Pandemic Shaming-- or do you just call it Corona-shaming

Here I thought I was being original. A man on telehealth worried that if he had  Covid-19 that others would think he deserved it and worse, that he had done something irresponsible, something that put not only himself but others in harms way.

Jason Gay is always funny

Being in harm's way is exactly what those on the frontlines in treatment are rightfully concerned about, or would be if they gave it any serious thought. It is a given that those of us who are not have the right to a healthy social distance from others who might harm us. The implication is that if we get the virus it is because we got too close.

Jennifer Weiner writes in the New York Times. Pandemic shaming, she says, is alive and kicking. Finger pointing is a big deal. Photos on FaceBook, videos. See? No mask. A crowd in the park.

Ms. Weiner is angry (she writes in present tense and I'm pretty sure she's over it). She notes that the anger she feels when she hears about those who put us all in harms way. They have had contact with corona-positive friends or loved ones, yet still wander out into public without a mask. George Stephanopoulos is the prime example, his wife ill with the virus, front page news, and yet he is spotted without a mask at a pharmacy. The establishment serves older people.

NPR ran a story about Brian Glazer. He's on his yacht, perhaps the size of a city neighborhood, talking about how tough it is being in isolation. I try to empathize but Brian but he probably has a bowling alley on board.

The story worked, properly shamed Mr. Glazer. He apologized for his thoughtlessness, for complaining that he can't fly wherever he wants. He has so much.

Now with the economy opening up and expectations that the numbers of cases will rise, we'll have a new phenomenon: State Shaming.

And I didn't even start with athletes shaming. Or biker shaming. Especially those who sweat.

The finger-pointing, the direct accusations about putting others at risk, this is what upsets  Ms. Weiner, and me, too. She rightly recognizes that her anger is driven by fear; it is a measure of exerting control. She credits therapy for the insight, and nicely de-stigmatizes therapy, thank you dear, in the process.

Damon Young, she writes, the author of What Doesn't Kill You Makes You Blacker, has seen his share of pandemic shaming. But it is mostly aimed at poor people, people of color.

But posting pictures of non-compliers on social media, or calling them out to their faces, is unlikely to help. It might even make things worse. And it comes with risks to groups who are already suffering more than most from the virus and its effects.

“When there’s a mandate to snitch or to shame, that’s going to disproportionately affect black people,” Mr. Young said. “When you call the police on a group of black people, you are threatening their lives.”

If there is an opportunity to point a finger at someone we want to hate, we're going to do it. Human nature, insecurity, the need to displace self-hate and fear, to fop it onto another, schadenfreude, these are the things we contend with on any typical day. Some are vigilant, on the hunt for another good reason to hate (with self-righteousness to go). Party time on social media.

Try being in Germany in the late 30's and early 40's. The Nazi's had a field day.

But back to being a patient who fears getting sick because of the fear of blame, for causing it somehow.  Mind-blowing that this should even be a thing, a fear, but it is. For some people, having the virus triggers shame for having done something wrong, perhaps going to buy groceries-- even with a mask-- and being outed for it. It is a raw feeling irrationally associated with innocent behavior. The patient feels more at risk of social castigation than death from the virus. These types of patients are the first to keep their distance, the first to disinfect.

Many of you remember when the word "cancer" had to be whispered or never mentioned at all.

Shaming is another way of making people feel good by putting someone else down.  It reminds me of an old Bob and Ray joke. One of the two would say in all earnestness,

"I like to bring myself up by putting other people down."

This always makes me laugh because it is so true of so many, many people.

Parents do it, shame their children. The point is that the kids will refrain from whatever it is that they are doing that is bad (hands in the pants, among other serious crimes). It works if the child is young enough, but adds baggage to the rest of their lives. They come to therapy with guilt for wanting to punch someone in the face.

A word about anger

Anger isn't a bad thing.  Anger is normal. It is violence that is bad.  

