Exposure Therapy

High risk of exposure to the coronavirus may also cause high risk of post-traumatic stress disorder. One such individual, a nurse, provided the following insight into a typical day in an intensive care unit:

I have worked the COVID ICU for several weeks now. Here is what I have seen so far. I start my shift changing into hospital scrubs and getting my assigned PPE for the day. When you enter the ICU, all patient room doors are closed and each patient is alone in their room. The patients are all on ventilators. Because they are on ventilators, they cannot speak. Under normal circumstances, patients in the ICU can develop delirium from sensory alterations and medications used for sedation. In this delirious state, patients are at risk of injury that can result in their death. This risk is elevated by the fact that it takes me several minutes to put on all my PPE before I can come to their rescue. If a patient accidently pulled out their breathing tube, we might not be able to put it back in before they die. Because of this safety concern, all patients on a ventilator are restrained. Yes, we tie you to the bed. We don't want to do this, but if you accidently dislodge your breathing tube, it could be game over for you. My patients are so sick with this virus that our usual treatment protocols to get your oxygen level up aren't working. When this happens, we chemically paralyze you. Why? Because muscles use oxygen. If we paralyze you, you need less oxygen. When that fails, we put you on a heart lung bypass machine.
 So let's paint the picture so far... You are alone... No family, no friends. You have a rigid tube down your throat into your lungs. You cannot speak. You cannot eat. You are sedated and delirious. You are tied down and possibly paralyzed. You will have a feeding tube inserted in either your nose or mouth. You will have a urinary catheter. Many patients have persistent diarrhea and will need a rectal tube. If you have a fever, which most do, we may need to use an ice cold blanket to cool your body down to a safe level.
 Now imagine, this is your new reality for weeks. Yes, weeks. We are seeing patients on the ventilator for 2-3 weeks. Imagine this is your reality for the same amount of time we have had stay at home orders. After you fight for several weeks on a ventilator, your chance of survival is less than 20%. If you have diabetes, hypertension, cardiovascular disease, chronic renal impairment, or liver disease, your chances go down significantly.

Exposure to sources of anxiety also happens to be a form of therapy. It is a technique used to treat anxiety disorders. It is tempting to imagine whether or not that work in this case. It is more tempting to conclude that no one wins, that there is no way out.

My mentor once told me that he once faced his fear of the dark by sitting in his basement, with no lights on, until he was no longer afraid. I confess that I have taken this method to extreme lengths in my life, but I have never taken a job where it is part of the daily routine. At most, I can only respect those who are doing it right now, because I know I could not do it myself.

Anxiety is my pre-existing condition, along with bipolar disorder. These conditions have often been confused with momentary setbacks. In the era of the coronavirus, each day is now filled with symptoms that are so familiar, aren't they? Self-care is vital for all, but what about those of us who have been working hard at it, in therapy. Are we at high risk? Or are we in a rare position of leadership? We know the answer.

Coronavirus Coping Skills

My heart goes out to the mental health professionals and patients and the affect this is having on their lives. Only they may truly understand just how much this all sounds eerily familiar, while continuing to suffer symptoms once invisible to others, yet now experienced by many. It is with them in mind that I will attempt some of what I learned, to life in quarantine:

• Map it out.

There is nothing you cannot map out, nothing you cannot plan. Get the notebook, journal or piece of paper of your preference. I prefer a hardbound sketchbook with plain white paper. Only recently, there were days where my ability to record a day's events ended up being crucial in my recovery. Once I committed to writing out exactly what I was going to do the next day, or the next week, I began to make progress. Now, like everyone else, that routine has been upended. BUT, I promise you that simply mapping out your days will make them more bearable.

• Group therapy.

Are you holed up in a small space with the same people day in and day out? Welcome to group therapy! It's time you learned what you are made of. I know I did.

• Be mindful.

Mindfulness for someone like me, with bipolar disorder, puts things in order. It allows the unstable to feel more stable. Paying attention, pacing myself and taking my time. Blobs of time with countless distractions start to form a clear picture. Take a look at what you're doing. Break it down into steps. Repeat.

• Catastrophizing.

I believe this word was invented in therapy. Everyone knows what a catastrophe is. Only some of us start to see catastrophes everywhere we look. Sound familiar? There are so many places to look that are not catastrophes. You need to look in those places.

