entering an operating room with The Child in tow, cute as he is. The horse I never ride is not named Silver, and sterile technique was probably not one of The Lone Ranger’s major weapons. So, what is it that binds us all together? We all wear masks. 

Now, this column has never been political, and I see no reason to start down that path now. It is not an extension of the CDCwebsite, which I trust you can search for and read yourself if you are so inclined. I am not writing this week to browbeat you about vaccines or positivity rates or partial vaccination percentages. I am going to talk about masks, but not in the way you might expect. This is after all a column that deals with the mind and mental health, so I’d like to share a few observations with you about mask wearing and its effect on interpersonal interactions, as seen from behind the desk of a psychiatrist. 

Like many of you, I was abruptly sent home to work at home in mid-March of 2020, and there I would stay for the next year, learning to turn a guest bedroom into a functioning office, trying out chairs and tables and bookcases, setting up new printers and laptop stands, attaching clackety keyboards and positioning phone stands at just the proper angle for Zoom or Doximity or Doxy.me calls. I made it work, like a lot of people have, for over a year, when I was then gradually allowed back into the clinic building, and even more gradually allowed to see real live breathing patients back in my office, face to face. Well, sort of. The mask thing, you know. We were and still are under a department directive to wear masks when indoors, in our offices seeing people, or when we are out and about in the building’s public spaces. We are still physically distancing, but we are not as gung ho about cleaning every single surface after every single visit as we were back in the early days of the pandemic. We know a lot more about the virus that causes COVID-19, but we are still diligent, even after vaccinations, even as we feel that the end of this awful pandemic is finally in sight. 

How has mask wearing affected us? I have some thoughts. You may agree or disagree but bear with me, and see if any of this resonates with you in your daily life. 

We wear masks first to protect ourselves and others from the spread of viruses like coronavirus or flu. The science bears this out, that high quality masks worn correctly can indeed slow or virtually eliminate significant transmission of virus particles that can make you sick. That being said, when we wear a mask we can feel pretty confident that we are doing something that helps us protect people. At first this felt very odd, unnatural and even silly. When virtually everyone started to wear a mask in certain situations, it felt much less so, much more normal and much more expected. Like remembering your keys on the way out the back door, you needed to stuff a mask into your pocket or make sure you had a spare one in the car before you got to the store or the restaurant. In places like family homes or even workplaces, where we knew people “B.C.”, or before COVID, we remembered their faces and it was not a great stretch to “see” them smiling or frowning or otherwise emoting behind those cloth coverings, because we knew their facial expressions and reactions so well from before. 

Going into new places or situations was different. If you do not know a person and all you can see and read is his body language and his eyes, it is much harder to gauge what he is really thinking or feeling behind his KN-95. The social dance becomes much more cumbersome, with us straining for physical cues, sounds, or anything else that does not involve a smile or a frown. In my field of psychiatry, being able to see a person’s body language, watch her facial expression, hear her voice and see if all of the above match up in a meaningful way is a big part of what I do every day. A mask, small and unobtrusive as it is, makes this much, much harder to do in a meaningful way. A mask also gives us something to hide behind, for better or worse. I have found that in some ways it is easier to be myself, crack jokes, be more personable with my patients, and they with me, when we are wearing masks. I believe that some patients have found it easier to speak freely when masked than not. Paradoxical, yes indeed. 

When sitting across the table from two accreditation surveyors who were visiting our center last week, we all found it a little odd to be presenting ourselves, our programs and our achievements while masked. Even one of the surveyors commented that we didn’t really know each other, or our features, while interacting in this way, and how odd that was. 

So in summary, masks can be physically protective against pathogens that can harm us. They can quickly be assimilated into everyday life and provide minimal barriers against interactions with those we know well. They can also be barriers, literally and figuratively, that prevent knowing others and assessing their emotions and interactions if we do not know them well. They can be something to hide behind, which might make it easier for some to interact, or harder for others to be themselves. They can make it much harder to get to know someone new. There is also one more thing to consider. Though we are all so tired of the pandemic, the quarantines, the isolation, the distancing, and the mask wearing, it may be harder to give up the latter than we think when the time comes. One previous life experience reminds me of how hard this might be when we are told we really, truly do not have to wear masks any more.

I can remember playing in a staff/patient softball game many years ago. I had just hit a driving single that I was sure I could stretch into a double, so I rounded first base and raced towards second, sliding in a cloud of dust. It was an ill planned slide, and my left leg caught the bag, which decided that it would not move. I heard a snap, felt immediate pain, and looked down to see my lower leg in a weird angle that was certainly not natural.(I was safe, by the way) After a trip to the emergency room, I headed home the proud owner of a new set of crutches and a cast that encased my lower leg to my knee. I hated that cast, though it allowed my broken bone to mend over the next six weeks, because I could not take a shower easily and could certainly not carry my own coffee cup while rocking crutches. However, as my bone healed and strengthened and the muscles of my leg dwindled to half their pre-slide size and power, it soon was time to shed the cast and go back to supporting myself without an exoskeleton. I was afraid to give that cast up. Why? Because I knew that while I wore it, I was relatively steady on my feet, my leg was strong and supported, and I would be able to walk and not fall. Without the cast, as soon as it came off, I felt vulnerable and weak. It took a few more weeks after that to get back to my normal strength, confidence and steadiness. 

