No one listens, learns, or changes their mind when they are being attacked. As healers, we know this. We deal with patients and families all the time who don’t understand or are so traumatized that the last thing we would think of doing is yelling at them as we try to help them on their journey to health.
I totally agree that, as an adult, if you want to not wear a seatbelt, you have that right. But you don’t have the right to drive drunk and kill or injure someone else. If you want to drive 80 miles an hour on your ranch and ignore safety, go for it! But if you want to speed and run stop signs on our shared roads, that’s not ok. Why? Because the person you hit with your car could be a family member or friend… and they will unquestionably be a neighbor (because we are all neighbors).
Masks are about compassion.
If you come down with COVID19, it’s also not just about you. If you do get sick with COVID19 (and I hope you don’t), it’s not about “getting over it” like a cold. You could have a lifetime of consequences… but if it was just about you, that would be your choice. But that’s not how this works. If you are COVID19 positive (with or without symptoms), you can infect your elderly family member, the kid next door who is on chemotherapy for cancer, the nurse who takes care of you when you go, frightened and alone (since no one will be allowed to stay with you), to the hospital.
Since my new friend on Twitter asked me about the science, I’m happy to help with some of what we know:
p.s. I changed how I interact with folks on social media after I listened to Nadia Bolz Weber’s interview with Megan Phelps-Roper on her podcast, The Confessional. Megan Phelps-Roper was a member of the Westboro Baptist Church who became the voice of her family on Twitter, spreading their particularly venomous message. But a funny thing happened … there were people on Twitter who, instead of yelling at her, responded to her venom with compassion and curiosity… and it changed her life.
It’s almost impossible during times of stress to be motivated to do hard things. For all but the most hardcore exercisers, ice cream just seems more soothing than running when you are emotionally exhausted (Right?). I’m no different. But, as much as I would like to think “later” will be ok to regain what I have lost in these months of being more sedentary than usual, I have begun to realize that I needed to get moving again.
Enter Richard Rohr
I’ve been a fan of Richard Rohr for years. He’s a gifted writer with the laugh and smiling eyes of someone who has tapped into something I want to know more about. I subscribe to his weekly email, which this week introduced Jonathan Stall’s practice of moving “as a way to invite brave creativity.”
There is a lot to unpack in that idea.
What exactly would “brave creativity” look like? I’m not sure, but it sounded like something I, and I suspect all of us, need more of right now.
“We invite you, as able, to take some time this weekend to move mindfully through your local area.”
I set off on a different kind of walk.
I grabbed my mask and headed out for a walk in my neighborhood, trying to think about this not just as exercise, but as something more. I read Jonathan Stall’s advice again:
Bring something to jot ideas down while you are out, but more importantly, invite your “goals/pains/dreams” to join you on this walk.
Walk for at least 30-40 minutes
Wear a mask if you get within 6-10 feet of anyone (respect for your neighbor)
Start the walk with a sense of being open. “As you begin to move, seek the realms of wonder, of space, and of reaching high into what’s possible…”
Where did all these lawn chairs come from?
I’ve walked many times before in my neighborhood, and I’m an observant person. But today, as I walked, I began to notice all the chairs on people’s lawns and all the swings, and “tires” hanging from trees.
Were they always here and I didn’t notice them?
Are more people sitting outside now than before – even though it’s outrageously hot here in August?
Is this because of how much we all need (safe) connection to each other during the time of pandemic?
Are there actually more chairs, swings and tires because of how much we all need to hear birds, see trees and listen to the cicadas in the summer evening right now?
Yes, there will be next steps. This experiment led me to more questions than answers, but I had a real a sense of being taught, too.
As a former Program Director, I couldn’t help but imagine the conversations that occurred after this event…
After “WHAT WERE YOU THINKING?????” – which would have probably been my first sentence – I would have been upset, but I also would have realized that these residents were meeting in the way that residents and students have met forever. They were having a goodbye party for people who were leaving. Probably not outside, and probably not socially distanced, judging by the outcome, but I totally get it.
But the consequences of a casual party like this are real and it’s worth thinking about this by asking three questions…
1. What are the chances you’ll get infected at a party?
This one is easy. You have 100% chance of getting infected… unless it’s 0%… and there is no way to know which way it will go.
