The last two weeks my practice has been taking upwards of ten referrals a day. We can’t take everyone. There aren’t enough of us and I’m the only person who is full time.

I try and get back to every one. I’m not sure I’m always successful. Between the e-mails and phone calls and seeing patient’s at least nine hours a day, often more, and dealing with insurance companies…yeah it’s a lot. Aetna screwed up my reimbursement and they only let you give them three claims at a time that need to be corrected when I call provider services.

It’s their error but I’m the one who had to call three times to have them re-process nine claims. I emailed my rep and blasted them. Then sent the remaining ten via email to her to process in bulk.

Anthem. I can’t even comment on Anthem. At the end of this I will be dropping them.

Meanwhile I still have two four year olds screaming in the background of all my sessions.

My clients are all anxious. They all can’t sleep. They are Mom’s feeling like failures because they’ve yelled at their kids more in the last six weeks than ever before. They are teenagers stuck inside missing out on their senior year- senior prom, graduations, it’s all passing them by. They are Queer or abandoned young adults who had found refuge on college campuses; now finding themselves homeless; couch surfing or taken in by a generous friend’s family. They are front lines worker’s fearing for their own safety and the safety of their families.

They are front lines worker’s who have already tested positive. They are family member’s of people who have died from COVID.

For the people protesting this lockdown and calling it all a hoax. Sit in my chair for one day. Then take yourself back home. People are dying.

It’s a heavy time for mental health professionals. We are carrying the loads of everyone impacted by COVID. Because I haven’t talked to one person who hasn’t been affected by it.

There is a general feeling of exhaustion among parents. We are tired. We want a break from our kids. At least I do. And many of my friends and clients agree. I don’t miss the daycare bill. But I miss the reprieve. My kids do too. Even my Jackson. He’s finally started asking to go back to school. Only took him seven weeks to miss it.

I keep trying to be grateful for having a job. For having an income (no thanks to Anthem). I’m grateful for my health. I’m grateful for…yeah then I fall flat. Because I desperately and acutely want life to go back to normal. I feel like I go through the stages of grief. All five of them- rapidly- daily. Denial. Anger. Bargaining. Depression. Acceptance. Except I think I mostly skip the acceptance part. Maybe that’s when I’m trying to be grateful. Definitely lasts a minute. Maybe less.

I deny that this will permanently change my life. I’m angry that our whole life was turned upside down. I try and think in my head the different ways I can fix this. Then I get sad because I know I can’t. I see some clients. That may or may not make me more sad. Then I accept. Then I start over again.

It’s twisted.

We try and make things seem normal. But they aren’t normal. The first two weeks were like adventure camp. The next two were like an outward bound likely abusive wilderness camp. The last three weeks were a blur. So busy with work and clients. Aching for warm weather. Making follow-ups into July and saying, “Maybe we will be face to face by then…”

I’m meeting people’s pets. They are meeting mine. Both cats make frequent appearances on camera.

During a rare hour of me working with my wife out…me doing an intake; I wiped one of my son’s butts while on facetime. The things I never thought I’d do. Wipe poop during an appointment. The struggle is real. The client actually had no clue and was relaying a rather distressing part of their history.

I tried to maintain a neutral expression as I slowly moved down the stairs and into the bathroom, (in response to him screaming “MAMA! I POOPED!! CLEAN MY BUTT”) then wiped with one hand while carefully keeping the phone held up and in the opposite direction. My whole body was contorted and it was one of those times I wish we were filmed. Because that would have been reality tv gold.

My friends in mental health agree. We are all beat. We all feel the brunt of this pandemic on our clients. We all also feel the brunt in terms of the broken healthcare system. Clients can’t pay their premiums or their deductibles. Then they get mad at us for billing them. I do payment plans, and reduced fees, but I need to get paid also. It’s a reflection of our broken healthcare system but it gets taken out on healthcare workers who are business owners.

Seven weeks. I crave normal more than I can possibly put into words. I crave time away from my kids. I crave normal volume of referrals. Not ten a day. Not desperate pleas for help. I crave work that is separate from my home. Because the blending of the two makes it harder to create boundaries for my personal life.

