Category Archives: COVID

PALPABLE

One year ago last week, I was supporting a dear new mother during her labor and delivery, just as the first US pandemic deaths were taking place – in the very same hospital. An intense experience of birth and death, dipping into that sacred river of life and renewal. And a moment of intense loss, for those unseen families who were grieving beloved members even as we welcomed a new spark of life just floors above them within the same four walls. So much gratitude that mother, baby and dad are healthy and have made it through this difficult year with their family intact, as I have. Meanwhile, this new family along the rest of us here are nested within a country that has a full 25% of the global COVID cases. To fully grasp that statistic, remember that we only have around 4% of the world population. Sadly, our country has been likened to a veritable cesspool of disease that spreads as it would in any place without proper hygiene and public health. Very humbling indeed to see another aspect of our dark underbelly as a nation. And personally frightening, burdening us with an ongoing, gnawing fear as we tread these new paths in the dark.

As individuals who do not make policy, we can do little to assist our government and the experts, whether local or national, in slowing the pandemic, beyond following science-based recommendations. So we have been isolating and working from home and avoiding much of what makes life joyful. Even the introverts among us, myself included, are coming to the realization that we are still very much social animals. We find our lives contracted and diminished while trying to stay in hiding from this pandemic – mostly alone or in very small lifeboats. The longing for human contact has grown over the weeks and months in unexpected ways, and our nearest and dearest within our bubbles have had the added burden of being our all-in-all. Most people in my area wear some sort of mask and wash their hands, but it is not universal, and it still feels perilous to get on a bus, sit anywhere indoors, or even chat with neighbors. Every simple decision – whether to meet up with anyone, whether to sit outside, whether to mask on a hike – carries that morbid background worry: What if I kill someone? What if I bring home this illness and a loved one literally dies, or has lung damage that lasts their lifetime? Such a weight upon everyday activities once blissfully taken for granted.

As a health worker, I was recently able to get vaccinated along with my colleagues. Many of us still work remotely, but we stay in touch. I have found a common golden thread running through our talks. Almost everyone has said that they didn’t realize how much stress they were feeling while waiting for the vaccination, until they finally got their shots, and found themselves flooded with a sense of relief. Several even teared up when describing the feeling. They hadn’t noticed how much they were carrying, feeling responsible to their loved ones, in fear for their own health, every time they went to work in person, or even bought groceries.

The relief of finally getting the COVID vaccination has been real and palpable. It is not a 100% safety net, and we will continue to use personal protective equipment, and sanitary measures such as handwashing, along with social distancing, especially those of us who work in healthcare with our daily reminders of how very fragile our grasp on life can be. But as my colleagues have come forward about how much lighter they feel, how much more optimistic, and how it feels like we are indeed heading toward brighter days as we come into springtime again, I share in their relief. Here is hoping that we can reach maximum vaccination, extending to our many vulnerable populations, as soon as humanly possible. And in the meanwhile, keep ourselves and others as safe as we can.

FORTUNATE

COVID-19 update from my personal circle: Seven infections, all caught at work, then spread to their households. One works in a bank, another is a teacher, and one is in a factory. The others work in health care. All those affected got early notice and appropriate care. All, including family members, have been able to weather the disease at home, and only one got pneumonia. None of them have died, thank God, and thanks to some circumstances that they share, but are not universal in our country.

All of them have health insurance. All of them are set up for medical attention with their primary doctors, easy ways to access appointments, including same day, online access to their charts, and the skills and knowledge for communicating with their medical care team. They were able to consult with nurses via phone, get chest x-rays, lab work and other studies as needed. They were able to have prescriptions called in to their preferred pharmacies, get the best updated information on self-care at home, and had the means to pay for any copays and medications.

Why so few households infected out of a fairly large circle of family, friends, and colleagues? Social capital. Money and contacts. Knowledge enough to follow the science, wear masks, wash hands, and protections in the workplace (as imperfect as they may be). Confidence to ask for and expect help, and know where to go. Sanitary living conditions. Safe, running vehicles. Warm houses with several bedrooms. People to call and ask, hey, this is what’s going on – do you have any ideas? What would you do? And to have the answer be relevant and informative. This is what a safety net is all about.

I realize we cannot get all of that to everyone tomorrow, but there is no reason we cannot have universal health coverage. Five people doing the same job at five different companies should not have four widely disparate plans and out-of-pocket costs, while the fifth worker is completely uninsured. It makes no sense to tie our healthcare to private individual employers and have them choose our plans and bear the expense. Or not.