A recent report of 32,480 nursing home residents and staff showed that “Of the individuals who tested positive, 70.8% of residents and 92.4% of staff lacked symptoms at the time of testing.” The authors also showed that the viral load (which helps predict whether or not the individual is infectious) was the SAME in people who had symptoms and those who didn’t; “In a large cohort of individuals screened for SARS-CoV-2 by qRT-PCR, we found strikingly similar distributions of viral load in patients with or without symptoms at the time of testing.”
2. What are the chances you’ll get really sick or even die if you get COVID19?
Based on data from the CDC, for 20-40 year old people with no underlying medical conditions, here’s the answer to my hypothetical M&M question:
700 of the M&Ms will give you fever, cough, and/or shortness of breath. Lots of patients describe it as having “lungs on fire.”
440 of the M&Ms will give you some pretty awful muscle cramps and aches.
120 of the M&Ms will make you lose you sense of smell and taste. It usually comes back, but not always
3 or 4 of them will put you in the hospital (that goes up to around 20 M&Ms if you have an underlying medical condition)
1 of them will put you in the ICU unless you have an underlying medical condition. In that case, 5 of them will put you in the ICU
It’s unlikely you’ll die unless you have an underlying medical condition, in which case 3 of the M&Ms will kill you. If you carry this home to your 70 year old grandparent with an underlying medical condition, they have a 20% chance of dying (the equivalent of 200 M&Ms for you).
3. If you are in health care, what effect will this have on your patients and your colleagues?
Whenever I struggle with a decision as a doctor, I go back to my “rules”, which serve as the reference point for my moral compass.
Rule 1: Do what’s right for the patient.
Rule 2: Look cool doing it.
Rule 3: Don’t hurt anything that has a name.
If, as a healer, you decide that “just this once” won’t be much of a risk and you end up with COVID19, you break all three rules. You will be infectious for a long time before you get symptoms… which means you will expose patients, friends and colleagues (who all have names) to this potentially deadly disease. And – there is nothing less “cool” than creating a avoidable situation that ends up with colleagues having to cover for you while you are in quarantine and/or recover from COVID19.
We all want this to end… and it will.
We have a special calling – and responsibility – as healers (which includes all healthcare workers since healing takes a team). It’s what makes our work so filled with awe, and so rewarding. It’s also a burden sometimes. But we all took an oath, we all made a promise, and when we are past this point in history and looking back, it will mean something that we held true to that promise.
“We had a graduation celebration, but it was smaller than usual… only 20 people… and the older people just stayed a little while.”
“We meant to stay socially distanced… but you know kids.”
“God will protect me… I don’t need a mask.”
Oh, how I wish this were over. We all do.
And it will end.
It will end, but what we have to grapple with now is how many of us will die unnecessarily before it ends… because the rest of us “had to get our hair cut” or thought this was some kind of political “hoax”… or just couldn’t be bothered.
Because I am a physician, I have a lot of friends and family who call to ask some version of “Do you think it would be safe if….” I usually respond by telling them what I’m doing and then answer questions as they try to figure out the changes they need to make to be safe.
So, with gratitude for the science that has helped us better understand #COVID19, here’s what I tell my friends and family we are doing when they ask….
Stay Home. We stay home unless it’s for an essential need. For example – we would go to the dentist for a painful tooth (but not for a routine cleaning). We have supported our local restaurants with pick up or delivery, but we don’t go to restaurants yet. When we do, it will only be outside and only if we are sure CDC guidelines for restaurants are being followed. There is no way we would go inside for a movie, rally, worship or other public gathering. The data are more than clear… large gatherings inside are the highest risk activities right now.
I get our vegetables from Pierre at a Plant It Forward farmer’s market sponsored by Dandelion Cafe. (I’m mentioning them on purpose because having these just picked vegetables has been a true gift!) But I have the rest of my groceries delivered. I ask the delivery person to put them on the step (by text). I wear a mask, and don’t open the door until they are more than 6 feet away to thank them. (BTW, they are doing amazing work to keep our communities safe – please tip often and as much as you can).
One of the questions I get asked about staying home is “but I’m young… isn’t it ok for me to go out?”. The answer is yes and no. Younger people are less likely to die or develop chronic lung disease from COVID19, but it’s not impossible. Here’s the real issue – If you end up infected with COVID19 you’ll infect people around you that are at high risk… and they could die or have horrible outcomes from the disease. Do you really want to risk hurting your grandparents or that nice guy at the store who always says “Hi” to you? Think about creating a “quarantine pod” as an alternative to going out to restaurants, bars and concerts… it’s not going to be the same, but it’s a good compromise to keep socially connected while being as safe as possible.
