“Nothing will ever be the same,” my patient said to me as we reflected on the last few months of living in a world that is facing a global pandemic. She took the words from my mouth completely.
For months I have been wondering how to process everything happening. Initially I minimized and challenged the emotions that I was having – I had not lost any income after all, I had not gotten sick or lost someone to COVID, I had not been killed because of the color of my skin.
I am a mental health professional in the healthcare field and while I have been considered “essential personnel” during COVID-19, I have not been a frontline worker like those caring directly for COVID patients in urban areas like New York City. No, I am a different kind of “essential” worker and for the longest time I questioned whether I had the right to feel how terrible I have felt during this pandemic.
Let me step back about two years.
At the start of 2019 nothing could have been harder for me than the decision I made to leave the safety of my secure & reputable job at Penn Medicine, sell our first home in Philadelphia, leave my husband there to carry on our floundering business, move into a fifth wheel RV for an indefinite amount of time with our four animals, and essentially start over in upstate New York. I took a job with a healthcare system that was still building their social work program. I was excited to be able to program and design a role in a rural healthcare office that saw huge numbers of patients on a daily basis whose care often was complicated by psychosocial factors. Yes, the job paid significantly less. Yes, the office was decorated still in the 1970s. Yes, I had no windows in my office. I was all alone. I was apart from my husband for eight months, only seeing each other on weekends until he also obtained a job and followed me to New York. Despite the seemingly downsides of my new job, I was finally able to do something I wasn’t able to do in my previous roles – have a seat at the table, create programs from scratch, see the fruit of my efforts as the program grew, and essentially be autonomous and report to myself. Not only did I have a seat at the table, I was setting the table, and inviting people to sit with me. This was a new feeling, and I liked it.
My office is now one of the largest referral sources for social work in my health system (eh hm, this translates to revenue) whereas less than two years ago they had no idea how to utilize social work services for their patients. We are now drowning in referrals, and even hired another social worker not long after I started. Myself and my co-worker provide mental health counseling to a combined 40-50 patients weekly and constantly have a waiting list, on top of addressing immediate social work needs and referrals to community resources. Our patient outcomes are positive and they are often being successfully discharged within a few months of therapy. Needless to say, I am extremely proud of what we have been able to do in my job and a lot of effort went into making it happen, as well as the emotional energy of what I was going through personally through it all. If you need a social work refresher course or more information about my credentials, let’s chat offline!
It’s important for me to lay this groundwork in the context of what is happening right now, because when I made this huge life change in 2019, it felt impossible to explain why I had to do it to our friends & family. And we received a lot of questions. Some unfriendly questions. Some point blank attacks of abandonment, actually.
All I can say to sum it up is that… we just had to do what we needed to do, even if people did not understand. Nobody knew that we had over 40k in debt from our yoga studio business. Nobody knew how it was affecting our marriage, our ability to buy groceries, or how we had maxed out credit cards to buy the essentials. We knew that in six months we were going to be sitting in a very dark place that was going to be hard to come back from. We needed a radical change before it came to that and we needed it fast. Moving to a beautiful area (hello life satisfaction!) with a low cost of living, and being able to start over was a life-changing decision. We paid half cash for our RV and put the rest on a credit card (just add it to the debt!) and we began living on about $400 a month in expenses in the RV (Erik stayed at our amazing friend Shelley’s house in the city) while we began to attack our debt. We could not have anticipated that we were making all of these changes right before a global pandemic.
It was January 4th of 2020 when my husband started his job in Ithaca, NY. He ended his time commuting back and forth from Philadelphia where he was still running our small yoga studio, and ultimately made the decision to return to the world of news to give our family more security, and start to pay down the debt mountain we had accumulated over the last five years of being self-employed. January 2020 was approximately two months before everything changed for our country and our world. I remember now a time when we were still living in the RV, when Erik said something to me about having a feeling that something big was coming. He said, “it’s going to affect the whole world.” He was having dreams about it and at the time it felt very ominous. (He’s usually right when he has these intuitions which is frustrating to no end to tell your husband he’s often right!) But all we could do was continue onward, and brace ourselves for whatever it could be.
We were so happy to finally be reunited as a family. Erik got situated in his job, and we continued to run our business from afar with a great team of teachers in Philadelphia. Not everybody understood our decision to leave Philadelphia, and it was hard to explain it in the way I hoped we would be understood, without oversharing our personal issues and financial troubles which I didn’t want others to take on as their issue for us. I quickly realized that the people that were going to “get it” with the information that was shared, were going to be the people that mattered most. I can honestly say that this was the hardest thing I’ve gone through as an adult, and I was shocked at how uncertain I felt about my place in the community as students left, friendships ended, and I wondered, Was all of this a mistake? Have I ruined everything?
