All posts by witch

COLLECTIVE GRIEF

People seem to be pondering grief and a sense of loss as common COVID responses.  Articles talk about the five stages of grief (denial, anger, bargaining, depression, acceptance).  But this COVID grief is different than, say, the passing of a loved one, or losing a marriage.  Instead, we are losing our sense of normalcy on a global level.  And it is not a single event that grows more distant in time as we heal.  COVID is coming along with us, as close as the Grim Reaper, and no one can say what the end point will be, or whether there will be one.  How can we truly grieve, how can we “put it behind us” when we are facing constant changes on the ground, and a series of unknowns in our health, our financial picture, our social lives, and almost every aspect of our daily routines?  We cannot move away from something that isn’t an event in time with an end point.  The very idea of grief seems to presume that the loss happened in the past and it is over.  The grief model doesn’t fully cover the COVID experience, and yet there is grief.

One aspect that I haven’t seen discussed much yet is how COVID is bringing more people to question the very meaning of their lives.  It seems impossible not to wonder, in this quiet downtime, what was it all about?  Why was I in such a hurry?  Where was I going, and what did it all mean?  Being detached from our set goals and ways of doing things – and the rituals and daily routines that defined us – can create a sense of detachment from our very selves – our identities.  It can leave us floating in a void of uncertainty.  Not just “when will things get back to normal” but “what was I doing, and do I even want all that back, and if not, then what do I want, and why is it all so scary, when I could take it as an opportunity?”  Then we can easily start beating ourselves up for not handling it better, for not having better lives, for succumbing to all the uncertainty, for caving in to our fears.  What was it all for?  What was it all about?  Why does it even matter, and if it doesn’t matter, is that depression, or acceptance?

There is also more acknowledgment, at least in the medical community, that we are physically carrying sadness, anxiety, fear and stress in our very fibers.  Our heads are hurting.  Our muscles are tight.  We may feel a heavy weight upon our hearts.  Any old aches and pains we didn’t really notice in our busy days are rising to our conscious awareness.  Any problem we have grows enormous and insurmountable in the face of so much instability.  We cannot easily turn to our friends or our usual support systems. We are not “too busy to think” with our daily routines, so it is easy to ruminate and even become morbid. Our sleep is disturbed and off.  We feel more fatigued, even exhausted.  Spent.  We feel like we have been through the wringer.  Our bodies have all the stress hormones of running from danger, but there is no defined set point where we are declared out of danger, where we can start to shake it off.  No wonder so many of us have simply slowed down almost to a stop.  Fight, flight, or freeze.  Sometimes, freezing might be the safest and easiest waiting it out position.  The trick is we need to be able to ease back into movement when the time comes.

While hibernating is my natural refuge in times of pain, as the weeks have gone by, I have found unexpected solace in talking with others.  I was truly starting to wonder if something was wrong with me, if I had become some sort of weakling, for not handling things better. But in talking with others and finding that they have similar thoughts and struggles, I have taken great comfort and found relief.  So much of what I had considered to be a personal problem turns out to be collective sadness and loss that we are dealing with across the board.  This helps me hang onto the fact that I am still a part of a larger whole even while isolated. “I don’t know if I can do this” is transformed into “we are all in this together,” and that means I don’t have to handle it alone.  The old saying “safety in numbers” has never felt so real.

So yes, we have a new, uncharted form of grief.  We have dragging sadness.  We have an underlying nagging sense of unease.  Of impending danger, and unknown risk.  It is hard not to walk around on high alert “waiting for the other shoe to drop,” waiting for the next disaster, the next bad news, the next wave to hit us.  We are each finding ways to cope wherever we are holed up, alone or in shared housing.  We each have to decide how much to push ourselves, and how often to check in with ourselves and really notice how we are feeling, so we can take care of ourselves.  We also have time to develop our patience.  Time to forgive ourselves for our humanity, our puniness and fragility, in the face of these overwhelming unknowns and pending changes. And, if we are lucky, we have trusted loved ones with whom we can share these experiences, and we can take comfort in the fact that even when we are isolated, we are not alone.

COVIDY

My speech community has a new word to describe being extra sensitive, teary, emotional, sad, scared, and reacting more strongly than would be considered reasonable under reasonable circumstances. It includes being vaguely uneasy, on edge, even being on high alert and hyper-vigilant, and worrying beyond repair. It covers wanting control over things like the neighbor’s dog – and a global pandemic. It also encompasses brief moments of flooding joy that wash away as quickly as they come. It does NOT include anything close to letting things slide like water off a duck’s back. It DOES include being thin-skinned and feeling unsteady, like the ground under our feet is about to give way. The word is “covidy”. It may disappear from our vocabulary along with this pandemic, but for now, I find myself being – and apologizing for – and forgiving myself for – being, well, covidy.

My hospital just announced they are changing their policy for visitors to loosen up after a very strict period of virtually no one allowed at bedside, and I almost started crying with relief. Women in labor can have a partner AND another labor support person, who can stay up to two hours after the baby is born. The partner can stay on for the duration. Dying patients can have someone at their bedside again, even two visitors at a time, and older children can see their hospitalized parents (one at a time with an adult accompanying). Patients having surgery can have their support person during the long waiting time, and in-patients can have a loved one in their room during hospitalization.

Patients can even bring a friend to a routine clinic visit! All the usual precautions remain in place. Temperature taken at the door. If you leave the room, you leave the hospital. Mask on at all times. Still protective, but less restrictive, because we are having less cases, and it seems our isolation is paying off. When I read through all the new rules, I got trembly and joyful with the kind of relief I felt at age 4, when my Mom found me in next aisle at the grocery store after I was convinced she was gone forever. Safe again! We are safe again, because we are back together.

So why did I tear up with relief, why did my face beam with joy, at such a simple thing as loosened visitation rules at my hospital? Mostly, because I am covidy. I am carrying my share of the weight of our collective burden of concern and sadness. I am a health worker and I care deeply about how vulnerable people are feeling, and at the same time, I have been feeling quite vulnerable myself. Quite like a bird in a storm-shaken tree, watching as twigs and moss and other bits of my carefully placed nest fly away in the screaming wind.

As I sit and translate the new visiting rules for one of my speech communities, I feel momentarily happy and relieved – like the storm clouds have parted just a bit and those ephemeral beams of light are shining upon the waters. There is a feeling of cautious hope and coming renewal. People are able to be with their loved ones again in their hour of need. People are getting support. Visitors are able to show their love and share it, and we can lean on each other again. Especially in those communities where independence isn’t even a core value – where interdependence is the mainstay of the social structure. Being together is the way.

