Our national mental health crisis is in full display at your local Emergency Department

My wife volunteers one day a week at our local hospital’s emergency department. During the worst of the covid-19 pandemic she was told to stay home, but for the last six months or so she’s been invited back. She’s heavily gloved and double masked and of course has all her shots and boosters. She mostly cleans bays in the E.D. and tries to lower stress by offering patients snacks and drinks.

When she was allowed back there were still a lot of covid-19 cases coming in. There are procedures to isolate these patients in special rooms. My wife can’t clean these rooms. A special technician in something like a spacesuit comes in and uses a large machine to shine ultraviolet light all over the place. This kills the virus better than wiping down surfaces.

There’s still a lot of covid-19 out there, but it’s been around long enough where most cases don’t require hospitalization or a trip to the emergency room. Most days though when she is there the place is bursting to overflow. What she’s been seeing most of this year are people having mental health crises.

In better days, these people would go into a local psychiatrist ward, but there’s no beds for them; they’re all taken. So they end up in the E.D. As my wife can attest, there are a lot of mentally struggling people out there.

In a recent case she related, an adult son took his mother to the E.R. because he couldn’t deal with her craziness. He just dropped her off; his mom was their problem now. Confused and disoriented, all the bays were full so she was placed on a gurney in the E.D. hallway. She was triaged as best they could handle her, but she decided she was going home. Dressed only in a hospital gown she made a beeline for the exit to be stopped by a security guard who was hastily called in.

Most of these patients “graduate” to a hospital room. That doesn’t mean they get much in the way of treatment, at least for their medical condition, but at least they can be effectively monitored. A staff psychiatrist might come by once a day, but everyone’s waiting for some bed to open up somewhere in a facility that can treat these people. Naturally, many of these people are poor, underinsured and in some cases, even here in Massachusetts, uninsured.

Nationwide, it’s adolescents though who are disproportionately affected. Suicide is now the second cause of death among adolescents. Parents are left holding the bag trying to keep their kids functional while waiting months for a therapist, which often they cannot afford. Ending up in an E.D. is something of an act of desperation, but an E.D. visit can easily become a traumatic episode to a child who is already having problems coping with life.

It’s pretty clear that, at best, the pandemic made things worse. For many adolescents, a healthy self-image comes from relationships occurring mostly at school. That was suddenly taken away with classes held online. Making it back after months online trying to get an education didn’t help much either. It wasn’t the same. There were new protocols and masks. For many, the pandemic turned their whole lives upside down. It was a huge burden placed on all the other burdens that come with adolescence.

I might well have had a mental health crisis too when I was a teen had I gone through what teens today are going through. I suspect it would have helped that I am naturally introverted, but that doesn’t mean I don’t need some regular company other than my wife and cats. One thing I didn’t have to worry about were school shootings. Nuclear war was a theoretical but existential threat. Worrying about sudden death from some crazed gunman, largely unprotected by a society that placed the rights of gun owners over the lives of kids probably would have been enough of a trigger.

We live in a crazy, topsy turvy world now. In some ways it strikes me that it’s entirely logical that so many teenagers can’t keep it together. They face myriad stresses I never had to face. My biggest concerns were overcoming my shyness so I could get a date and pimple control.

I can keep it together today because I’m introverted and relatively isolated. I have my wife as my primary company and a supportive community of seniors nearby. I don’t have to struggle to raise a child anymore; she’s 32. I don’t have to worry about rent increases and soaring food costs. I find inflation somewhat concerning but we have the assets to see this through.

But we are the exception. Most people are struggling, anxious and nervous, and this is inculcating a general public mental health crisis. There is too much personal and global risk and it affects almost all of us. We’re becoming unmoored as a society. It seems like this mental health crisis is a harbinger.

I don’t know how my wife continues to keep volunteering at the E.D. It’s one of the last places I would volunteer. I already know that my capacity for dealing with this kind of stress is not large. She reports the staff there is stressed too and burned out. It’s been a true hell of a last few years, but emergency departments are usually challenging places to work. There’s just little to no downtime there these days.

I can already sense that regardless of how much the pandemic wanes over the next year, our local E.D. will be mostly the same a year from now, and about a third of the people in it will be trying to cope with a mental health crisis in a place not really equipped to deal with the depth and breadth of the problem.

Trapped in the Crazy Hall of Mirrors

It is true: there are days when it is better not to get out of bed. Yesterday was one of those days.

