Category: COVID-19

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COVID-19 Public health psychiatry Seattle

StoryCorps Interview.

I wasn’t familiar with StoryCorps until I received an invitation to record with them. They were looking for people who were front-line workers during the Covid-19 pandemic. Once I learned that the recording would be archived in the Library of Congress, I signed up.

Here’s the recording of the interview. It’s about 48 minutes long.

I still believe that most people don’t want to hear anything about the pandemic. Prior to the recording, I have said little about it. (My conversation partner in the recording has been a close friend of mine for over 20 years. Almost everything I shared during our recording she had never heard before.)

There was a time when I literally could not say anything about it: my mind would go blank, my chest would tighten, and no speech would come out.

“I don’t know,” I’d finally say. The blankness—how expansive it was, how it encompassed everything—was overwhelming.

I myself have not listened to the recording and don’t expect that I will anytime soon. Even though the recording was nearly an hour, it still wasn’t enough time. (Enough time for what?) Working as the medical director during the pandemic was the hardest thing I’ve ever done in my professional career. I am thankful that I was given the chance to talk about it.

If one person, 100 years from now, before, during, or after another pandemic, benefits from hearing my experiences, then it will have been worth it. May they learn from my experiences and errors.

Categories
COVID-19 Policy

Standing Up.

Five years ago I was working as the medical director at the largest homelessness services agency in Seattle.

My dad, who skimmed headlines from major newspapers in the US and China every morning, had been tracking news about a respiratory illness spreading in China. “It sounds bad,” he said in January.

On February 29th, 2020, the first death from Covid happened in the US. The death happened in a suburb of Seattle called Kirkland. (If you are a Costco member, those Kirkland jeans and Kirkland cookies and Kirkland laundry detergents are named after the city where the original Costco headquarters were located.) Without consulting the executive director, I sent out an e-mail to the entire agency that same day. I can’t remember what I wrote, though my intention was to offer information, presence, and transparency.

I couldn’t offer true reassurance. I knew nothing. I was worried.

At that time there were close to 50 medical professionals at the agency. During a meeting that happened shortly thereafter to consider next steps, one of the psychiatrists, his voice quavering, asked, “We’re going to shut down the [program he worked in], right?”

“No,” I said, perplexed. “People need that program — and they might need it even more because of what might come next.”

That psychiatrist then abandoned his job. No notice, no explanation. He just left.

Everyone else on the medical team stayed. Though I have expressed my gratitude to them many times, they will never fully understand the depth of my appreciation. There is no way the agency could have kept people — most currently or formerly homeless — well without their help. They applied their knowledge and skills in unknown territory, sought out patients wherever they were, and worked within and across disciplines. There were hundreds of staff at the agency and well over 2500 patients. By the summer of 2022, only five patients had died from Covid. (More died with Covid, but SARS-Cov2 was not the primary cause of death.)

During the Stand Up for Science rally in Seattle yesterday, the president of the Washington State Nurses Association spoke. He talked about the service of nurses during the pandemic, how they all continued to show up and work despite the threat of disease and death.

His point was two-fold: Nurses need science to do their jobs. Nurses also do the right thing: They don’t back down in the face of threats. They keep showing up, even when the situation is scary and hard.

This is true for the vast majority of people who work in health care.

Do I feel great annoyance with the current federal administration? Yes. Do I think people will suffer and die unnecessary deaths because of their policies? Yes. Does that enrage me? Yes.

Serving as the medical director at that homelessness services agency during the pandemic was the hardest thing I’ve ever done in my professional career. The fruit of that experience, though, is an unexpected equanimity.

It’s not that I don’t feel worry or sadness. I do. The actions of the federal administration just seem like a series of surmountable problems. Their triumph is not inevitable. All of us who were essential workers during the pandemic showed up, did our jobs, and supported the people in our communities. If we were able to do that when the threat was unknown, global, and indiscriminate, why would we be cowed by a shrinking faction of spiteful people?

Categories
COVID-19 Nonfiction

A Plan = A Thought.

Since the onset of the pandemic, I have taken many steps to keep myself healthy. This was all in the service of making sure I didn’t give Covid to my elderly father.

(“Making sure.” The arrogance of that statement!)

The grand irony is that I ended up getting Covid from my father.

The universe reminds me again that a plan is just a thought.

Categories
COVID-19 Medicine Nonfiction Public health psychiatry Reading

Things That Made Me Smarter This Week.