I think back to my beloved dying parents, when each of their turns came, and how grateful they were, how safe they felt, when they knew I would never leave them. They had me and my siblings, along their grandchildren, and they were never alone. No matter how scary it got, or how long it lasted, or how many unknown variables were in play, they knew that whatever they faced, they had the comfort of family right alongside them. Asking questions, getting that warm blanket, arranging a visiting nurse, showing them how to do the home injections, setting up a hospital bed, arranging for hospice and pain control, talking to their doctors, or just being in the room. Just being nearby. Within reach. The immeasurable, unspeakable comfort. They were not alone. They had us.

I am unutterably happy for my dear patients, that they no longer have to face the hospital alone. Happy that they once again have the deep comfort and relief that comes with having a loved one nearby. Because in spite of the fierce independence that a few of our cultures like to pride ourselves on, underneath it all, not so very far beneath the surface, we are completely and irremediably interwoven and connected, interdependent in every way possible.

If any of you out there are feeling as covidy as I am, I totally understand and relate. And I hope we can all be as patient with each other as my loved ones have been with me. This, too, shall pass. But the web of interconnectedness will remain as always, vibrating and humming just below our conscious awareness. And even if we lose sight of it as we slowly and carefully hunker back down into our usual daily routines, let’s remember to look for it, and appreciate it, and revel in our glimpses of it, just like the sun through the clouds over shimmering over the water. As covidy as we may be feeling, we are not alone. We are in this together.

DAY WITHOUT A DEATH

We just had a strange and quiet celebration in my state – our first day without a registered COVID death in over two months. People have been dying every single day for the last eleven weeks without cease. With this one-day respite, we are invited once again to make meaning out of numbers and statistics, and decide what we think is happening, and come to our conclusions. No doubt, competing essays will emerge over the coming days, parsing out what this break in our death count means, and how we should understand it. Folks will use it to prove their foregone conclusions of hope and despair, blame and praise.

Does anyone else feel bombarded? Even as we practice mindfulness, avoid the news overload, try to spend time out in nature, and appreciate the life and health that we have at this moment? Does anyone else feel like we are constantly having more pieces of the puzzle thrown at us until our psyches are bruised and avoidant? More shards of colorful facts shooting out from the broken kaleidoscope of our media system, leaving us with cuts and scrapes and an overall feeling that we have been knocked off our feet, and have tender wounds to protect?

I think back to everything I have read, mostly literature, about the various plague times and pandemics, and how people dealt with it in those distant times. The information traveling at that time was of course slow and limited, and rumors and religion stood more strongly than any science and statistical analysis. But from the perspective of the individual human, I wonder if it was easier in the past. Forgive my nostalgia.

Imagine a community where you know all your neighbors, and live where you were born, among kinspeople with ties going back through generations. Your world is small yet complete unto itself. You eat locally, shop locally, and support each other very naturally. And in most places, you have a collective way of processing changes in weather, harvests, and health. Things sweep through. You don’t have to “figure it out”. You just accept it. You don’t have to become an expert. Of course you are scared. But I would guess that you accept the mystery. You don’t have this modern need to grasp it, make sense of it, read about it, study it, watch videos and podcasts, attend zoom meetings and share scientific and pseudo-scientific information and misinformation ad nauseum. You don’t have this need to become an expert, or make yourself safe by presuming others are wrong. You wouldn’t feel called to “have an opinion” about it at all.

I work in a major research hospital that is a global center for pandemic studies. We have had a rolling roster of 70 to 125 hospitalized COVID patients each day since the pandemic hit our area. I have personally had COVID patients among my cases most days at work, and along with my colleagues, I am constantly trained, informed and updated at work. Enough is enough! I really don’t need or want to give this disease any more of my time or attention. But I cannot go online or walk around the block without someone telling me in the strongest of terms what COVID is, what it does, and how it works, citing everything from scientific research to their old Uncle Harry.

They know! And they feel strongly about it! They speak and write with such grave certainty, and they forward studies and videos, or cite something from the newspaper, as seriously as if they knew that what they read was accurate, complete, and unbiased. My friends and acquaintances have heated online arguments about wild edible bats versus nefarious biochemical labs, the clear perils of sheltering in place, vaccinations, herd immunity, and more. They “know” their facts and relentlessly cite their sources and cannot understand how others can doubt this or that study proving this, that, or the other.

I sympathize, as a need for certainty is one of my core personality traits. But perhaps because I work closely with COVID patients, and have easy access to grand rounds, meetings, and research results, I feel strangely distant from any further need to seek out and ponder the typical mass media editorials and internet theories, like how far a cough carries biohazard in a cyclist versus a runner, or how long COVID may survive on wood, metal or cloth, and at what temperatures. Or how essential businesses are coping, and whether the economy will recover to the satisfaction of the stockholders. Or what plots the various interested parties are hatching to use or misuse COVID, and how the disinterested parties are interested in having us get involved on their side.

I think I may have done better in the middle ages in a more collective community. Accepting the mystery of it, infusing it with my own personal meaning within an unknowable cosmos, recognizing myself and my loved ones as miniscule sparks of life destined to be here for the mere blink of heaven’s eye. To the degree I can replicate that simpler life in the face of so much bombardment, I will do so. And one important step will be to put myself on a very intentional COVID diet, which may include covering my ears and closing my eyes while humming or singing, which is what we did as children to effectively block out what we instinctively knew would be too overwhelming. I hope my neighbors and friends understand.

SCOPE

I had the unhappy experience of watching a scope enter into a very long and deeply laid tube. As a medical interpreter, of course I had seen hundreds of colonoscopies, but this time it was closer to home. The scope had a light and a camera on it, one man operating it quite carefully, the other standing by and telling him to pull out, or move further along the tubular structure, while he explained to me what he was seeing and his diagnosis. There was some yellowish liquid and bits of almost dissolved fecal matter, and things were looking bad. But it wasn’t a colonoscopy. This tube was filled with invading birch roots. It was the tired and worn sewer pipe of my nearly 100-year-old home.

A century of settling earth, prying roots, and normal aging had loosened each joint along the old concrete pipe and it was no longer solid. As sewage welled into my basement, and the bile rose in my throat, I was lucky to get hold of anyone. Our plumbers have been overbooked now that everyone is at home. I was even luckier that the one who returned my call came highly recommended by several neighbors. Yet now I had to make a rushed, on the spot decision regarding a very expensive repair – projected at ten to twenty thousand US dollars. I had made the decision with another plumber to make a limited repair five years ago, and apparently that had failed.

