Month: March 2020

Pandemic #3…New Normals
#COVID-19

Pandemic #3…New Normals

lesbehonest2017Leave a comment

End of week 2 of telemedicine for my patients.

My wife is working one day a week- Saturdays- to essentially pay for our health insurance. The rest of the week she’s home with the boys while I see patients. I saw clients all week, and am booked next week. No one wants to baby-sit for a nurse during the pandemic even a nurse doing telehealth.

I am incredibly grateful to still be able to pull an income during these uncertain times.

I set up a tent. A massive tent. In our playroom for the boys. I put their beanbag chairs inside of it and blankets and pillows and Jackson calls it his bounce house. It’s essentially their man-cave as the doors open to their TV. They can often be found either with the tent completely closed up literally bouncing around inside, or with it all open chillin’ on their “couches” (bean bag chairs).

IMG_8573

It’s an LLBean King Dome tent, I think it was made for 6 or 8 people. But it’s been in our basement since we moved in. We used to use it once or twice a year. I’m not a camper. But the thought of camping is appealing to me. Until I go. Then I want to go home.

But thank God we kept the tent. It’s been a lifesaver.

Tuesday and Wednesday I worked in the office, but saw client’s remotely to avoid being at home. It felt amazing driving into work those days. It felt normal. It felt like I was going to work and all was well with the world. But the roads were empty of normal traffic. My kids were not in daycare; they were home with my wife. It all just felt off.

So by Thursday I decided to work exclusively from home. It felt like I was mourning something, and then I was excited to have it back, and then I realized it still wasn’t what I had before, so I just wanted to keep being home until it truly can be normal again.

Thursday evening we all drove down to my office and moved out what I needed to make my home office more functional. It felt very final. I locked my door with a sense of foreboding that this is going to go on much longer than we anticipated. I then no-showed my own therapy session because I totally forgot/spaced and was so focused on moving stuff out of my office. Then I felt like an ass and asked my therapist for the address to send the check for our missed appointment to and he sort of yelled at me via text to forget it because there’s a pandemic and he knew I was losing my mind a bit. I’m still going to send a check.

I feel anxiety and grief. Grief for what was. Anxiety for what is to come.

I keep picturing stupid things like what some one will ask in job interviews after 2020- “Do you have any questions for us?” “Yes, I’m wondering what coverage and plans you have in place for a pandemic?”

It’s like life before 9/11 and life after 9/11. There will be changes we; just don’t know the full extent and breadth of them. For me I also continue to vacillate between extreme guilt and extreme relief: feeling grateful for being able to work remotely, knowing I have critical care experience and those skills are beyond needed right now, but sitting this one out of the front lines.

Healthcare provider’s are dying. Even with PPE we will get sick and some will die. I worked in the ED during H1N1. Many of us got it. I’ve been exposed to tuberculosis and pertussis and meningitis. I know that sinking feeling in the pit of my stomach when I find out about the exposure. When we find out about co-workers who are sick now.

I furthered my education in mental health partly to avoid ever having to be front lines again. I went into private practice to avoid hospital work. But I’m still affiliated with the hospital, and I still feel this gnawing guilt that I should be there.

I keep reminding myself I have severe asthma. Severe enough to be on a biologic agent monthly for two years now. That I would die from this. It just all sucks.

My clients are all doing okay. I’ve found that they all truly look forward to seeing me for a change. That I seem to be an anchor of normalcy for them in these constantly changing and isolating times. I try and look the same as I normally do. I try and act the same as I normally do. I try and be that presence for them. It’s taxing. But worth it. I’ve had the lowest no-show rates this week probably in the history of my practice. People want to see me.

I treat a lot of healthcare providers. They know I know what they are going through. It’s heartbreaking and raw. These sessions with them.

My kids and wife and I go hiking every day. There are not a lot of people around us, we live very rural. It’s a blessing right now. It’s also one of the very few times I’ve felt blessed to have twins. They entertain each other. They have a built in playmate. They play now in a way that siblings with age differences don’t. They are on the same level. They also are old enough now to not just do parallel play but actually play together. They take their snacks and their art supplies and go into the tent for hours. On rainy days it’s essential!