Do it virtually if you can. If we are asked to run or be in a meeting, we do everything possible to make it virtual. If you are in charge of gatherings, this is an important responsibility. There is no reason to expose any of your colleagues or employees unnecessarily.
I’m an academic surgeon. I can’t do surgery virtually, but I can do a lot of clinic visits by video. I can do all my group teaching and committee meetings by Zoom. There is no moral justification to have meetings in person if they can be done online and I’m happy, as someone who can decide, to make sure my students and colleagues aren’t exposed to more risk than necessary.
Socialize outside. If I am meeting a friend (or friends) I’ll only do it outside and only if we have discussed in advance how to manage the event. I’m excited that this weekend I’m going to an outside workshop that FAMHouston is facilitating to teach refugees how to grow vegetables in container gardens. These are my friends, so I really want to see them! We have established in advanced that we will meet CDC guidelines with everyone in masks and more than 6 feet apart.
#WearYourMask. If I’m around anyone, I wear a mask, and I ask them to wear one – AND we stay at least 6 feet apart. The masks only come off if we are outside and more than 6 feet apart. It’s also really important to wear it properly! In particular, if your nose is hanging out, you might as well not have it on. Two other important things: 1) A face shield alone is better than nothing, but isn’t as protective as a mask and 2) the masks with the “breathing valve” aren’t worth wearing. Remember, my mask protects you. Your mask protects me. That’s why if we all wear masks we can stop the spread of COVID19!
Exercise with a mask available. When I’m outside exercising, I have a cooling mask (it is Houston, after all!) around my neck. As soon as I see someone coming towards me, I pull up my mask. I get a good 20-30 feet beyond them before it comes back down.
Bring your own glass. I had a friend over for a glass of wine on the back porch not too long ago. They didn’t come through my house (and I would do the same for them). I opened the gate to the backyard, and they walked through my back yard to the back porch where I met them. They brought their own wine glass. We sat on opposite sides of the porch, 10 feet away from each other and had a wonderful, soul healing visit.
Assume if someone else has touched it there is COVID19 on it. It’s a long shot, but what if… the UPS driver has COVID19 but is asymptomatic, coughs on their hands, picks up the package they are delivering … and now you pick it up. One inadvertent rub of the eyes at that point could easily mean an infection.
We put an old towel on a table and designated that table as “contaminated.” We put new packages on the table and immediately wash our hands. (If you work in an OR, you will understand this well… if you touch something contaminated you “rescrub” i.e. wash your hands before touching something else.) This sounds complicated but it’s not… if it’s just been handled by someone else, we assume it’s contaminated.
We have found that it’s easy to leave things on the table for 3 days before we open them (surprised us, too!). Obviously, groceries that need to be in the refrigerator are a little different (they get put in new plastic bags which go into the fridge). And, because three days may be long for some items…bottles of beverages get washed with soap and water before they go in the fridge.
Now, I have to be honest. A lot of new data are coming out that says we may be on the far end of safe with this. Some surfaces clearly are more at risk (like door handles), but things that get delivered are probably not really a problem. This is one to figure out your comfort level, stay up to date on the new info, and come up with a reasonable plan.
I hope this helps.
Whenever I am tempted to say “just this once” … or fall into the trap of feeling like it can’t really be “that bad” to meet without masks, I think about how all my colleagues are putting their lives on the line to care for infected people… and how I would feel if I were the one responsible for their death, or the death of someone I know and love.
I just waved goodbye to a dear friend as she started the drive to her new residency – with a jar of “Tamar”, my sourdough starter* in her cooler. I was going to print some instructions to send with the starter, but decided it might be better to put those instructions here for her – and for all of you who have thought about making sourdough bread (but think you are too busy).
This is a legitimate question. What I’ve learned from making my own bread during the pandemic is that it’s more than just having delicious, warm bread to sustain you. I won’t wax too poetic, but there are three reasons I think you should ponder baking your own bread:
A sourdough starter is a living thing who is there to help feed you
Making the bread is an act of self-care, a gift to yourself
This is a profoundly slow and deliberate act. Mindfulness doesn’t get any better than this.
