Gimme Shelter

Gimme Shelter

Ooh, a storm is threatening
My very life today
If I don’t get some shelter
Ooh yeah, I’m gonna fade away

The Rolling Stones

Shelter. It’s a safe sounding word, a comforting word, a good ending to the story word. We have all needed shelter at one time or another in life, if just to lay our head on a pillow for the night and sleep to be able to face another day. What is shelter, exactly? Well, Merriam-Webster tells us that a shelter is something that covers or affords protection, or an establishment providing food and shelter. There are shelters like lean-tos in the open forest, homeless shelters in inner city neighborhoods and animal shelters that care for strays until they might be adopted. Remember Maslow’s Hierarchy of Needs? Shelter fits right into those bottom two sections of the pyramid that talk about basic needs like food, water, rest, security and safety. If you do not have these basic needs, safe shelter being one of them, then it is very difficult to focus on the more complex, higher needs like relationships and self-actualization. 

I have worked in and around shelters run by the Red Cross and other organizations in times of need, and maybe you have too. The traditional shelter layout that most of us envision is a very large, somewhat open space like a church parish hall or a gym, with room for the cots and belongings of hundreds of people who for some reason need to be there. These people are very close to each other, sleeping just a few feet apart. There is usually some kind of communal eating, with shared tables full of foodstuffs and community coffee pots. There are often common bathrooms, albeit cleaned and monitored to the extent possible. Helpers and volunteers often work in very close proximity to those in need. There were some days during my deployment for Hurricane Katrina in Mississippi and Louisiana that I would talk to literally hundreds of people a day, some for one minute, some for fifteen or thirty, depending on need. We worked, ate, comforted and rested in very close quarters. There has been the need for this type of sheltering and aid during Hurricane Laura and now during the catastrophic wildfires in California, some of the worst ever. 

Shelter has recently become a concept and an operationalized idea that is fraught with challenges. The age of the COVID-19 pandemic has turned on its head the idea of getting many dozens or even hundreds of people in the same large room, living and eating and breathing in the same vicinity, for days if not weeks at a time. This is virtually impossible. Or is that the key word? Virtual?

We have all been asked to shelter in place for varying lengths of time since the start of this pandemic. We have found ourselves staying in our homes for days, weeks, or even months at a time, with little contact with the outside world or even with others in our own extended families. We have made makeshift home offices, set up school environments for our children, ordered our groceries and meals from companies who will deliver to our door, and driven by for curbside pickup of everything from internet purchases to communion. We have found that parking by school busses that are reconfigured to be WiFi hotspots might be the most reasonable way to stay connected while still sheltering in place, that place being the family vehicle. Our concepts of normal work, education, and providing for our families have been significantly challenged, altered and modified, some perhaps for the foreseeable future. 

What is the new meaning of seeking or providing or benefitting from shelter? There are several aspects to this new pandemic-inspired concept. 

First, there will always be the physical component. The facts as we know them now mandate that we continue to exercise caution in the form of physical distancing at least six feet from others any time we are outside our safe zones, which for most of us is our own home. This physical distancing, combined with wearing face coverings, gives us the ability to essentially “shelter in place” no matter where we are, so that we can roam a little more freely to get groceries, fill up the car with gas, or make short trips as needed. 

Emotional support is going to be an ongoing need. This is hard. No question. I talk to people every day who are tired of being cooped up, tired of not seeing their loved one and friends and tired of basically being on house arrest. We are human animals, and we crave social and emotional togetherness, closeness and community. That is never going away, but it must be tempered until this pandemic goes away for good. Connectivity that leads to communication is key. As discussed before by many others, use FaceTime, Skype, messaging apps, email, phone calls and even good old fashion letter writing to keep in touch with those you care about. The need for connection does not go away just because physical distancing is necessary. 

School has been a huge issue for many families over these last many weeks. How do we go back to school? When do we go back? For how many days each week? Virtual versus hybrid versus online versus paper versus-you get the idea. Kids must be sheltered and protected even as they learn. This may be in the classroom with plexiglass and masks, or it may be at home with Chromebooks and headphones, or a combination of both. Education is paramount, but safety is on the hearts and minds of everyone who has ever taken on the wellbeing of a child as a primary responsibility. 

Daycare and the ability of parents to work is another major component of this new sheltering in place idea. Are parents able to supervise kids while still doing their own jobs at home? Must in home childcare and supervision be obtained in order for parents to go back to the office? Are kids sent back to school rooms that have been modified based on current knowledge in the hope that teachers and kids will all remain healthy? 

