Tuesday, April 28, 2020


I've been working from home since late March--I actually self furloughed the week before my managers realized they needed to move as many of us home as they could.  The situation became untenable as I could not, in good conscience, ask my patients--many of whom have chronic physical health problems on top of their mental illness--to come to the office.  For the last week before I came home I was madly engaging in sanitation theater by wiping down the chairs and the door between patients.  But I was becoming increasingly anxious myself on public transportation and as I realized that even in a Medical Health Provider Organization my bosses were sleepwalking forward without thinking at all about our health and safety as workers.

A few days after I came home they figured it out--and to do them credit a lot had to be put in place in a short space of time. I work in a 500+ organization that provides health care and mental health services, runs group homes for the developmentally delayed, mentally ill, and addicted and which runs three clinics one of which (mine) is devoted primarily to persons living with psychotic disorders.  Now the clinics are closed and the prescribers (psychiatric nurses and doctors) and the clinicians (clinical social workers) are all working from home. We are not yet licensed to give tele therapy by Zoom so no face to face work but we are permitted to access our medical records and call our patients.

I'm busier than ever and its terrible and wonderful at the same time.  For me being able to work through this pandemic has been a saving grace, I can't imagine what I would be doing if I were just sheltering in place with no work demands.  And the work itself is very rewarding still--ridiculous, touching, powerful.  But there is no respite--not even five minutes to walk down the hall and chat with the secretaries, or as in the bad old days walk down the hall, out through the swinging doors, around to another corridor, unlock the door to our disgusting bathroom, and run back to the next patient. Instead I sit down at my desk at 8:30, review charts and make notes about who I'm going to call and the order that they are expecting the call, check email and respond to whatever crisis or hospitalization or plea for support from another provider, and then I start calling at 9:00 and finish at 5:00.  Now I take an hour break for lunch, where before I ate at my desk for 20 minutes.  That's because I'm working from home with four other people all of whom would like to be able to scamper around the first floor and eat lunch in more time than I had been giving them. I grab my lunch and retreat to my bedroom and eat in solitude while they emerge from their rooms/desks and eat lunch together.

I sometimes speak to eight or nine patients in a single day. One new intake a week.  The work feels qualitatively different because when people come to your office in a sense they have self selected for functionality.   They have chosen to come in to see me, they have gotten dressed and made it on public transportation or arranged The Ride (subsidized transportation for elderly/disabled), and they are quite triumphant and organized when they get to me.  Calling people at home is like throwing a lifeline to a drowning person--they may fight, they may be confused, they may pull you in.  I've had several sessions with people who are cowering under the blankets--I have even asked people to get into bed and pull the covers up if they sound like they are having a panic attack--It feels like a high wire act, like juggling bombs, choose your metaphor.  Absurdly, its a bit like calling my daughters when they were in college--its quite a familiar experience to have to parent at a distance and hold someone's hand over the phone.

Its fine, its all good, but the tension involved in having to switch gears so rapidly is overwhelming.  I have hard of hearing patients with trauma histories and delusional thinking (VPN communication), I have trans patients who are depressed/anxious and schizophrenic living in shelter, hiding their identity from the other shelter patients,  I have Princess Sparkle Poney who is alternately suicidal and in a rage with me and hand making me gifts;  I have patients who are depressed and delusional CEOs of failed companies, I have a guy I call Chance the Gardener who never launched but did rouse himself enough to stab a relative with a fork and throw himself in front of a train, I have Lady Job whose life history reads like outtakes from a Dennis Lehane novel, I have little Mouse woman schizophrenic woman who usually comes to my office and chooses a rock from a bowl and takes it away, I have a patient for whom I have cast out demons and prayed to Jesus.  I have about 35 patients at the moment, and one more every week, and I speak to about 26 + of them every week or otherwise touch base about the rest of them via email or conversation with other prescribers/caregivers.

I have patients who don't know what day it is and others who sit waiting for my call. Such is the uncertainty of the situation that being four minutes late for a call caused one patient to spin out and begin worrying that I had died or that the clinic had closed without informing him. I have had patients tell me not to bother calling who then call a week later asking to be put back on the schedule.  I've been fired twice by the same patient and then when I call the next week she resumes with me as though nothing happened.  I have basically taciturn, non communicative patients ask for the teletherapy session and then be floored when I point out that we need to be talking or its not much use.  One thing that I do now that is entirely new: I send cards to a lot of my patients. Just cheery notes so they have something to hang on to between sessions.  The borderline patients often have both separation anxiety and lack object permanence so they love it.  The paranoid ones love it too but they scold me, fondly, for "putting too much information into it" since they believe that their housemates are creeping into their rooms at night and reading things left out.  "But its ok" one told me, "I keep it in my pocketbook so no one else can see it, but you should really know better." [The letter had said "I look forward to our next session on ___ date."

OK, got to run, the day begins!