This plumber was very friendly and approachable, and we even joked about how similar his scoping was to a colonoscopy. But I must admit that I didn’t understand everything he was telling me and I didn’t ask all the reasonable questions that an “informed buyer” would think of. I was too scared. I was literally flooded with anxiety hormones, trying hard not to choke up in front of the plumber, and feeling a huge impulse to flee and hide somewhere, sell the house and move abroad, or otherwise wash my hands of the whole problem. I was staring at the screen and hearing the plumber’s words, but too panicked to process them correctly. I felt myself free-falling into my anxious inner child, whose life is fraught with disaster scenarios out of her control, and who suffers immensely from things that never happen – but could. Oh, dear! The panic – the heart in my throat! The “sick tummy” that my mother always carefully reminded me came from my dad’s side of the family!

“This problem isn’t going to go away – it’s only going to get worse. So you tell me what you want to do.”

I was in his hands, because there was no way I could take care of it myself. And who knew when I could even reach another plumber? He offered to start the very next day, and I agreed. It wasn’t life or death, even if my trembling nerves and shaky body thought it was. It was happening in my yard, not in my body. It could have been a doctor with a scope. It could have been cancer. It could have been a forced leap of faith into the darkness of a long, drawn-out medical situation, irreversible and permanent. It could be a myriad of things outside of my control, with information I cannot process because I am in a panic, and decisions that have to be made right away – about my own health and longevity.

As I see my garden torn up and mysterious work being done, the quality and correctness of which is above my understanding, I have to trust this unknown expert with something I absolutely could not do for myself. And it gives me even more compassion for my patients, who most often get sudden, unexpected news that they have something quite serious or even fatal. The information given is overwhelming. The decisions to be made are stabs in the dark, and I truly understand why the most common response is, “you’re the doctor – you tell me!” And unlike houses, which can be sold, there is no escape from our own bodies, except for that one final journey.

So as I wait for the inspector and the final invoice next week, and make tentative plans about rebuilding my garden, I lift my gardening hat to my patients, their struggles, and their courage in adversity. And I am humbly struck by how very much we are asking of our patients when we expect them to be “informed consumers” and “ask questions” and be “proactive in taking charge of their own care” when they wish nothing more than to have their problem just disappear and leave them with the life they had right before the doctor spoke. Especially for those patients, who, like me, have an incurable nervous stomach on top of whatever ills life throws at them. It is not as easy as it looks, believe me.

I AM HERE!

Medical interpreters for common languages struggle with doctors, usually residents, wishing to display their spotty “second language skills” to their colleagues. I am consistently fascinated by how little self-aware these highly trained individuals are in assessing their own language skills, and in judging the appropriateness of their taking over someone else’s certified and regulated roll in the hospital. I can only presume they have a deep-seated, unmet need to display non-medical “expertise” that would somehow make up for their Impostor Syndrome feeling of not knowing enough in their chosen field of study. This is my working theory on why it is most painfully prevalent among young and insecure residents.

No doubt many of these doctors would be surprised to hear that their behavior is tainted not only with their personal insecurities, but also with an unhealthy dose of underlying racism and xenophobia: “My second-language skills are good enough for THIS KIND of patient – and it is fun for me to practice (even if the patient may understand a little less, or I may mislead them, the consent for a serious procedure may not be fully informed, and my supervising doctor may not even know what I told them) because THESE KINDS of patients will be quiet and docile, and I want to impress my colleagues! I didn’t spend three months abroad for nothing!”

Some will tell me it is not racist, and not even wrong, but simply friendly. They just want to help! Okay, if you say so. But let’s face it. These simple monolingual mortals with stethoscopes and scrubs have others skills, too. They know how to clean and cook, perhaps even garden, or tinker with repairs around the house. Therefore, I will believe these doctors are not acting on subconscious bias just as soon as I see one of these “helpful” doctors grab a broom or mop from a cleaning staff, because they “know how to clean”. When they shove aside the guy on the riding lawnmower, or grab a rake. When they leap over the cafeteria counter and start flipping burgers. Or when they mount a ladder to work on some pesky wiring in the ceiling of the clinic hall, because they are quite the handyman. But why stop there? They could even shove aside the hospital clergy at a deathbed gathering, announcing to the spiritual care team, “I’ve got this! I know how to pray!” and pop out a childish version of the Lord’s Prayer. A few missing lines, maybe the wrong theology, but close enough. Unless and until any of that happens, I will persist in my belief that the behavior is racist, and the underlying thought is that these patients – our patients – my patients – don’t deserve equal care.

Meanwhile, the interpreters are put into the awkward position of having to argue with the doctor to try and make them stop practicing their second language on the patient, all the while in front of the patient and the doctor’s colleagues, in both languages. Or trying to guess at what the doctor meant to say and give a corrected version of it. Or stand awkwardly by and then try to mitigate the harm by asking if the patient has questions, or has understood. Or announce that as everyone present doesn’t speak that language, the interpreter must now back-translate into English everything that the resident is saying. Or try to apply any spectrum of other gut-twisting remedies for a situation that shouldn’t have happened in the first place. This would include pointing out to these doctors that their language skills are lacking, that they are setting themselves up for personal and institutional liability, by providing sub-standard and inadequate care to a vulnerable patient. Not a conversation ideally held in front of a patient. But what to do? Should we clench our fists and ask them if they want to “take it outside”?

Come video remote, now, during the COVID pandemic, and hand me a sweet solution. Simple. To the point. And fun. When a resident doctor turned to the patient in front of the team yesterday and decided to display his mediocre language skills to a patient who needed serious surgery that was being delayed because of even more serious fluid retention and hypertension in the pulmonary artery, which made the urgent surgery too dangerous to perform immediately as hoped, and they were weighing peritoneal dialysis versus a continued course of intravenous diuretics, or going ahead with surgery by first threading a cardiac catheter through the neck directly into the heart to better monitor the pressure under anesthesia, this interpreter was able to leap into passive-aggressive action.

Imagine a quiet interpreter who has been unobtrusively interpreting for about half an hour to a team of doctors in a patient room. All going smoothly, in spite of masks and equipment, side conversations, and decisions being made and changed on the spot. The patient is comfortable enough to ask questions and get explanations as to why the surgery is being delayed until tomorrow. It is a difficult situation, but things are going smoothly and patient needs are being met, including pain control. Enter: young resident. He starts to say in his second language: “You have a – I don’t know how to say – the lung, the blood…machine come, for looking…” Now, I could guess that he means to say that they are coming in to do an echocardiogram, but it is really not my job to guess. Instead, I call out from a great distance via video remote, in my sweetest and most innocent but now very high volume voice:

“DOCTOR! This is the INTERPRETER! I am STILL HERE! I am still on VIDEO! Can you SEE me? Can you HEAR me, Doctor? I AM HERE TO INTERPRET! CAN YOU HEAR ME OKAY? Hello?!”

