how to wring humor out of troubling times

bamboo

"The human capacity for burden is like bamboo,
far more flexible than you'd believe
at first glance."
~Jodi Picoult~

It shouldn't surprise any of us that people are responding to the Covid-19 crisis the way they are...with worry, fear, sorrow, resentment, and anger. Some have suffered through the illness themselves, while others have watched loved ones suffer and die because of it. People have lost their jobs, and therefore, their income. Some are stuck at home with an abuser. The kids are starting to get on their nerves. They've had enough.

"There is nothing worse

than thinking you are well enough.

Don't turn your head.

Keep looking at the bandaged place.

That's where the light enters you.

And don't believe for a moment that

you are healing yourself."

~Jelaluddin Rumi~

What might come as a surprise is the fact that some people have found ways to wring humor out of these troubling times. It may seem inappropriate to trivialize the tragedy unfolding around us by making jokes about it, but this is another example of the duality that keeps our heads on straight. Some of us are well, some are ill. Some are scared, others are unconcerned. Some look on the bright side, others are stuck in the dark. 

I had to smile at a few posts that appeared this week.

.

If you're not ready to entertain humor yet, maybe you can appreciate something of beauty, or sweetness. 

If it's still too soon for that, you could simply go to the window and inhale the fragrance of honeysuckle, or check out the tender new growth down in the woods, or listen to the birds singing their little hearts out. 

If you simply can't muster a smile right now, don't worry. It will come. You will get through this. You'll know it the next time--or the first time, if it hasn't already happened for you--someone or something brings a smile to your lips. 

"It is both a blessing and a curse

to feel everything so very deeply."

~David Jones~

jan

why this? why now? why me?

Yesterday was pretty much a perfect day for me. It helps that I appreciate solitude, so social isolation is comfortable for me. It also helps that I don't suffer food or financial insecurity...I don't like to cook and I'm not "a shopper."

That said, I got up early in the morning, had a bite to eat, spent an hour in meditation, and took my (almost) daily five-mile walk in the brilliant sunshine under a cloudless blue sky. While listening to beautiful music. Spring treated me to vibrant shades of translucent green. No one else was out.

It would have been a totally perfect morning except for one problem. The rest of the world is suffering. The majority of humanity is either sick, worried they will get sick, or grieving for someone who has been sick. People are scared. Angry. Broken. It hardly seems fair. It makes you wonder. It keeps you guessing. Why this? Why now? Why me?

"There are times when explanations,

no matter how reasonable,

just don't seem to work."

~Fred Rogers~

But such is the duality of existence, the inevitable interplay of joy and sorrow, of pleasure and pain, of hope and despair. The struggle between attraction and aversion, between surrender and control, between humility and pride. Between "can" and "can't", "will" and "won't."

Today is a different kind of day for me. A wave of sadness crashed on shore this morning.

One of my best friends brought her husband home from the hospital. To die. It had nothing to do with Covid-19. He has not been well for a while. There was nothing more the doctors could do for him. The sad thing is that my friend will be alone with him at the end.  She will not be comforted or supported or cheered by the near presence of family or friends. She will be alone.

"We're all just

walking each other home."

~Ram Dass~

As the tide of sorrow recedes, though, it will leave a few sweet consolations behind. The comfort of knowing that she has these last few days or weeks together with him. That she is able to bathe and feed him herself, to tell him everything she needs him to know, to kiss him goodbye.

"Whatever is good for your soul,

do that."

~unknown, but claimed by many~

Today I'm going to walk by the lake. That usually helps.

jan

a grim reality

The Covid-19 pandemic has touched each and every one of us in ways we couldn't have imagined just a few weeks ago. From disbelief to fear, from illness to exhaustion, from annoyance to anger to grief to guilt, it has invaded every aspect of our lives. We weren't prepared for schools and businesses to close. We believed our health care system was infallible. We never thought we'd have to worry about affording or procuring food and supplies. We thought we were pretty safe.

"Expectation is the root

of all heartache."

~William Shakespeare~

It has been a challenge to reconfigure our lives just when things were going so well for so many of us. It isn't easy to home school your children, or to work from home when you've never done it before. It's annoying, if not maddening, to have to clean and sanitize everything you come into contact with over and over again, to don a face mask every time you wander outside, to worry about every cough or sneeze. It's unsettling to witness family members and friends taking ill. It's downright scary to think it could happen to you.

But this is the worst thing, I think. Worse than social distancing. Worse than quarantine. Worse than watching the emergency room door close behind someone you love because you are not permitted to be with them in the hospital. Worse than abandoning them to their fate.

"Love knows not its own depth

until the hour of separation."

~Khalil Gibran~

The worst thing is knowing that the person you love may be left to suffer alone. That they could die unattended. That there will be no loving presence at their bedside to support and comfort them. No song or prayer to see them off. No funeral. No burial. At the end of life, they may be assigned a body bag in a refrigerated truck, and, as we learned just today...some will end up in a mass grave. A grim reality that offends everything we hold sacred.