So, if you are intrigued, I’ve thought about this for a while and here is how I think this could work for residents – even during a crazy 80 hour week.
Step 1: Get or make a starter
There’s a decent chance that someone where you work bakes sourdough bread. If they do, they will be delighted to give you some starter. It’s not a bad way to make some new friends and/or expand your circle of friends.
If you don’t find someone with starter, make your own. Sourdough starter comes from the bacteria and yeast that are in our environment so it’s a matter of mixing flour, water and time. If you want to help out some scientists while you make your starter, check out the NC State Sourdough Project.
Step 2: Understand the big picture
Sourdough starter is a living thing. You need to feed it once a week by adding some water and flour. Period. If you want to stop here and just have the starter around “in case” you decide to bake, this is all you have to do.
You are going to love the science of this. I’ll even predict you’ll end up using a scale to make sure your grams of ingredients are exact… but remember, as much as this will feel like science, its also how our ancestors made bread thousands of years ago. Don’t lose that perspective.. or that connection… when you bake.
It’s a four-step process with variations depending on the recipe:
Mix the 4 ingredients (starter, flour, salt and water) to make dough
Rise – long and slow. Overnight in the fridge, 2-6 hours on the counter. It varies by the recipe.
2nd rise – usually. for 1-3 hours and in a container to shape the dough
Step 3: Find an easy recipe to start with so you don’t get overwhelmed…
Mix the dough (1 cup starter, 1.75 cups lukewarm water, 5 cups of flour, 1 tablespoon of salt)
Let it rise for about an hour then stretch it out and fold it onto itself several times. The recipe says repeat this once an hour for a total of three times, but you can skip the 2nd and/or 3rd times if you need to.
Put it in the refrigerator overnight.
Flip it over, seam side up into a bowl or loaf pan (to shape it) and let it sit for 2.5-3 hours.
Flip it back over (seam side down) into your pan, slash the top to provide a controlled way to expand and bake.
Step 4: Map out a schedule
Let’s say it’s Thursday evening and you are off on Friday. Here’s how this recipe might work for you…
Thursday when you get home, mix the dough. If you don’t have time to let it rise on the counter for an hour and stretch it, just put it in the refrigerator. (Trust me, it will work). Take the starter that didn’t go into the recipe, feed it, and put it back in the refrigerator.
Friday when you wake up put the dough in a bowl or loaf pan and let it sit for 2-3 hours on the counter. This will mold it into whatever shape you want.
Heat up your cooking container (dutch oven, oven proof pot, tray) as you preheat the oven.
Put parchment paper on top of the bowel and flip the dough out of the bowl onto the parchment paper.
Use the parchment paper to lower the dough into your hot cooking container.
Score the top and bake!
(Don’t forget to let it sit for an “hour” before you slice it… no matter how good it smells)
It’s an art. Everyone has bread that bombs.
Don’t worry! Just keep the starter alive, regroup and try again!
If you find you are having issues with getting a good rise, it’s ok to put some dry yeast in as “insurance”. Poilâne’s famous sourdough includes it as part of the recipe, so it can’t be a “failure” in the sourdough world!
What to study next
If you are reading this, there’s a good chance you are Type A. You’ll probably get a notebook and treat this like a science experiment … like I did. Go for it! It turns out that even though sourdough bread has only 4 ingredients (starter, flour, water, salt) there are lots of variables that can affect the loaf e.g. temperature of the water, humidity in the room, etc. There is real joy in paying this much attention while creating something that is so sustaining. On the other hand, if this doesn’t make you happy, just make the bread!
Did I mention?… it’s not just bread…foccacia, pizza dough, pancakes… just wait until you find all the cool things you can do with sourdough starter and discard!
As a longtime customer of your dealership, a physician, and a concerned citizen I wanted to reach out to you to talk about the experience I had today when I picked up my car. Please know that this is not an attempt to complain – it’s an attempt to explain – and hopefully make you, your family, your employees and your customers a little safer.
I woke up this morning excited I’d be getting my car back today! Since I realized I didn’t want to expose or be exposed to anyone that wasn’t necessary, I called ahead to pay online (thank you for making that possible!). But, once I got to the dealership… well, it just wasn’t safe.