Doctor (sheepishly): I guess I should switch back to English, then.

Interpreter (neutrally): That would be handy.

BEWILDERED

When I tell people I work as a medical interpreter, they often joke that I should go with them to their own doctors, as they find doctors hard to understand. But these jokers are well educated. They have insurance through their work. They have permission to live and work in the US as their birthright. Their native language in English. They can understand the gist of what their healthcare team may tell them, and are competent to research their condition and look for support groups. Most get routine checkups and screening tests, understand what each prescription they take is for, and are even aware of risk factors based on their family history. They also have a clear sense of how, when and who to call with questions, referrals, prescription refills, and more. They may not like the price tag, and they may not religiously follow the recommended health regime, but they can access and manage the care they need. They are medically literate.

Our patients who need interpreters tend to have a vastly different experience. Of course we run across educated and nearly fluent patients. But the typical immigrants who cross the border to do field work and manual labor have had extremely limited opportunities for education at home. Most have not had formal healthcare, certainly never in a high-tech foreign set-up. And their complete bewilderment can be so extreme that the typical US citizen as described above cannot easily process or even believe it. Sometimes, when I offer a scenario of what a typical patient said or did while free-falling within our healthcare system, these same people ask me, “But how can someone be that ignorant?!”

My first response is to question whether they mean the staff or the patient, because the gap in care is the space between the two parties. My second answer is that we don’t know what we don’t know. None of us tend to notice where our blinds spots are, because we cannot see them. We are each and every one bewildered in some aspects of our lives, be it home repair, intimacy, or balancing our finances. Believe me. We are all stumped somehow or another. I am routinely bewildered and frightened at my sense of displacement and helplessness in managing tasks that others seem to handle with ease. But being bewildered about one’s own body, and how it works, and how to access healthcare, can be life-threatening.

This week, I took a video call with just such a patient, and saw the caregiver’s eyes getting bigger and bigger as the interview went on. The patient had walked into the Emergency Room with a tangled tale of severe pain in the heart, stomach or lungs. Could he get something for it right away? No? Oh, dear. Questions first. Okay. It started two days ago, the night before last, but it had been going on for oh, 6 or 8 months. But it moved around from here to there and it came and went. He wanted something for pain. When did it get bad? You mean before, or now? You could see that the patient was trying to answer but he was really not understanding the purport of this line of questioning. The doctor could not figure out how to get him to focus his answers so she could the specifics for a quick and efficient diagnosis, or at least decide what testing to offer.

At some point, the patient happened to mention that he had been seen at a connected clinic, and the doctor was able to find his chart online. She took a moment to read through it, and said, “Oh! I see you have been in treatment for cancer. You never said! How is that going?” And he launched into an explanation of how he broke his arm at work, and they sent him for an x-ray and it was called something like a fracture, but that means broken, and then the doctor found he had some kind of myo-something that is in your bones and it’s kind of like a cancer that eats something in your bones and he doesn’t know if that’s why the bone broke but he doesn’t think so, because he broke it at work. They had a new guy driving a tractor who shouldn’t have been. The doctor was still reading the file on the screen, and noticed he got some chemotherapy around six months ago but then it terminated during Round Two. “What happened? Why did you stop? The chart doesn’t say.”

He told her he quit the chemo “because I got hiccups in my stomach and it lasted for a day and a half”.

She turned from the screen and stared at him. “Wait. Wait. You quit chemo because you got hiccups?” She put her gloved hand to her forehead to help her process this fact.

“Yes. Hiccups in my stomach, here,” pointing to his stomach. “That was oh, late last year maybe? Hard to say. But now I am in a lot of pain. I kept hoping it would go away. I sleep sitting up in case it might help. And drinking warm water before bed, but it hasn’t helped. Pills? I was taking lexo- or levo- something like lexopheno something? But I ran out. No, I didn’t bring the bottle. No, I don’t really know what it was for, but the doctor prescribed it so I took it. Which doctor? Well, they keep switching them, but it was a lady with a ponytail, reddish hair. Really tall! Do you know her? Annie? Alice? Something with an A. Do you think I should keep taking those pills? Do you think they help?”

The doctor brushed over these questions with a “we’ll see” so she could move on to the physical examination. Then she noticed a heart murmur, and inquired about that. He seemed confused again at her line of questioning. It all seemed mysterious. Where was she going? What was she thinking? Could he get some pain pills, please? Not yet? Okay. Let’s talk about the heart, then. He was writhing in the bed, clutching the blanket.

“Family history of heart problems? It seems to me that my mother had some kind of a heart thing but you know I am saying it seems to me, because I haven’t been around her much. You see, I was sent here to work when I was a teenager and I never got home to visit her again. I can’t cross the border and re-enter, you see? So I just send her money and my brother said there is something wrong with her heart, but didn’t say what. I can’t call too often because I have to use a pre-paid calling card and they can’t call me because my number keeps changing every time I buy a new calling card, and my Mom doesn’t have a phone at home, so I have to call one of my brothers or my orphaned niece but she doesn’t live in the village now.”

The doctor asked again if he had ever been diagnosed with a heart murmur.

“Not that I know of. I mean, I don’t know what that is. Do you think something is wrong with my heart? Is it the same as what they call wind, or air? Like a leak? Do you think that’s my problem? Do you think it will get better? What should I do for it? Is there treatment? Or diet? Can you tell me? Because I really need to work!”

The doctor put her gloved hand up as if to stop the flow of words. She had other patients waiting, and the Emergency Room was neither the time or the place to have a long, cozy chat with one patient. It is not set up for that. She told him that she would try and figure out what medicine he was taking, and look in his chart. Because if he had already had a heart murmur for years it might not be a problem. It’s not always dangerous, but if it was something new, she would want to investigate it further and run some tests, just to make sure he wasn’t in any immediate danger. “We’ll figure this out and let you know what we think is going on,” she told him.

“Good! That’s what I’m here for! So you can figure out what’s wrong with me and fix it!” he told her, then repeated his urgent request to get some pain relief while waiting. Please. The doctor reluctantly agreed to give his a low dose of Oxycodone. The patient adjusted himself in the bed and straightened out his blanket with seeming satisfaction: “You’ll put me to rights, Doctor, I have no doubt of it! May God repay you because I cannot! Bless your heart, and guide your hands. I am in your hands now, Doctor!”