We might say that shaming out of anger on social media is a type of verbal and emotional violence. 

As I said to the patient, as I have said to dozens over the years:

If anyone ever does that to you, shames you--about anything--which is unlikely because you are the nicest, most empathetic person on the planet-- consider the source. Then feel pity. If you must respond try something along these lines:

I feel sorry for you. I really do. And walk away. Or simply, Must be hard to be you. 

Because most of the time if you call someone out on something that person will lash back at you in response, not cower. (Think about your own response to the driver of the car behind you, honking. It is a reflexive hand gesture). Nothing to be gained from this.

 The shame is in the shaming. Just this therapist's humble opinion.

therapydoc

Why We Aren't Sleeping

I apologize. I was obviously tired when I wrote this (so says FD). There's no mention of our limbic systems or reticular formations, or that many people actually sleep better on a full belly. But there's not time to edit it now. He tells me it will sing to some of you.

We're not feeling great in the morning, many of us, not sleeping so well at night. What's going on?

Aside from the obvious. 

The answer is multi-factorial. (There are many reasons). Let's dive right in because the obvious doesn't explain much. We need the commentary.

1. Work
If we're lucky enough to still have a job then working from home is essentially like working on another planet. Another planet that feels very familiar. Yet the shift of venue demands cutting new paths in the brain to adjust to an ever-changing environment. Outside in the workplace, despite perks like a yoga room or snack station, it can be ho-hum in that even the surprises are expected. It is as home used to be. These WFH (work from home) environmental changes are a new  paradigm, and new paradigms, revolutionary, stimulate. 

2. Furloughed/ lost job
On the other hand, if we have lost our job, there's the fear of never finding one. Also stimulating. Terrifying. The only difference there's so much company in this place that humiliation isn't associated with that anymore.

3. Annihilation anxiety
No matter if we have jobs or not, during discretionary hours there's always been the option of staying home or leaving home. No more. Leaving our comfort zone is laced with decisions and fear, or should be, and fear is stimulating. We don't sleep well under fear. It is called annihilation anxiety.

Oh! But you're not afraid. So you think, grasshopper. Enjoy. 

ANALYSIS of ABOVE/ ARMCHAIR PSYCHOLOGY:  That running program, let's call it the Must Protect program (MPP), demands attention, perhaps more than any video game (pick your addiction). The MPP Start button is activated as soon as we prepare to leave our homes. Where's my mask. Do I need a new mask. Can I even touch this mask. I just work it a few hours ago. Do I have my supplies: Purell in the pocket, disinfectant wipes for doors, grocery carts. Must I swipe the doorknob of my car? I must consider these things. 

Once activated, the MPP runs through the body as we move about the cabin, whatever cabin we visit, even the great outdoors. We're suspicious of a passing jogger who has no mask. What's wrong with him? I wish he were dead. 

Now. Do such thoughts and activities affect sleep 8-10 hours later? Maybe yes. No matter how sedating our shows, no matter how funny the memes, it takes energy to attend to them, to consume, and there's even more energy generated by some. Have we put all that to bed? Everything pounding our eyes, ears, even our noses distills to energy. 

And our mouths, dear G-d, our mouths. Let us continue.

4.  The food/exercise equation
Most of us complain that we are not exercising like before, and this is the problem. 

(You're thinking: Why did I never build a swimming pool in the back yard? Now I'll never have the money to do that, not that I ever did). 

Not exercising means changing eating habits-- but that's impossible, or let's say, really hard. If we could do that we'd weigh a zillion pounds less, probably a trillion. We're throwing around numbers differently these days due to the stimulus package. How will that affect our economy? Let's worry about that, too. 

But back to food and exercise. What we need to keep our current weight, calorie-wise, is an equal balance of calories in, calories out. What we take in, what we use. 