As if it weren't hard enough to have watched family and friends fall ill, suffer, and die, how will we ever bear the heartbreak of coerced separation? The void of utter helplessness? How will we survive the tidal wave of bitterness, despair, and sorrow we feel?

What is the way through? How will we rise again? 

"I am wounded but not slain.

I will lay me down to bleed a while.

Then I will rise to fight again."

~John Dryden~

What would you do if someone you love died like this? How do you dignify and honor a life that passes abruptly, cruelly, unjustly? 

How do you want to be remembered if it happens to you?

"When someone you love
becomes a memory,
the memory becomes a treasure."
~author unknown~

jan

look for the helpers

Something changed for me this week. I downshifted from disbelief, frustration, even outrage, to sadness, a deep penetrating sense of helplessness and despair. Covid-19 hit a little too close to home.

One of the nurses I worked with for many years got sick...reminding me that most of my colleagues and friends are at high risk because of their age, or if they're still young enough to be working, because they are exposed to the virus every day. Without adequate PPE.

A friend who has diabetes, end-stage liver disease, and worsening heart failure was denied hospitalization because the risk of exposure to Covid-19 was too great, a certain death sentence.

A distant relative who lived in Italy took his own life this week for reasons we can only imagine.

My daughter's obstetrician recommended an elective induction next week so as to get her in and out of the hospital before the case load peaks where she lives...and before her husband is banned from the delivery room. Not to mention that today is her birthday.

My grandson missed his fifth birthday party today, too...

which is no big deal considering the incomprehensible toll the pandemic has taken on patients and their loved ones, on health care workers and first responders, on teachers and parents and the children they care for all around the world. Still...

"It is both a blessing and a curse 

to feel everything so very deeply."

~David Jones~

And then there's this. I'm used to being on the care-giving side of the equation...not on the receiving end. The thought that I would put someone at risk delivering my groceries, or running an errand for me, or, God forbid, taking care of me if I get sick...the thought of it worries me. It scares me. It saddens me. And, it leaves me feeling guilty...not being able to help, not being able to do my part with the skills I possess.

Instead, I've called all my closest family members and friends this week to check in on them. I've created get well cards and birthday cards, printed them out, and mailed them off without venturing into a store, or settling for e-cards (well, maybe one or two...). Why I've sat in mindful meditation for hours, launching loving kindness into the universe. You do what you can.

"Do what you can,

with what you have,

where you are."

~Theodore Roosevelt~

How is it going for you? Who and what are you caring for today? Remember to be kind and gentle with yourself, too. 

"When I was a boy

and I would see

scary things in the news,

my mother would say to me, 

'Look for the helpers.

You will always find people 

who are helping.'"

~Fred Rogers~

jan

how to acknowledge reality and still spread compassion

When the Covid-19 pandemic is just a memory, those of us who survive will all have stories to tell. They will include tales of fear, isolation, and sorrow. Some will recall moments of relief, laughter, and kindness. Most will never be told.

"O, what an untold world

there is in one human heart."

~Harriet Beecher Stowe~

It isn't too early to start sharing our stories. We all want to know how other people are coping with the crisis, what precautions they're taking to prevent the spread of the disease, how they're faring financially, how the homeschooling is going, where they're finding supplies. The list goes on...

But there is more to it than that.

As a physician, I would like to hear from people who have gotten sick, and from their caretakers. Were they at high risk? Did they smoke or vape? Did they have asthma, or emphysema? Were they diabetic, or immuno-compromised, or frail? Alcoholic? Homeless? Did they follow all the guidelines for preventing illness, or were they careless, or defiant? 

"Nothing ever goes away until

it teaches us what we need to know."

~Pema Chodron~

In other words, I want to know what sets me apart from them. I want to believe I'm less susceptible because I'm healthier, or younger, or more compliant with preventive measures. 

I want to know how they felt when they first got sick. What finally made them call the doctor, or go to the Emergency Room. I want to know how scared they are, or how depressed. How they're dealing with being separated from family and friends. What it must be like to miss a loved one's funeral. To postpone your wedding. To run out of money. 

Stories like these help the rest of us to monitor our own response to this crisis, to adjust our expectations, and confront our mistakes and misconceptions. To acknowledge reality. To spread compassion.

"Every one has a story to tell 

that will break your heart.

And, if you're really paying attention,

most people have a story 

that will bring you to your knees."

~Brene Brown~

Please don't underestimate the importance of telling YOUR story. Someone needs to hear it. Pick up the phone, or dash off an email. Put it out there on social media. Talk it over at dinner. When it comes to frustration, regret, fear, sorrow, and despair, we're all in this together. When what we need are courage, compassion, cooperation, patience, and surrender, it helps to be able to lean on one another. 