When it comes time to shed our masks, how will we feel? Will we smile, timidly at first? Will we avoid others, wondering how vulnerable we are to illness and disease? Will we relish the ability to gauge someone’s delight or anger or sadness from their facial expression, or will we find it hard to open up again? Time will tell. I just know that one day, and soon, we will pass someone in the hallway at work or in the store or at church and we won’t need to ask, “Who was that masked man?” Because we’ll know.

So Much Is In The Doing

My wife and I both work in service industries. We both do a lot of listening. She is a flight attendant who travels all over the world, walking up and down the aisles of Boeing and Airbus airplanes at forty thousand feet, listening to stories and responding to requests. I am a psychiatrist who is usually found sitting behind a desk, tapping away on a laptop, listening to stories and responding to requests. We have have many conversations about how people interact with each other, how they talk, how they ask questions, how they respond to demands and rules, and especially how they function under stress. I know you have seen the various YouTube videos of enraged, unruly passengers who have attacked cabin crew members over issues of mask wearing or alcohol consumption or some such. My wife has never been on the receiving end of one of those attacks, thank goodness, but she is aware of the possibilities every time she signs in for a flight. I have been hit twice and lunged at several other times but never seriously injured while doing my job. We do realize, as I am sure you do, that the last eighteen months has brought out the best and the worst in all of us, and part of that is the lack of attention to the social graces and the simple interactions and courtesies that we once paid each other as a matter of course.

In her recent 8-14-21 article “COVID Anxiety and Fear of the Base”, Wall Street Journal columnist Peggy Noonan addressed some of this. Now, my own column is not political, so some of her writings in the beginning of her piece are beyond the scope of what I want to discuss with you. However, she does start out by stating that people now have mask fatigue and other associated side effects of living through the first serious global pandemic in a century, and that issues such as mask wearing are pushing people to pick a side. Moderation, which in my book went hand in hand with politeness and social grace and simple courtesy, has now become only “for the gutless and insincere”. My wife and I have both noticed, in our very different but very similar worlds, that moderation, patience, respect, and tact have all become signs of weakness. As Noonan put it in her piece, “nothing has been so damaged by the pandemic as what had remained of American tact”. We pick sides of an issue or an action, then demonize and vilify those with different opinions. Noonan suggests that we “make a decision, then encourage, persuade and and exemplify helpful behavior” to win over our fellows who may have opposing views. We all tend to talk and rage against one another, but she says that instead of emphasizing the verbosity, “so much is in the doing, especially in a crisis”. Why are we this way? We are tired. Very tired. We are irritable, and we are much less confident than we were even a year ago because we simply do not know what is coming at us next. We cannot predict the future of this pandemic, and that now makes us gun shy about predicting anything that has meaning in our lives.

Now all politics and divisions aside, the part of her column that I liked the most was the part where she asked, “What rules of the road might help us…….what general attributes?”

First, she challenged us to “regain a sense of give”. We should stop pushing each other around. We should strive to have a generous and sympathetic sense of who our fellow Americans are. Those people that you so vehemently disagree with? Have you ever thought, asks Noonan, that they might be thinking about things that had not even occurred to you? We should be patient. I am always looking for signposts in my own life and work. Two recent events assured me that patience was a virtue that I sorely needed to pay attention to. First when my seven year old granddaughter stayed with us for five days, we learned that operating on her schedule and living life with her level of energetic intensity requires planning, stamina, and yes, patience! The other was when a patient told me the story of living with an incurable and potentially fatal disease, while caring for an elderly relative with their own serious health issues, and how this had lead to a major upheaval in schedules, vigor, and enjoyment of life that was not as it used to be, but as it now was.

Second, Noonan challenges us to stop picking on each other. Does it help to ostracize others? To demean or fight or assault? No. Once again she asks us to empathize, teach, educate, and lead by example. Third, we should admit that there most likely reasons that people do not trust the experts. (This could hold for virologists, and psychiatrists and flight attendants too, I suppose!) If you are ever in a position where you are the designated expert, and believe me, almost anyone who reads my column is more than likely in that camp at some point, play it straight, says Noonan. If you don’t know, say you don’t know. (It took me years after I finished medical school to get comfortable with this very simple but extremely difficult act) Do you like your fellow Americans? Are they “other”, “imbeciles”, or dare I stray into the political quicksand and use the term “deplorables” to you? Or are we all Americans, with different ideas and beliefs and values, and through our differences, embody e pluribus unum? Noonan tells us that if we do not like and respect each other, no matter how hard we try to hide it, “nothing is more obvious than a lack of affection”.