Consider: When we take in more than what we use the left-over calories have feelings. They want to be used and they are angry. Fine, that's a stretch. But it is not a stretch to say that they're just hanging around in our bodies. Before we swallow, potential energy. After, there's no limit to that potential  

So these buddies of ours, our calories, are chomping at the bit to be used. Yet we aren't cooperating. We refuse to use them. The exceptions? Worrying, sedentary work (brain), or watching. All imply brain activity. They work anyway. 

Food is digested and energy released, busy finding places to go. If the muscles aren't busy they find a marvelous home in our heads telling us: Stay awake. Pay attention to me

With so much food, so little exercise relative to that, how can a person get any sleep at all? 

5. The new reality
Let's not forget our new reality, the many casualties of war brought to us by whatever news source we prefer. This is a war against disease and deterioration, one that usually is fought in the laboratories of our friends, the scientists. 

The grieving for casualties is exhausting with endless possibilities, ramifications, thoughts about ourselves and those dear to us (scary stuff). Depression, sadness is exhausting. Throw this into the mix. The entire gestalt of 50,000 deaths just in the United States (at this writing) and a feeling person has to feel it. We mourn vicariously. Who hasn't lost someone, or heard of a loss in their community?  

The Zoom funerals, I've been to two, yes this is about me, so intense. A handful of mourners. No one can shovel dirt on the grave. A tractor does all of the work. A tulip in the coffin.

The reality of death is grievous and terrifying and although we defend very nicely on an ordinary day with our humor and our song covers, defending against anxiety--  hey even I wrote one at the very beginning of all of this-- it is still a fact that millions of people are sick and thousands are dying, and as we are reminded by the World Health Organization: It is not over. 

6. Reopening 

People worry, whether they admit it or not, that reopening the economy is going to lead to a corona revival. That is worrisome, too. Our MPP (Must Protect Program, remember?) is activated. Our automatic defenses, the ones that never stop working, even when we think they have, even when we're getting ready to lie down to sleep, operate at full strength. 

Hearing about reopening and resurgence alone-- just hearing about it--  activates the Start button. 

Once again we look our mortality in the face. This is anticipatory anxiety, mother of them all, at its very best. 

7. Body rhythms

There's one more thing, something else that is relevant to the conversation, although we hinted at it earlier when we spoke of working from home, being at home, that ever-changing ecology.  

And that is that for most of us, our lifestyles truly have changed. We aren’t required to clock in at work at a certain time. Our appointments aren't in the flesh. We don't have to wear heels. We don't have a commute. In many ways this is far more healthy and far more normal . Think about it.

In many countries, especially those with intense mid-day sun much of the year, the weather commands a mid-day shut-down. The 2-5 pm siesta is the norm, or it used to be. There's a nap. People take one and don't feel guilty. Linner (lunch-dinner) is before or after.  Then the shops reopen, the malls fill up. Back to work.

Western nations eschew this as unproductive and a waste of time. The go-getter mentality that we associate with America isn’t, or didn't used to be thing in such countries, and it is why, according to the American work-ethos, the American economy thrived, prevailed over all others. 

That may be a be a thing of the past, that siesta,that shut-down, I’m not sure. But even if it is, consider that this is a less stressful lifestyle. The mental set associated with that changes bio-rhythms. People rest. The brain shuts down out of habit. 

PollyAnn-ish, probably, maybe untrue, women surely still second shifted. 

To bring it home, sum it all up, we all have bio-rhythms. 

Those of us who never had sleep problems in the past, who once shut down at around the same time, say 11 PM or even 4 PM for the sundowners are responding to their biorhythms. Our biology lets us sleep a solid 5-7 hours or more. 

Under stress, even before Covid-19 and the uptick in cortisol,  sleep is  interrupted, a problem under stress. We judge it as a problem. We can't function the next day, or so we think. 

In therapy we would discuss it, all of the stress, all of the things that buzz through the brain, and aside from venting, work at relaxation strategies. Breathing is the winner. You still breathe when you lie down to go to sleep. So focusing there is advised (see a recent previous post). It is very hard, but helps. 