The hiking has been good. Feels nice to get outside every day. More than we normally do. We also have this built in family time that feels sort of normal now. It will be weird I think when we go back to our “normal” life.

A year ago at this time my Dad was on hospice. He was ten days away from dying. I’m relieved this wasn’t happening last year. That would have been too much to handle. It seems surreal though to approach the year anniversary of his death in the midst of a global pandemic.

My takeaways so far from the pandemic: Work a job that allows for telehealth options. Live in a rural or suburban area (social distancing is built into our infrastructure and town layouts). Have twins (literally only do this if you know there is a pandemic coming). Keep a pop up tent in the basement at all times in case of rainy days. Get outside every day (unless it’s raining then see previous statement). Don’t no-show your therapist during the pandemic. Zoom drinking dates with friends and family are cool. Two of my cousins and I did one last night and it was fun. Take nothing for granted. 

To all my nurse friends reading this: I think of you every hour of every day. My heart is with you all in these dark times, it’s just my lungs that preclude me from actually being there. You are heroes. I have a rant about professional athletes that my wife knows well. Doctor’s and nurse’s save lives but it’s the damn football and basket-ball players that make millions. I know how hard it is to save lives. I’ve done it. I also know it’s harder to watch some one die than to save them. You will watch many die in the days ahead. Cry. Hurt. Feel. Survive. You are entitled to feel and act any way you want. Don’t let the bastards in management get you down. Don’t let #45 get you down. You are the bravest people I know.

***Myself and several other mental health professionals are offering free services to any healthcare provider in crisis at any time in the upcoming weeks. Call. 

 

Pandemic Journal Entry #2- But Where Did All the Yeast Go??
#COVID-19 · politics

Pandemic Journal Entry #2- But Where Did All the Yeast Go??

lesbehonest2017Leave a comment

In an ironic and rather cruel twist of fate I found a use for all the fabric I’ve saved for ten years. Most of which I used to make my own scrub tops back in my emergency department days. I started making fabric masks.

Apparently the United States of America supposedly, one of the most advanced countries in the world, doesn’t have enough masks and PPE (personal protective equipment) for a pandemic. We also outsourced all our manufacturing to China (They also were hit with the pandemic worse and first) so…yeah. Essentially the hospitals here are fucked.

The CDC and JACHO and DPH…all the most dreaded initials in healthcare…have now declared that wearing a bandana is “okay”. Let me put this in perspective. About three weeks ago these were the SAME initialed departments that were ding-ing hospitals nationwide for nurses keeping their water bottles “at the nurse’s station”.

I hope everyone wearing a bandana at work today eats a damn pizza at the nurse’s station.

The jury is out if cloth masks do anything. There are studies showing they don’t.

But of course because I’m smart and a nurse and have had to wear these masks for twelve hours on end I am a step ahead of the average “sewist” (someone who sews a lot? I dunno my Aunt used the term and it sounded official). I started sewing. Something I actually haven’t done much of since the boys were born.

I still got it though. After a first crappy mask. I got the hang of it. I make them three layers- cotton, thick fabric, cotton- with an opening at the top to slide in either a surgical mask or a HEPA filter. I’m using framing wire to make the nasal bridge part malleable and more snug.

I’ve also learned where to make a cinch (yes that’s a sewing term that I actually knew) in order to make it more snug to the nose and jaw. I also practice talking and breathing while wearing it. I can’t tell you the number of times I’ve tried to open my phone with face ID only to realize I have a damn mask on. They are comfortable. They are breathable and they are better than a bandana. I told my wife I should patent this shit.

But I won’t. I also saw some lady charging for them! Screw that noise. Any nurse I know can have as many as you want.

But while I’m making them I’m just thinking Fuck you CDC. Fuck you #45. No nurse on the front line should have to wear a fabric mask. Why don’t we have enough N95’s? Why are you risking the lives of the only people in the world who can save every one else?