Lastly, she says we must “adjust our sense of proportion”. Put quite succinctly, “COVID now is part of life; it’s not life.” There are so many pressing issues in the world right now, war and famine, and climate change and heart disease and cancer and poverty and mental illness and we focus just on this pandemic and lose sight of all the others at our own peril. We will be dealing with emotional stress of these times for the foreseeable future. Life is hard. Illness is hard. But as the WSJ column concluded, “Life has to be lived.”

Mentors

My six year old granddaughter was getting frustrated. It was very hot as we played a round of nine holes of miniature golf under the blazing sunshine at Topgolf, the first such round for her. She was doing quite well, all things considered, until we hit one of those holes that required a tricky shot into one of two small holes at the end of a log which then allowed the ball to roll downward to the green and cup below. She lined up, struck her pink ball up the gentle incline, and down it rolled again. When she was finally close enough to attack the shot through the log, she stood with feet pointing in two different directions, putter head at a strange angle and an aim that was obviously going to send the ball upwards to ricochet back toward her and perhaps down the hill again. Golf that only Sisyphus could appreciate.

I approached her and gently asked that she let me help her with her stance, club alignment and swing. “No! I can do it myself! I want to do it myself!” I tried to remain calm but finally said, “No, you can’t, and I would like to show you what might make it easier for you to get this ball in that hole and down to the green.” After a little more bluster and vague noises of discontent, she allowed me to guide her hands. After a couple more tries, the ball entered the log, came out the other end as expected and a stroke or two later she had successfully completed the hole.

We all need a little help at times. There are things that we have never learned to do, things that we have learned to do incorrectly and things that simply require learning skills that we do not yet possess due to age, or training, or experience. As a young medical student, I remember thinking that I knew more things about more things than I had ever known in my entire life, but also having a vague inkling that most of this knowledge was absolutely useless without primary experience and the guiding wisdom of teachers that had my best interest at heart. Like my granddaughter, I wanted to cry out, “I can do this myself! I want to do it myself!” Fortunately for me, I was surrounded by learned men and women who were patient, skilled and who wanted to teach me how to be a doctor, an excellent doctor. I listened to most of them (I think!) and am the better for it every day of my working life now.

Over the last couple of years, I have lost several of those mentors. Some were ill and died too soon. Some were old and it was just their time to pass the baton along to my generation. One taught me general medicine mixed with psychiatric consultation, one taught me rheumatology, and one taught me how to approach problems in medical ethics, still one my all time favorite courses in any of the schools I have attended in my lifetime. I was shaped by these teachers, in ways that not even they fully knew, and they will always be a part of me and the way I approach medicine and patients who need my expertise. They not only taught me the facts, but how to think about the facts, and then how to take that thinking one step further and formulate a viable plan that would help my patient recover from whatever ailment they presented with. There are still times that I cannot do it all by myself, and I turn to those who can help when help is needed.

We are still battling the coronavirus pandemic, like it or not. As we have discussed here in several previous columns, this illness has lead to both physical and mental illness in thousands of people. It has cost hundreds of thousands of lives. In this fight to better understand this illness, to learn how to treat it and to save lives, we have desperately needed mentors who could guide us in our endeavors. Whether it has been the pure science of the vaccines, the protocols involving ICUs and ventilators in acute care hospitals, or mental health and substance abuse issues we have sorely needed words of wisdom and tested treatment measures. Unfortunately for us, this is the first such pandemic in one hundred years, and no one alive has been able to act as such a mentor.

Now, we are at a crossroads where science and facts learned over the last eighteen months are in juxtaposition to fears, misinformation and rigid dogma. We must, like it or not, allow someone to come in and guide our hands. We need those with facts and tests and procedures that will help us to beat this illness modify our grip on our own fears, align us with solid scientific facts, and insure that our steady and confident swing is complemented by a fluid and smooth follow through. We need the mentors that this crisis has created in real time. Like my granddaughter, we can learn to make the shot, but we cannot do it alone.

Mercy

“Woah, ah, mercy, mercy me

Ah, things ain’t what they used to be.” Marvin Gaye

I have another podcast that I want you to know about in this week’s column, but first I have a few questions to ask you. Better yet, I want you to ask them of yourself as you read this and think about it today. We have been talking a lot, a lot, about the COVID-19 pandemic and how it has affected us physically and now mentally as we struggle to find the finish line of this biological disaster. Many of my family, friends, colleagues and patients have been dealing with issues of isolation, depression, anxiety and stress for well over a year, and the dilemmas that have come up have not been easy to resolve.The questions I have for you?

Has the pandemic made you reevaluate your associations and friendships with others?