Almost by definition over the last six months or more, we have been physically and socially distanced, but we are still very much emotionally connected. That connection and common purpose are the only way that we will survive the stresses of the pandemic, social upheaval, climate change, and an economic downturn that has impacted so many in our country. Educate yourself. Challenge suppositions that seem spurious or nonsensical to you. Protect yourself and your family in the ways that you feel are scientifically based, logically thought out and that are in the best interest of all. 

Triggers

I saw a patient today who looked familiar to me from the moment she left the waiting room and headed down the hall toward my office. 

“Have I seen you before?” I asked, trying to recall.

“No, I don’t think so. No, I’m sure I’ve never seen you before,” she answered, a little befuddled at the circumstance and the question.

I weighed her, showed her to her seat and began the interview with the usual questions, accompanied by the now-commonplace clackity-clack of fingers on keys, second nature to me after a year of learning to “collaboratively document” my interactions with my patients. 

I know her.

She answered the usual demographic questions with little difficulty. Then, on to the reason for her being there, the things that lead up to her referral to us at the mental health center. 

As she told me her story, it became clearer that I had indeed heard it before. I had seen her before.

How did I know this? How did it become clear that she was someone I knew, had listened to before?

Her tone of voice was a giveaway. Somewhere in my brain, that nasal twang and breathy syntax was recorded. 

Her facial expression, or lack thereof, was another clue. She was almost flat affectively, with little movement of her facial muscles, little smiling, no animation.

Her mannerisms, the way she halted between sentences, the way she shifted in her chair, the way she paused. 

Her medical history, of course, as it came back to me when she recited it in detail for me again. 

Even her gait,  a little half-hitch, slightly off balance, shuffle out the door and back down the hall when we were done was another clue that yes, indeed, I had seen this lady before. No doubt in my mind now. 

She did not remember me, but I now remembered her. A quick check of some old records in the EMR confirmed what my brain had already been trying to convince itself of. 

I had seen her ten years before.  

So, isn’t it fascinating that our brains, our minds, can take in, process, catalogue, file away, organize and store memories of friendships past, patients seen, movies watched, music listened to, or sand felt between toes on a faraway beach when we were only six years old. These memories, coded according to certain key elements such as sounds or smells or feelings or emotions, are sometimes retrieved, almost pulled into our conscious minds, at what appears to be the slightest provocation. 

For me, these triggers, the things that bring these memories rushing back, are many. 

A touch, both my touching something or having someone touch me, can evoke tender or emotionally charged memories, almost instantly. 

Smells are a very powerful trigger, as I have written about before. Evergreen and peppermint mean Christmas. Clove and roasting turkey and cornbread dressing and cranberry mean Thanksiving. Incense means holiday time at church. Sweet marsh grass and plough mud mean the Lowcountry. 

Tastes are another. Who among us does not have instant memories,wonderful memories, when homemade strawberry ice cream, creamsicles, boiled peanuts, coffee, fresh milk, or a grilled hamburger cross our taste buds.

Sounds are a big one for me as well. I can listen to a particular piece of classical music and be transported. Rock music, drum and bugle corps, snare drums and pianos all have places in my brain, and my heart. Cicadas at night, croaking frogs by the scores on a warm summer midnight, and the rush of the wind as I drive down the interstate with the music loud and the window open. 

The seasons are triggers for me as well. I have so many memories that are linked to the beginning of summer, the transition to fall, the coming of winter and the holiday season and the rebirth of all things beautiful in the spring time. 

All of these things trigger memories, some wonderful, some painful, some hurtful, but all fresh and new and alive and begging to be front and center again.

What are your triggers?

Happy stickers courtesy of Leonard Porkchop Zimmerman, Augusta, Georgia, USA. 

Lights. Camera. Emotion.

I’ve been looking at a lot of pictures lately.

I have fourteen thousand personal ones on a hard drive at home, dating back years.

I have just seen, and seen again and again, the hundreds that were taken by professionals, family and friends at my daughter’s wedding last month.

I have revisited pictures of my father on the nineteenth anniversary of his death, the now fading images still conjuring up sights and sounds and smells from decades ago, some of them so real that they are almost hallucinatory.

I have been bombarded with online and onscreen images of sporting events, victories by long-dead competitors in long concluded contests, reminding me that this year’s installment of the Belmont or the U.S. Open or the World Cup is not too far away.

I have laughed out loud (something I rarely do) at pictures of my children and grandchildren in some silly pose or acting out, word for word, some scene from a recent movie or show.

I have wept silently at pictures that I took myself, or others took, of row upon row upon row of pristine white crosses on grasshopper-green grass, a testament to a struggle now relegated to history, but enshrined forever on wind-scoured cliff tops and in sunny valleys or under Spanish moss-draped live oaks.