• It's not happening now. (Zen)

The word 'zen' is included in parentheses because I have used my understanding of the practice to create one of my own in the early days of this crisis. No matter what I saw or heard on the news, or from others, I would go to my window and observe. Once or twice, I went live on Facebook and began to report on the nothing I saw. I take things too far. The point is that all of it was happening but none if it was happening outside that window. Feel like the world is collapsing? Head over to the window.

• You always have tomorrow's end of the world to look forward to.

This is a daily reminder when you are in group therapy. Remember the end of the world that started you on this journey? Worry about today's. Did you have one to talk about from yesterday? Focus on the one that just happened. There will always be another one.

A Tribute to Therapists

Picture a room about the size of a doctor's waiting room. About ten people sit in a circle. All of them suffer from mental illness. Many of them have either attempted suicide or lost a loved one to it. Only a tiny percentage of their pain can be discussed in approximately two hours. It is a ring of tips of icebergs. This is a microcosm of the courage that actual people display on a daily basis. The credit I failed to give them is enormous to me now. Now, let's get to the therapist.

The therapist CHOOSES to walk into this room, day after day. He or she does this for a LIVING. Listening is a profession. Knowing what to say and when to say it is an art form. Again, this is just two hours of this person's day. Do you know what a therapist can do during a ten minute break in the middle of one of these sessions? It could be paperwork. It might be saving a life. Rest assured, he or she will be back in that room after the break. Just imagine what the rest of the day looks like. The only way I can imagine that therapists manage this is to apply the very skills taught in their groups.

Fellas, raise your hand if you fancy yourself a tough guy. Go ahead, I myself grew up on a steady diet of one-man armies, action heroes, troubled loners and other assorted alienated idols. Do you know where it got me? A seat in that room. As I began to heal, I began to realize the full scope of this profession.

Don't get me wrong. There is still work to be done. The sheer awe I am trying to express here is just a byproduct of that work. I began to see my team. That team consists of me, a psychiatrist and a therapist. My admiration for the therapist, as well as the doctor, helps me come to see my own importance in my care.

Of course, there are many others that choose to report to this environment day after day. Even the maintenance woman uses the word 'mindful' and gets down when there is a Zumba class in the morning. These folks ENJOY showing up to a place where death looms. What is sheer terror for so many, or utter misery, is merely a challenge to which years of experience and education are applied.

Therapists are unsung heroes.  What they do is also not reserved for emergencies only. Therapy is hard work. You do not have to wait for an emergency, or even a setback or rough spot. It applies to any stage in one's life or relationships. There isn't just one type, either. Visit https://www.psychologytoday.com/us/therapists to learn more.

Goodbye Rusty

Rusty does not have much longer to be with us. I have been through my own journey of understanding mortality and the value of life. All the love I could give him was given to the fullest extent every time we were together. Even that does not compare to the round the clock mothering and care given my mother, JoAnn Wilkey, or the fathering and love given by my father, Charles Wilkey. As much as I don't want any of those I love to feel pain or even cry, all is happening at least with the knowledge that everyone in Rusty's life loved him. Maggie started as a single mother of two cats. They are now like children of my own and I know she felt the same about Rusty. She hasn't stopped wishing for a dog since she met our beagle.

I fell apart when I first saw the X-ray. It came at a time of great vulnerability. But I still faced it best I could, bawled my eyes out and said my first goodbyes as soon as I led him out of the vet's office and into our van. My mother began administering the prednisone that would reduce his tumor and help him enjoy what time he had left. He has eaten all the chicken, ham, bacon and assorted treats. Each of us had the chance to take him outside and see him manage to poop and pee. He's been the best boy right to the very end.

I know that my last moments spent with him were mindful ones, with kisses and treats that I'd bought him for Christmas. Just as now I know that continued mindfulness has helped me prepare myself and my loved ones for his passing. I've applied skills learned for my own well being to the task of supporting my mother and father, encouraging them to cry and making sure that they knew that a veterinarian could be called tot he house, so they did not have to worry about any sudden emergency or how they would transport him.

I've been a good son to my parents and a good brother to my beautiful beagle, Rusty. I don't know how to bring this to an end, any more than I know how to face the end of a pet I love. All I know is that my love knows no end. In the past, our goodbyes were said at the vet's office when a pet passed. This time, some kind of service will be held and Rusty will be memorialized. I will take care of this because it is important to me to be part of this, and to make sure we all grieve and remember him properly.

Love forever and ever, to my boy Rusty.