Author: Maria Yang, MD

Categories
Observations Seattle Systems

About the CHAZ….

You’ve heard about Seattle’s Capitol Hill Autonomous Zone (CHAZ), right? With free press from President Trump, people both in the US and abroad now know about the “Seattle takeover” and his imperative to “Take back your city NOW”.

Well, dear reader, if you believe that I am reliable narrator, let me share with you my observations of the CHAZ.

First of all, this is how the CHAZ website describes the Capitol Hill Autonomous Zone:

The Capitol Hill Autonomous Zone née “Free Capitol” is a 6 block section around the East Precinct in Seattle, WA. Abandoned by police and left to burn, this area was instead siezed [sic] by anarchists, BLM supporters and other protestors who have since transformed it into a unverisal [sic] community based on mutual aid. Fundamentally, CHAZ is an occupation of Capitol Hill, not an official declaration of independence.

Here’s some context about the Capitol Hill neighborhood where the CHAZ is located: In addition to being the gay mecca of the Pacific Northwest, Capitol Hill is the hip neighborhood of Seattle.[1. Some would comment that Capitol Hill is the hipster, not hip, neighborhood of Seattle.] Bars old and new cater to the spectrum of genders. There’s wood-fired bagel cafe; a bike shop where, after spending time in the physio lab, one can order a Matcha Chicken Avocado Bowl; and a music venue called whose full name includes “Crystal Ball Reading Room”. Two blocks south from the CHAZ is a dealership shared by Ferrari and Maserati. A local cafe offers apricot jam doughnuts for $3.85 each. Rent for a one-bedroom apartment near the CHAZ is around $2000 a month.

Now, onto my observations:

According to the City of Seattle, about 65% of the city population is white and nearly 7% are Black. The vast majority of people (much more than 65%) I saw in the CHAZ were white. Perhaps this was due to the clumps of white tourists who wanted to witness the CHAZ themselves. Maybe white allies had taken upon themselves to “do the work” and use the CHAZ to advocate for Black Lives Matter (BLM) causes and demands. (Of note, I cannot find any comments from the Seattle-King County chapter of BLM about the CHAZ.) Despite the ongoing pandemic, a notable fraction of these white individuals were not wearing face coverings.

While there is a beautiful mural of “Black Lives Matter” physically on Pine Street and references to Black individuals of Seattle and beyond who have been killed by police, the overall vibe of the CHAZ seems more focused on opposing authority. The graffiti on and around the now abandoned police station, the “conversation cafe” stations, and the new community gardens seemed to chiefly cater to white audiences and suggest an anti-establishment philosophy. Black Lives Matter and “a universal community based on mutual aid” are not the same thing, and this is highlighted in the deliberate demands of the Seattle-King County chapter of Black Lives Matter. To be fair, there is overlap between the demands of CHAZ and BLM, though what people do often reveals actual intentions compared to what people say.

In addition to philosophical contrasts, there were physical contrasts within the CHAZ. A man was hugging his adult poodle like a baby, while a crowd of people were nearly running after a man who was yelling at someone about a stolen phone. A white man with what appeared to be a taxidermy weasel draped around his shoulders got into a profane shouting match with a Black man (one of the very few I saw) seated on a bench, a push cart stuffed with belongings next to him.[2. I promise you, dear reader, that there was indeed a man who had draped what appeared to be a taxidermy weasel around his neck. Maybe it was a plush weasel, but the effect was the same.] A (white) man was shoveling wood chips into a new community garden marked with a hand-written sign that read “This garden is for Black and Indigenous folks and their plant allies”. All the doors to the public bathroom were closed and the phrase “shoplift your future back” was scrawled in spray paint on its foundation.

Meanwhile, Seattle Parks and Recreation collected trash from the CHAZ and hauled it away. An employee, wearing a face covering, emerged from a Seattle Public Utilities truck with a clipboard and headed towards the park.

Here are my questions:

Is the Capitol Hill Autonomous Zone a distraction from Black Lives Matter? If yes, what are the consequences of that distraction at local, state, and federal levels, now that President Trump has condemned this “occupation of Capitol Hill”? What are the consequences to BLM if it is conflated with the CHAZ?