Therapy addresses early awakening, too. Up at 3 or 4 AM? The recommendation: Don't give in and get up so fast, give it a half hour and DON'T check the clock. Watch the breath. If this isn't working, don't dwell on thoughts, do something, anything. Get up, drink a beverage without calories or caffeine. Be productive. If jet lag doesn't set in after a few hours begin your day and push through it. Whenever that feeling of inevitable sleep hits, give in. Disappear.

If at all possible. Make excuses. Take an hour and sleep. Set an alarm. 

In the process, especially when sleep is elusive, try not to judge it as a bad thing. Not judging is very Zen and it is crucial now. 

It also means no judging the nap. The nap is the bomb. The nap is life-saving, crazy-smashing. You've heard the expression that quarantine is crazy-making? The nap serves as the opposite when we are sleep-deprived.

And then there's the signature therapydoc recommendation, 
which would be that when you do nap, when you take that nap, if at all possible, do it with someone you love.

therapydoc

The Honeymoon is Over

While the last few weeks have been challenging, the visible among us rise to the challenge of isolation. We're using social media (I restarted my FaceBook account!). We want to check in on friends and family, really want to, as opposed to feeling that we must. Some of us are soothing our lonely souls with stabs at painting, reading, praying, and playing-- either solitaire, video or board games. What puzzle are you doing? Let me show you mine! All done. 

And yet, the honeymoon is definitely over. The most patient among us is feeling either claustrophobic or crowded, out of sorts, at least once or twice a day. even more than we do working outside the home. 

Your therapist will tell you that your mood ebbs and flows as the day wears on without isolation. Nobody isn't cranky sometimes. 

That over-crowded feeling is leading to arguments. I'm hearing about really explosions. The kids are scared. Tensions are boiling over. Consider yourself lucky if your quarantine relationships are in better shape. But people lose it. If they're healthy they apologize, work it out. 

But hey, that's my clinical population. The truly dysfunctional relationships aren't rising to the occasion. And we're hearing that domestic violence is skyrocketing, and marital sexual assaults are on the rise. No place to go to escape.

We'll look at one type of social dysfunction in this post: The Over-adequate Under-adequate Relationship

In this model someone is sick, either has a physical, mental, or behavioral disorder that sucks the air out of the room for the other(s). To be fair, attention is inevitably on a person who is sick-- it has to be. Nobody wants to ignore the needs of a helpless individual. When there's love and understanding, patience, and especially experience in care-giving or health care, the stress is less of a problem.* It is only dysfunctional when there are systemic issues going on. I.e., the one in the sick role

 (1) the 'helpless' partner, is liking it and isn't doing much to be less so.  Or

(2)  the helpers won't let the sick person do more, when he could. That could be for a variety of reasons, such as the fear that the condition will worsen. But also,

(3) it feels good to be a helper. It raises self esteem knowing we're helping someone who needs the help. Yet you can see how that need for an ego boost isn't helpful for a person who wants to flex a few of her under-employed muscles. 

Then there's another creepy reason, which is that

(4) having a sick person stay sick legitimizes avoiding avoidance. We can't . . . you know. 

No, not a thorough discussion but add your own thoughts by all means, in the comments. They are undoubtedly correct. 

And guess what? We're all in the inadequate role now! We're all being told to stay home, get help with the groceries if you can. If at all possible, for crying out loud Stay home! Don't go here, don't go there, don't do this, don't do that. 

Some of us rise can't take it and are going out anyway. Our self, the independent individual that we have become, needs air. And we wonder, how crazy are we, taking the chance of infecting someone else or being infected. Who me? 

Having our arms tied, legs shackled, we're rising to a new level of empathy, the feeling of what it's like to truly be sick, too weak to go out, that feeling we have when we're stuck in a hospital, for whatever reason, for having a baby on a sunny day.  