Do you find that you have been carrying grudges based on old wounds that now feel just a bit trivial in the shadow of six hundred thousand deaths?

Do you struggle, amid the pandemic, with wanting to unburden yourself of hurt and anger but somehow find it easier just to keep carrying them after all these years?

The podcast suggestion I have for you this week is Hidden Brain, hosted by Shankar Vedantam. This is a wonderfully rich podcast that takes deep dives into emotions, motivation, relationships, stress, coping and everything in between. On a recent episode, Shankar welcomed Charlotte Witvliet, a psychologist at Hope College in Michigan. They had an in-depth discussion about grudges, holding them, dealing with them, letting them go, and the emotional stress and strain involved in all of that.

Dr. W, if I may be so bold, started out by telling us that we often go about our lives with a detailed ledger of all the wrongs that have ever been done to us, all the betrayals and hurts that we keep meticulous records of. Our anger over these can fester and grow stronger with time, not fade as we might think. It can feel both good and bad to hold a grudge. It is sometimes easier to keep it and nurture it than it is to let it go once and for all. Grudges, she says, may take the edge off of our profound sadness, and help us feel that we have a tiny bit more control over our emotions and lives.

We may always be on the lookout for clues that justify why we feel the way we do, clues that feed our anger. We sometimes dismiss things that might get us out of our destructive loop and actually make our lives better. Sound familiar as we navigate the treacherous waters of this pandemic? As we get more inflexible in our responses to a pandemic or an old grudge, we tend to get stuck in a do loop of bad behavior and anger that brings us further down. This rumination on negative emotions can actually affect us physically, according to Dr. W, in that our blood pressure rises, our heart rate increases, and our beat to beat variability ( a measure of healthy heart function) may be off as well.

Have you noticed that your response to that old friend or even a new acquaintance may sometimes be out of proportion to the thing that they said or did that set you off in the first place? Dr. Witvliet says that focusing on the humanity of the person, the fact that they are a person just like you, with a story, stress of their own, and their own baggage, may help you deal with them in a more positive way. The interesting thing about this to me was that even if you cannot completely give up the thoughts and hurts that might haunt you, if you truly try to understand the person that offended you and truly try to forgive and show mercy, your actual physical response will be very real, in a very positive way. She goes one step further (and you may or may not agree with her here) and says, “Forgiveness is a moral response to a relational breech.”

Now, you might tell me that in your case, you can just distract yourself with other thoughts, other activities, other pressing issues and that the grudge is dealt with in that way. You might be right to some superficial degree, but real forgiveness trumps distraction every time, says Dr. W. The real physical effects that I mentioned above, such as lowering your blood pressure, tend to be much more long lasting if the forgiveness, the grace, and the mercy are sincere and real.

Forgiveness is a process, says Dr. Witvliet, a journey. It unfolds over time. It’s like grief in that way, in that it is not a linear, A to Z process, but more a series of rolling waves. We have all had deep hurts from losses. All of us. That’s being human. Where we fool ourselves sometimes is that we tend toward decisional forgiveness, which is based mostly on our cognition, instead of the truer emotional forgiveness which involves a change of heart. The psychologist says that the two are not equal.

The trick to dealing with these relationships that you are struggling with now that things are opening back up? The way to deal with the hurt, the anger and the wounds that have been allowed to fester for over sixteen months now? Generate positive, empathetic responses to other people, says Dr. Witvliet. Empathy is key. Think about the gift of grace, forgiveness and mercy that you can give that person, and then think how wonderful it would feel to receive that kind of gift. Commit to giving the positive, not committing the negative again.

The hardest relationship, hurt, offense or slight to deal with? One that is truly targeted, evil, or destructive. These kinds of hurts are not just subjective or a matter of having our feelings hurt, muses Dr. W. They are objectively terrible wrongs that are terribly hard to forgive. One example that hits close to home for us in South Carolina? The shooting of nine innocent churchgoers at Mother Emmanuel AME Church in Charleston, South Carolina. The tragedy that occurred there that day was unspeakable, but the responses from the families of the victims, a commingling of grief, sadness, anger and profound love and forgiveness towards the shooter, was almost unimaginable. But, as many of you might know more than I, it was about as real as it gets.

So, back to my questions. In this time of reentry into the almost normal of a post pandemic life, are you struggling with relationships, grudges, long ago hurts and injuries, or the inability to let destructive issues in your own life go? Were these magnified or made center stage by the isolation and stress of lockdown, working at home, more time with your family or wearing multiple hats between work and home and schooling your kids? Do you harbor and carry those heavy grudges towards someone and wish you could unburden yourself? As the psychologist in this podcast episode about the power of mercy instructed us, thinking about the humanity of the transgressor, truly forgiving them, and approaching the coming days with positivity and creativity will surely help you to experience less anger, stress and physical ills than you ever did before. Find this episode, listen to it, and ponder. You will be glad that you did.