Could an Autonomous Zone exist anywhere else in Seattle? Does it matter that this part of Capitol Hill is young, trendy, and expensive? Could the Autonomous Zone exist in a Seattle neighborhood with more Black lives, such as the Central District or Rainier Valley? Even if the Autonomous Zone could exist in another neighborhood, would it exist? Would protestors want that? Would the neighborhood support that?

Has the local chapter of BLM made a statement about CHAZ? If yes, why is it difficult to find? If no, what worries or hopes does BLM have about doing so? The Seattle-King County BLM chapter has demonstrated great thoughtfulness about its activities in the midst of this pandemic, including specific rules about their protest. Their silent march drew around 60,000 protestors despite the rain. I look forward to learning more about and supporting their perspectives.

Will the CHAZ protestors vote? Some argue that the only way to change the system is to join it. Others insist that change can only come from the outside, as there are too many conflicting interests from within. Voting applies in either scenario.

Will the CHAZ protestors follow the lead of BLM? Sometimes the urge to “do something” is overwhelming, when the most productive and helpful action is to wait and follow. Before people congratulate themselves on the actions they are taking, it is prudent to ensure that these actions are in the service of the goal that will both change and improve the system.

How will the CHAZ end? Will the protestors leave of their own accord? Will they stay until forced to leave? Will there be non-violent negotiations, or will we witness more violence? How much effort will Seattle Police put into returning to their precinct building? What is the Mayor’s strategy about this, now that she is the target of antagonizing messages from both Seattle residents and the President of the United States?

When will the CHAZ end? With unemployment rates high in Seattle, as in the rest of the nation, some people may choose to remain in the CHAZ because the economy continues its slump. There is a Presidential election in November and if the President continues to give his attention to the CHAZ, that may reinforce their desire to remain. If Seattle sees a spike in coronavirus cases, will the city recruit Public Health to help assess the safety of the encampments and gatherings and then ask people to leave?

If you live in the Seattle-King County area and are able, please donate money to the Seattle-King County chapter of Black Lives Matter. Whether you live in Seattle or elsewhere, please also participate in the US Census and make sure you vote in the upcoming elections. Please continue to ask questions, engage your mind, and exercise critical thinking. Change will take all of us.

Categories
Consult-Liaison Medicine Nonfiction Reflection Systems

Mental Health Awareness Month During a Pandemic.

It’s been Mental Health Awareness Month during a pandemic.

When we look back at this time, people will have different memories of their experiences: Some will remember changes in job duties and extra time for leisure. Others will remember intense pressure and stress as essential workers. Still others will remember the despair due to unemployment and financial worries. We all will remember how the COVID-19 pandemic disrupted our routines and affected our mental well-being: It impeded our freedom to go outside, abilities to pursue the activities we want to do, and usual opportunities to express ourselves.

Wearing a face covering may mask the expressions of displeasure and anxiety on our faces, but it does not diminish the discomfort and worry we feel within. As many in our community try to avoid illness, some will fall ill and and others will succumb to death. There are reasons to grieve.

Because discomfort and anxiety are internal experiences, our culture often frames these reactions as a personal problem—a disorder of one individual mind. However, this pandemic has had adverse effects on everyone. Many of us are feeling the same emotions. These are unsurprising reactions to an unexpected and (hopefully) once-in-a-lifetime situation.

We must avoid medicalizing these reactions. Individuals receive psychiatric diagnoses within specific contexts. Our reactions as a result of the the pandemic are collective experiences within the same context. It is unfair to argue that all people experiencing distress during this pandemic have psychiatric disorders. This argument also undermines opportunities for communities to support their own members who are suffering.

Not all distress reaches the threshold for a clinical diagnosis, especially during extraordinary times. While mental health professionals can help people who feel anxiety and sadness, that doesn’t mean that increasing the number of mental health professionals and their services is the primary solution during this pandemic. Most people feeling worry and anguish now will not need specialized services. Support from people from the same culture or context can and will help people tolerate and then grow from these emotional experiences. Relationships, stemming from faith traditions, hobbies, cultural groups, and friendships, are invaluable during these times of stress, loss, and grief. Providing education and resources to the community at large, such as through programs like Mental Health First Aid,[1. You can learn more about Mental Health First Aid here. I have no affiliation with them.] can help ensure that those in our community receive attention and emotional support. Communities can also provide support through other concrete means, such as financial donations, food assistance, and employment opportunities. Though individuals should remain six feet apart, the distance does not dilute the healing power of relationships.