I stood outside while someone went inside to start the process of checking me out … and here’s what happened – which is what prompted me to write you this letter:
I watched as one of your customers, who was clearly in at least two, if not more, high-risk groups walked up the ramp. She was passed by an employee coming down the ramp, who passed her shoulder-to-shoulder. The employee’s mask was on their face, but below their nose.
I watched as the service folks checked in two people who both had masks on properly (as did your employees). But they walked up to them and held out their hand to take keys, which meant they were within 2-3 feet of each other.
The service employee who checked me out came out with papers and then handed me a pen – which I suspect they had been using all day – and stood right next to me. When I shook my head and asked if there was another way to do this, they said “I can get you hand sanitizer”… and then “We know it’s coming again.”
When my car was returned to me, the employee who drove it up to me had a mask on – around their neck. The windows were up and there was no smell or sign of any disinfectant. They walked up to me (2 feet away) and reached out to hand me my key (which I put into a ziplock bag I had brought for this purpose).
As I was leaving, an employee walked by with their valved mask on… around their neck. Two strikes! These valved masks are being sold because it’s “easier to breathe” but that’s because all the air you breath out escapes… with the virus. So, they have no benefit at all.
Let’s break this down… and I hope this will help you and other businesses to think about this in a way that makes sense. We all want businesses to open – and stay open! So working together to prevent more spread of this deadly virus just makes sense. What’s making this hard for some people is how politicized this has become. But, it’s important to know that this virus doesn’t care how you vote or what you think. This is just medicine, science and common sense.
The official CDC recommendations can be found here, but here’s how I would translate them for your employees i.e. what I would post somewhere if I were in your shoes:
Assume everyone you meet has COVID19
Unlike other viruses, you can be infected for up to 6 days before you feel sick. During that time, you can infect other people. Which means that everyone you meet could be infected… whether or not they are ill. If there is nothing else your employees remember, they should remember this.
If anyone with COVID 19 coughs on their hands, touches something and then you touch it (followed by touching your face), you can become infected.
This is not the primary way this virus spreads but it can spread this way. (This is why it was so upsetting to be handed a pen.) I also wish the person who returned my car had a spray bottle of disinfectant with them. I sure would have felt better if they got out of the car, sprayed down the seat and steering wheel and then wiped it off. Oh, by the way, once COVID19 is on a surface (depending on what the surface is made of) it can last for up to three days. That’s why it’s so important to disinfect surfaces frequently and wash our hands after we touch anything that hasn’t just been disinfected.
If anyone with COVI9 talks, yells, speaks, coughs or sneezes in a closed space, the virus can hang in the air for up to 3 hours. If you walk into that space during that time, you can become infected.
I can’t think of a worse closed space for COVID19 than inside a car! It’s true for any room, including your office space, but this is why I was perplexed when the person who returned my car didn’t have their facemask on. This is also why there is a “6 foot” rule and why we wear masks. (By the way, it’s not either-or, it’s both). We wear masks to protect others, not us… which means if we all do it, we’re are all protecting each other. (That’s also why you shouldn’t let any employee wear a valved mask) We stand at least 6 feet away from each other because the viral load will be much lower if we are talking to someone who is infected. By the way, the aerosol an infected person produces when they sneeze can travel up to 20 feet … and, remember, those viral particles can remain in the air up to three hours.
Most of us will probably be infected eventually, but that’s not relevant.
I understand that in the face of such a terrible disease there is a tendency to just throw up your hands. I’m sure that’s why your employee told me “We know there’s another wave coming”.
But here’s the deal – every day we postpone any one of us getting COVID19 (or preventing it, if all goes well!) is one day closer to a vaccine.
With every day that goes by, we also understand more about COVID19 and how to treat it… so the odds of not needing the hospital, ICU, or morgue goes up.
For every case we prevent, we are actually preventing many, many more cases because of how this spreads.
There’s also the part about just being a good person; You don’t want to be the person who bends the rules, gets sick and then infects family, friends or customers.
You have a wonderful dealership and I will continue to be an enthusiastic customer. Your service is incredible, your employees are kind. Stay safe, stay well, and thanks for giving me an opportunity to share this information with you and for others.
How can people justify gathering together like this party in Missouri?