Reentry

Reentry

 

 

Did you watch any of the comings and goings of the Crew Dragon capsule as it went up and down from the International Space Station? It’s a sleek, slick, dazzling white, truly space age looking piece of hardware that has now ferried several astronauts to space and back as part of the partnership between SpaceX and NASA. I decided to watch a video on the You Tube channel Everyday Astronaut to learn more about how this tiny capsule gets back to earth once it has been in space and docked for a while. I would encourage you to check it out.

 

Spoiler alert: this last mission resulted in the first successful water splashdown since 1976. That being said, what were some of the most interesting facts about the timeline and process of bringing this little capsule and its human cargo home safely to earth? First of all, once the Crew Dragon backed away from its home away from home, it had anywhere from six to thirty hours until possible splashdown. That’s quite a range! As it entered  the atmosphere of our planet, its heat shield was turned to face forward in the direction of travel, having to withstand temperatures of 1900 degrees Celsius, and G forces of three to four times earth’s for the crew inside. The air that rushes towards the speeding capsule has little time to get out of the way, is superheated to half the temperature of the surface of the sun, and is compressed into what is called plasma, all of which puts tremendous pressure on the capsule and its contents.

 

Once the capsule did make it past the blistering heat of the atmosphere and was free falling towards the water, it had to be further slowed down, first with two small parachutes that oriented it for its final descent. Then, four main parachutes partially opened, then fully opened to help the capsule gently settle onto the surface of the water. The exact timing and manner of deployment of these chutes is critical. Too fast and they simply won’t open, too slow and they will not slow the craft enough to prevent a hard landing on the water. It was picked up, placed in a “nest” on the recovery ship, and saw the extrication of astronauts who had been in space so long that they could barely negotiate one atmosphere of pressure and could barely stand without support. As the host of the Everyday Astronaut video stated, “The entire system makes reentry safe.”

 

Now, think about where we are today in this pandemic cycle, which officially started in March of last year. We are battered, bruised, tired, grieving, and so ready to re-enter our prepandemic lives. We would like to think that we can just magically return to what we did, how we acted and talked and functioned in January 2020. The truth is, just like Crew Dragon, we have been docked for over a year, in one way or another, stuck in our homes, working out of closets and bedrooms, teaching kids at the dining room table, talking to coworkers, friends and family by Zoom, emotionally weightless. Now, we are ready to suit up, get back into the capsule, back away from being forcibly tethered to pandemic life, and head for freedom. What will it take to do this? What will it cost us to get back on the ground?

 

First, just like the crew leaving the space station, we must be protected. We cannot do this alone. We must orient ourselves in the proper way so that we can face the onslaught of heat that will be coming our way in the form of social gatherings, parties, dinners, school activities, sporting events, church gatherings, and family outings. It is going to be wonderful and brutal all at the same time. Is your calendar already filling up like mine? We need a heat shield. This may come in the form of a good support system, good self care and good habits like exercise and getting enough sleep. The events and obligations, like the air that cannot get out of the way of the capsule and is compressed into super hot plasma, will rush at us so fast that all we think we can do is say yes and hang on for the ride. I would counter with the fact that if we have learned only one thing in this time of pandemic, it is that we can say no.

 

What are your parachutes? What will gently place some directional drag on your descent back into the helter skelter that was your pre-pandemic life? What will slow you just enough so that you can take your time, pick and choose your commitments and activities and interactions so that they will make you stronger, not dash you against life in a rush? Think about that now as you get vaccinated, as your mask comes off in more and more places, as you begin to hug friends and family again, and as you feel more comfortable in your own skin outside your own home.

 

Like the Crew Dragon astronauts, we will miraculously come through the fiery descent, get ourselves oriented in the right direction, gently slow things down to a manageable speed, and come out of our confinement a bit unsteady, but ready to accept the support that will get us back to our best selves for the years to come.

 

Happy reentry!

Cast Off

It happened too many years ago to remember now, but I still do. It was a time when we who labored in mental health could be more real, could actually connect with our patients in meaningful ways and even let our hair down from time to time and have some fun. A group of staff members were playing a group of patients in a friendly softball game in Aiken, a few miles from the mental health center. I was old enough to know better but still young enough to think that the teen athlete still lived in me, and you know how that always turns out.

 

I was taking my turn at bat, connected with the ball and drilled what should have been a solid single to right field. I should have been more than satisfied with that, but of course I wasn’t. I rounded first, saw that the outfielder was fumbling with the transfer from glove to throwing hand, and made a split second decision to stretch a sure single into a maybe double. Getting to second was easy. I was still moderately fast in those days. The next decision I made was not a good one, however. Without a clear need to do so, I decided to slide into second in a blaze of dusty glory. Bad move.