Other countries have proven conclusively that nothing is cheaper than preventive care as the mainstay of good, consistent healthcare accessible to all residents. Here’s hoping we can catch up to Canada and over a hundred other countries, nearly a decade after the United Nations General Assembly unanimously endorsed a resolution urging countries to accelerate progress toward universal health coverage. Their basic idea – and not a new one – is that everyone should get the health services they need, and not suffer undue financial hardship in the process.  It serves all of us to have healthy neighbors.

ROOM IN THE BOAT

When I was a wee girl in an impoverished public school, they were just moving away from openly inculcating us with Christian values, trying hard to figure out how to separate church and state without failing to guide us. We were lab rats of a sort, torn between what our parents and elders told us at home, and whatever public school district we were in had decided (by committee) that we should learn or explore as a group about right and wrong. Of course I didn’t think of it that way as a child, but remember various “lessons in morality” presented as open-ended hypotheticals so we could start to parse out our own values and figure out what we ourselves believed in.

We were asked to discuss things like, should a person who steals their grandmother’s rent money (450 dollars) and gets her evicted, be punished less than someone who takes a thousand from a millionaire who underpaid him? And does it matter what they did with the stolen money? We spent hours discussing the ins and outs while unwittingly learning how to think about our own values and hearing the views of others. What is important? What matters? What is right and wrong to you? Most of all, I learned that for myself, the “devil is in the details” and the actual facts matter a whole lot to me. Perhaps that is why I have shied away from being one of “God’s little helpers” and judging my neighbors for their multitude of perceived sins, as tempting as that is. Because there are always facts beyond my ken.

The specific hypothetical I remember best is sometimes called the Lifeboat Game and has endless versions of a pending shipwreck. Basically, you posit a set of people larger than the lifeboat capacity, and state it will sink if everyone is allowed on, which means everyone dies if everyone is included. Choose your passengers – usually there is a pregnant woman, an elder, a brilliant scientist, a humanitarian, an all-around good and kind person, and sadly, someone physically disabled. As a child who spent a lot of time on the water, I admit I wondered which person was best at rowing – but I digress. The discussion began with the question, is it better for all to die than to have someone die to save the others? (The idea of killing some people for the greater good is of course a terribly ancient and recurring one.) Once we decided (by majority rule) we had to kill someone off, the rest of the argument went into the comparative value in our eyes of the other people to be saved or abandoned (or pushed off the lifeboat if they fought for their life).

Many of the children were uncomfortable and wanted to circumvent the point of the exercise. What if they draw straws? Would that be fair? What if they put everyone in the boat and maybe it would float? What if people take turns swimming behind the boat, tied on with ropes? What if we ask for a volunteer? What if everyone chooses a number? But the teacher would keep adding more facts that would not allow any escape. We simply had to choose who we would let die and justify to the class why their life had less value than ours in our mind. Because we were each in the boat. One at a time, and arguing our case against the other passengers and their merits.

All kinds of arguments came up to show our deepest prejudices. An old person has lived their life and should swim off. The person in the wheelchair could tip over the lifeboat and was too much a burden. One teacher threw in a man who beat his wife but was the only one who could stop a nuclear war. There were all kinds of hilarious and ominous sets of facts to confound our minds. I think by adding saving graces to anyone we wanted to kill off, they were leading us toward suspending judgment on the value of another human being. Kill off granny? But what if she is raising three grandchildren because mother and father were killed in a gruesome accident along with grandpa? Kill the blind guy, but wait – he is a world renowned pianist and does more for disabled rights than anyone alive – dedicates time, money, and free concerts to it. And lost his sight saving strangers in a housefire.

So what of it? Who “deserves” to risk drowning at sea for the greater good? Who “deserves” to get to decide? And should we all just give up and die together if everyone cannot live, in a heroic show of solidarity? Or shall we kill off the weakest of the litter, and carry the weight of what we have done? Or just get ourselves into the boat by any means necessary, and leave the rest up to fate? After all, we are not our sibling’s keeper! Let’s face it, we cannot fit everyone into the boat, can we? Well, the Quileute Tribe newsletter, the year they hosted an international indigenous paddle gathering, included a riddle that has stayed with me:

Q: How many people can fit in a same canoe?

A: An infinite number, just not all at the same time.

Which leads nicely to our COVID vaccination debates. Every time I hear or read the arguments for or against “certain people” getting the vaccine, I harken back to the lifeboat hypothetical. Elders should get it first. (But why? They have lived their lives!) Vulnerable patients with health issues should get it first. (But they are sick and likely to die soon anyway!) People living in group settings, including prisoners, should get it first, because they cannot social distance. (Prisoners before law-abiders like me? What the hell?!) Nursing home patients. (Sick and old! Don’t care!) Medical care staff. (They wear masks and take their temperature. They should be fine.)