Critical care nurses are not common. We have years of training and experience and most of us leave the game because on a good day it’s taxing. During a pandemic…yeah we don’t want to be near it.

But I would go near it if you had PPE. But you don’t. So you can’t pay me enough.

Yesterday the boys and I went for a 1.5 mile hike together. Only the state parks are open right now. No playgrounds. And there are talks of closing the parks. Please GOD NO! We literally would have no where to go with them. Maybe not literally. We have a yard. Try explaining to a 4 year old why we couldn’t go to a restaurant though. It was rough. He does not believe me when I tell him they are all closed.

We officially have no childcare this week because our baby-sitter’s told us they are abiding by the governor’s order to stay home which is totally valid and I’m not knocking at all. My wife and I had a pow-wow and made the decision that my wife will stay home from work (her store is still open as it is considered essential) so I can still see patients.

I’m worried all the time about everything.

Today was yeast. I bake bread or pizza dough every weekend. I used my last two packets of yeast today. Apparently every one decided that we will not have access to bread?! So there is no yeast anywhere. Not online not in stores. My wife went to over 8 stores before she found some. I know all y’all are not out there making homemade bread. Because every time I make it literally no one has ever even seen homemade bread before.

So where the hell is all the yeast going?! I don’t know. With the toilet paper I guess.

Anyway I made my cinnamon swirl bread today. My wife is stopping work this week so we will be down an income. I volunteered to provide telepsych services for the state of NY due to COVID-19. I also got an e-mail stating any one on a biologic should be excluded from direct patient care…I am on a biologic for my asthma (yes it’s that bad)  so that made me feel validated in doing remote work only. I don’t want to die. I probably would if I got this virus.

We are heading into the week where we will really feel the pandemic. Our numbers are growing. We are at the part of an exponential curve that is climbing with no end in sight to the top. It’s the scariest part to the curve. I tell people with panic symptoms that panic attacks always peak. There is always a time that is the worst after which they start to come back down. This isn’t a panic attack though. These are human lives.

Hang in there America. Shit’s about to get real.

 

 

******Also in case any future person is wondering politically what is going on during this pandemic…Our President sounds like an ass. So nothing new. The senate Republicans are idiots, got exposed, tested positive, and now they need the Democrats to agree with them for votes because too many are absent and they don’t have a 60 vote majority anymore. Can we get a new Supreme Court Justice NOW! In case you didn’t understand- The Republicans are acting and sounding like idiots and as a result are testing positive for COVID-19. The D’s are doing their thing. Squabbling and bitching that the R’s suck and not really getting anything accomplished.

 

Day…__…what day is it? Pandemic Journal Entry #1.
#COVID-19

Day…__…what day is it? Pandemic Journal Entry #1.

lesbehonest20171 Comment

I read somewhere to keep a journal during the pandemic. I’m thinking this week has sucked and I’d like to forget it. But if it helps someone else in the future trying to learn about the 2020 COVID-19 pandemic read on.
I’m all set with the pandemic situation. That could move on.

I never appreciated or craved my normal life as badly as I do now.

I transitioned all my clients to telehealth. For one week. Still working on next week and the week after.

All the major insurers actually stepped up to the plate and said they are accepting all claims for telehealth whether they’ve approved the provider or not (except for Anthem, shocker. Fuck Anthem). They recognize that there’s a damn pandemic and people are freaking out.

Add the panic e-mails from the hospital I work at assessing every one’s skillset as stories are coming out of Italy of eye doctor’s learning to use a ventilator.

This week I’ve ranged from calm to panic to despair back to calm again.

My therapist told me he has to close his practice for the time being due to the financial strain of COVID-19 causing half his caseload to cancel. I felt incredibly heartbroken for him to be in that situation, terrified that the same thing would happen to me and my practice, and also like wtf. It took me a year to find a therapist who was good and who I didn’t know professionally. Selfishly I was like now I have to find a new one?! During a freaking pandemic?!