"It is both a blessing and a curse

to feel everything so very deeply."

~David Jones~

jan

pre-morbid reflections on Covid-19

I'm a physician, so I feel like I need to be out there with my colleagues caring for victims of the Covid-19 pandemic. There's one problem: I just became a card-carrying member of the Covid-19 High Risk Club, so I really can't.

Those of us who are in the high-risk category because of our age, an underlying medical condition, or the fact that we're immuno-suppressed are not necessarily more likely to pick up the virus than anyone else, but if we get it, we may not be able to mount an immune response to fight the infection. What might be a debilitating case of pneumonia to a young, healthy person can be fatal to someone who is immuno-compromised. And, in a worst case scenario, there simply are not enough ventilators to go around.

Remember that even though you may not be experiencing any symptoms...you may already have been exposed to the virus by someone else who appeared healthy, but may have transmitted it to you. Likewise, you can transmit it to the rest of us even though you still feel fine. "Sheltering in place" is probably the best course of action for all of us who can.

"Sometimes you just need to

lie on the couch

and read for a couple of years."

~hookedtobooks.com~

Trust me, it's not all that bad.

Remember all those jobs around the house you haven't had the time or energy to tackle? Now you have nothing but time and energy.

Remember that book you've always wanted to write, the poem that keeps running through your mind, the song you've been singing to yourself for so long, the picture you've been longing to paint? Now might be a good time to get started.

"Dancing, singing, storytelling, 

and silence

are the four universal

healing salves."

~Gabrielle Roth~

This is the perfect time to explore the gifts of meditation and yoga.

To get out and walk. Take your camera along.

To shoot some hoops with your kids, or prep your flower beds for spring. The possibilities are endless.

As for me, I'm hunkered down for the foreseeable future. That means I may have to miss the birth of my very first granddaughter...and my grandson's fifth birthday. I wish things didn't have to be this way, but...

~i2symbol.com

This is my wish for you:

May you be well.

May you be safe.

May you be happy.

May you dwell in peace

and loving kindness.

~jasrinsingh.com~

jan

the story of the present illness

The story of my life during the years leading up to my retirement could have been recorded in ten-minute sound bites, patient after patient, day after day. This was in keeping with the trend toward abbreviated discourse, 140 character tweets, and snarky comebacks that have come to replace the leisurely, thoughtful exchange of ideas that human beings have always enjoyed, and sometimes depended upon.

In medicine, the written or dictated patient note has been largely replaced by the electronic medical record (EMR). Nowadays, rather than narrating the patient’s story, you navigate his data base with a series of clicks that pull up a confusing array of bulleted lists, complicated charts, and sketchy details.

www.1stproviderschoice.com

This is intended to expedite what has been ruthlessly abridged to a ten-minute office visit. After all, as physicians, we have productivity quotients to meet and income to generate. That forces us to see more patients faster and to learn less about them at the same time.

It wasn’t always this way, though. There was a time, not many years ago, when I could scan my schedule for the day and envision every patient I was scheduled to see. I knew them that well.

With a quick glance at the chart, I was able to recall the patient who was getting ready to start chemo. She’d presented with palpitations and chest discomfort that could have required an extensive cardiac work-up. Instead, we discussed the anxiety she felt having watched her mother die of the same cancer despite having consented to the same treatment. My patient’s heart was fine. Her family history (a.k.a her story) made the diagnosis. Try teasing that information out of an EMR.

I knew instantly whose intractable headaches began the day she discovered the cigarette burn on the sweater her ten year-old wore to school that day. I could have run every test under the sun and prescribed every medication known to mankind, but unless we addressed the problem she was having with her child, nothing would have helped.

I remembered it because I'd asked about her family, she'd told me the story, and I'd written it into the chart.

This isn’t just idle chit-chat. It’s not a waste of time. In medical jargon, it’s called “the history of the present illness” but it could just as well be called “the story of the present illness.” And it should interest more than just writers. Research has shown that patients require fewer medications and fewer follow-up appointments when they are allowed, indeed encouraged, to tell their whole story. Patient satisfaction improves. And it improves the odds of getting the diagnosis right.

This should appeal to the CEO’s and CFO’s of hospital health systems because in the long run, it has been proven to save time and money.

Good history taking is the key to excellence in medical care. Every patient is embedded in a family, a community, and a culture, each of which affects his health. All patients experience illness in terms of their expectations, beliefs, and hopes. They know all about fear, shame, anger, guilt, and despair. Every one of them deserves our attention, respect, expertise, and honesty.

Each and every one of them has a story to tell and a lesson to teach. And that takes time.

"You are not your illness.
You have an individual story to tell.
You have a name, a history, a personality.
Staying yourself is part of the battle."
~Julian Seifte~

jan