 

I knew that I had really screwed up when my left leg made contact with the base, which felt at that moment like a concrete block. The snap was audible, the pain immediate and the shame followed close behind. When I tried to get up, I saw an acute angle between leg and foot that was not at all natural. Not good. A short ride and check in at the emergency room later, I was not at all comforted by the well meaning nurse who told me that “only really active people get injuries like these”. You know the drill. Ortho tech, clean it up, put it in a cast to the knee, get fitted for crutches, see ya in a few weeks.

 

The hardest part about being in a cast for those long weeks, besides not being able to take a real shower without wrapping my leg in plastic bags? I couldn’t walk with crutches and carry a coffee cup at the same time. This, my friends, is the definition of crisis. But, of course, like many weekend warriors, I made it through.

 

Fast forward to the doc’s office on the day that the cast was coming off. I had lost about half the muscle mass in my leg, and I was more than a little worried about taking away the plaster exoskeleton that had held me up for those weeks. Would I fall down? Rebreak the leg? Be able to do the things that I could before the injury? Getting the cast off felt so good in one way, with cool air on skin and mobility that I had missed terribly. But the worry about reinjury or weakness or worse still gave me fits for a few days, until I knew things would be okay again.

 

Now, forward to March 13, 2021. The CDC decides that after more than a year, those who are fully vaccinated against COVID-19 can shed their masks indoors and out, around people who are also fully vaccinated and those who are not. This seems to come so suddenly that it catches us off guard.  After being so careful for so long to avoid exposure, protect ourselves against infection and illness, we are now told that all is clear and safe! To me, it almost instantly brought back memories of taking my cast off, something that I was more than happy to shed, but with the anxiety of what my health would be like after it was gone.

 

Protections, even if restrictive and painful in the short term, often make us feel safer in the long run. Removal of these restrictions is exhilarating but can be frightening at the same time.

 

When I was recovering from my broken leg, just as we are now seeing the beginning of the end of the COVID-19 pandemic in the United States, letting protections fall away was the only sure way to test ourselves and our safety going forward.

 

The second half of that lesson is also clear: testing ourselves is the only way to grow.

Languishing

How have you felt lately? Really?

Good? I am happy for you. Depressed and hopeless? I sincerely hope that you are seeking help and on the road to recovery. The rest of you? My hunch is that you may be feeling a little flat, not motivated, and “meh”. This is weird, right? Vaccines are here, many of us are back to work, things are opening up a little bit, and the warm sunshine of spring and the promise of summertime should be brightening our days. Why then, do we still feel a lack of motivation, have trouble concentrating and find it challenging to focus on the things that matter to us?

Adam Grant, an organizational psychologist at Wharton, addressed all this in his April 19, 2021 article There’s a Name for the Blah You’re Feeling: It’s Called Languishing. He pointed out that we are not depressed or hopeless. We are not impaired. We are functioning daily. We are not burned out. There is just little joy and we feel aimless at times. We lack anticipation for the good things that we used to look forward to.

According to Grant, languishing is a sense of stagnation and emptiness. We are muddling through, and as some of my patients have said in the past “existing but not really living”. Many of us who have had COVID and recovered or those who have not had the illness at all are struggling not with long COVID syndrome, but with “the emotional long haul of the pandemic”.

Think back to early spring 2020. We were all a bit frightened, unsure of what was happening in the world around us that was heading our way. Back then, according to Grant, our natural threat detection system was “on high alert for fight or flight”. We learned that masks were helpful, but we were still scrubbing surfaces and sanitizing our groceries. We developed crude routines that “helped ease our sense of dread”. The problem is that as time has gone by, our acute state of anguish “has given way to a chronic condition of languish”. As languishing is squarely between depression and flourishing, we don’t feel bad but neither do we feel back to our pre-pandemic good either. Grant says that “you’re not functioning at full capacity. Languishing dulls your motivation, disrupts your ability to focus, and triples the odds that you’ll cut back on work”.

The term was coined by a sociologist named Corey Keyes. According to the article, his research suggests that these who are languishing today are going to be at much higher risk of developing depression and anxiety over the next decade. That second great pandemic wave you’ve heard about? It may be psychological, not purely medical. Grant also says something about languishing that hit me: “You’re indifferent to your indifference.” You may not even realize how slowly you are sliding into the malaise.

So, what do we do with all of this? Grant says that one of the best ways to handle emotions is to name them. In the spring of 2020, we were all obviously experiencing acute grief, from loss of loved ones to loss of freedoms to loss of routine to loss of income. So many losses. Now, we learn that we are languishing, and naming it may be the first step in battling our way out of it. Languishing is “common and shared” and just knowing that may give us the ability to bestow a little grace not only on others but on ourselves.

What next? Focus. Relearn, if you must, how to pay attention to the things that are important to you. I am the worst when it comes to this, so believe me when I say I am not preaching to you. Grant says in his article that “computers are made for parallel processing, but humans are better off serial processing”. Simply put this means do not try to multitask! Again, I have five or ten or fifteen things that I must do, want to do, love to do, and I delude myself into thinking that I can do five of them at a time extremely well, but this is simply not true. Pick something, make it realistic and doable, and put your whole focus into it. You’ll feel much more accomplished and maybe even happy if you do!

