COVID-19, alcohol and other substances

 

Unfortunately for mariners, the total amount of wave energy in a storm doesn't rise linearly with wind speed, but to its fourth power. The seas generated by a forty-knot wind aren't twice as violent as those from a twenty-knot wind, they're seventeen times as violent. 

-from Sebastian Junger, The Perfect Storm: A True Story of Men Against the Sea

The September edition of The American Journal of Psychiatry has a commentary on the effects of alcohol and substance use disorders and susceptibility to COVID-19 infection and its sequelae. The authors point out that a "perfect storm" exists between the combination of COVID-19 factors and alcohol and substance use. These factors include: 

• both alcohol and substance use decrease the immune response which increases the risk of lung infections and other complications from COVID-19
• there are reports that COVID-19 infection can involve the brain in some people, which makes it conceivable that neurological changes related to substance use could combine deleteriously in people infected with COVID-19 and and make both disorders worse
• cannabis and nicotine consumption are linked to specific COVID-19 risk factors (i.e. smoking anything is bad for the lungs, especially during COVID-19!)
• inability to purchase alcohol and other substances may lead to withdrawal, as well as risky behaviors to use to counteract withdrawal symptoms
• COVID-19 is a huge stressor, leading to increased fear, anxiety and social isolation. I am seeing this first hand everyday on the inpatient psych unit. Increased stress is related to increased substance craving, consumption, and risk of relapse. The authors make the point that it is crucial to remember that stress-, alcohol-, and drug-related alterations in brain chemistry persist even after the stressor resolves

If you would like to talk to someone about being isolated, if you are questioning if  your substance use is something to be concerned about, or have any other mental health concerns, telemedicine offers an easily accessible option. Both psychiatrists and therapists see patients virtually (check your insurance plan).  For more information on alcohol use, visit the National Institute on Alcohol Abuse and Alcoholism by clicking HERE. For more information on drug use/abuse, click HERE. 

For access to the full article, click HERE.

Sympathy vs. Empathy

Today's post was written by my current attending, Steven Berger, MD. He wrote it for the residents to discuss. Something to ponder. (Goodness I am blessed to work with such wonderful compassionate attendings!)


Sympathy vs Empathy

Sympathy means similar. It consists of being similar to another person. For example, at a funeral, you express sympathy and say things such as: "You must feel awful," "I’m sorry for your loss," or "I can’t imagine what it’s like for you to lose a child." In a funeral setting, you are saying that you are supportive of the person in his sadness and that you stand beside him in his time of need. A friend feels and expresses sympathy.

Empathy means same. It consists of having the same feelings as the other person and being one with the other person. As a psychiatrist, you are the authority of thoughts and feelings. With the patient, you identify the thoughts and feelings the patient is having. You bestow credibility and acceptability to the person’s thoughts and feeling. You endure those thoughts and feelings with the patient. You become one (same) with the patient in his thoughts and feelings. Instead of saying sympathetic things, you say empathic things, for example: "You feel awful," "The loss of your child is unfair," or "I know you feel unconsolably grieved. I will endure that inconsolable grief with you."

In being sympathetic, you act as a friend standing beside the person. In being empathic, you act as a holy spirit co-existing with the patient in his experiencing his thoughts and feelings. You experience the patient’s thoughts and feelings with him. You demonstrate to him that he is not alone, that you are with him, that you are bearing his burden with him, you are on his side to deal against his struggles with him. You are more than just a team with him. You are one with him.

As a psychiatrist, you side with the patient against whatever devils he is fighting. Instead of opposing the patient by saying, “Those voices you hear are not real”, you side with the patient by saying, “How are you and I (together) going to deal with those voices?”