I would like to blog about things that happened in my life yesterday, but I cannot get into specifics. All I can do is synopsize how the toxic crap I endured yesterday is affecting me.

In one incident I was called to task for not communicating with someone about an important matter. Apparently, this person wanted to be regularly consulted and communicated with on this sensitive matter, but I was insufficiently skilled in reading his brain. Therefore, he is insulted and deeply hurt by my actions, said my not consulting with him was about the most egregious thing anyone had ever done to him, and he felt like cashing in his chips and going home. The good part (if there is a good part) is that he communicated this to me privately. I responded as best I could. I did not know you wanted so much information on this sensitive matter, I am sorry if I hurt you, and I hope we can move beyond it. Left unsaid were many things I would have liked to express. I was just doing my job. What I was doing was really none of your business. I am sorry you were so upset but I also know you are a Prima Donna and irreplaceable, so I must treat you with utmost respect, even though this is none of your damned business. I think you are a terrific person and I like you a whole lot, but you lost perspective on this issue. I cannot say those things.

The second issue revolved around a long-standing personal problem that increasingly feels like being in a crazy hall of mirrors. Everything is distorted and it is even hard to tell which way is up. Good is bad, bad is good, I am not sure if I am good, or evil, if I am wasting my time and my life, or if things are on the verge of resolving themselves. Suffice to say I am spending a lot of time and money trying to resolve the issue and it seems go on forever with no resolution. Yet I must remain endlessly stoic, patient and play the role of the guilty person, even though I do not feel that guilty and feel pretty darned aggrieved myself. It feels like it is reaching the theater of the absurd. One would think one set of kid gloves would be sufficient to deal with this situation, but I am not sure four or five would be enough.

One of these kinds of issues a day is more than enough; having them come back to back inside of six hours made for a nasty double whammy. Neither is likely to come to quick resolution. I would love to actually talk about them with the aggrieved parties, but I am cast in the role of submissive supplicant who must wait around until they decide to communicate. So I sit here and stew and fret and wonder why I put up with both of them. Where is the reward for doing your job to the best of your ability? Where is the reward for being endlessly patient? Why should I feel guilty for being who I am and the way I dealt with the crazy cards that I was given?

It seems the reward never comes. Therefore, I am left in an interminable state of suspended animation, frustrated, headachy, and sleeping badly. I know over this three-day weekend things will lighten up. I will probably sleep well tonight. Perhaps I will hear on one of these issues and things will be back to the status quo. Or perhaps not. Perhaps it is just that time of year for me to twist slowly in the wind. As a believer in karma, I suspect I probably deserve these things that came my way. On the other hand, maybe I am more like a rape victim who thinks they must have deserved the abuse. A part of me says what I am dealing with is ridiculous, unnecessary, unwarranted and unjust. However, as I learned Catholic guilt at a tender young age, I figure, no, it must be me. I must be a sinner. I must be a bad person. I probably deserve this.

So I will wait, cross my fingers and hope I am not too far from the exit from the crazy hall of mirrors. Given past history though I am more likely still stuck somewhere in the middle. Perhaps if I stay in it long enough, it will feel like home.

Taking Care of Business

It’s one thing to go to work to work. It’s another thing to go to work to work.

This week was a week where my team and I had to put our noses to the grindstone. Separated by geography (I have three employees here in Reston, one in Alaska, one in Oregon and one in Montana) we needed to come together in the same room at the same time and work. I wish it could have been interesting work, like designing a cool new web interface. Instead it was hard grunt work: putting together detailed project schedules that we could commit to for our projects for the remainder of the year.

It was work that we should have done about the time I arrived in February. I had no idea at the time this kind of detail was either expected or required. So we are playing catch up. It meant inhabiting a conference room from 8:30 AM until 5 PM. Everyone brought their laptop computers. We borrowed a big computer projector and threw up Microsoft Project on the big screen. And then we hashed through in laborious detail how we were going to finish our work.

Of course we had an agenda, but it was a bit too ambitious to put together plans for all our projects. So we concentrated on the ones that we had to finish or at least start this year. None of us are Microsoft Project gurus, which made the exercise frustrating at times. Meanwhile since we were all of course plugged in we were all reading our email too. The usual stream of requests kept coming in and we kept answering email and troubleshooting problems even while we hammered away at our schedules.

