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.

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.

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.

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.

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.

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.

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.

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.

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.

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.