Personally, one of my favorite pieces on the difference between empathy and sympathy is a short, two minute cartoon by Dr. Brene' Brown. I first saw it during medical school orientation at Wake Forest. The images from this short clip have stayed with me since. It's definitely worth watching (click HERE to view), but in a nutshell Dr. Brown proposes that empathy consists of four key steps:

1. Perspective Taking, or putting yourself in someone else's shoes.

2. Staying out of judgement and listening.

3. Recognizing emotion in another person that you have maybe felt before.

4. Communicating that you can recognize emotion.

A way to understand empathy is one that I carried with me throughout my active ordained ministry and still use today. When I express empathy towards another who is hurting (whether spiritually, physically, or mentally) I picture the person who is hurting in a deep dark well (kind of like the one in the Brown cartoon above). I picture myself empathetically entering the well with the person to sit with them in their pain, but I also always picture the rope that maintains a connection to the outside. I picture that rope tied securely outside the well, and I hold onto while in the well. If you as the helper/healer do not maintain the grounding lifeline, the way out of the well, you will both just be wallowing in the darkness.

Thank you Dr. Berger for the thought provoking writing!

Is it time for the house church to re-emerge?

 

Is it time for the re-emergence of the house church in mainline denominations?

Despite not being able to worship in person during the COVID pandemic, I’ve really enjoyed attending different churches virtually—from the grandeur of Easter morning, morning prayer, and even a weekly Covid-19 memorial service at the Washington Cathedral (click here to visit), to the familiar faces at Sunday worship at my mom’s congregation, St. Peter’s Del Mar (click here to visit), to the memories sparked by Sunday services at my sponsoring parish, St. James Paso Robles (click here to visit)--all with out leaving my office.

I have loved this and applaud the creativity of these big and small worshipping communities to find new and innovative ways to proclaim God’s never ceasing love in a time when we need it so desperately. As my congregation in New Zealand used to say, “Good on ‘ya.”

As I’ve thought about where we are, and where we are going, I wonder if we might need to push ourselves even further outside of the mold of what we know. While these virtual experiences work, there will always be something missing from not being able to gather in person as a community. And after COVID is over (yes, that will happen one day) I worry about the financial state of congregations and their ability to continue to afford “church” the way we’ve always done it--aging buildings and full time, seminary trained clergy in a society with declining interest in mainline Christian denominations are all  concerns. My fear is that COVID has accelerated the unsustainable nature of our current model.  

I wonder if it is time to think about the house church again, and how the first models we have of the “ecclesia” might inform how we do church. The description of the house church appears multiple times in the bible (Corinthians 16:19, Philemon 1:2, Romans 16 to name a few). The practice in these house churches is best described in Acts 2:42-47, They devoted themselves to the apostles’ teaching and fellowship, to the breaking of bread and the prayers (NRSV).

What if we were to go to a model, maybe even just during COVID, where congregational hubs supplied materials and creative ideas for gathering that could occur in people’s homes with proper social distancing. These could be like the “learning pods” that are springing up for educating children. We could offer “worship pods” or “spiritual growth pods” that focus on authentic and relevant biblical teaching that is applicable to these very difficult times we are living through. These pods could be a way to safely be together, break bread safely, and support one another. And we could pray...

House churches could allow us to reclaim some of the best of the early church in a new, evolved way.

 

When to seek mental health help for your child: Questions to ask before therapy/hospitalization (Part 3 of 3)

 

 

Your children are not your children.

They are the sons and daughters of

life’s longing for itself.

They come through you, but not from you.

And though they are with you,  they belong not to you...

you are the bow from which your children as living

arrows are sent forth.

from Kahlil Gibran,  The Prophet

Previously I’ve shared work from one of the UNR faculty, Tom Lavin, MFT, LADC. He recently wrote a piece for parents about when to seek help if they think their child is struggling.

While all of us are facing increased stress due to COVID-19, children are especially vulnerable. In addition to the worry about their health and the health of their loved ones, there is the disruption to their schedules, having to adjust to a new type of schooling/education, isolation from peers, and more. They are also surrounded by reminders about the fragility of life.

In a three-part series I am sharing Lavin’s advice* on when to seek help. Part one covered when to seek help for children and part two focused on teens. The series concludes with this post, adapted from Lavin’s work and the AACAP website, which focuses on some helpful questions to ask when considering outside help. 