Our coffee maker broke this morning. I had an epic meltdown. We have a new one now. I’ve said this to my clients and feel that it resonates with me…I’m filled up. Too much stress. I can’t handle extra stress. Broken coffeemaker…that went into the extra stress category and I couldn’t deal. I made one of my sons eat his muffin on the deck. I was sick of vacuuming the crumbs. It’s not warm out- not freezing- but not warm. Within about thirty seconds I felt like maybe I should let him back in. But my wife didn’t say anything. So he finished his muffin on the deck. Then he cried. I cried. In the midst of the meltdowns and muffins his brother stated “He will get eaten by coyotes!” And my wife and I shrugged and said maybe.

That’s where we are at. His brother opened the door and announced he would save him from the coyotes because obviously both his Moms have lost it. But legit, the amount of crumbs is not just a little bit. It’s like half the muffin on the floor.

If I have to tell them to leave the cats alone one more time it might break me.

I’ve already warned my co-workers who work inpatient to just drug me up and let me sleep if I make it in there. Honestly it would be a relief. Bed. Drugs. No kids. You know it’s bad when you’re dreaming of a psychiatric admission.

This is the essence of COVID stay at home orders. Feeling filled up and still having to make room for more.

Seven weeks. Hang in there. Parents of kids…we are all heroes after this for making it through alive, sane, and with our kids intact.

P.S. #45 still sucks. No surprise there. North Korea’s leader may be dead. Weird. And New Zealand’s leader is killing it. But female leaders all are too emotional and irrational to lead…and the e-mails.

Some things I never thought I’d do that I’ve done during COVID.

• Apply for NY state licensure. I’ve had several clients who are transplants living here now, and want me to continue seeing them when they move back to NYC. I figure why not, it’s the right thing to do.
• Had my sons do so many crafts they now literally cringe when I asked them if they want to do a craft, and run away.
• Contemplate my mortality in a way I never have before now, even when my asthma was severe enough to warrant an ICU assessment in the ED a few years ago. Still didn’t seem as real as life and death does today.
• Make masks for my kids and watch them wear them.
• Mail masks to family and friends.
• Become more bitter toward Anthem than I already was as a healthcare provider.
• Buy a fancy mic and earphones for telehealth.
• Buy pillow shams and make bed daily. Literally never in my life until COVID.
• Miss people.

We finished week 5. It feels like week 15. While at the same time thinking we have at least another month of this seems insurmountable.

My boys finally were able to connect with a friend from daycare via FaceTime and that was fun. Though there seems to be this sadness with them after every video call- of why can’t we see them? Why are we stuck here and them there? Why? They know vaguely that there are germs we are waiting to go away. It’s really hard to explain a pandemic to a four year old without getting too graphic and without being too vague.

I’m tired. I find that my practice is busy, and my patient’s are sick. Sicker than normal. People I would normally refer to intensive outpatient programs (IOP) or interventional psychiatry (ECT, TMS, etc) or even inpatient; I’m trying to manage them outpatient at a private practice. It’s a lot.

I’m involving families (spouses, parents) more than I normally would because for people who would generally require a higher level of care- it’s a condition for me to try and manage them at home that supportive adults in their home know the situation and are actively involved in their care.

There are a lot of ethically deep situations that normally don’t exist. Pandemics change everything everywhere. I’ve refused to trial new stimulants on children who have had adverse reactions it the past because I don’t want them to need acute medical attention and not have access to it. It’s caused some heated discussions with parents. Spouses don’t always want their partners involved. Adult children don’t want their parents involved…etc. etc. But sometimes it’s not safe to do it any other way.

I try to live in the grey. I try not to be black and white. But there are certain standards of safety I will not compromise on and COVID-19 is making me learn a whole new level of compromise (and my clients).

There remains a blanket of fear and anxiety across everyone including myself. Who will get sick next? Will it hit clients, their families, my friends, their families, etc. There remains a level of fear regarding finances and income and paying next months bills.

My kids have been five weeks without daycare. They miss their friends. They still miss their teachers. They still crave a normalcy and routine that is not the same at home. Well, correction, one of my kids wants preschool back. The other could live this life forever. I have a homebody and an extrovert. My homebody says he only misses his cousin, my niece, and her mom’s (my sister and sister-in-law). My extrovert misses everyone and routinely runs through the names of his teachers and friends in case we’ve forgotten them.

They watch me as a I sew masks. They comment when I use a new fabric. They know that something isn’t right in the world because never has their Mama sewn masks before. They are acutely aware of the fear around them. We all do our best to move through each day as best we can though.