Grocery workers. Firefighters and first responders. Anyone with lung problems, including asthma. Anyone immuno-compromised, transplanted, or with cancer. People in ethnic groups with much higher infection rates. Schoolteachers. Factory workers. Farmworkers, especially in crowded housing. The homeless. Anyone working in person. Sex workers. Multi-generational households. Massage therapists and hairdressers. Yoga instructors working in person. Bartenders. Food servers. People over 80. Or 70. Or 60. Children. Teens. Young adults. College students in dorms. Anyone who has ever had pneumonia. Smokers? Parents. Musicians who play live. Delivery drivers. Postal workers. Taxi drivers and especially public transportation drivers. Airport staff. Law enforcement. Housecleaners. Nannies. Caregivers. Librarians. On and on. We all have people we know and love who deserve protection from this virus. Now.

And let us not forget the people who are really important. People who make decisions with broad implications. Legislators. Scientists. Policymakers. Heads of state. Board members. Shouldn’t we vaccinate our top surgeons before the cleaning staff, on the theory that one is less easily replaceable? Yes, the factory floor is a dangerous place, but surely the people who keep the whole corporation running need their health more than an assembler? What about the gifted and creative? As to the people with “social capital” and privilege who are “smart enough” to get to the front of the line… Good for them for being proactive! Shame on them for cutting the line! And the rich people who have donated to a hospital and are then invited to “donor vaccination parties” with an open buffet and shots of both kinds. Get me a bucket – they make me sick! Kill the rich – or at least, don’t vaccinate them first!

Oh, dear. This is hard to decide. Who deserves to live? Who deserves to have more risk? Is the mother of five more valuable than the person without children? Someone married more valuable than someone just shacking up? Someone with a higher IQ more worthy than that happy dumb guy we all know and love? What about musical talent, cooking skills, master gardeners, and people who are the last keepers of techniques like basket weaving or speakers of a dying language? Then there is the infamous millionaire couple who flew to a small town in Canada and pretended they were temporary hotel workers to get their shots. Shame upon shame. Imprison them BEFORE they get their second shot! That’ll teach them! Oh, my goodness!

I am not going to try to parse out how we as individuals justify our strong beliefs about who should get the vaccine first, much less how we should value others, and on what basis. But back to the boat scenario, and who to throw overboard, even as a child I remember thinking, we have to do some better planning and prepare for these things by having a bigger lifeboat, so we can all fit safely. There should be room for all of us, even if, as the Quileute newsletter so aptly pointed out, it cannot happen all at the same time.

Here’s hoping that most of us can get our COVID vaccinations within a reasonable time and add to the overall “herd immunity” safety for those who wait longest. And no, I do not want to get invested in valuing my neighbors in order to feel either righteous or indignant about the vaccination order set up by the public health department. I am not going to follow the specifics of how closely the guidelines are being followed by the well-intentioned people trying to vaccinate maximum numbers while following the guidelines in place to the best of their ability. But it makes for an interesting discussion and reveals more about how we value the lives of our fellow travelers than we might realize as we continue to debate who should get vaccinated first, and why. And who should be kept at the end of the line, for now.

SAME BOAT

With the pandemic, the environment, and political changes at the forefront of the year we leave behind, I have seen quite a few opinion pieces stating that “we are all in the same boat”. And I want to reframe that thought, because it is not quite accurate. Yes, global climate change will affect all of us to some degree. Yes, with nearly two million COVID deaths around the world, and the push for vaccinations, we are all affected in some way. And yes, people around the world are facing the consequences of international policies, the spread of the virus, and economic implosion. We are all in this together as earthlings. We are all subject to the human condition.

We are all connected. The metaphor of a stone in the water, and its ripples emanating beyond our view, holds an important truth. The idea that the simple fluttering of a butterfly’s wings can cause a tiny shift in the air that can contribute to a storm, yes, we are all interrelated. We can none of us know the final extent of any action we may take. We don’t know who all we may influence. We cannot see far enough to grasp the extent of our own actions, or appreciate the whole pattern of which our life is but a tiny thread in an infinite weaving. We are each a part of the whole.

It is comforting and pleasing at times like these to think that we are in this together. There is strength in unity. At the same time, living our often insulated lives, especially now under our various lockdowns and social distancing, it is incumbent for us to keep in mind how very differently people are affected by these major political, environmental, and health crises. No one is guaranteed safety, especially from a virus, but some are certainly more protected. Others are vulnerable on all fronts – without legal status, unable to access health insurance or unemployment relief, with economic and living conditions that leave them many steps closer to homelessness and disease. We cannot say in good faith that because anybody can get COVID, we are all in the same boat. It is more apt to say that we are in the same storm. And we are weathering it quite differently.