Pictures evoke memories.

Pictures remind us of triumph and tragedy, decisions wisely arrived at and mistakes unwittingly made.

Pictures pull us, gently and unavoidably, back into the life that we once had, the good old days that were not as good as they seem now, the ideal and the unreal and the times when everything seemed right, if only for the instant it was caught by the photographer.

Pictures give life to memories.

Pictures objectify the past.

Pictures help us hold on to something that we desperately do not want to lose.

What do the best pictures really do for me, personally?

When all is said and done, the pictures that draw me in, time and time again, the ones that hook me, spear me, grab my soul and make my eyes moisten with the warm feelings of a thousand summer days, are the ones that make me feel.

The picture of Payne Stewart as he pumped his fist after sinking the birdie putt that won him the 1999 U.S. Open. (He would die in a tragic plane crash only four months later)

The picture of my granddaughter, mouth agape with absolute delight, as she blew bubbles on the deck behind her house.

The picture of my daughter walking down the sandy “aisle” at the beach on her wedding day, and the memory of her soft exclamations as we topped the dunes and saw all the people waiting for us there.

These are the pictures that make me feel alive and human and present in my own life.

What else do pictures teach me?

We all have a limited time here, some shorter, some longer. We can revisit the past, wallow in it, be consumed by it. We can fret and catastrophize and be paralyzed by what the future holds. Or, we can choose to be present in our own lives, to feel every little bit of emotion, good and bad, happy and sad, that comes our way.

We can consciously look for, and find, as many of these intense, emotional, real-life moments as we possibly can and revel in them.

None of us is guaranteed tomorrow.

All of us can grab the now, feel the present moment, enjoy it to its fullest for what it is, and be very grateful that we were here to experience it.

CHRIS SEWARD — 1999 News & Observer file photo

CHRIS SEWARD — 1999 News & Observer file photo

IMG_2366

Photo by Anne Sims

Photo by Anne Sims

 

 

 

Sign Felled. A Post About Nothing.

This has been a killer week.

I have lost count of how many patients I’ve seen in two clinics and in EDs around the state of South Carolina for Telepsychiatry. There have been children out of control, threats to shoot, stab, hit, bite, run, rape, murder and commit suicide.

There have been too many notes to type, too many prescriptions to call in, too many records to review.

There have been justifications for drug abuse and justifications for abusing your wife. There have been people so psychotic that they didn’t even believe that they had a mental illness, in spite of overwhelming evidence to the contrary.

There have been scammers and sweet talkers and threateners. There have been people I met for the first time and people I saw again for the first time in a decade. There have been people who professed love for me and people who couldn’t wait to get away from me.

There have been gratitude, happiness, sadness, regret, fear, irritability, guilt, anger, jealousy, worry, concern, disbelief, joy, anticipation, longing, love, hate, impatience, inquisitiveness, impulsivity, plodding, planning, perusing, predicting, fantasizing, and calculating.

I have used my brain, my iPhone, my fingers, my iPad, my hands, my MacBook Air, my feet, my scanner, my eyes, my camera, my ears, my earphones, a notebook, a pencil, a pen, paper, tape, boxes, folders, file cabinets, hard drives and flash drives.

I have driven a car. I have walked. I have flopped down flat, so tired that I thought I should set two separate alarms just to be sure. I have sat under a blanket. I have become intimate with the markings…markings…markings…markings on the belt of a treadmill. I have smelled the leather of the recliner and wondered why I don’t spend more time in that wonderful chair. I have ventured out on the porch, saying hello to the tiny feathered couple who occupy the nest above my rocker.

I have listened to music and podcasts, read a book, perused a paper publication, downloaded and read a PDF, held a real newspaper in my hands and smiled at the little known fact that ink smudges are still seen in the wild.

I have created.

I have destroyed.

I’m happy about the one, but not about the other. I’ll let you guess which is which.

I have felt-viscerally.

I have spoken-harshly.

I have cried-softly.

I have laughed-often.

I have remembered the past through songs and stories and pictures.

I have envisioned the future through day dreams and night dreams and plotting and planning and scheming and hoping and yes, even praying.

God.

Things are never tidy. Things are never neat. Things are never orderly.

Actually, things are just things.

Feelings are just feelings.

There will be more of all of it.

There will be less of some of it.

I’ll be here.

Maybe the next post will be about something.

When it writes itself, I’ll share it with you.

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Photo taken February 15, 2014, on the South Rim Trail of Tallulah Gorge State Park, Tallulah Falls, GA, USA, with an iPhone 5s.