A cloud crossed the doctor’s face, and I strongly guess that she was pondering, then discarding, the option of taking yet more time to try and explain how the US healthcare system works. That the ER is set up to stabilize and release, not at all to do an in-depth heart work-up, manage medications prescribed by other doctors, or monitor ongoing cancer treatment, let alone explain how chemo works or “fix his heart”. She decided to end there, and with a quick thanks, she reached over and disconnected with me.

I am not at all suggesting that an emergency room can or should take the place of a community clinic, a social service center, an immigrant’s rights project, a housing service, counseling program, labor union, adult basic education, citizenship classes, or even cardiology and cancer care. I understand and agree that emergency services are for acute discrete emergencies – what some of us call “catch and release”.

My issue is not with what this Emergency Room staff did with this patient, but how and why so many of our patients end up in an emergency room when the care they need would be better served elsewhere. What is happening in the clinics, what barriers to care are being unwittingly placed that end up funneling people like this patient through the busiest and most expensive door in the building, where the routine and ongoing care they need cannot be provided?

As my screen went dark, then switched to “available” for the next incoming call, I was left pondering on hiccups, and dropping out of chemotherapy during the second hopeful round, and wondering what the missed opportunities were, back while he was getting cancer care. Who didn’t talk to him? Who didn’t provide an interpreter? Which resident practiced their poor second language skills on this patient and presumed he had understood? Who didn’t listen to his questions, which would have quickly revealed his confusion and lack of framework to even begin to process his own healthcare and treatment plan? Who didn’t obtain a message phone number to reach him? Where did the system fail him?

Fixing the world so that everyone will have a nurturing childhood in a safe environment, educational opportunities, good and safe jobs and health habits along with overall quality of life is not the short fix, obviously. Some staff go the extra mile to make sure patients understand as best they can, and give them extra guidance to assist in their education and integration into our complex healthcare system. Some hospitals are using patient navigators, who work with and educate incoming patients and families about how the system works, and conversely train staff on what the patient and family may need. This seems like a great way to close some of the gaps that still exist in our healthcare delivery, and I understand that it can save time and money as well, because it increases efficiency along with quality of care and outcomes. For a patient unused to this system, having a friendly patient care navigator could be a life saver.

I hear a few of you demanding to know what I think about this patient’s own responsibility to take care of his own health. He shouldn’t have quit chemo! For hiccups! Come on! What an idiot! Can anyone be that ignorant? Yes, they can. Because they didn’t have your opportunities. And yes, as you may have guessed, his cancer is back and has now spread, which is why he is in so much pain. So if you think he should “suffer for his stupidity” I can assure you that he has and he will. I just don’t happen to believe that his ignorance is his fault. I believe he is straining to his utmost to understand and navigate our healthcare system. So I hate to see him free-falling into the gap. And I don’t think it is much to ask that some of our trained staff within this bewildering and complex system should put more thought into how to help the poorest and most vulnerable among us to access appropriate care.

BACK BURNER

I remember years ago, talking to a patient who had a very rare form of stomach cancer, and a tentative and uncertain treatment plan. She was lying in bed, very ill, playing with the edge of her gown. “I kind of wish I had something like breast cancer,” she said softly. “People know more about it and they march and everything.” She felt ignored, placed on a back burner, in her treatment and care. Likewise, some of the press around COVID may leave us forgetting that while we put all our attention and all our efforts on COVID, and for good cause, everything that was happening the day before COVID hit our shores is still happening. People have cancer. People have other diseases. They are just facing it in a much altered and limited landscape, with skeleton staff and few live appointments. Things are delayed, and there will be consequences. Some people without COVID may die from COVID.

So many people are involved behind the scenes in any service or product we use. I remember seeing a video where a person held a cup of coffee, and gave a monologue about where each item involved had been harvested, processed, warehoused, fabricated, and transported. From the paper cup to the plastic lid, the coffee, cream and sugar, the coffee machine that produced it, the water source, the little wooden stir stick, the story spread across the globe to metal mines and forests, sugar plantations and dairy farms, hillsides covered with coffee trees, urban plastics factories using petroleum products and more. Hundreds, perhaps even thousands of human hands and human minds had been involved. Each item involved had been processed and loaded onto trucks and ships, reloaded for delivery, bought, sold, and handled in countless ways before eventually ending up in the hands of the consumer. It was eye-opening to contemplate the vast resources and numbers of people it takes to accomplish the smallest and most ordinary of things – a single cup of coffee.

This week, I was with someone who was not looking for a simple cup of coffee, although he may have enjoyed it back when he was healthy. He needed something way more expensive, way more technological, involving many more expert hands and partners, something difficult to coordinate and carry out even in the best of times. He needed cancer treatment. Like many laborers, this patient suffered from symptoms for quite a long time, but not having a job that provided health insurance, and not being eligible for a government plan, he labored on in the hopes that his increasing symptoms would simply go away on their own, or with home remedies. They did not, and when he began spitting blood, he finally made it through the bureaucracy to a medical center and was diagnosed as needing urgent care for a very aggressive cancer. That was in February, just days before COVID hit our area. Now it is April.

His cancer is treatable, according to the doctors he saw in February. They started the usual steps in arranging his care. They did some scans and blood work and started to plan out what would be best as to chemotherapy and radiation. They even referred him to our cancer center for some of his treatment. But here is the thing. Because he was just getting set up for care right as the COVID crisis hit our area, many things have been put on the back burner. Not things, actually, but people. He is one of them. In the two months he has been waiting without treatment since his diagnosis, his health has declined dramatically. He has lost the ability to eat any food, even baby food, and is surviving on protein shakes alone. A strong and healthy 160 pound laborer is now a very weak 120-pound patient, who talks in a whisper and spits into a handkerchief. As COVID patients tragically die or heroically recover, he is still quietly waiting to start his cancer treatment.

The hospital is doing their best under the circumstances. They expect to get him in next week (on the severely reduced surgery schedule) and place a feeding tube into his stomach, so he can hopefully gain some weight while he continues to wait for treatment. They didn’t talk about when the chemo or radiation might start, or how much longer it might be delayed. I can only presume that they are not fully staffed, with people being moved around in response to COVID, and of course priority must be given to those already mid-course in their cancer treatment. One of the downsides of interpreting is that we don’t get to ask questions. We don’t get any backstory upon demand. And we don’t know outcomes, unless that information just falls in our lap in a future appointment. So I may never know what happens in this case. And by case, as always, I mean an actual person with their subjective experience taking place under these very harsh and scary circumstances.