Then much of my caseload canceled or rescheduled this week- some because I was waiting on Anthem BCBS to approve me for telehealth- others because they thought this would just pass and we could schedule out for two weeks.

I may have freaked out moderately. But then today I saw 16 patients, all remote, between the hospital in the first half of the day and my practice the second half of the day.

Me seeing inpatient psychiatric patients remotely was a first. It went well for me. The patient’s didn’t seem to mind. One was actually quite happy to see my cat who strutted in front of the camera at one point.

This week has been a new reality. So many unknowns. Lots of pressure to maintain my practice, an income, and support my colleagues working inpatient.

I don’t think my life will ever be the same which sounds dramatic but if anything, this week has shown the fragility of our every day existence and how interconnected we are and how dependent I am on others for my income.

There are too many proposals and not enough action. I’ve read many proposals about freezing student debt and credit card interest but not seen anything set in stone about it. I don’t want to fall behind in making payments to any one or anything but at the same time I’m worried that we won’t have a steady income.

Childcare is a freaking issue. They are with me all the time. ALL the time. We’ve had our neighbors and my mom helping out, but it’s not like I can leave when they are here. I see clients in my home office, and shut the door. I can still hear them. ALL the time.

I’m an introvert. I need my space. My office. My alone time. My time away from home and kids. I feel constantly overstimulated and I’m ready for a break from them.

The first week has been a blur of figuring out how to transition my practice to an entirely different platform and also work inpatient remotely. My wife and I are in constant fear that we will lose everything. I’m pretty sure every one in America in the middle class is feeling the same way as that topic takes up the majority of my sessions with patients.

The phone started ringing today for intakes. It was silent for a few days which also terrified me. But now people are realizing that this is the new normal, they are panicking worse than normal because of the pandemic, and they still need mental healthcare.

For now I’m lucky to have that job security and incredibly blessed and grateful to be able to transition my practice to remote health. I’m grateful I can be here with my kids even though I’m sticking them in front of Disney + for far too long while I see patients upstairs. It doesn’t feel sustainable. I hope it’s not. I hope life gets back to normal soon. But unfortunately I’m not stupid. I see the numbers and the timelines and I fear this is only the beginning.

There will be many more deaths. More illnesses. And many more days working remotely.

Some of my top pandemic moments weeks 1:

1- Rounds with an Attending, LCSW, nurse, nurse manager etc. I’m remote on the screen. Both my sons run in and poke their heads onto the screen. They then start chatting. I think I mute the screen. I hustle my kids out the door telling them to be good and I’ll get them a donut, and to go watch Spiderman, and yes I love them too, and No that wasn’t Mama’s patients, now please just stop talking, go downstairs, No donut if you say poopybutt again, I’m sick of it Declan, stop saying poopybutt and gross Jackson quit licking me, just come on….etc. I sit back down. All eyes are on me. I hadn’t pressed mute.

2- Patient clicks in to join the video session. “Hi! Uh, wait are you driving?!” “Yeah, don’t worry I’m getting off the exit, right…up…here….we can start though!” Literally started talking about their meds while driving.

3- Patient clicked in. In bed. Under covers. Just waking up. It’s 3 PM. “Well I made it to the session!” me- “You seriously couldn’t get out of bed and at least pretend you’ve been up for ten minutes?” them- “It’s a pandemic what do you want from me?!”

4- “Mama are you done seeing patients?” Me “No, just taking a quick break” he looks at my wife, “Yeah she does this at Gramma’s house too. Lots of breaks.” then he rolled his eyes! Freaking four year olds.

5. My business partner talking me off a ledge. Multiple times. Some of her words to me “Calm down.” “It’s the flu calm down” “Get a grip.” “Send yourself some Xanax” “You’ve lost your mind” “You’re a mess about nothing” me “It’s a PANDEMIC” Another frequent exchange between us- as in daily sometimes twice daily we just randomly text each other two words. “Fuck Anthem.” No explanations ever needed.

6. The best news of my week which I texted to my wife “Our liquor store is delivery only!!!”

7. At some point I drank wine and made double chocolate chip cookies. They were amazing.

These are light moments in dark times. Stick to the light to lead you through the dark.