Back to the OA-UA

In this classic dysfunctional relationship someone is well and someone else is not. The well person can do more and usually does. The sick person does less-- she is under-adequate. Her partner (or child) does more, compensates, relates as over-adequate relationship. 

The therapy is always to get the over-adequate to do less, the under-adequate to do more. It's more complicated, but that helps.

Now we're all theoretically under-adequate, ordering fruits and vegetables to be delivered, doing as little as possible outside our four walls. This upsets the entire homeostasis we've been talking about.

TWO EXAMPLES

(A) Say it is the young adult in the family who always makes the beer run to the fridge for the adult alcoholic. The child is already over-adequate, a parental child we say. But she has enabled since the dawning realization that this behavior, getting daddy a beer from the fridge while he watches TV is rewarding. There's secondary gain, his love and admiration. 

How does that work when she can't get him a beer, when there is no more beer? He may not be as nice. She may be confused and have to re-examine the relationship. That could be good for her, or alternatively, the relationship might become even more dysfunctional. She may spend an inordinate amount of time trying to make her father happy, land in an even more co-dependent role.  

Or 

(B) What happens when the one in the sick role wants to raise the level of corona awareness with the one who is usually healthy, but incurably carefree? The sick partner pounds the healthy partner with instructions on mask-making, how many feet he must stay away from others, and wiping down his shopping cart with alcohol swabs. Will the "healthy" one not lose his cool? Will it become a horrible argument? Of course it will. This won't go over well, the sick telling the healthy what to do. It just feels wrong.

Suffice it to say that in a clinical population upsets like these aren't unusual. Now, more than ever before, they are what no one needs or wants. There is nowhere to go to cool down. Domestic violence is rising in these troubled times, as is marital sexual violence.  

 So much depends upon the relationship, right? In the above dysfunctional OA-UA relationship model  the therapy is about inching toward the center. The OA, the over-adequate partner, gives over some of the work to the UA, the under-adequate partner, who is to do more. They listen to the complaints of one-another and delve into the origins of learned dependency. Support, trust, and validation rule. This is not the time for criticism. 

Success depends upon tone, the process of expressing wants and needs, validation. 

We could say, as we did at the start of this post, that truly dysfunction families will still be dysfunctional in a crisis; the more things change, the more they stay the same. Or we use this as an opportunity to change them.

Yes, let's do that. 

therapydoc

*Watch Zoey's Extraordinary Playlist to see how that's done. You'll need insulin, but it's okay.

Empty Spaces

FD is a doctor and when he tells me, it's okay, we can go out on the trails and ride, I take it as the word of the Old Mighty and fill up my tires.

The New York Times has a recent feature, Empty Places, I think it's called. There's also a place there with only stories, most pre-quarantine, but not pre-diagnosis. 

Here are mine. If you're from Chicago, you'll recognize them. It is truly eery, seeing so many empty places.

Von Steuben High School, empty

The river trail, Chicago

River trail, Chicago

Northeastern University, empty

Paranoia, schizophrenia, and shaking delusions

It can't all be about Covid-19.

The marvelous thing about being mentally ill is that you're oblivious to the news that affects everyone else. The thoughts and pictures in your head that have always been the enemy continue to be the enemy. So if you suffer from ideas of reference, if you believe that when you bring your phone to therapy that your neighbor will be able to listen in, well, you take the battery out of the phone. Merely turning it off isn't enough.

Is it even worth it to relieve people of their delusions? Won't they be replaced with others?

Not always.

This is such a lovely case that I can't help but share it. Details are changed to protect the identity of the patient.

The story:

He comes to me originally to diagnose what is wrong with him. He has noticed that he may have high functioning autism. He gets most of his news on YouTube.  A brilliant man, but entirely unable to function socially, the diagnosis makes sense. His psychiatrist treats him for bi-polar disorder, has not caught onto what we used to call Asperger's.