When the economy “shuts down” it does not shut down equally. Most of my neighbors have kept 100% of their salaries, while working safely from home. I myself lost two of my interpreting contracts but was able to retain a 50% employee position, so I went down to half my income (which as my grandfather used to say, is a lot better than a poke in the eye). The people I interpret for are not so fortunate. Few own houses, most are behind on rent, and those who still have work are in precarious situations with limited hours. The typical immigrant jobs have been hard hit. Homeowners are putting off repairs, painting, and yardwork. Restaurants have closed down or moved to take-out only. Babysitters have been laid off and housecleaners have lost clients. And that’s just the money aspect.

From unsafe farmworker housing to overcrowded city apartments and suburban trailer parks, I meet otherwise healthy people who have contracted COVID while they stayed “safely” in their homes. Some recover, with unknown future health consequences. Others go from healthy workers to a ventilator and untimely death. Through many years, I have sat side by side with grieving families as they negotiate with medical staff, make end-of-life decisions, meet with social work and spiritual care, and eventually, arrange for the transportation of their loved one’s body. But I am not sitting with them now. They are not even allowed to gather at the bedside. And I am working safely from home, a face on a screen, soon to be vaccinated as a health worker at no cost to myself. So no, we are not in the same boat.

While I say yay to unity and harmony, I also try to keep the image in my mind of a storm. Some in little rafts with waves crashing over. Some trying to swim to shore from a capsized boat. Some in cruise ships, complaining of seasickness that might keep them from the abundant buffet they already paid for with their abundance of income. Some flying overhead and looking down. Some so far from the storm they claim there is no storm. Some close by, even on shore, longing to dive in and help, but not knowing what good they can do.

As I write this, there is a literal storm blowing outside. But I am warm and cozy in the comfort of my own home, and the heavy rain battering my window cannot reach me. I am insulated, both from this storm, and from the COVID situation, and I feel as safe as any mortal human can be. Because I have a protective cushion in every sense of the word: family, health, education, housing, and work. And friends with the means to help me if everything else falls apart. Here’s hoping that those who are adrift and vulnerable make it to shore, and with the help of humane policies and kind people, can make their way into safe and sustainable, healthy lives.

ALL THE TOOLS

While some of us have been celebrating our various winter holidays, weighing travel plans and deciding which gatherings are “worth the risk” others are having a vastly different experience. Others have been struggling with COVID as more than an idea, because they are hospitalized with the disease. Patients on a ventilator can no longer speak, and those interpreting sessions on my video screen become a group meeting, with windows into five or six households and family members wandering on and off screen with questions and tears. Hoping for a miracle from the doctor but hearing hard truths and sometimes confusing euphemisms instead:

I know this is hard but I want you to know that we have used all the tools in our toolbox. And your family member continues to decline. Even in the last few days, his fever is up and his blood pressure is dropping. He would not be able to breathe without the ventilator. We checked to see if he may have developed a new infection but we didn’t find anything so we think it is his – final decline. His health is – declining. Questions so far?

Yes. Why don’t you just poke his lungs again and drain them like you did before so he can breathe easily again? Get the water off the lungs?

Good question! Unfortunately, he does not have any liquid in the lungs, so there is nothing to drain. The reason he cannot breathe on his own is because of the damage to his lungs caused by COVID and that not reversible because it causes scarring and stenosis, or stiffening, of the lung tissue, and that makes it hard to breathe if you cannot expand your lungs.

Let me add that when we say we have used all the tools in our toolbox, I want to assure the family that we have done everything in our power, and you know we chase the numbers – we follow the science and the statistics, and every time there has been an advance in COVID treatment, we are right there and we have implemented it. But when we weigh the risks and benefits of each new treatment option, we find that we have nothing left to offer him that would ultimately benefit him. Do you understand so far? Any questions?

Yes. When you showed us his face for a minute, it was black and blue, and his eyes are swollen shut, it seems. Why is his face so bruised and swollen? How did he get hurt? Did he fall?

Great question! That’s what I was just talking about, how the treatments and techniques we have to help him, like rolling him onto his stomach to ease the breathing, are not working anymore. The pressure on his face when he cannot move at all caused his face to get hurt just by lying there, so we had to turn him over to let his face heal, even if it is harder for him to breathe. Otherwise he will get pressure sores on his face and he can get a new infection. There will be more and more things like that. Here’s another. The medicine to raise his blood pressure, if we up the dose, causes painful twitching and cramping in the fingers and toes, so it doesn’t seem worth doing at this point. Questions or comments?

Yes. We do understand you have done what you could and please know that we are very grateful. We think you have done a great job and your team has tried everything you know of. We understand that sometimes a disease takes over and the patient goes downhill but please know that we are still hoping for a miracle. Because like all the rest of us, he is in God’s hands.