We first became aware of the realities of COVID-19 as a family around late November of 2019, as Erik’s brother, wife and two sons live in Hong Kong and it was becoming very real for them at this time. We watched from afar as their city shut down, their sons started home-schooling, and they began working remotely. At this time it didn’t seem real, like something that would ever affect us in the United States. In early February I traveled to California to see my sister and her family. COVID-19 in the United States was still just a “worry” and the first case in Seattle had not yet been reported if my memory serves me correct. I came back from this trip not knowing it would be a very long time until I would be able to travel again.
On March 13th, 2020 – a Friday of course – everything began to get real on the East Coast for us in the United States. Businesses were closing, and we were bracing for directives from both Governor Wolf and Governor Cuomo that could put us all on lockdown. We were one of the first yoga studios to announce that we were closing temporarily – and not just enhancing cleaning protocols at the studio – which is what many were doing. Again in this moment, I questioned my choices. I ugly cried for a solid hour before sending the e-mail announcing our closure to our community – hoping, praying, that they would not hate me for another decision of mine that impacted everybody. We received some frustrated responses, but ultimately I was relieved by how much support we received from the community and our teachers.
I could go into more details about how COVID-19 closed our business, but the truth is that our business had been on the brink of closing for way longer than we wanted to admit. We had continued to sacrifice our personal money and kept funneling what we had in our personal accounts into the business to keep the doors open. In hindsight, I am amazed at the resilience of our marriage and how we worked through this together, and kept it going for as long as we did on my social work salary. It wasn’t easy, and other than my therapist and best friend, nobody really knew how hard it was for us. Even now after some time and space, it’s hard to put into words. Ultimately in the end we were able to negotiate with our landlord to do a payout to get out of our lease. We owed them three months in rent and this is what we paid to leave without additional penalties. We were lucky to be able to receive a 5,000 forgivable grant from the City of Philadelphia and received another federal loan to help us with our closure.
The weekend we needed to move out of the studio was less than ideal. It was the end of May, and we had to be out by the end of the month on a Sunday at 5pm. Erik had driven up on a Friday and planned to rent a U-haul, and drive it back with his brother. This was the weekend the protests started in Philadelphia in response to George Floyd’s death. Erik was unable to access a single moving van in Center City Philadelphia, and as it was one of the biggest moving weekends of the season, couldn’t secure a van anywhere in the surrounding suburbs. I was eventually able to rent a U-Haul for him from afar, but when he got to the location the truck had accidentally been given away to another customer! Ultimately, I left very early that Sunday morning with a U-Haul from our local grocery store (The “Big” M market… not so big, in tiny Ovid, NY), met the boys in Philadelphia and arrived in the city by 11AM, right before the city was locked down to outside traffic because of the protests. It was a close call to say the least and we drove back to New York the same day.
Our studio was closed and emptied, our lease was terminated, our clients and teachers were updated, and now we had to process this loss and heal from it. Again in my mind’s eye, it didn’t feel like I had the right to be upset. We in some ways had received the answer that we needed for moving on from the business, but the guilt and weight of having finally done this was not easy and will take many years to understand how it all eventually happened. Even though it was ultimately completely out of our control, I still felt responsible and thought that this was all my fault. For a few weeks I tried to keep it all together with a few Zoom Classes, and eventually realized I did not have the heart to keep teaching and wouldn’t for some time.
Since March I have been doing most of my mental health work remotely. The amount of mental health referrals I began to see trickling in for adolescents were tripling as schools went into lockdown. I couldn’t keep up, but kept trying to. My productivity numbers were well into 140% on a monthly basis, yet I felt guilty for working at home when other “essential workers” could not. I asked for help addressing referrals from my management and they said it was coming. I often had to advocate so much for myself for more support that I felt I was becoming mean – something I have a hard time reconciling with is asking for what I need unapologetically and without this extra self judgement. Meanwhile because of COVID, telehealth and working remotely, my leadership team began to develop process changes from afar. The changes were sometimes gradual and sometimes reactive and implemented right away. I began to feel frustrated that the program I had built from scratch was now being redesigned from afar by leadership that didn’t understand the culture of my office nor my patient’s needs. I even was asked to train to cover the inpatient hospital in the event of a COVID surge, while continuing to cover my own caseload.