In the mean time people still get depressed. People still get manic.”Normal” mental health and physical health problems still happen. STD’s still happen. Pregnancy. Births. Deaths. Life goes on as we all try to adapt to life in a pandemic.

What keeps me going is my family. My kids. My wife. But also that moment when a client first connects with our video session. I have seen so many sincere smiles when they see me. And I have given so many sincere smiles back. I’m an anchor of normal in a wild sea for many of my clients. And whether they know it or not, they are an anchor for me as well. Doing my job, psychiatry, that grounds me. It’s normal. It feels right. I’m good at it. Even remotely via video I’m good at assessment, diagnosis, and clinical recommendations.

It feels good to be doing something I enjoy, that I learn from, that I feel confident doing and that I know still challenges me in every way. It also feels good to see people I’ve treated for years pop up on my screen and smile. To see a familiar face that suddenly relaxes when they see me; feels good. Even if five minutes later they are breaking down due to the stress and mental illness. It still feels right.

I can’t describe what it means to me to be able to continue to do what I know and love day to day during a time of such uncertainty. It provides me immense stress in some ways but also is incredibly grounding in other ways.

I didn’t go into owning my own practice three years ago with the intention of facing a pandemic in 2020. But I have rolled with it. Changed and updated where I needed to. And I continue to be open to change to help my practice survive and thrive. The first two weeks were absolute panic. But now, five weeks in, this seems somewhat manageable. Most of the time. If I really think about it I can spiral into a sea of…failure, broke, homeless…and every other bottom of the barrel thought I can imagine. I try not to spiral.

COVID-19 brings incredible stress and illness everywhere it hits. Even remotely. But it continues to allow me to grow as a practitioner and also to grow as a Mom. Not many parents can say they’ve parented through a pandemic. These are strange times. When we come out on the other side we will have done something incredible.

Some day our kids will look back and, hopefully be asked along the way about being alive during a pandemic, and be able to say they don’t really remember because it just seemed like normal times other than no preschool. That is my hope for my kids.

On the periphery COVID-19 has only affirmed my belief that our President is Hitler re-incarnated. #election2020 #votelikeyourlifedependsonit

Also on the periphery is the fact that many nurses I know are furloughed. Yes furloughed. Many hospitals have cut back on nursing because outpatient clinics and surgical centers are closed. So while it appears we have a major healthcare crisis in terms of shortage of PPE and shortage of warm bodies…healthcare professionals are being furloughed.

And there is massive shortages of PPE. Local hospitals are telling staff to use gowns for multiple patients (supposed to be single patient use), and wipe down after multi-patient exposure to use again later if needed. Masks are to be used for an entire shift, sometimes entire weeks at at time, and if JACHO or DPH ever comes in and bitches about food/drink at nurses station again I’m pretty sure they will be slapped. Hard.

Regulatory bodies love to show up when nurses are breaking their rules. But when hospitals are breaking the rules, to the detriment of nurse’s health, well those regulatory bodies are just nowhere to be found.

If you thought there was a nursing shortage before the pandemic. Just wait until after. I guarantee there will be many who will leave the workforce (I know some who have already quit due to no protection) and the horror stories are out there to prevent people from wanting to join. Polices have to change to protect nurses.

Cheers to week 5.

Stay well. Stay sane.

And it’s cold here in the Northeast. It snowed. Twice this week. I’m ready for some warmth. Still going hiking. Even though it’s freaking cold. Because there is literally nothing else to do. Work. Bake. Arts & Crafts. Hike. Obsess over pandemic. Sleep. Repeat.

It’s been an eventful week. One night a drunk driver crashed through the guardrail across the street at 2:14 AM. He then proceeded to wander around our driveway, our neighbor’s yard and driveway, and tried to open our cars. I called the police. I live in the sticks. It took about 10 minutes for the police to come. The drunk guy’s friends showed up and sped off with him. The police missed them.

If I was in my hometown the police would have been there in two seconds. And I likely would have gone to high school with the responding officer. It was weird. Calling a stranger police. My wife and I also had a discussion that if we were actually in danger that was a long ten minutes to wait. Not a fan. As a result we are looking at alarm systems today.

I was about to purchase one at 3 AM the other morning, but decided to wait until daylight and after some sleep so I could think rationally. In retrospect that was a good decision.

Another night my cat ate my flowers (my wife had them delivered on the anniversary of my Dad’s death) at 4 AM and then puked.

Another night one of my kids peed the bed. Another night we found him sleepwalking in our bathroom where he peed on the floor.