Absolutely. And it is more true than ever because we have honestly given him everything we can, every advanced treatment, using all our equipment and basing our practices on the latest research. But he is in decline, and outside of a miracle, we are asking you to consider that we now presume him to be at the end of his life. Any questions? This is for his brother – sir, this is your first time at our weekly meeting, and you have not said anything yet. I know this is new. Might you have any questions?

Yes. Can’t you just give him a medicine that would make him better?

Sadly, we cannot. There is no medicine that can make the lungs come back – the damage from COVID is permanent. Because it is scar tissue. If you have ever had a scar, you know the scar stays and never changes back to normal tissue. That is why we suggest that we change our focus and simply try to keep him comfortable and avoid as much suffering as possible – for as long as he lives. For example, why keep drawing his blood for studies if we are not going to change the treatment plan? He could have less shots, less blood draws, less studies that are invasive or painful. We can change our focus from curative treatment and can keep him comfortable as he declines. Other questions?

Yes. Does keep him comfortable as he declines means you just watch him – die? You just – take him off the breathing machine and don’t give him any medicines?

Oh, no! Thanks for asking! Not at all! We can keep him on the ventilator and keep giving him pain relief. We can use what we are using now for blood pressure. But we will not increase the blood pressure medicine or add any new treatments, because there aren’t any that would help him. Just like turning him over in bed. That is not helping him any more. But we will support his breathing – we don’t want him to struggle for breath. And we will give him the pain meds – we don’t want him to have to suffer more than he has to. Questions?

Yes. We know he cannot talk because he is on the ventilator. But do you think he is aware, for example, of the people who go in to take care of him? Do you think he can hear and see them? Do you think he is aware?

No. We do not believe he is aware, for two reasons. One, we have to sedate any patient that is on a ventilator so they can stand to have the breathing tube in and don’t struggle. And secondly, he has been so very sick for so very long, that he is not really awake or aware at this stage. Another topic, and this is a hard one: we talked with the two grown children about removing the breathing tube. I want to be clear that if we remove the breathing tube, he will likely die very soon – within minutes. If we do not remove the breathing tube, he will continue to decline for days or even longer, until the next complication arises.

Excuse me, but what kind of complications do you expect? You have watched people with COVID for almost a year now. What complications do you mean, like an infection?

An infection is one likely complication. That is what we suspected when his blood pressure dropped so low and his fever went up, but when we didn’t find any infection, we realized that he was likely reaching end of life decline. And we expect that to continue. But other complications from COVID at this stage could be say a blood clot that can form and travel to heart or brain, causing heart attack or stroke. Lung collapse from being on the ventilator for so long, because the ventilator causes lung damage over time, especially at this high setting. A breakdown of the skin such as we already see on his face, simply from being bedridden, what we call pressure ulcers, can develop and become infected. And of course other organ failure – kidneys, liver, heart… This is a lot of information and we don’t need any answers today about any next steps. You can take time to think it over, talk it over, but we don’t believe, I hate to say it, we too would love a miracle, but we don’t expect that your family member will leave this hospital alive. We cannot predict the day and hour, but we fully expect that he will die here. He will not leave here alive. We are so sorry. Questions?

Can we visit?

We already spoke to the two grown children about this – due to COVID, we have very restricted visits. Even for patients who are – not expected to live very long, or to recover. We can only allow two visitors, one time, for one short visit, to say goodbye. We presume that will be his two children. We are so sorry. Now, this is for the children – you don’t have to make any final decision about – end of life care, or removing the ventilator –

No!

You don’t have to make any decision like that before you can visit. Just so you know.

So we can visit first, see how he is, talk to him, see if he responds, and then decide? And then if we decide to take him off – the machines, we can come back for that?

No. I am sorry. You can only come one time. So you can either come first, or come when we remove the ventilator, if you decide to do so. But you won’t have a good idea or really any idea of when he might pass if he remains on the ventilator. So think it over and we can talk in a couple more days. Of course we will call you if anything changes. But feel free to make your visit at any time, irrespective of making a final decision. You can come when you decide. You may wish to come soon.

We would like to offer your family an opportunity now to visit him with our video remote – we will set up the camera at the bedside and you can all stay on your phones – we will release the interpreter and we will hang up ourselves and the nurse will leave the room and then you can talk and pray freely and have a bit of privacy to visit with your family member. Okay? We are so sorry! We really used all the tools… here he is.

Before they cut me off, I hear the family member voices cross each other as they call out to their sleeping family member through the ether: Oh, dear Uncle! We never thought it would come to this! – Daddy, I am not ready for you to go – Oh brother, my soul is rent asunder. God is indeed mysterious! – The nurse thanks me and reaches for the disconnect button and then there is silence.