Parties like this will almost surely lead to COVID19 infections…. and deaths. Probably not death for the people who attended parties like this one, but the death of their grandparents, their friends recovering from cancer, the doctors and nurses who see them and take care of them when they fall ill from COVID19.
I recently listened to the first episode of Nadia-Bolz Weber’s new podcast ““The Confessional”. In that episode, she interviewed Megan-Phelps Roper who grew up in the Westboro Baptist Church. Megan’s “job” for the church, along with picketing synagogues, the LGBTQ community and the funerals of American soldiers killed in the Middle East, was to use Twitter to spread the hateful beliefs of the church. And boy was she successful.
But then something changed. Instead of being yelled at on Twitter by people who (justifiably) found the behavior of the Westboro Baptist Church abhorrent, she was befriended by someone who was kind to her. I’ll let you read this article, her book, or listen to the podcast, but through the kindness of her new Twitter friend she was able to have space to think without being judged… which led her to a place of love rather than hate.
As I thought about the angry responses to some of my recent Twitter posts, some of which I can’t even share here because of the language, I realized that “yelling”, in person or online never leads anywhere. If we are to get through this time together, and alive, we have to be kind to each other – in person and online. We have to see through the rhetoric and understand that anger often comes from a place of fear. We have to acknowledge that we are all afraid… and that we are all in this together.
Wear your mask. Stay home when you can. Stay at least 6 feet apart. And, please… be kind.
It’s so important, and so very hard, to care for yourself
when times are tough. When routines are disrupted and fear and anxiety are
present, our usual ways of caring for ourselves seem to (appropriately) fly out
the window. So, here are some ways to
think about caring for yourself in the time of COVID19, whether you are working
(at home or in the hospital) or isolated at home.
Connect with nature. Long after this pandemic is
over, the earth will still be here and spring will continue to happen every
year. Make sure you get a good dose of the smell of grass, the sight of a blue
sky, the feeling of a cool breeze on your face at least once a day (but hopefully
Move. It’s normal that workout schedules are disrupted right now, but it’s not a good time to completely give up on your physical wellbeing. There is nothing good about being sedentary – not only does it make you feel physically bad, it also contributes to sadness and anxiety. A good, brisk walk outside may be the best “workout” right now since it combines movement and getting a dose of nature… but please make sure you practice social distancing and stay six feet away from everyone.
Eat well and enjoy good chocolate. You may be limited
in your choices and your ability to get real food, but do your best. This is
not a good time to succumb to the junk food as comfort food diet. Nor is it a
good time to be overly restrictive. Splurge on small doses of the foods that
make you feel comforted, but make sure it’s the best version of that food
possible! Now is not the time for cheap chocolate… just sayin’.
Keep your spaces clean. Our homes need to be a safe sanctuary
now more than ever, and that means we need to know they are clean. In addition
a ritual to enter your home, come up with a plan to keep your home neat and
cleaner than usual. If it helps, what we’ve done is set a mindfulness timer to ring
3 random bells an hour when we are home. Every time it rings, we do one small
bit of cleaning (or one set of an exercise) e.g. vacuum one room, clean the
countertops, wipe off all door handles or do some pushups. What you lose in
efficiency is made up for by breaking up an otherwise boring task and by the “surprise”
of the random “request”.
Dose your news. We need to know what’s happening, but
we don’t need to know it all the time. The human brain doesn’t like being continually
bombarded with potentially dangerous information. It promotes the physiologic
stress response and pushes us towards fight, flight or freeze… none of which
are helpful in this time. I love Twitter, but I have to be careful right now…
it can be an echo chamber of sadness and stress. The news I’ve found that is
the most informative, most accurate and least stressful is the PBS News Hour.
Guard your spirit. Find a place and a way to keep your heart full, your #EyesOpen and your compassion alive. This is not a sprint… it’s clear we are in this new world of COVID for a while. #WeNeedYou so please protect yourself in body, mind and soul.
Taking care of patients in this time is beyond stressful. I’m keeping my eye out for anything that might help support healers of all kinds. This was sent to me today and I found it profoundly helpful. Take 5 minutes to listen to this amazing professor, pastor and friend.
This video was made for the students of Illiff School of Theology by Dr. Cathie Kelsey. Although the specific examples she uses are from the Christian faith, the practice she teaches in this video can use text from any religious tradition, or no religion at all – perhaps a poem, a quote, or an inspiring song?