If you are considering therapy for your child on an outpatient basis (i.e. not in a hospital setting), parents are encouraged to ask the following questions:

• If someone else is suggesting that your child start therapy, why is it being recommended?
• What type of therapy will my child receive?
• What are some expected results?
• How long will therapy last?
• Will the family also receive therapy?
• How will the family be included?
• How will the family be informed about our child’s progress?
• How can the family be most helpful and supportive?

If inpatient hospitalization is being recommended, the AACAP recommend that parents ask the following questions:   

• Why is psychiatric inpatient treatment being recommended for our child, and how will it help our child?
• What are the other treatment alternatives to hospital treatment, and how do they compare?
• Is a child and adolescent psychiatrist admitting our child to the hospital?
• What does the inpatient treatment include, and how will our child be able to keep up with schoolwork?
• What are the responsibilities of the child and adolescent psychiatrist and other people on the treatment team?
• How long will our child be in the hospital, how much will it cost, and how do we pay for these services?
• What will happen if we can no longer afford to keep our child in this hospital or if the insurance company denies coverage and inpatient treatment is still necessary?
• Will our child be on a unit specifically designed for the treatment of children and adolescents and is this hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as a treatment facility for youngsters of our child's age?
• How will we as parents be involved in our child's hospital treatment, including the decision for discharge and after-care treatment?
• How will the decision be made to discharge our child from the hospital?
• Once our child is discharged, what are the plans for continuing or follow-up treatment?

 The AACAP web site contains much more information and is a reliable and trusted place to learn more. Click HERE for a list of Family Resources.

 

*The following resources were cited by Lavin: 

"Understanding Teen Depression” by Empfield and Bakalar  

“Overcoming Teen Depression: A Guide for Parents” by Miriam Kaufman, M.D.

  American Academy of Child and Adolescent Psychiatry: www.AACP.org

 

When to seek mental health help for your child: Teens (Part 2 or 3)

                                                      

Your children are not your children.

They are the sons and daughters of

life’s longing for itself.

They come through you, but not from you.

And though they are with you,  they belong not to you...

you are the bow from which your children as living

arrows are sent forth.

from Kahlil Gibran,  The Prophet

Previously I’ve shared work from one of the UNR faculty, Tom Lavin, MFT, LADC. He recently wrote a piece about when to seek help if your child is struggling.

While all of us are facing increased stress due to COVID-19, children are especially vulnerable. There is the disruption to their schedules, being out of school, isolation from peers, trying to learn in their home environment and more. They are also surrounded by reminders about the fragility of life.

In a three-part series I will share Lavin’s advice* on when to seek help, first for children and then for teens. The series concludes with some helpful suggestions about questions to ask when considering therapy. 

Today’s post focuses on teens. 

Sometimes parents are the first to recognize problems with their teen; sometimes they are the last to know. Parents who are concerned about a teen or pre-teen child can review the following checklist, provided by the American Academy of Child and Adolescent Psychiatry (AACAP). If parents recognize some of the signs below, a thorough evaluation by a mental-health professional may be useful.

• Marked change in school performance
• Abuse of alcohol or drugs
• Inability to cope with problems
• Inability to cope with daily activities
• Marked changes in sleeping habits
• Marked changes in eating habits
• Many complaints about physical ailments
• Aggressive behavior or frequent outbursts of anger
• Violation of others’ rights
• Opposition to authority
• Truancy, theft, vandalism
• Intense fear of becoming obese (with no relationship to actual body weight)
• Depression (sustained negative mood and attitude, poor appetite, difficulty sleeping)

Teen Suicide Signs

Parents of teens need to be aware of the signs of suicide risk and know when to ask for professional help. Research cited by The American Academy of Child and Adolescent Psychiatry reports that suicide among teens has risen dramatically in recent years. Suicide is the third leading cause of death for people ages 15 to 24 years of age.

Many of the symptoms of suicidal feelings are similar to the signs of depression. The AACAP recommends that if one or more of these signs occur parents talk to the child about their concern and seek professional help if concerns persist.