Some media recommendations for your consideration:

Three Years Into Covid, We Still Don’t Know How to Talk About It. This article is one of the few that resonated (more) with my experience of the Covid-19 pandemic. Despite my professional training and expertise as a psychiatrist, I still can’t find the “right” words to describe what happened to me, the people around me, and the world. Without adequate words to create a coherent narrative of my experience, I still don’t fully understand what happened. (I hope that I will not give up trying.)

Freedom House Ambulance: The FIRST Responders. Did you know that the first modern ambulance service in the United States was developed in a Black neighborhood in Pittsburgh? The Freedom House Ambulance served as a model for the rest of the world.

This Book Changed My Relationship to Pain (title of the podcast, not my comment). Dr. Zoffness explains the bio-psycho-social nature of pain in an engaging way with plain language. (I am one of the many people she describes in the podcast who developed chronic pain during the pandemic; I have known since its arrival, both as a professional and as a human being, that there is significant a psychological component.) Pain is not all in your head AND the state of our minds affects how we experience pain.

Mathematician Explains Infinity in 5 Levels of Difficulty. I have always found math interesting. What I particularly enjoyed in this video is the skill Dr. Riehl shows in teaching the concept of infinity to different audiences. This is something I aspire to (and have mused about doing something like this for myself for psychiatry, à la the “Feynman Technique“). I also appreciated the similarities between the explanations she provided at level one and level five.

Salve Lucrum: The Existential Threat of Greed in US Health Care. When I read things like this, I see yet another pathway that someone can unwillingly tread upon that will result in homelessness. (Some people think they are immune to homelessness; that’s just not true.) “… unchecked greed concentrates wealth, wealth concentrates political power, and political power blocks constraints on greed”, and “[g]reed harms the cultures of compassion and professionalism that are bedrock to healing care.”

Categories
COVID-19 Homelessness Nonfiction Observations Policy Public health psychiatry Seattle

Gifts of Our Lives.

Photo by Leeloo Thefirst

(I know it’s the holiday season and I promise I’m not actually a grinch, but here’s your warning: This is going to be kind of a bummer of a post.)

Some recent scenes for your consideration:

  • The sliding wooden gate did nothing to dampen the sounds of traffic on the boulevard. Inside the wooden gate was a parking lot that was now occupied by around 40 small sheds, each painted a different color. At one end was an open-air shared kitchen and a set of small bathrooms. It was snowing, the kind of wet, clumpy snow that doesn’t stick, but instead seeps immediately into clothes, hats, and sleeping bags. Though people in this “village” are still technically homeless, they were at least protected from this unusual Seattle weather. Within a few minutes of my arrival, a skinny kid, maybe eight or nine years old, wearing a sweater, shorts, and sandals, ambled outside alone to look up at the sky. Later, another skinny kid, maybe thirteen or fourteen, came out, his hands shoved into the pockets of his sweatpants and his eyes fixed on the ground. I wondered what their ACEs scores were and hoped that, as adults, they would escape and remain out of homelessness.
  • As I threaded my way through the city and the morning chill, I kept a mental tally: One man wearing a tank top and making grand gestures at the sky; another shirtless man pacing in tight circles; one woman wearing a soiled hoodie, with either black ink or a black substance smeared across the bottom half of her face, picking up trash from water pooled in the gutter; a man hobbling with a cane and screaming a melody; a man emerging from a collapsed tent to fold up a crinkled black tarp; a woman with bare legs and swaths of bright green caked on her eyelids who, in slurred speech, offered me a wristwatch dangling from her fingers.
  • “We have burned down the house of mental health in this city, and the people you see on the street are the survivors who staggered from the ashes,” writes Anthony Almojera, an N.Y.C. Paramedic [who has] Never Witnessed a Mental Health Crisis Like This One, who also comments that “there’s a serious post-pandemic mental health crisis.”

Maybe my expectations about the pandemic response were too high. A pandemic is an act of God; what could mankind possibly do that can deter the power of God?

And yet.

There were things we could have done to protect mental health during a pandemic. I am not the only one who was (and remains) worried about the psychological consequences of this pandemic in the years to come. There remains insufficient mental health policy or policy implementation, insufficient resources, and insufficient political will, among other implementation failures of public mental health.

I do believe that hope is a discipline. It’s hard to practice every day. But this is why I still question whether my expectations were too high. God spared us—you, dear reader, and me—during this pandemic. For what reason? What can and should we do with the gifts of our lives?