FOUR WALLS

Our son is not doing well. He gets angry, and he hits himself in the face. It really scares his little sister, and she cries and begs him to stop, but he can’t hear her when he is like that. He only hears the voices in his head, God bless him. And now he is getting his feathers, you know, becoming a man, and he has a lot of hormones. He has a lot of aggression and energy. If I try to hold his arms or hands when he is really enraged, I could get hit. So sometimes I have to send her to her room for her own safety. And then she thinks she’s in trouble. I try to explain, but she’s too young to understand.

His Dad took some days off to try and help me when our son first got worse, but he had to go back to work. He doesn’t want to lose his job, and we need all his income. And of course I can’t work because no one could watch our son. Yes, he’s taking his medicine. But it doesn’t fix things. He yells at the top of his lungs, I think to quiet the voices, bless his heart. But it scares his sister a lot. And it breaks my heart to see her crying and begging him to stop hitting himself, to stop yelling. He will call out all of a sudden and we all jump in fear. It is really a family disease, isn’t it? Mental illness, I mean. It hits us all.

I try my best. When I can catch his hands safely, I try to grab them. I try to pat or rub them. I sing or hum a soothing song. I try to drown out those nasty voices, the devil in his ear. I want to help him rise above it, and come to kinder thoughts. I tap my feet or rock with him. Once he calms down some, I can massage his ears, or play with his hair, and that seems to calm him for the moment. Yes, he takes that other pill for sadness besides the Haldol, but I don’t know if his kind of sadness can be dissolved.

More medicine? Well, I don’t know. Maybe. If you think it’s because he’s growing, and needs more now. I myself think it’s mostly these four walls that are driving him crazy. The pandemic, you know. We used to take him out every day, and his Dad would take him running or to a park and kick a ball around or to the grocery store. But he won’t wear a mask. He pulls it off. He saw those guys on TV saying it’s fake news and we don’t need masks and the masks are a trick to fool people and he got stuck in that thought. He’s suspicious of the masks now and he worries when we wear them, too. And we can’t convince him. He won’t believe us.

So we can’t take him anywhere because people scold him to wear a mask, and then he yells at the top of his lungs. He’s loud and now he’s tall, a man’s size, and he scares people. They don’t know him. He yells about the masks, like those guys on TV, and I’m afraid someone will call the police and then God forbid they might arrest him or even shoot him, you know. You know how things are. So we never take him anywhere like a grocery store at all, and now we don’t dare take him to parks either. I wish there were a special park for people like him where he could run free. They have parks for dog but not for people like him. It’s sad. Heartbreaking, really.

Maybe he needs more medicine. Maybe. But mostly it’s these four walls. He’s just trapped inside our little trailer, staring at the same walls. He has all that young male energy, you know, getting his feathers now, and he needs to run and exercise, and work it off, but we don’t dare take him out. He’s been stuck inside these four walls for months and months on end. We are too, but we’re not trapped inside our minds, not in the same way. It’s the pandemic, and who knows when it will end? Sometimes I just wish he were little again, before he got sick. When I could comfort him and keep him safe and happy. But we don’t get what we wish. We just don’t.

I appreciate your idea about taking him out very late or very early, before people are around. But with all due respect, I think you don’t know the area where we live. People won’t understand. They’ll be scared of him. They see a big, dark-skinned guy at dusk or dawn or the middle of the night who is yelling or thrashing his head around, throwing off his mask, or running and talking to himself. And his Dad can’t keep up with him when he runs because remember I told you he hurt his leg at work and it never got better. We can’t put our son on a leash! So they won’t be side by side. Our son will just be this random guy all by himself, acting scary, and someone will call the police. We don’t want him to end up on the news. So no, it’s gonna be these four walls. These four walls, for a while.

BURNOUT

Within the last couple years, burnout has made it into the official international classifications of diseases published by the World Health Organization. First classed as a “state of vital exhaustion” under problems associated with “life-management difficulty” it just got pushed over into “problems associated with employment or unemployment”.

I prefer the “state of vital exhaustion” definition. Burnout feels much broader than a work problem. Especially now, while we are dealing with social isolation, the death of loved ones, ongoing disease threats, and associated closures and workplace changes, it seems like everyone I know is burned out to one degree or another. Everyone is depleted. Everyone is to some degree disheartened, feeling low, second-guessing themselves, and wondering uneasily about the future.

I will expect a new definition in the 2021 handbook of ailments:

PANDEMIC BURNOUT: A pervasive state of vital exhaustion, coupled with a disturbing sense that things will never be the same again. Often accompanied by a lack of hope bordering on despair, and a sense of futility. Symptoms include disengagement from others, and a sense of absolute isolation, even with loved ones available by phone or video. For workers over 45, there may be an element of strong fear and confusion regarding the technologies for working from a home office. For the economically vulnerable, symptoms include economic disaster and loss of housing. Additional exacerbations caused by the countless moral micro-decisions, such as whether to wear a mask outside, whether to attend a funeral, or whether to move off the sidewalk each time one meets a pedestrian, add to the pervasive sense of not knowing the possibly disastrous affects of one’s simplest actions. This causes catastrophic thinking in anxious patients.