Although I may never see this particular person again, I will continue to hold him in my thoughts. And I will continue to ponder how many people, what equipment, which factories and biotech companies, which truck drivers, and how many staff within the hospital, doctors, physicists, techs, nurses, schedulers and more, must all coordinate seamlessly without anyone dropping the ball or being absent in order for this patient to get the care he needs. And how many of these many people, human beings all, have had to step out of place due to illness, reassignment, closed schools, reduced hours, lack of equipment or other reasons. What pieces of the puzzle are missing, what has unraveled, that inhibits this patient from getting his care in a timely manner, and maximizing his odds for survival? Because he is literally losing himself as I write these words. He whispered to us that even his dear old dog doesn’t recognize him now, because the cancer has altered him so profoundly: “I am not myself anymore”.

To the people with COVID, my heart goes out. To the patients whose care is severely impacted by COVID, my heart goes out. To the workers trying to run faster, do more, track down the missing equipment that others are also trying to obtain, my heart goes out. To those in the fields and the factories, those waiting in isolation with no pay, to every member, every family, every thread of this precarious patchwork society, my heart goes out. We are truly interdependent, relying on uncountable visible and invisible people, places, and resources. Beyond what we can know, in infinitely expanding circles. Our healthcare, our food supply, even our cup of coffee, are in each other’s hands. Most vitally and fundamentally, our very lives are resting delicately in the overwhelming immensity of our collective hands. Let us keep them steady, as best we can.

SERVING COVID

With any overwhelming event, people naturally try to make sense of it. Knowing that people I truly care about are simply trying to process what they are seeing at a distance, I do understand. And I have had some very thoughtful and respectful dialogue with friends about this. But I remain struck by how many people known and unknown have posted a veritable flood of how they personally know why COVID is happening. It is here to serve the needs of (their favorite religious, spiritual or even political persuasion). Because it is high time for (whatever their vision is of a better world) to come to fruition. Finally! All hail this blessing in disguise. It’s all over the media. Some say we are being punished for our sins. And they have a strong, specific vision of what the sins are, and feel delighted at the coming punishment. Other promise future delights, for the survivors, of course. Almost a Second Coming or Age of Aquarius feel.

Ironies abound. A southern minister famously claimed that COVID was a liberal hoax and then died of it himself only days later. Others claim that COVID is here to serve our purpose to become more enlightened while lighting the path for lost and wandering souls, and those folks have a strong abiding belief about what enlightened people will look like (hint – quite similar to the person posting). I myself acknowledge that I hope more people will share my views about the importance of healthcare and social equity after this crisis. But here is the important difference, in my mind. Because I am dealing with it at very close quarters, I am careful not to hail it as a phenomenon brought for my benefit, much less to further my personal agenda. That would be a serious case of having the tail wag the dog. And I would find it disrespectful of those fighting the disease and mourning their dead. I fervently hope we can learn and improve from the experience. But COVID is not here to serve me. And I am not cheering.

Seeing how various individuals are processing and understanding COVID reminds me very much of the age-old religious battles, sometimes fought most fiercely among various sects of the same religion, or even members of the same congregation. While many humbly try to “pray in silence” to ask for God’s guidance without ostentation or seeking praise, others have a strong need to proclaim that they know God very well, and can ask Him for special favors, and even tell their ignorant neighbors how wrong they are. And how right they could be, if they would only listen to those few chosen among us who “know God” and are “saved” in the one special way to get through the one special doorway. We know! We are so very enlightened that we can say with authority WHY things happen! And give you advice on how to handle it better, especially when it hits you closer to home. We see it all so well from across the street.

Some of the “Why COVID is happening and how COVID will serve us” posts come across as painfully disconnected from the realities being faced on the ground, even though well-meaning. For those of us who are actually telling patients that they will go onto a respirator, or that they have permanent lung damage, heart failure, or have acquired a secondary infection that will kill them although the virus is now under control, it aches our hearts. For those of us with patients getting sent home while still clearly symptomatic, with strained breathing, and fear in their hearts, it pains us to read the eager COVID predictions about how more people will “see God” and come to think more like the person posting. Glory be!

I can assure you that the patients I have worked directly with do not consider COVID something that has come to serve them and further their agenda. The patients are coming in, mostly out of the blue, not having expected the illness. To add to it, we have had to turn away visitors for the time being, and the policy is confusing and changing day by day. We have had patients physically alone for days or weeks, no one to hold their hand or sleep on the couch beside them. No one to get them a glass of water, help them to the bathroom, comb their hair, or get them lotion, until the overworked staff have time. Hours and days in bed. Not one beloved face walks in. No matter how ill they are. No matter what they are in the hospital for. The staff are doing the best they can, but a sea of strangers cannot replace the faces of their beloved, no matter how kind.

This very day, and into the foreseeable future, patients may literally have to die without a single family member present. Or in some places choose one person alone to come say goodbye, who cannot be switched out for another. As the notice says, one person maximum to sit with the dying. The same individual every day. Anyone who steps out the room must leave the hospital immediately. If you are a dying parent? Well, if the kids are under 16, they will not be allowed in at all. If you have several adult children? Do you flip a coin? Draw straws? Not have anyone come, so no one feels left out? Meanwhile, on another floor, young mothers may be giving birth without their partners, even complex births with unhealthy children who need immediate medical decisions. The loneliness, the sadness of that makes it dissonant indeed to read cheery slogans about how COVID has come to perform modern day miracles – for those who don’t have it.

We just sent a young mother home in a weakened state, on oxygen, to care for her four young children. Can such a person carry out the COVID isolation precautions, such as sleeping in a separate room, using a separate bathroom, using separate dishes, having her laundry washed separately, and staying six feet away from all family members? A healthy teenager who was working in construction and sending money to feed his parents and keep his siblings in school is getting discharged from the hospital while still under quarantine, but he will not be allowed back to sleep at the teen shelter where he presumably caught it. Still breathing laboriously, still feverish, he will be heading to some kind of a COVID warehouse for people who don’t have anywhere else to go under quarantine. His first question was, when will I be allowed to get back to work? A fifteen-year-old. Too much of a baby to be allowed at a dying parent’s bedside, but old enough to come to the US and support a family of five on his earnings. Yes, good things may come of COVID, but not for all of us. Not by a long shot.