To be clear, some individuals do experience levels of distress due to the pandemic that warrant professional mental health intervention and support. This does not mean that they have meaningless relationships or are “weak”. We often do not know the struggles people endure. Complications from the pandemic can overwhelm already strained internal and external resources.

We are living through an extraordinary time in history. We are all experiencing psychological stress, though perhaps at different frequencies and intensities. There is nothing routine about our external circumstances, so there is nothing routine about our internal experiences, either. The pandemic has demonstrated how interconnected we are. Let us focus not on individual distress, but focus instead on how we can all help each other during this difficult time. This will not only bolster the mental well-being of others, but will help our mental health, too.

Categories
COVID-19 Homelessness Medicine Nonfiction Observations Policy Seattle

The Space Between Us.

I am one of the few people walking through downtown Seattle these days. Most of the people outside are people who slept outside the night before. Sometimes they are still sleeping in sleeping bags or tattered boxes when I walk past. They’ve always been there, but now that there are much fewer people outside, they seem to be everywhere.

The other people walking through downtown in the morning fall into two groups: People going to work, like me, and people walking their dogs. The people out and about in the morning are much more likely to wear face masks. The evening crowd seems to be younger and they are much less likely to wear face masks.

I see the magnolia trees bloom. Their pastel petals are already falling off to make room for new leaves. The soft pink cherry blossoms are already gone; the tree limbs are already full of fresh green leaves.

The offices now have bottles of liquid hand sanitizer from local distilleries. The hand sanitizer coming out of the wall dispensers have floral and chemical notes.

Every staff person should have their own set of cloth face masks. There are two in a bag. Volunteers sewed and packaged them. One of mine is dark blue with intersecting white lines. The other is light blue with a large pattern that is reminiscent of paisley.

Several people staying in our shelters have tested positive for coronavirus. There haven’t been “clusters” of cases yet, just one here, another one there. Staff show up to work, don their cloth face masks, put on gloves, and wipe down surfaces with disinfectant when they can. Some people staying in shelters cough and sneeze. Most put on the surgical face masks that staff give to them and try to stay away from other people, but where are they to go? A few are unable or unwilling to wear face masks. Staff continue to don their cloth face masks, put on gloves, and wipe down surfaces.

People are moving from congregate shelter settings into motel and hotel rooms. What will happen when people have their own private spaces? Their own bathrooms, their own beds, their own doors that they can lock? This reduces the likelihood of disease transmission. What else does this reduce? Hypervigilance? Paranoia? Pain? Substance use? (Or maybe it increases all of those things?)

The nurses are amazing. They try to assess for respiratory symptoms from six feet away, a subtle dance that we’ve all had to learn how to do quickly. Maybe it’s a chronic cough. Maybe it’s flu-like symptoms. Maybe it’s coronavirus.

The internal coronavirus team is amazing. They organize the waterfall of data and quickly refer people to the county isolation and quarantine sites. The system has started to move faster, but it’s not fast enough. And what are we to do when the isolation and quarantine sites won’t accept our referrals? Who holds the balance between liability and public health? What will the emergency departments say when it is the fear of acute withdrawal, not the actual withdrawal itself, that results in a visit from someone with coronavirus?

When I start feeling angry, I pause and realize that my colleagues in hospitals have even more reasons to feel anger. I’m not misreading the guidance: Following a high risk exposure to someone with confirmed coronavirus, staff should continue to work even if asymptomatic. Of course, I know why: The system needs health care workers to work during this pandemic. But what is the message this sends to individual workers? You might get sick, you might contribute to asymptomatic spread at work. The people who live with you might get sick. Despite this worry for yourself and those around you, please continue to work. And because we don’t have enough tests right now, we won’t test you until you start to demonstrate symptoms.

(What about the grocery store workers and farm workers? Do their employers provide face masks? Are they part of unions? Do they have health insurance?)

You are essential, you are a critical worker, you are immune to worry and anxiety. Right? This is no time to worry about yourself because we also don’t have time to worry about you.