Let’s take a quick detour from the heavy stuff that I’m unloading onto you. I work with some hilarious doctors, that on the outside you wouldn’t expect to have much personality to them (sorry guys). The truth is they are mostly older white men that began practicing medicine in the late 80s. They began this primary care practice from scratch over 30 years ago, and many of them are now retiring or have retired since I started. So I was shocked to learn about some of their traditions, the bands they played in, their dedication to having big holiday office parties, etc. At Halloween for example there is a huge costume contest between departments – and these straight-laced, highly-respected, physicians… they go all out at Halloween. The first year, I was the judge of the costume contest since I was sort of my “own” department. The office made a whole day of it, and most of the doctors stayed in costume while seeing patients. The pediatric department’s theme was Toy Story characters, the Internal Medicine doctors dressed up as characters from Willy Wonka and the Chocolate Factory and our OB team dressed up as … I can’t remember but they didn’t win! There were similar parties and traditions at Thanksgiving and Christmas. I didn’t realize how amazing these traditions and connections were even though I only experienced them over the course of one year, until there was not even a mention of any of it in 2020.
I have seen three, maybe four patients, in-person since March. I miss these connections. This is the part of patient-care I’ve always loved so much. COVID-19 not only changed everything for healthcare temporarily, but it will change healthcare permanently for so many healthcare workers. In many ways this will benefit patients that previously did not have access to services through telehealth. There were insurance and billing barriers to telehealth services being offered. Not anymore. The barriers that stood between patients and telemedicine before now seem ridiculous, considering we were able to roll out so many telehealth platforms in such a minimal amount of time. It just goes to show how resilient we all are, and able to adapt to new systems to meet the needs of our communities when in a crisis.
While I believe that the access to telemedicine should be permanent, I am so sad for what we are losing if it becomes the default or the standard, with office visits becoming less of the norm. There is just something we miss, when we are not physically with another person. We are all zoomed-out. We need a reboot. I hope that as we move forward we can have both telemedicine and those office connections and give patient’s choice of which is the better fit for them.
This brings me back to my current job, and the notion that nothing will ever be the same as my patient so aptly put it this morning. I have come to accept that the job I was hired to do, will not be the job I continue doing because of COVID, and even long after COVID is less of a concern (it may be years after all). And now I am left with feeling so much loss about the work that I put into this program, and that now someone is telling me- we’re going to do it this way now. Someone with a business degree, or health administration degree, with good intentions, who has never stepped foot in the building where I found myself again after starting over completely from scratch.
So now I have closed my small business, and I am losing the identity of the work I saw for myself and have been building on my own for so long since moving to New York.
When it comes to minimizing how this pandemic has affected me, it feels like I don’t have the “right” to be angry, to be sad, to be hurt. But I am all of these things.
I am angry at yoga, for making me feel like practice should be able to make everything better, and years of dogmatic practice, and trying to make money doing something I loved, that has left me hardly wanting to do it at all.
I am angry at social media, for making me feel like I should have been doing more, more, more, than I was already doing at the start of the pandemic. Time to devote yourself to that musical Instrument you haven’t been playing! Screw off to everyone that made anybody feel that simply noticing, bearing witness, earning income and remaining safe, was not enough during our lockdowns.
I am angry at health care systems and policy makers that are asking healthcare workers to do more with less.
And I am thinking about deleting all of this, because it just feels “too big” to put into words. How will we ever make sense of this year?
I took a break from writing this today and the way I typically write is that I bottle it up until the container (me) cannot hold it in any longer, and to make sense of all of the hurt I usually will need to get it all out at once. I don’t edit much as I write, so I’ll probably make a few updates to this over time. But during the course of my break today I had a call with someone that I supervise and we were both commiserating over our shared experience during this global pandemic that has stretched on for way longer than anybody anticipated. She said, and I will try to paraphrase accurately –
All of these things individually that we have gone through – maybe they are not so big or too much to handle. But that all of these small changes, hurts, hurdles and losses we have gone through in 2020 combined – this cumulative collection of loss is what makes all of this so hard to cope with. And this – this is trauma.
This has been a somber post with more feelings than revelations so I would like to end on a positive note. The light in all of this year has been my husband, our two dogs, three cats, and the addition of 36 chickens to our little homestead. We also became foster parents during the pandemic. I am so proud of us in many ways. We have reached new levels of communication as a couple that could only have been possible with the trials we have experienced. What we have gone through is nowhere near what others have lost. I’m working on not minimizing how this has affected me and also allowing room to recognize how lucky we have also been in all of this. Gratitude is no longer a voluntary coping skill, a suggested writing practice, or a word we toss around. It is our compass and way forward. Hope is our steering wheel.