• Change in sleeping habits
• Change in eating habits
• Withdrawal from friends, family and regular activities
• Violent behavior
• Drug or alcohol use
• Unusual neglect of personal appearance
• Marked personality change
•  Decline in schoolwork
• Difficulty concentrating
• High level of boredom
• Physical complaints (often related to emotions): stomachaches, headaches, fatigue
• According to the AACAP, a teen who is contemplating suicide may also:
• Complain of being “rotten inside”
• Give verbal hints (“I won’t be a problem for you much longer”, “Nothing
• matters”.)
• Give away favorite possessions; throw away important belongings.

If a child or adolescent says “I want to kill myself”, always take that statement seriously and seek a professional help immediately. A parent can call 911, call the National Suicide Prevention Lifeline at 1-800-273-8255 or visit their site at https://suicidepreventionlifeline.org/, or contact their child’s primary care provider.  

*The following resources were cited by Lavin: 

"Understanding Teen Depression” by Empfield and Bakalar  

“Overcoming Teen Depression: A Guide for Parents” by Miriam Kaufman, M.D.

  American Academy of Child and Adolescent Psychiatry: www.AACP.org

When to seek help for your child: Children (Part 1 of 3)

 

And he said:

Your children are not your children.

They are the sons and daughters of

life’s longing for itself.

They come through you, but not from you.

And though they are with you,  they belong not to you...

you are the bow from which your children as living

arrows are sent forth.

from Kahlil Gibran,  The Prophet

Previously I’ve shared work from one of the UNR faculty, Tom Lavin, MFT, LADC. He recently wrote a piece about when to seek help if your child is struggling.

While all of us are facing increased stress due to COVID-19, children are especially vulnerable. There is the disruption to their schedules, being out of school, isolation from peers, trying to learn in their home environment and more. They are also surrounded by reminders about the fragility of life.

In a three-part series I will share Lavin’s advice* on when to seek help, first for children under the age of 12, and then for adolescents (12 and up). The series concludes with some helpful suggestions about questions to ask when considering therapy. 

Today’s post focuses on children. Specifically, if you see any of the following you in your child you should consider seeking outside help:

·        Fall in school performance

·        Poor grades in school despite trying very hard

·        A lot of worry or anxiety

·        New onset hyperactivity/fidgeting that persists

·        Persistent nightmares

·        Persistent disobedience or aggression

·        Provocative opposition to authority figures

·        Frequent, unexplained temper tantrums

 If you have noticed any of the above signs in your child, it may be time to enlist the help of a professional. The first step is to talk to your child’s pediatrician/primary care provider. They can then guide you in the right direction.

It’s a hard time for everyone, even the youngest among us.

Check back next Monday for some of the signs that may signal it is time for you to consider outside help for your adolescent.

*The following resources were cited by Lavin: 

"Understanding Teen Depression” by Emmpfield and Bakalar  

“Overcoming Teen Depression: A Guide for Parents” by Miriam Kaufman, M.D.

  American Academy of Child and Adolescent Psychiatry: www.AACP.org

Psychiatry, Racism and the Census

The above table appeared in the October 1851 issue of the American Journal of Insanity

The June 23, 2020 issue of Psychiatry News focuses on Structural Racism in American Psychiatry. In that article I was shocked (and horrified) to find the above table. The article explains that the 1840 census added a new category, "insane and idiotic."

The article states: 

The census reported that in free states, there was one insane or idiotic person for every 144.5 Blacks; the ratio for whites was 1 to 867. However, in slave states, the ratio of insanity for Blacks was 1 to 1,558. Also, the farther north one went, the higher the ratio of insanity in Blacks, and the farther south one went, the lower the ratio. The ratio of insanity among Blacks in Maine was 1 in 14, while in Louisiana the ratio was 1 in 4,310. John McCune Smith, the first Black licensed to practice medicine in the United States, and Edward Jarvis, a physician and father of American biostatistics, wrote scathing rebuttals highlighting fundamental methodological flaws. John C. Calhoun, who had resigned his position as vice president to become a senator from South Carolina, supported the findings of the census, proclaiming, “Here is the proof of the necessity of slavery. The African is incapable of self care and sinks into lunacy under the burden of freedom. It is a mercy to him to give this guardianship and protection from mental death.” John McCune Smith’s conclusion was different: “Freedom has not made us mad; it has strengthened our minds by throwing us upon our own resources.”

