Dr.Sana;
Its Monday morning and the Monday Blues engulf me like nothing I’ve known before. I am packing my bags for yet another week at work, trying my hardest to keep as calm as composed as I possibly can, making a mental note that I’ve completed all the necessary chores over the weekend, ensuring there are adequate supplies for my family in anxious anticipation of what may lay ahead in times of sheer doubt and uncertainty. Forlorn, fearful and heavy hearted I leave the home. It’s dim and dark, the roads are deserted, streetlights appear brighter than usual. Birds have been a constant feature in this Covid consummated commute to work – ritualistically singing the morning tunes. God, where did we go wrong, I say a silent prayer, and sense one of my eyes welling. I feel overwhelmed, almost queasy. Now somehow, I could relate what a soldier leaving for the battle field must have felt. Leaving your family behind, as you step out in the red zone. Intending to save lives. Intending to put yourself on the line to protect others. It sounded dramatic, and never in a million years I knew this would be my reality. I am not a very brave person. I could hardly take swing too fast. The ‘ self-rotating Cup’ in the local theme park being my most explicit adrenaline inducting endeavour. I was more of a curled on the sofa with Nancy Drew kind of person. I never chose army or air force. I always knew I just wasn’t brave enough. Now as I find myself hurled in and around the frontline, with scarcely any arms or ammunition, missing even the basic personal protective equipment, I think of my 2-year-old – and wonder how in the world would I muster up the courage to fight this battle, battle on the outside, and a bigger battle brewing within my own self.
This decision however hard is different, whether it’s worth it I am not sure. What I am certain of is the how desperately people need us, in times so dire like these. The 21 one-year old girl with paranoid hallucinations who has stopped taking her medication. The 56 years old immunocompromised man with panic disorder now clutching for dear life as the world around him crumbles and this time quite literally – I might possibly be their (one of the very few) last resort(s) Adam is my 7th * patient of the day (Mental Health reviews being far more elaborate, extensive and time consuming than Physical Health ones). He is worried and weary. He is 65 years old with underlying physical health co morbidities that render him vulnerable to the current pandemic. His anxiety is worse now, the feeling of impending doom- more real than ever before, sweating more severe, palpitations more persistent. Social Isolation has not been helpful to his already precarious mental health. He has not left his home since a week now; nationwide lock down meant no one has visited him either. He is unable to cope, has lost his sleep and appetite and has little hope for future, our conversation is desperate, options limited. These indeed are the most testing times in modern day history. Tedious talks of risks and vulnerabilities. Non-stop news, minute to minute coverage of chaos and calamities, a tornado of unfiltered information, facts figures and fatalities – a strange mix of social media insurgence and depleted human interactions. Indeed, man stands alone, ironically ‘isolated’ fending desperately for himself. As we whizz through hundreds of heart wrenching stories linked to the current biological apocalypse, harrowing tales from ITU, collapsing patients and dwindling staff safety and moral. This pandemic has affected patients and healthcare workers alike, this may be no less than a world war, if not worse. As Psychiatrists we are the biggest preachers of social interactions, and there is great fear, that the impact of desperate measures like Self Isolation and Social Distancing may bear dire, unprecedented consequences. Its perplexing for both, us as professionals and our patients to fathom and familiarise themselves to these changes. In recent days we have seen a commendable surge in emergency mental health referrals; and there seems to be a very obvious trigger.
Ariana is 30 years old lady with a diagnosis of Autistic Spectrum Disorder. She has also struggled with low mood since last 10 years, it was reassuring to see that she was finally managing to do well in herself after years of struggle. One of the most important aspect of her contingency management plan was maintenance of social activities and routine. Her life now was organised neatly with several weekly events – she was learning sewing at a local community centre, and attended a craft class weekly where they made cards and gifts for people in hospitals, this added purpose to Ariana’s day, she had a routine, made friends and felt valued.