Set boundaries and block out time for yourself. A colleague and I were talking about this by email just this morning. We need processing time, thinking time, planning time. I know it is hard to come by when you are working from home, taking care of the kids and responding to emails and Zoom invitations all day, but it is worth aiming for.

Grant tells us to focus on small goals. “Try starting with small wins”, because the pandemic was such a big loss to us all. Don’t be too easy on yourself though. Pick something moderately challenging sometimes. “The most important factor in daily joy an motivation is a sense of progress.” Do things that matter to you.

The article finishes up by acknowledging that “languishing is not merely in our heads-it’s in our circumstances”. “Not depressed doesn’t mean you are not struggling.” As one of my patients told me that other day (I told him I would steal this and he agreed), “Just because I am smart and can articulate what is going on with me does not mean that I can fix it.” Don’t let yourself languish, isolate and fall into the pandemic abyss. Use the tools outlined in this article, use your support systems, and get professional help if you need it. We are so close, and we will get there together.

(Un) Comfortably Numb

“Hello? Is anybody in there?”

“I have become comfortably numb.”

Pink Floyd

We are being bombarded with numbers. Numbingly numerous numbers. Allow me to share some familiar, and maybe not so familiar ones with you.

When I first wrote this piece, there had been one hundred ten million, thirteen thousand eight hundred forty-one cases of COVID-19 across the world. Global deaths were two million, four hundred thirty-two thousand six hundred ninety-five. In the United States, we had twenty-seven million, eight hundred twenty-eight thousand one hundred fifty of these cases, and four hundred ninety thousand, seven hundred eighteen deaths. Of course, the numbers have only grown since that time.

The monster winter storm that engulfed the United States from Texas to the northeast resulted in four million without power in Texas alone, and forty deaths across the land. By Thursday of that week, FEMA had already distributed seven hundred twenty-nine thousand liters of water, fifty thousand cotton blankets and two hundred twenty-five thousand meals.

During the COVID-19 pandemic, forty one percent of adults surveyed in January 2021 had some degree of anxiety and depression, up from 11 per cent in January through June of 2019. Thirty six percent of those questioned related poor sleep, and thirty-two had appetite changes. Up to fifty-six per cent of young adults ages 18-24 had been battling depression and anxiety.

Did you see how I wrote all these numbers out in words? Why? Because it takes you longer to read out each word, to really process what the sheer numbers mean, than if you see another in a long string of mind-blowingly large figures. The numbers do not lie. We see them, day after day after day, but my fear is that we are becoming more and more (un) comfortably numb to them.

It is easy to develop compassion fatigue in times like these. There is so much hurt and fear and pain and need and stress in our world right now that it is easy for us to develop emotional numbness to these massive threats to our daily way of life. Compassion fatigue is that indifference to charitable appeals on behalf of those who are suffering, experienced as a result of the frequency or number of such appeals. It comes in no small part from actually absorbing into ourselves the trauma and emotional stress of others, leading to a vicarious pain and discomfort that become a secondary trauma to the caregiver or helper.

How does it manifest? Physical and emotional exhaustion, depersonalization, irritability (raising my hand here), self-contempt, decreased sleep, weight loss (or gain in some), and headaches are just a few of the signs and symptoms you might find yourself experiencing during these very troubled times.

How might it affect your ability to function at your best daily? You might be trying harder but find yourself helping less. You might give up, feeling that the stresses in the world are so huge right now that there is nothing one person can do. You might find yourself coping by using alcohol, drugs, or food to self soothe. Small, nagging physical symptoms might worsen into actual illness.

How do you decrease emotional numbness?

Reconnect with the world, with your world. Find a way to reach out and connect locally, nationally or internationally as you feel might be most helpful.

Practice good self-care. This is not the time to back off good pandemic hygiene, good patterns of eating and sleeping, or your usual exercise routine. It is time to double down on these things that make us healthy and keep us happy. I have recently started meditating, having never done it and knowing absolutely nothing about it. I have been amazed at how a brief ten-to-twenty-minute meditation practice session can put me back in the game. Learn something new. I recently listened to a chapter in Dr. Sanjay Gupta’s book Keep Sharp that talked about learning a new language or something equally as challenging. I was heartened to hear him say that it is not impossible to learn these difficult new things as we age, though it might take a little longer than when we were younger. Give yourself the grace to try, to do, and to succeed. We are making history just by surviving in this one-hundred-year pandemic!

Take time with family and friends when you can do so safely and practically. We need social interaction, as discussed here before. We just need to realize that continued vigilance is necessary until we can see the true end of the pandemic approaching.