I see the pairs of police officers leaning against their cars on Pike and Pine, their arms crossed. The sun stretches its warm rays across the sound and the new leaves rustle in the spring breeze. My cloth mask is mildly damp from the humidified air moving in and out of my lungs. I make brief eye contact with the person approaching me. We make time to worry about each other and the physical space between us grows.

Categories
COVID-19 Homelessness Medicine Seattle

Some Notes Related to COVID-19.

Some notes:[1. Personal notes that reflect my own opinions, not those of my employer!]

To my knowledge, as of this writing, no individual staying in our shelter or housing programs has tested positive for COVID-19. (Note: Only a fraction of them have been tested.) This continues to boggle my mind. There may come a time very soon when I will look back on this post and think, “Well, that was quaint.”

I received a phone call from a medical epidemiologist this afternoon. Among other things, he said that his job is “to get swabs into people’s noses”. I won’t lie: I had to stifle a laugh.

The medical epidemiologist also shared that there is apparently a shortage of “viral media”, though he didn’t want to “get into the sordid details” about that. My secret source commented that the cause of the shortage of viral media is a shortage of bovine serum albumin. Holy cow.

I haven’t talked so much about nasal anatomy and swabs in my life, even as a medical student learning anatomy. The FDA has apparently approved self-swabs for COVID-19 testing, which include sampling from the anterior nares (nose picking) and mid-turbinates, both of which are easier to access than the nasopharyngeal region (the experience of which has been described as “brain tickling” or a “brain biopsy”). Supplies are limited, though, and we don’t know how to access them.

Homeless shelters and other congregate settings are the lowest priority to receive personal protective equipment (PPE). The only way these settings rise in priority is if there is a confirmed case. Thus, volunteers have made cloth face masks for PPE. It’s wonderful and terrible at the same time.

With Washington State’s “stay home, stay healthy” order, most of the people now on the streets are pushing overflowing carts, wearing soiled blankets, carrying stuffed trash bags, and carrying broken backpacks because they have no homes in which to stay. It is hard to witness this.

I appreciated Ed Yong’s article about How the Pandemic Will End. You may, too.

Categories
Consult-Liaison COVID-19 Education Medicine

Vulnerability and Resilience.

We had our medical staff meeting on Friday, which was the first time we had all convened since the COVID-19 epidemic was announced in Seattle-King County.

I shared with the team the following framework, which is from a paper about demoralization.[1. It is common for other medical specialties to request a psychiatric consult for a patient who seems depressed. Consultation psychiatrists often learn that it is demoralization, not depression, that results in consult requests. (Though demoralization and depression share features, most psychiatrists agree that they are distinct conditions. These distinctions are discussed further in the paper.)]

The authors note that:

Demoralization refers to the “various degrees of helplessness, hopelessness, confusion, and subjective incompetence” that people feel when sensing that they are failing their own or others’ expectations for coping with life’s adversities. Rather than coping, they struggle to survive.

and later comment that “[a]cknowledging suffering and restoring dignity are potent in strengthening a patient’s resilience to stress.”

This is the valuable table from the paper:

During this extraordinary time of the COVID-19 pandemic, this framework may help you, whether you work in medicine or not. Sometimes the act of putting words to our emotions can alleviate our discomfort and help us feel more empowered.

We may all feel overwhelmed with the emotions and experiences on the left side of the table. Many, if not all, of us during the past few weeks have felt confused, helpless, and resentful. We have felt lonely and isolated, though we may recognize that we’re lonely and isolated all together. Sometimes fear gets the best of us and we wonder if anything we do matters. Vulnerability is often an uncomfortable position.

Remember that there are things we can all do to nudge us over to the right side of the table. Thanking others helps us reconnects us with people. Looking for the helpers can inspire us and give us hope. Taking a breath (or two or three) and slowing down helps us pursue clarity so we can find the signal in the midst of all the noise. The choices we make in each moment can help us recognize and cultivate our own courage and resilience. How we choose to react to what’s happening around us can shape our purpose. Do we react in anger or kindness? Do we have faith that we will do the best that we can in face of uncertainty, or do we assume the worst in others and ourselves?

To those of you who work in emergency departments and hospitals, regardless of your role, we thank you for your courage and efforts. We in outpatient settings are doing our best to keep people healthy and out of EDs. We all look forward to the time when this will be just a memory.