Here we are at the apex of wealth, technology and coordination. A major center for epidemiology and infectious disease research, as well as health metrics and vaccine development. We are literally flooded in money and technical capabilities, and if we pooled our resources, including our local tax-subsidized mega-corporations, we could no doubt go for several generations feeding, housing and providing healthcare to every needy resident. Yet I have been on a ward where all the hand gel had disappeared overnight – a long, ghostly row of empty wall-mounted dispensers outside of each room. Who were inside these rooms? Highly vulnerable medically complex immuno-compromised cancer patients. Area hospitals are facing a dangerous lack of masks and other supplies, to varying degrees, with attendant risk to employees and their loved ones. And that is right here, in the bosom of wealth and comfort.

A city in Ecuador has been hard hit over the last couple weeks, and if you can stomach the news footage, you will see human bodies wrapped in garbage bags left out on the street with bricks to keep animals from dragging them away. Morgues and funeral homes overflowing, people literally dumping bodies illegally on the streets. Countless untested, with the ensuing dead notably absent from the global counts. We are only seeing the tip of the iceberg in terms of human suffering. We cannot see the enormity. I invite you to imagine how very many people must be ill without getting care in order to fill the streets with the dead. Imagine how bad conditions would have to get before you, yourself would put the body of your loved one in a garbage bag and set it outside on the sidewalk in front of your house, because it is starting to rot, and there is no one left to pick it up with the dignity we like to accord to our deceased. Please ponder.

For myself, I am trying to serve those impacted by COVID to the best of my ability. And although I too have hopeful visions of how we may emerge from this crisis stronger and more humane, with better values (not coincidentally to match my own excellent ones!) I am doing my best not to co-opt the dialogue and twist COVID into my service. It is bigger than that, and the direct sufferers deserve better than cheery slogans. COVID is a virus that has already killed way more people than will ever be reported. If you don’t believe me, compare the recent news from Ecuador with their official death toll, and extrapolate from there. Given the enormity, unless you are in the trenches, and facing the risk and the physicality of it up close, please be circumspect in bringing claims of coming glory. Let us pray humbly and in silence, if so inclined, and do our good works without ostentation. The vast majority of health workers are already doing just that.

IN PERSON

I have a wonderful situation. My boss at the hospital is allowing me to work completely from home for the foreseeable future. There are still some technical quirks. A few of our video calls get dropped, have delays, or I am looking at ceiling or floor (or in one case, the wringing hands of a nervous doctor) not to mention that I cannot seem to get out of my pajamas, but I am not spreading the Corona virus. I have zero physically proximate contact with patients, colleagues, or people on the bus. And for this I am grateful.

In each of my video calls, I am looking into a room with a patient. Most are in-patient, lying in a hospital bed. Some are on oxygen. Most have IV’s and other equipment running. Some have COVID. Some are on the cancer ward. Others are dealing with transplant issues, emergency surgeries such as broken bones, and the usual specialty hospital cases that many people haven’t even heard of, like pulmonary hypertension, or severe pemphigus.

Today, I helped a young mother figure out how to use a breast pump. Her baby is very ill and was already sent by ambulance to our children’s hospital. The nurse talked at length about post-partum depression, and how the sadness can last from a couple weeks to even a year, so make sure and tell your doctor in case you may need some medicine to help you for a while. The mother had been regularly wiping her tears with the edge of her hospital gown, carefully avoiding the breast pump parts attached to her. When the mother found out she will be allowed to be at the children’s hospital with her baby, her whole face lit up. “I thought because of COVID,” she murmured. It sounds like she will be allowed to board with her baby at the children’s hospital in some kind of quarantine. The nurse was very happy for her, and reminded her to take care of herself there, almost as an older sister would.

I helped another young man with bone cancer, whose doctor praised him for handling the treatment so well, although he has had terrible foot cramps lately. The doctor told him that every time his foot cramps up painfully, remember that it is the tumor shrinking that is making his foot adjust to having more space for its healthy tissue. Yay, foot cramps! Woohoo! We are winning! The cancer is shrinking and dying! You are going to make it through! The doctor was exaggerating her gestures to compensate for having to talk through a mask and via remote interpreting, so she was shaking her fist in the air at the tumor and saying things like “Die, tumor, die!” and making punching motions. The patient smiled and then giggled and so did the doctor, and so did I. It was a sweet moment.

My patients typically relate to staff through their family members, but now they are not allowed to have anyone present with them, no matter how sick they are. Even if they are dying. Even if they are birthing. It sounds so terrible, and of course it is for the patients involved. But this state was an epicenter and our trend is going down surprisingly, lower than all our predictors, and lower than all the other states at this time. Many other states are way up off the charts by comparison. We may even have enough hospital beds for our expected peak in mid-April, at least with current calculations. So there is a sense of cautious optimism. But we are doing it by avoiding each other.

Each patient is now an island. And it can be such a lonely, scary place to be ill and alone. Yet what I have been witnessing in the video remote is that our doctors, nurses, assistants, physical and occupational therapists, social workers, spiritual support, respiratory therapists, and others are filling in the gap left by the absent families. Of course staff are worn off their feet, concerned about their own health, and anxious about the future, but it doesn’t show in the encounters I have seen. They are being patient, warm and concerned in all the encounters I have observed.

For most of our patients, it is the first time they have ever been alone at the doctors. Everyone drags someone along – a teenage son, a second cousin, the husband’s aunt, even a neighbor. Going to the doctor simply isn’t something you do on your own. Patients take great comfort in “strength in numbers”. They feel less vulnerable. In a typical visit, the patients often answer a question by first catching the eye of a family member, questioning how and whether to answer, or directing the family member to answer for them. It must be quite scary to suddenly have to confront staff all alone, with everyone masked and cloaked, and the interpreter on a distant screen.

It has been heartwarming to see that now that patients are “trapped” in the hospital alone, with zero family members allowed to visit, much less stay, these patients are finding a new, perhaps unexpected safety net in the caring staff, kind nurses, thoughtful doctors, and general sweetness of care being provided at this time of crisis. I felt so happy to see these smiles and hear these words of comfort while interpreting today. I have never seen a doctor with her fist in the air yelling, “Die, tumor, die!” but it really brought a smile. And I do believe she was trying to make up for the family absence and the fear by revving up and getting dramatic, and it brought a sparkle of joy to the patient.

Back to the doctor who angled the video remote camera so he showed me only the hands he was wringing. I told him several times that I could not see our patient, but he was unable to adjust the angle, so I dropped it. The patient sounded like an elderly lady who was recovering, perhaps from COVID. She had just come out of Intensive Care and off the respirator, seemingly on a path of rapid improvement. After a long and stressful week of uncertainty, something about watching his wringing hands while hearing their disembodied voices was so delightful, and the off-screen patient was the most delightful of all.