Of course we could each add several symptoms to the above list. But the section I would like to read would be entitled “effective treatments” to revitalize people with this conditions. Ways to encourage, enliven, and cheer up those of us who have fallen low and lost some of our resilience. Societal and personal changes that could lead to the “new normal” becoming a good normal. A sustainable normal. An acceptable normal. A healthy and vigorous normal. Both for societies and the world. And for us puny, frail, and very human individuals. I hope for effective treatment and positive change. There. I have given myself something to look forward to, after all.

FEAR AND CONFUSION

I have a theory that scared people are the easiest to confuse. They grasp at straws in a bid for certainty, and that makes them more gullible. Ironically, their craving for assurance leads them down a path of accepting false information and being misguided in ways both big and small. They can be convinced of all sorts of things that others would red flag and question immediately. Because they cannot live in uncertainty. They want to “know” even if it makes them wrong. I have an inside track to more reliable information, working in healthcare. I happen to work at a global center for infectious diseases and related studies, including testing and vaccine development and broad statistical analyses. We have instant access to cutting edge science as it emerges. Not claiming expertise, but simply more ease, comfort, and acceptance in processing the onslaught of COVID information.

Of course, one need not work in healthcare to have a grasp of COVID and the basic preventive measures available today. Many of my non-medical friends seek out and discern what is reliable from the scientific research, government agencies, and international health organizations as well as other sources. They follow current guidelines, and keep up on the data as it emerges. Yet a few people I know choose to ignore the available evidence. They focus instead on the dramatic COVID stories of someone they know of who had it or didn’t get it, who narrowly escaped or died from it, or who was exposed to it and now has terrible problems! Debilitating! And these few weave a tenuous and fragile web of perceived personal safety by throwing around wildly generalized rules of conduct based on some third-hand stories they have unconsciously merged into their personal (fabricated) story. They cling mightily to it as if their lives depend on it. And the conclusions they draw tend to involve a lot of strong feelings about what other people should be doing, along with a sense of certainty that whatever they themselves are doing is correct. They know! They have a friend, a cousin, an acquaintance. They saw a meme, a cartoon, a chart or a graph on social media. It’s true!

It is human nature to try and make sense of the world around us. Otherwise, I don’t think we could handle living in it with all the natural uncertainty that surrounds our daily existence, and the even more frightening certainty of our own mortality. Knowing we are infinitesimally puny in the face of an immense universe (or multiverses!) and that our lives cannot count for much on a such a overwhelmingly immense scale, it is understandable that we want to break down the COVID pandemic information. How else can we begin to digest it? COVID is terrifying and it can sweep in unannounced and unsuspected, leaving permanent holes in our precious circle of loved ones, or even snuff out the very light of our own bodily existence. How can we face this risk?

For some, the same way we face other risks. By relying on the most reasonable sources of scientific information, and avoiding social media and other fear-mongering, misleading sources. Then by focusing on the practical steps we can take that the most reliable studies consider worthwhile: Working remotely. Avoiding unnecessary contact with others. Social distancing in public. Using a mask as appropriate. Using good hygiene and sanitation, along with a full dose of common sense. Now, will these measures guarantee that we and our loved ones do not catch COVID? Of course not. Just as wearing a seat belt, having our car regularly maintained, and driving defensively cannot guarantee that we don’t die or even kill someone in a traffic accident. Yet we don’t spend our time obsessively reading and sharing stories about freak accidents where people burn to death in their vehicles.

One of my friends told me she had read about someone pregnant catching it, and now she is worried sick about a pregnant relative. Another said her cousin who is a nurse caught it at work, and has antibodies, but she just read that having antibodies doesn’t help you. One told me they just read that all this surface washing and hand-washing doesn’t help you at all and even gives a false sense of safety, which puts you at higher risk! Another just saw that masks don’t help much, so it is better to wash a lot. Oh, no! Someone read or heard that keeping your distance is way better than trying to “wash it off afterwards”. So they are just staying at home and not even grocery shopping, getting deliveries at the door and not opening the door until the delivery person is gone. Problem is, she is freaking out because of being alone for so long. Heads are spinning. We want certainty that we won’t die, but of course we will die. We can be certain of that!