 

 

 

 

Nurse to Nurse. Hang in There.
Nursing

Nurse to Nurse. Hang in There.

lesbehonest20171 Comment

I have been walking around with a ball of anxiety in my stomach for roughly two weeks. I knew last Friday would be a turning point. When I left my office that night I packed extra things I normally would leave there. I stopped going to hot yoga two weeks ago.

You know that was hard for me. But I knew from the stories coming out of Italy that after even only a handful of cases in our state the worst was yet to come.

I did a presentation once on mass casualties. The head of emergency response of our state was there. I presented on Hurricane Katrina. The largest barrier for them was helicopters. They didn’t have enough helicopters to rescue people, and they waited roughly 5-7 days to contract with private companies. By then many had died.

I asked the head of operations how many helicopters we have in our state. He said, “One”. You could hear a pin drop. He rushed to add that we “would never see flooding like in New Orleans,” to the roomful of 100+ people now freaking out that we were all going to die.

Two weeks ago I started to get a pit in my stomach because I am acutely aware of the estimated number of ventilators in our state. That was part of my presentation five years ago. I was also acutely aware that the numbers coming out of Italy were bad. Very bad. I started feeling like we were New Orleans being hit by Katrina with one helicopter.

A lot of people are going to die. We are going to be faced with tough decisions. I implored my Mom to stop yoga class and any other outings. I bought into social distancing far sooner than the rest of our country because being in healthcare is a double edged sword. We know the limitations of our system. We know how to interpret statistics and death rates and percentages. I knew two weeks ago we don’t have enough ventilators to save people in a pandemic.

I moved my practice to telehealth only. Of course so did the rest of the USA so it’s been a nightmare dealing with insurance companies. Many patients are still canceling though because they don’t have their own incomes and are worried about medical bills, even small co-pays can be detrimental when people are out of work.

In the midst of me worrying about keeping my practice afloat I received messages from the hospital I work at asking for me to work there in the coming weeks. I know the risks. I also know all the people who work there have their own risks.

I know the doctors with kids with cystic fibrosis, the doctors over 60 with cardiac disease, the nurses with respiratory diseases, the social workers…I know everyone’s story just like they know mine. I know they are risking their health and their families every time they go to work. It’s not a question for me. I have to help out. I didn’t go into nursing thinking there wouldn’t be any hard times.

None of us make enough money for the work we do. But we all take these risks to take care of strangers not just for the strangers, our patients, but for each other. The bonds of health care professionals are what keep us all going. Time and time again when I worked in the emergency department I didn’t show up for management or the money. I showed up for my co-workers. The same is true now.

I know how it feels to be short staffed. I know how it feels to be scared of going to work. I’m scared to go to work. But I’m going to go.

To all my nurses and doc’s and techs and hospital staff- hang in there. You are the true heroes in our society. You deserve the tests that the NBA team received. The disparity in our society that we laud celebrity and neglect our most valuable members of society- nurses and healthcare professionals- is despicable.

I know we are afraid. I know we don’t have enough supplies. I know we are all putting ourselves and our families at risk. From the bottom of my heart I thank you for all you do and I’m with you. I’m showing up at work. I’ll see you there. Tune out the noise and do what we do best. Heal. Tell dirty jokes. Make horrible coffee. Complain about management. And save some lives. We got this.

 

The Struggles of Parenting
lesbian mom · mom of boys

The Struggles of Parenting

lesbehonest20171 Comment

It’s been a better 2020 so far than 2019. However, our sons have been sick every other week it feels like. They have been as sick this Winter as they were the first year of daycare. It’s been rough. We all are sleep deprived. Because God forbid the fever spikes in the middle of the day or Croup or vomiting or any other one of the hundred illnesses that have run through our house this Winter.

Nope it’s always in the middle of the night when shit hits the fan. Sometimes literally. Then we have an argument in the morning about who has to miss work. She’s at a new job, trying to make a good impression, of course since she started, we’ve been battling the plague like we are ground zero of the infection.