So no sleep this week. And it’s Easter on Sunday. Trying to make it “normal” but also acknowledging that it will just be the four of us and so not normal.

All day with the boys. Every day. It was a year since my Dad passed on 4/6. I took the boys for a hike up by a waterfall. It was a beautiful day and thanks to the pandemic I wasn’t focused on my grief at all. More generalized anxiety due to COVID.

I made the boys masks. It’s bizarre sending my kids out with my wife to the post office (to mail masks to our friends and family who have asked for them) and having them wear masks. We’ve told them there are a lot of germs right now, and they are definitely anxious- hence the peeing I think- but we try not to emphasize the germs and illness piece. Though the masks they have to wear. It’s all bizarre.

My days are full with patients who I see remotely for at least eight hours, often straight through, then at night I make masks and try and catch some snuggle time with the boys. It’s an odd regimen. I have finished four weeks now. Four weeks of telehealth for my practice. Four weeks of making masks. Four weeks of no daycare for the boys.

For my wife it’s been three weeks of being out of work and a full time stay at home mom.

Our lives have taken on this strange rhythm. I find I like looking out my home office window and seeing the big pines sway in the wind. I like the fire going and walking downstairs and being able to hug my kids in the minute or two between patients. Then I feel angry at myself for liking any of this.

Because there is a deeper part of me that longs for our lives back. Normalcy. Going to daycare drop off. Going to my office. Running to the grocery store for a few staples. Running to the bank. Seeing friends. Playdates. Seeing my mom regularly. Going hiking with my sister and sister-in-law and niece. All of these normal, seemingly simple things, that we all took for granted.

I miss hot yoga. I don’t necessarily miss people. Naturally an introvert, I’m okay with minimal interactions. But I miss my people. I miss my friends. My family.

I have a very low no-show rate. That’s a bonus. Everyone is sitting at home. I am often their one and only “thing” to do that day. They greet me smiling and with some relief. I am still the same. I’m still somewhat snarky, I’m still very caring, I still cause their teenage kids to roll their eyes at me and I now am taking care of several parents of my teenage clients who need acute treatment for anxiety. It’s been multiple sessions when parents ask their kid to leave for a minute and they have a minute of breaking down with me, and relay their fears about COVID.

So many of my clients are afraid. Afraid of catching COVID, afraid of dying. Afraid of family members contracting COVID and dying. Afraid of not having a paycheck. Afraid of not being able to pay bills.

My Queer clients are afraid of the stories of doctors choosing who lives. They have asked, “If there is a trans person and a cis person who do you think will get the vent? If they know that I’m Queer I’ve got no chance.”

The fear and anxiety is palpable and after four weeks on quarantine it’s taking it’s toll on everyone.

I remain humbled and honored that family members of my clients feel safe with me and have asked to see me or another practitioner at my practice in these strange times. I’m lenient with the co-pays. I’m telling people I’m keeping track of who owes but if they need to wait and pay me in September they can.

I’m working late and starting early to see trans intakes and healthcare provider intakes. I’ve had far too many healthcare providers call. It’s heart wrenching. I am providing space for front line providers to talk. I hear about the conditions. I hear about the deaths. I hear about their fears for themselves and their families. They grapple with the loneliness and isolation that comes with working front lines. They can’t see their families. They haven’t been touched with affection in weeks. During the toughest months of these people’s lives they can’t hug or be hugged. 

I treasure every snuggle with my sons. I treasure every time I round a corner in our house and one of them bangs into me and wraps their arms around me. Because I see the strain in my client’s eyes, I see the bruises on their faces from the masks, and I hear their sobs as they recount their utter isolation.

The days are draining. The weeks are long. And now we are through a month.

To all the front line workers…I see you. You are incredibly brave, selfless, and it would be wrong if you didn’t have a few breakdowns during this. Please reach out for help. There are many mental health provider’s who are here for you. It hurts me in my gut to know you all are not getting hugs and affection right now. What a cruel punishment for the people who need it most. This is temporary. You will be hugged again!

To all the mental health providers seeing front line workers…keep on keeping on. This work is important. I’ve yet to meet a new client who is a healthcare provider who is anything but grateful for giving them space to grieve/feel/cry etc.

Meanwhile I will keep spending each day trying not to be come too accustomed to this life even as I find myself staring out at the pines not admitting to myself that I love the view.