I don't even have to test him, can confirm from his oral history that he's not able to absorb social cues, that he can't put together the meaning of silence, when it is full of anger or merely just silence. To him it is angry. He thinks in pictures. He is always, always in need of direction, has no idea what to do, when. Misinterpretations abound, dominate.

Upon further examination, it is quite obvious that he has severe paranoia, and maybe that is the primary diagnosis. Maybe is is bi-polar, but maybe, more likely, a simple paranoid disorder. He doesn't hear voices or see things that aren't there. Nobody is telling him to do anything. He infers it all. (These are called ideas of reference). They, J. Q. Public, are out to make him miserable. The average man on the street wants to harass him. Even people in my waiting room-- when they gesture, it is about him.

You see, there is so much more that telling some people, It's not about you. Most of us get that. Some of us don't.

How to treat it? Not easy, especially if the patient is not taking the meds prescribed by the doctor for crippling anxiety. They make him feel stoned, tired, and dead. He'd prefer his anxiety, his sleeplessness any day.  And anyway. He sleeps.

We went with breathing, centering him on that. Nothing else exists, only the breath. Watch that, not your thoughts. Do not give them power. Do not show them you care. Be the Buddha, stronger, implacable. Indestructible. Above them.

Especially hard for someone like him, but doable. And if he can do it, we all can.

therapydoc

Part Four: Universal coping strategies from another country, Covid-19

My cousin and favorite rabbi/psychologist Dr. Peter Rosenzweig sent me this to post. He lives in Israel now where the virus is keeping everyone home, too.  Thank you Peter. Smiley face, hearts and all that to you and my wonderful cousin.
Here goes:

A mental health primer-for a pandemic

Understanding some basic facts about mental health is useful when we are all under such duress. As with improving physical health, our mental health can also be strengthened. Let’s divide this idea into two parts.

Part one: fear & stress

The current situation brings home how little is truly under our control. At times like this, it is helpful to have as much clarity as we can about what is given to us to do, and what is not. Often, when we are able to decide that certain things are not given to us to do, this allows us to ease expectations. This small step, can lower high stress to a level that is less emotionally taxing.

On this note, we should expect to be shaken by “fear thoughts”. Like a pulse or heartbeat, these thoughts, however uncomfortable, let us know that our instinct to survive is “operational”.

How we deal with fearful thoughts is part of the “abc”s of mental health. It is good practice to note the fear and to then let it go. This means employing distraction, or utilizing exercise or meditation to calm ourselves. A more relaxed body will often ease the mind. The goal is to avoid allowing a “first fear” thought to induce an ongoing state of fearfulness and alarm.

A state of alarm often produces moments of panic. Panic differs from fearful thoughts because it triggers the natural flow of adrenalin. This event shifts what began as a thought, into a physical change. Prolonged states of panic, lead to a state of “depletion”. This resembles the exhaustion athletes may experience at the conclusion of a hard fought game. Since the experience of depletion can feel the same as depression, it is useful to be able to distinguish one from the other.

Part two: sadness and depression

Just as we should not be surprised to have fearful or morbid thoughts, we can also expect to feel sad. On some level, we have all lost some part of what our lives looked like prior to the outbreak of this pandemic. Feeling loss and sadness allows us to grieve. Although no one enjoys grief, the ability to grieve losses is a cornerstone of mental health.

Whereas “clinical depression” is a psychiatric problem that is eased by medication, grief-related sadness typically cycles through when we are able to identify and accept the loss for what it is. A shift from grief to gratitude for what we are able to maintain, is a basic part of practicing good mental health.

Lastly, being able to help others is a valuable human capability. It is also a reliable mood changer. The experience of actually helping another person is a useful way to manage the feelings of helplessness that are part of contending with this pandemic.

Snapshots: Corona

Remember this feature, Snapshots? 
I don't, not well, but somehow remember that it was a feature of this blog. 

So here goes. This will be quick. Just two stories, never happened, entirely made up.  