I own a practice and if I don’t work I don’t get paid. Clients also don’t like it when I cancel- rightfully so- as a result I run the risk of losing clients if I cancel them even once.

So with one of our sons sick (also God forbid they get sick at the same time- always consecutive never concurrent) we argue because we are both essentially terrified of losing our jobs because of canceling to take care of our son.

Our society is messed up. Parents shouldn’t feel this way. Pressured to go to work because if we don’t we will lose our job. That has never been said to us to be clear. But we know how it goes. Too many absences means unreliable. Unreliable means bad employee or in my case bad provider.

Then I get asked by any one who finds out that one of them is sick “Did you bring him to the doctor?” My answer is a resounding “No.” Well not always. Croup in one of my son’s can get very bad. So after the first night (When many people would likely call 911 but we stand outside in the cold and give him popsicles until his breathing improves) we do call the pediatrician and bring him in to get a prescription for steroids. I do have a respect for airway issues.

But for everything else. Nope. Viral illnesses happen. I understand that. Fevers happen. Vomiting/diarrhea happens. Unless they are severely dehydrated or still spiking a fever after a week or are compromised with their breathing in some way…we can manage at home.

I’m a nurse practitioner and worked as a staff nurse in a pediatric ED for over six years. Also I don’t want to be dragging my sick miserable kid to sit in an office for half an hour while we wait for the provider who is likely running late. Torture.

It’s also great that these weeks of illness still require us to pay full tuition at daycare. So one of us misses work all week, we don’t get paid, (My wife doesn’t have PTO yet as it’s still a new job), but we still pay full tuition at daycare for a kid or two who are not actually there.

When we said we wanted to be parents I didn’t really think about this part of the deal. Cleaning up puke. Shampooing the carpets. Taking care of sick kids. The stress of missing work and the ensuing financial stress that causes. As well as the stress of worrying that we will lose our jobs because of missing time.

That entire chapter of parenting was left out by anyone who ever told us we should be parents.

Today was another sick day. We finally asked my Mom to watch him because we were both feeling we couldn’t miss more work and the sick one wasn’t horribly sick anymore- not puking, no fevers, for over 24 hours, just still not himself.

The parenting struggle is real. Today required more juggling and taking the healthy kid to daycare while coordinating with my mom for sick kid. Also then worrying and feeling incredibly guilty for being the parents who can’t stay home and take care of their sick child.

But I’d feel worse if one of us lost our job and couldn’t pay the mortgage.

So there’s that.

These days feel like a lose-lose for us struggling middle class parents.

I find myself wishing for the teenage years when they can be left home alone. Then feeling very guilty for not “enjoying” them at this age. Feeling guilty that I was not home with him today.

I remember doing IVF and thinking I just want a healthy baby. I didn’t realize that baby-hood was only the beginning. Parenting hasn’t even begun when they were babies that was more basic survival.

I didn’t go to hot yoga last night and I had to cancel my therapy and acupuncture. Those all seem very first world problems. But they are actually my way to cope with the stress of life. So to miss all three in one day was not good for me either.

But I had to stay with the sick kiddo and at night he had a fever and he wouldn’t go to sleep unless he was in my bed with me in it. So I got into bed at 7 PM. It was kind of nice I’m not going to lie. Had there not been a sick kid with me I would have probably had a great night of sleep.

Anyway. I’m exhausted. My wife’s exhausted. We are crossing our fingers he can go to daycare tomorrow. But have my mom on standby again. At the end of the day we do our best to give them everything, but still go to sleep thinking we haven’t given them enough.

I guess that part of parenting. Giving your all and battling insecurities that it’s not enough.

I’m also ignoring the fact that the most qualified candidate is an intelligent woman who’s doing crappy at the poles losing to two other 70 something year old white dudes.

On the plus side…I have a stockpile of Purell which my business partner made fun of me for buying in bulk when we opened…who’s laughing now?! #CORONAVIRUS #NURSESARETHEBESTATHANDWASHING