It is so heart-wrenching to look back 180 years and see this example of both individual and systemic racism. I wonder how the words that are said today will be viewed by those who will come after us...

To read the entire article click HERE.

COVID Facts

This past week I had to complete a "returning to work" module on Covid 19 knowledge for the University of Nevada. While I dreaded completing yet another (boring) on line training, this module actually had some information that I found helpful. I'd like to share a few of these facts as I've found getting good, reliable data about the COVID-19 challenging the past few months.

How many virus particles does it take to become infected with COVID-19? It is estimated it takes approx. 1000 virus particles to become infected with COVID-19.  Here is a list of approx. how long it would take to inhale 1000 particles by different activity:

• Breathing: an infected person sheds approx. 20 particles per minute, so it would take about 50 minutes to inhale 1000 particles and potentially become infected. 
• Speaking: an infected person sheds approx. 200 particles per minute, so it would take about 5 minutes  to inhale 1000 particles and potentially become infected. 
• Cough: One cough contains approx 200,000,000 viral particles, so exposure time to inhale 1000 particles is immediate. 
• Sneeze: One sneeze contains approx 200,000,000 viral particles, so exposure time to inhale 1000 particles is immediate. 

How long does SARS-CoV2 (the virus that causes COVID-19) last outside the body? (From a study and paper by the New England Journal of Medicine, CDC, UCLA, Princeton)

• As an aerosol in the air--up to 3 hours*
• On copper--up to 4 hours
• On cardboard--up to 24 hours
• On plastic--2-3 days
• On stainless steel--2-3 days 

*Researchers used a nebulizer to simulate coughing or sneezing and found that the virus became an aerosol. 

Because the SARS-CoV-2 virus may remain viable on non-porous surfaces for several days, you should disinfect surfaces using a product that meets the EPA criteria for use against the virus. The University of Nevada uses TB-Cide Quat to disinfect. An important note. There is a difference between cleaning (wiping off dirt/grime) and disinfecting a surface. To disinfect, you need to spray the surface from approx 6" away, and allow the disinfectant to sit on the surface for approx. 2 minutes. You can then wipe the surface off, and finish by washing your hands.

So friends, wear your mask, wash your hands, and stay safe.

Strengthening your relationship during COVID isolation

Although always a prevalent topic, since COVID isolation began my patients have been talking about their relationships even more than usual. It must be that people are inside, spending more time with their partners/families. That can be a great thing, or it can be challenging (or maybe a bit of both).

I've been learning about couple's therapy this year as part of my psychiatry residency, and one of my texts is ACT with love by Russ Harris, MD. In this book, Dr. Harris applies the principles of Acceptance and Commitment Therapy to helping couples to stop struggling, reconcile difference, and strengthen their relationship. It has a lot of great exercises that would be helpful for nearly any couple at any stage of their relationship. (To learn more or purchase a copy click here.)

He shares a poetic metaphor for a healthy relationship. He writes:

If two people want to build a fantastic relationship, each needs to be like a mountain. A mountain is whole and complete in itself--and yet when it encounters another mountain, between them they create something new: a valley. A healthy relationship is like two towering mountains with a magnificent valley between them through which the river of life flows strong and fast and free. Neither mountain  needs the other--and yet their connection to one another gives rise to a lush valley teeming with the wonder of nature. 

Many people look to their partner to complete them, to solve all their problems,  to make them whole, or to fix them. Alternatively, they may chose someone that they think they can save. If you recognize some of these motivations in your relationship, you're likely running into problems. Dr. Harris describes a mountain as whole and complete with a firm foundation and clear borders, yet able to be part of a rich and luscious landscape.

If you'd like to learn more about being that strong and complete mountain then check out Dr. Harris' book. It's worth the read.

Relationship between suicide and religious service attendance

A new study published in the May 6, 2020 edition of JAMA looks at the relationship between suicide and other "deaths of despair" and attendance at religious services among health professionals.

Briefly, this study sought to answer the question "Is frequent religious service attendance associated with a lower risk of deaths related to drugs, alcohol, and suicide (referred to as deaths from despair) among US health care professionals?"