The pace gave us headaches. But the real headaches came when we reached those fuzzy areas that were hard to define. For example we needed to clarify a lot of requirements in a fairly short time frame with another team that likes to procrastinate. How to get them off their duffs when from their perspective we had been sitting on our duffs? Well, we had not been sitting on our duffs. We were working on things at the time that seemed a lot more important. We sent out exploratory emails wordsmithed by committee. We pondered whether we should CC certain people or not. There are lots of unwritten rules in our organization. There are lots of potential landmines. Sometimes we are criticized for not keeping people informed about what we are doing. Other times we get criticized for keeping people too well informed. We pondered the egos of various personalities who act as gatekeepers for getting our work done and tried to figure strategies that would move us forward. Only time will tell whether we read the tea leaves correctly.

The pace was frantic, the typing furious and the stress level was high. But there were other tensions. Generally my team gets along great, but there are occasional personality issues between members. I am not the most tactful person but I had to find tactful ways to move the conversation along and soothe feelings. Meanwhile I learn one of my team members is not happy in their position. The member is crucial to the success of the team so it’s not like I can just let him go. I can’t keep him and hire someone to replace him. The headache reaches the acute phase. I pop two Tylenol at lunch but the headache doesn’t recede.

I try to find some solace in the evening at home. But the headache is still there. I still feel the frantic pace of the day. The news that one of the members of my team is unhappy in their job weighs heavily on my mind because I feel in an unwinnable situation yet I am still responsible, since I am a manager. I have to figure it out. Then the phone rings.

My wife is across the Potomac River in Silver Spring, Maryland with my parents fixing their computer. My mother, age 84, has fallen in the bathroom and has hit her head. She is conscious. They call an emergency medical technician who recommends a trip to the emergency room. My wife, bless her soul, goes with them. I take my daughter to and from choir practice and fret about my Mom. I phone my sister. I send out emails to the family on the situation. I stay up late waiting for my wife to deliver more news and come home. At 10 PM she is still in the emergency room. Don’t wait up she says. Eventually I go to bed but don’t sleep well. At 1:30 I wake up and my wife is not in bed. I get worried. I can’t get back to sleep. I call her cell phone. I get voice mail. I try not to worry and to sleep but I can’t. At 3 AM she arrives home. I get the update: Mom is okay and they are back home. I manage a couple more hours of sleep but am up at 6 AM to send my daughter to school. Then it is back to the conference room for another day of schedule planning, mine-laden emails, and breaks of humor between my team to relieve the tension.

Wednesday is the night for my team to go out for dinner. Some members of the team bring family to the Italian restaurant we chose. We are very good for business: there are more than a dozen of us altogether. I order a glass of house wine. The persistent headache recedes. I am tired but the company is good. Two of my employees bring their young children with them. The babies move from lap to lap. Everyone laughs. Everyone eats a bit too much. As their leader I feel I need to say a few words so I do. I tell them truthfully that I am blessed to have such a wonderful and dedicated team. In spite of their own periodic personality quirks they are a terrific bunch of people. While few in number they are top notch. My words must have been good because they were heartfelt. I think they like me. But I beg off their plans to play pool. I head home, do my chores, crawl into bed and quickly drift off into a narcotic-like sleep.

Today at noon it was over. We put everything away. I was glad to leave early. Many on my team had a long day of flights ahead of them. I felt sorriest for poor Joe, who had to make it home all the way to Anchorage before he could crawl into bed.

But before we leave I am still not satisfied. We did a lot of work but I wished we could have done more. We are still behind the eight ball. We have our twice-weekly conference calls but this face-to-face time is very valuable and infinitely more productive. We must do this more often. We must get ahead of the planning curve. We are supposed to have plans ready by mid February for the work we want to do in 2006. So we must meet again. At least we have the freedom to choose the location. After some discussion we choose Denver. We’ll meet again there in mid January.

At home my weekend plans to be full of activities. In addition to teaching tomorrow, today was my wife’s last day at work. She is inviting her slash friends over for a party tomorrow evening, and two of them will camp out here for the weekend. It’s going to be a noisy place full of talk about the homoerotic fan fiction universe my wife inhabits. I won’t get much downtime. A long bike ride may provide some stress relief if the weather cooperates. I contemplate the mundanity of a few hours at the local Starbucks with a laptop and a wireless connection. Perhaps that is where I will find my escape … if I can squeeze in the time.