(1) A New Meaning to Vulnerability

After seeing a few patients face to face in the office last Monday, I knew it had to end. It's just a bad idea. It was fortuitous, too, getting an email that afternoon from the academic institution that keeps me on as an associate research professor. The email tells me that Blue Cross Blue Shield is now paying for phone and video-chat visits. Bill and use the usual codes. Don't abandon your patients in these difficult times! 

I forward it to a few colleagues. It's about time, we all grumble. Getting paid for virtual sessions had seemed an impossibility only a few weeks ago. It takes a plague.

So I send texts to patients: Call me. FaceTime me. Use WhatsApp, Zoom. I don't care. But don't come in.

They're fine with this, except for those who do not trust the airwaves.

Then I get an unexpected response.

"I'm sitting in my car sobbing. I just spoke to my doctor. Yes. Yes, call me on Wednesday."

JUST SAW THE DOCTOR AND HE'S SOBBING?

This is not a woman known for sobbing. Naturally I cannot wait and call her immediately but she doesn't pick up. I text and give her a time today. My four pm has cancelled. She texts back. "That works. Thank you."

This is a physically challenged person. On an average day she suffers, really suffers. It is hard to be her, and my personal feelings, like those I have for most established patients, are almost raw, so deeply caring whenever I think about what she's gone through. And she's young. To think that she might have coronavirus terrifies me. Could she beat that too?

We talk. She's fine. She wasn't, but now she is. She was upset because the doctor ordered her to be in quarantine, and she runs a huge  business, hundreds depend upon her to be there, to make decisions. And there will be the layoffs.

Not everyone, at that point, had to self-quarantine, and those of us who can work at home did that. But not everyone can just stay home.  She is freaked about the business, that it will tank.

And all I can think is: Dude, I've already been to your funeral. More than once. You will recover financially, Please G-d. Stay away from people. That's the only advice I have in the moment: self-isolate. Please. Just stay away from people. And breathe.

(1) Why Sometimes I Think I Married a Crazy Person

It is Shabbas, so we don't use the phone. But FD is a doctor and there is no Shabbas for him, he's exempt from Jewish laws. Saving lives is much more important, according to our rabbis.

We have finished eating a late lunch and are clearing the table. He's paged and walks away to make a call. He returns with his hat on his head.

"I have to take a little walk."

"Where are you going?"

"I have to see a patient."

"Why?"

"I have to tell him some news."

"Can't it wait until after Shabbas?"

No.

Understand. I am not a dependent, needy spouse who can't be alone. I like to be alone. We're together enough. We're apart enough. This isn't about me cramping his style.

"It can't wait."

"Why?"

"I have to deliver some bad news."

"Why can't you do it on the phone?"

"He won't answer the phone. It's Shabbas."

"Right. But why can't it wait."

"He tested positive for Covid-19."

Short pause.

"Who is it?" (not that he would tell me, but a girl can try)

"You don't know him."

"You are not going there."

"I have to go."

"You are not going inside that house!"

"I won't go inside the house."

"You promise?"

"I promise."

"You're crazy. Don't you dare go into that house."

It is bad enough, I tell him, that he tests these people. It is bad enough that he hasn't retired, left this practice. But he leaves to see a man and tell him that although he seems healthy, that he has coronavirus, Corona-19.

Did you know that there are several types of coronavirus? This is why they call it 19, because it presented in 2019. About six weeks ago FD had a case of a different coronavirus. That patient was very sick, too, hospitalized. FD started to cough, sure that he probably caught it. I kept my distance. His case, if it was corona, was very mild. Are we having fun yet?

He returns in a half hour to tell me they spoke through the screen door, glass in lieu of screens. We live in Chicago. It is still cold. Yesterday the temps were in the 20's.

I look deeply into FD's eyes. Because he cares about them, too. He cares about his patients, too. And there are times, there really are some people, who can't do it by phone.

therapydoc