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Update from the Homefront


I chose today to work from home.  Typically I am going in to have meetings, pass out candy to residents, and other tasks VITAL to the coronavirus effort.  I'm trying to stay home one day per week in solidarity with all of you who are staying home.  It is not easy to stay focused with the distractions of being at home.  I am lucky to have a nanny who goes through school lessons with my kids - a lot of our colleagues are not so lucky.


DH is continuing to plan for the surge.  I don't have a sense as to when it will hit us.  Other, larger institutions are making predictions - UCSF believes they will see a surge in two weeks.  Washington, DC thinks their surge will hit in early May. 


One of my key missions in planning for the surge is to make sure the work YOU are asked to do is manageable.  Today, I spent some time talking with a friend in the navy, currently stationed at Walter Reed.  We spoke how the military prevents exhaustion and burnout during deployment on submarines (she said that deployment to Afghanistan was too low intensity to be compared to what we might be facing).  One day off in seven is critical.  If working six days per week, shifts no longer than 12 hours are important.  Aiming for working two weeks at a high-intensity level, then having a week off is optimal.  I am a big fan of NOT reinventing the wheel - so understanding this will help as we think about how many patients we can care for safely given our numbers.  I remain committed to the idea that we do not work without PPE.  


I received resources for cultivating and conserving wellness in the Covid-19 era.  I'm going to be doling them out throughout the next week - see some are below.


Covid resource: this site is being updated by the folks at BWH with daily update on everything related to COVID management. There are some one page guides as well as more detailed stuff related to inpatient management, ICU care, as well as links to the most recent evidence that’s coming out.


Home Exercise Resources:

  • Peloton: use of app extended to 90 days (usually 14 days)—it’s amazing, you can use on treadmill, outdoor runs, bike, lots of floor exercise, yoga and meditation
  • Pure Barre on Demand: 60-day free trial (usually 30 days), click on 30-day trial, use promo code EXTENDEDTRIAL and trial will go to 60 days and $0
  • Free Barre Fitness Classes: links to YouTube videos
  • Daily Burn: 30-day free streaming trial

An Essay:

Earlier this week, a group of conservative Hindus in New Delhi took part in a communal ceremony where everyone drank a glass full of cow’s urine. Their hope was that this would serve as a prophylactic against the corona virus infection. In Istanbul, a Muslim cleric declared that he held a detailed conversation with the virus during which he prohibited it to enter Turkey. Lest these outlandish gestures be seen as restricted to exotic locales, one needs be reminded that many people in our own nation hold the belief that the viral pandemic is essentially a biological warfare unleashed upon the world by the government of China.

The emergence and mindless acceptance of such childish fantasies should, however, not be surprising. We are all frightened and vulnerable to magical thinking as we face an invisible, life-threatening enemy. The human mind, under such circumstances, desperately tries to avoid feeling helpless, seeks a ‘rationale’ for what is happening, and wants instant remedies to reverse the course of events.

It seems much healthier, even though difficult, to bear the anxiety aroused by the current threat, and resist the temptations of blaming others (‘they are responsible for it’), self-pity (‘first I lost my parents during childhood and now I have to go through this’), foolhardy denial of fear (‘I am young and healthy and will not get infected’) , or worse, sadistic glee (‘good that people are dying – maybe they deserve it’). But the question is how to avoid these morbid pathways? How to stay balanced in such scary times?

My 50 years of experience in the practice of psychiatry and psychoanalysis, has led me to conclude that the following measures might be of considerable help in staying calm under these trying circumstances.

• DEPLOY all possible preventive measures against this infection that are suggested by scientific organizations and Federal and State governments. This will not only enhance the chances of avoiding the infection but also will mobilize a sense of group loyalty, something that invariably makes us stronger in difficult times.

• DISTILL the quantity and quality of information you expose yourself to during any given day. It is good to be informed but undesirable to allow oneself to be overwhelmed. Thus, it is preferable to read the websites of CDC (the highly respected Center for Disease Control) or the National Institute for the Study of Infectious diseases, or the Johns Hopkins Medical School than to roam over the internet and collect ‘data’ from random and obscure websites.

• DE-PATHOLOGIZE your concerns. The emotional distress you might be feeling these days is not a psychiatric disorder. It is what Freud called ‘automatic anxiety’ or an uncomfortable feeling that follows from too much frightening stimulation. Your fears are not phobias. In fact, the absence of fear is more likely to be problematic. And, this might sound like an outrageous irony but I do suggest that you relax and let yourself be anxious!

• DISTINGUISH ‘physical distancing’ from ‘social distancing’. I am thankful to my daughter who underscored the necessity of making this distinction. She astutely put her finger on a crucial issue here: yes, we need to avoid too much proximity and close physical contact with others to diminish the chances of catching or spreading the infection. But this must not be mistaken for ‘social distancing’ which would leave us isolated and prone to disturbing fantasies. Thankfully the availability of social media makes it possible to retain all but physical contact with loved others. And, even when such ‘Neo-instruments’ of living are not handy, there is always the good old telephone.

• DIRECT some of your attention to matters other than the current public health crisis. Work from home. Take care of the clutter around you. If you live with others, play with them, cook with them, dance with them. This will restore vitality, enrich family bonds, and bring joy to all. If, for one or the other reason, you live alone, make phone calls, watch television, and sing to yourself. The psychoanalyst, Gilbert Rose, points out that singing divides us into two people: the singer and the listener. And this dramatically reduces the sense of loneliness.   -Salman Akhtar, MD Professor of Psychiatry, Thomas Jefferson University

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