Write in a journal. As you know if you have been reading my columns and blog posts for long, I love to write. I write in small notebooks, large notebooks, software programs, on Post-It notes, and on the back of envelopes. Our thoughts jotted down on paper or converted to ones and zeros in an app somewhere will be the primary sources for someone who one day writes the definitive history of this pandemic. Think about that and contribute.

I’ve borrowed from Mother Teresa before, and I will do it again to close these thoughts for the week.

“We cannot all do great things. But we can do small things with great love.”

Pandemic Pitfalls

I read a good article on the physical effects of the coronavirus pandemic on our physical health recently. Yes, the Pandemic Is Ruining Your Body was written by Amanda Mull and published on January 14, 2021 in the Atlantic. In it, she addressed many of the ways that living in the middle of the worst worldwide health crisis in a century affect us as human beings who are struggling to be brave, squash fear, stay productive, and thrive, all without the help of our usual social institutions and personal interactions.

She acknowledges that for some of us, myself included, sitting at home virtually all the time, even when working hard, is a situation of relative comfort and incredible luck. We have jobs that allow us to use computers, faxes, cell phones, scanners, email, and videoconferencing to meet, greet, schmooze and therapize to our hearts’ content, just not in person. But at what cost? She says that in her own experience of working from home, she began to experience decreased hip mobility, low grade headaches, sore shoulders, a stiff neck, and dry skin. At first, she and her ailments felt isolated, because she was isolated. She could not see that her coworkers were doing the same things, stretching the same tired muscles and “gobbling up ibuprofen” as she was. Many have been sickened or even died from COVID-19. Those who have avoided those fates, says Mull,  are living through an extended disaster that at the least is painful, but at its worst can be catastrophic.

What are doctors and others seeing? Aches and pains come up for seemingly no reason and then stick around. People who work from home found themselves setting up what they thought would be a temporary home workstation that they might need to use for a few weeks at best, a few months at worst. I did this myself. Over the last year, as pandemic reality set in, I have changed my equipment configuration, furniture and workflow more times than I can even remember. Sitting in front of a too short table, shoulders hunched, laptop screen too low, keyboard at the wrong height, and normal implements not easily reached, makes work tough. This, as Mull says, “all while sitting in a chair meant to support a human for the duration of a meal, not a workday”.

We are also working longer hours. How can that be, I asked myself after I read this in multiple articles for the fifth or sixth time. If you must get up, get ready, drive to your workplace and then leave at a prescribed time once you are done, there is an eight or nine hour rhythm to your day. If you subtract some of the prep time and all of the commute time, you find yourself (and again, I can attest to this) working an extra hour or even two. As I wrote this, I finished a “normal” ten hour workday that was jam packed with patients, emails, consults, and reviews. It simply feels that work has been busier, more packed with tasks and with much less down time or break time then pre-pandemic. Let’s be honest. Everyone feels just a little twinge of guilt when they work from home. And Mull says, “expectations of productivity have increased” because you are there. Granted, some may be able to outfit a spare bedroom or home office with nicer and more usable equipment, but “for those living in cramped housing with kids who go to Zoom school and other family members who also need space to work, building a personal mini office simply isn’t an option”.

Does any of this bleed over into our emotional wellbeing and ability to cope with the social and mental stresses that this pandemic has caused? Of course it does. In the past year, many months of which I have worked predominantly at home, there has not been a workday that goes by without me hearing about folks who are anxious and can’t sleep. Not a single day. Much like Amanda Mull discussed in her article about the physical stresses that can lead to physical problems, I have seen the psychological toll that the coronavirus has had on our normal psychological and emotional worlds. While staying home, we have lost out physical connection to others. There is no chatter around the coffee pot or in the parking lot before or after work. We have been forced to use different “equipment” to connect with each other. As my rector opined at a recent annual church business meeting, “Well, Zoom gets the job done I guess, but it’s not the same, is it?” Screens are now our “windows on the soul”. Why? Because any time we are face to face with most people we know outside our immediate family, we are wearing masks. Unless you are extremely close to someone, it is hard to read real emotion from just raised eyebrows or crinkling crows feet. Why is this important?

Because stress, anxiety, depression, loneliness, and hopelessness kill. They are not dangerous in themselves just for the misery they cause, and the potential for catastrophic consequences like suicide. As Mull states in her article, depression and anxiety “are enormous risk factors for heart problems, especially among people over 50. Quarantine itself is also a risk factor. Loneliness and social isolation increase the risk of myocardial infarction and stroke by up to 30 per cent”.

What can you do now, today? Connect with others, however you can, however awkward. Call. Zoom. FaceTime. Text. Reach out to the elderly who have little social support. Spend some non-screen time with a child. Cook dinner, and then leave part of it in a basket for the neighbors next door. I know I keep saying this, but it’s true. This pandemic will end. We will get through this together. We just need to make sure that we come out of this ordeal as physically and mentally healthy as we possibly can.