So how do we get back to living whatever time we have left without obsessively reading, guts churning, about one more shocking death, one more study that overturns all prior studies, soon to be refuted by another? One more shocking revelation about how broken in health certain of our COVID survivors are, and how it is linked to their blood type, their thymus, their dominant hand or their propensity to freckle? How do we turn off the voices of friends and family when they tell us how dangerous and scary everything is, how very old their grandmother is, how very young their pregnant daughter is, and how we should all stay home lest we all die? How do we move out of these tangled and choking threads of life stories shaped mostly as warning tales reminding us of our very fragile existence, by people desperately trying to weave a cloak of safety for themselves out of thin air?

People are farther apart than ever on what they think is right to do while navigating these quicksands of changing rules and numbers. One said she was justified in traveling to another country because her mother was turning 90 years old. Her friends were shocked, as they are decidedly NOT visiting their elders. One chose to travel to her dual citizenship country, as she had been in quarantine for nearly six months, had been working from home, never went outside without a mask, and had tested negative for COVID. Another friend wrote in response she herself would not feel right to do so, because “I wouldn’t want risk becoming a burden on the country’s healthcare system or harming other people, and I just cannot understand why some people in other countries think they can just do whatever the want!” Emotions run so high and they all circle around being right and making others wrong in order to try to feel safe while actually feeling very scared.

For me, my current philosophy is summed up by what a very wise cousin of mine told me when we fell into discussion about this. We absolutely agree that we must take all reasonable precautions in order to stay alive and protect the people around us, just as we do while driving. Yes. All of that. Be careful. Be responsible. But once you have taken all those steps, don’t shut down in fear, or get paralyzed by it, because then you ARE giving your life to COVID. Don’t presume that anybody you see doing anything different than you (such as visiting their aging mother) is a horrible, dangerous, and irresponsible person. Don’t let yourself wallow in so much fear that you cannot even see clearly, steer clearly, or actually keep yourself as safe and comfortable as you can be. My cousin’s advice to you all is that you be responsible and cautious, and considerate of others. But she added as a vital reminder that once that is accomplished:

“Let us keep in mind that we must also dare to live!”

I am with her.

WINDS OF CHANGE

I will be very interested to see how many of my colleagues, friends and family end up making a radical change to their established way of life after the pandemic.  How many will step off the hamster wheel into a more humane and natural pace?  How many will do something as simple as work from home a few days a week?  How many may end their primary relationship, or realize they want a new one?  Some may move to a whole new place, cut their career short, go back to school, take up new endeavors.  I imagine a lot of people will have a slow recovery and have real problems “revving back up” on demand.

As to our daily practices, I think a lot of us are feeling torn between heroic uses of our downtime:  Take out the front lawn!  Learn to read piano music.  Exercise each morning. Clean out the house. Grow your own food. Meditate daily.  Knit your own socks.  And the other end of the spectrum:  Give yourself a break.  Take it easy.  Don’t worry about being strong or resilient or even productive.  Just get through the day.  And if that means pajamas and binge-watching, accompanied by chips and ice cream, so be it. 

Part of the tension between “being productive” and “taking a well-deserved break” comes from the uncomfortable fact that we have to be closely attuned to how we are feeling in order to make our ongoing decisions.  And the high-wire balance of constantly noticing our feelings with so much sadness and fear floating around leaves us in danger of free-falling. So we either run back to busy-busy or collapse on the couch, but in neither place do we wish to deeply contemplate how we are feeling while we are feeling so poorly.  We may awkwardly avoid ourselves the way we would avoid a needy and broken ex-partner, because it is just too painful to face the feelings.

This does not even take into consideration the very real struggles that so many people are facing on the ground. Loss of their jobs. Loss of their housing. Loss of their health or even their life. Not being able to care for their loved ones. Not being able to keep their loved ones safe. With such a collective weight of sadness, I can only imagine how heavily it falls upon the many who are literally fighting for their lives and their future. Those who have to work in unsafe conditions without adequate protection. Who don’t even have the “I was doing okay” life to contemplate going back to. The list goes on and is overwhelming. It is exhausting. It is scary and sad, and yet there is a budding sense of tentative hope, at least in my city’s air, as we discover that not so many of us are eager to rush back onto the same hamster wheel and run, run, run.

As time goes on, whether we hibernate or supercharge our lives for now, whether we long for what we lost, or hope for something better, the day of reckoning will come when we each configure our post-COVID (or ongoing pandemic) lives. When we make the choices that will ripple into our futures. Only one thing is certain: we will not go back in time and pick up where we left off. That status quo has blown up in our faces and we will have to rebuild on many levels, not just economically. Just as the saying goes that you cannot step into the same river twice, because the river is changing, we too are changed by having stepped into the river. Here’s hoping that we may emerge with more compassion and strength. That our spotty and fragile downtime contemplation of how we wish to transform our lives may turn into broader lasting changes. And as we come back together after our lengthy solitude, that we can work together to create stronger, gentler, more humane and ultimately healthier communities.

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.