So how have you felt since I saw you yesterday?

Fine, thanks be to God!

How is your pain?

It is quite bearable, praise God! But the pain medicines have caused some – stoppage – you know, doctor. The nurses told me it would. I am taking juice, powders and such. God is great, it is all in his hands.

Oh, yes, these heavy narcotics can cause constipation. I will let the nurses decide how best to manage that part of it, so I will leave you in their hands.

Yes, and you leave me in the most capable hands, indeed! May God keep and protect your nurses, dear doctor, because they have treated me like a queen! So attentive, always caring and kind. They treated me as precious as they treat the eyes in their own face! I couldn’t ask for more, so blessed as I have been here! God is great!

The doctor went on talking about weaning her off the oxygen, and continuing some of the medicines to deal with secondary infections, and her latest blood test results. It was not all good news, but the lady was simply exuberant. Off the respirator! Indeed, God is great in his mercy and kindness. Then she gave a prayer beseeching God to keep the doctor and his family safe, so they could continue to do the important work of caring for the community. “May God keep you and protect you in the overwhelming immensity of His Hand, and keep your loved ones safe, dear Doctor!”

The doctor’s hands suddenly stopped moving as he interlaced his fingers. His chin bobbed down into sight momentarily as he nodded his agreement with his elderly patient.

“Yes,” he assented. “Yes, thank you, and you and yours as well, my dear.”

I rendered “my dear” as “my love” in the target language, because it conveyed the actual meaning. These two human beings, so far apart in their usual daily experiences, now alone together on this COVID island bedside, really were exchanging words of love and comfort. And it makes me so happy to see it. I believe these encounters are a healing for all concerned.

Hats off to all the healthcare workers still attending at bedside in person at this time. May they have enough equipment. May they stay healthy. And may they continue to give excellent healthcare along with a much needed dose of comfort, as they meet these isolated patients whose lack of family presence is a constant, aching burden upon them. And wherever we find ourselves upon this lovely, spinning globe we share, may we remember our shared goal: that when we reunite, we will have the absolute minimum of missing faces in our circles of loved ones.

LAUGH SO YOU DON’T CRY

There is an adage that when things get really bad, and you feel despair, look for the lighter side. Find the humor. Laugh so you don’t cry.

Humor is an age-old way to deal with things that scare us. That make us uncomfortable. For this week, I wish to bring some levity and a respite to the fear we are all fighting, if we are in the fight at all. And I am not alone, by a long shot. People are flooding the internet with home-made song remakes (Mama, I just killed a man – My my my my Corona – Amazing Space, six feet you are). They are creating poetry, art, music, altering famous paintings, sharing their trials and tribulations in humorous ways, and much more.

To what purpose? To keep our spirits up. And to show that we still have fight in us. That we are resilient.

Staying at home:

Having trouble making yourself stay at home? Shave your eyebrows off.

Weekly horoscopes: Aries: Avoid imminent danger by staying at home. Taurus: Avoid imminent danger by staying at home. Gemini: Avoid imminent danger by staying at home….etc…

Let’s have a moment of silence for those who agreed to live with crappy roommates because “when would be ever be at home at the same time for more than a minute?”

A lot of parents schooling at home are about to find out that it actually wasn’t the teacher’s fault.

Stuck at home listening to her owner drone on for hours every day, it dawns on Ginger that she wasn’t cut out to be a support dog after all.

Socially avoidant, pacing restlessly inside your home, obsessively self-cleaning, and somewhat moody? Congratulations, you are now a cat!

Charts:

How to distinguish Corona virus from the cold or flu:

  • Regular cold and flu: I really feel terrible. I think I’ll stay home!
  • Corona: I feel really terrible. I think I’ll fly to Colorado and go white-river rafting with a group, attend a large music festival in a major city, or head to Waikiki and play volleyball on a crowded beach.

Sanitation:

My body has absorbed so much soap and disinfectant lately that when I pee, it actually cleans the toilet.

After years of being too busy at work to thoroughly clean and clear out my house, I have just discovered that wasn’t the reason I didn’t do it.

Coffee filters will work as toilet paper, but it does change the taste of the coffee.

The neighbor kids we had hired to pick up the poop in our backyard just quit. They finally figured out that we don’t have a dog.

The notice said gloves and a mask were enough to go to the grocery store during quarantine. They were so wrong – everybody else had clothes on.

Politics:

News Flash: Dr. Anthony Fauci, head of the US National Institutes of Health Infectious Disease Institute unveils a simple yet effective mask that can potentially save millions of lives. (Photo of a press conference he held with Trump, with duct tape over Trump’s mouth).

Isn’t it strange that those of us who live from paycheck to paycheck are supposed to have months worth of savings to get ourselves through this crisis, while billion-dollar corporations have planned so poorly that they need immediate government bailouts or they will go belly up?

Top world leaders and global activists are gathering for a hush-hush summit on a small island to try and solve the COVID crisis. US President Trump, German Angela Merkel, Brit Boris Gordon, and Swede Greta Thunberg end up alone on the last flight, when the pilot announces that the place is going down, and they will have to grab one of the three parachutes for passengers. Just like with COVID, not enough protective gear to go around. A quick decision must be made, and Trump jumps up. He snatches the gear off of Greta’s lap before she can even unbuckle, and announces, “As the leader of the greatest country ever, and the smartest man living, I am the most important person on this flight!” and he jumps out. Gordon quickly grabs a parachute and jumps out after him, no apology. Merkel jumps up and tells Greta, “grab the last parachute, honey. You are so young with your whole life ahead of you. We are all in this together. Go and live!” Greta smiles and quickly hands each of them a parachute out of the bin. Merkel asks wonderingly as they gear up, “How can we have two left?!?” “Easy,” Greta answers. “The smartest man in the world just stole my backpack.”

Social distancing:

This quarantine has me finally realizing why my dog gets so excited about something moving outside the window. I think I just barked at a squirrel.

Today, the devil came up to me and whispered in my ear, “You are not strong enough to withstand this storm.” And I whispered back, “Get six feet back, you (insert expletive here).”

Corona pickup lines:

Is that hand sanitizer in your pocket, or are you just happy to see me from six feet away?

Dang, they keep saying they gotta flatten the curves but luckily it’s not working on you!

Look, I know this is sudden, but if COVID doesn’t take you out, could I?

More jokes will come, no matter how bad things get, because we won’t be able to process all this without humor. We will continue to make art about it. Continue to talk about it. Continue to laugh in the midst of our fear and sorrow. Remembering our resiliency, reaching out to each other, from at least six feet away, and laughing through our tears.