The researchers looked at a group of  66,492 female registered nurses and 43,141 male health care professionals in the US. Data from these groups was examined covering a 15+ year time period. Among the female group there were 75 deaths of despair, and among the male group there were 306.

When the relationship between deaths of despair and religious service attendance was examined,  attendance at religious services at least once per week was associated with a 68% lower hazard of death from despair among women and a 33% lower hazard among men compared with those who never attend. The researchers state that these findings suggest that frequent attendance at religious services is associated with lower subsequent risk of death from despair.

To read the full article click here.

Three minutes to decrease COVID worry

Acceptance and Commitment Therapy (ACT) is a form of therapy based on acceptance and mindfulness combined with behavior change and commitment. It's a form of therapy that is taught/frequently utilized in my current residency program.

One of our faculty who facilitates the resident processing group is Tom Lavin. He wrote out a 3+ minute meditation using ACT theory. While it can be useful in dealing with a whole host of stressors, it can also be very helpful in dealing with COVID-related stress/anxiety/worry that many of us may be experiencing. We might be worried about the health risks for our loved ones or ourselves. We might be worried about the financial fallout. We might be struggling with isolation, or conversely spending more time with family/housemates than we usually do. Or even just getting enough of the basic supplies... (For more on Tom Lavin's resources click here). 

Here's the meditation (shared with permission): 

Accepting, Choosing-Committing, Taking Action 

Tom Lavin MFT, LCADC, ACATA

Accept what is, as it is

Slowly... take a few deep breaths...

Allow your thoughts and feelings to emerge and just be there...

the ones you like... and the ones you don’t like...

take few more deep breaths...

and just let your thoughts and feelings be there...

Take a few more deep breaths...

and let your thoughts and feelings be there...

—not judging them and not trying to make them go away...

Just let your thoughts and feelings be there.

Accepting your thoughts and feelings does not mean you like them

and it doesn’t mean you like the situation ...

Just let your thoughts and feelings be there...let the situation be there...

and then settle into accepting what is, as it is...

If you’re having a hard time accepting what is,

go ahead and accept that you’re having a hard time accepting what is...that

you really wish the thought or feelings or the situation were different...but

they’re not...so you’re willing to accept what is, as it is...

After accepting what is as it is, focus on what’s important to you-is there

something about this you want to change---do you want to change your

perspective? Or change the situation?

What do you want to change?

If you think you can make the change, develop and plan a strategy

to make the change you discern would be good...

...then...engage in NIKE Therapy---be willing to “ just do it”...

Be willing to take positive, assertive action....

However, if you can’t change the situation and you’re struggling with

your perspective..... let go............let go...........let go.....

Let it go for today.

Just let it be.

Let it go... and move on...

Say “Yes to Life”...

... and focus your attention on other people and activities you value.

Image from the Center for Stress and Anxiety Management

Face coverings and how to help health care workers if you sew

This past week the CDC made the strong recommendation for people to wear face coverings in public. For complete and up to date information on face coverings from the CDC, please click  here.   

In response to this recommendation, the State of Nevada sent out an email to all State employees explaining the different types of masks and their preferred use, as well as providing information on how to make your own mask. 

If you like to sew, you can make coverings for your local health care providers in addition to making them for yourself/family/friends/neighbors. I was so grateful when I went for my N95 fitting to find that people in the community had made hundreds of cloth coverings for our N95 masks so that we can extend the number of uses per N95. There was a big bin of cloth masks that we could chose from with lots of fun patterns. Additionally, it's really helpful to have a headband with buttons sewn behind the ears so that providers can hook their cloth mask onto the headband instead of behind their ears. No one had donated any, but I'm sure they would be greatly appreciated as well. 

The information below on cloth masks is adapted from the State of Nevada email. I hope you find it helpful.

• Can be worn anywhere but should be changed out and washed frequently;
• If you are able to make a cloth mask, it is recommended to make a few to change out between home, work and other places.

• The cloth mask for work should ONLY be worn at work.
• Maintain in a plastic zip-lock bag.
• Change the zip-lock bag at least once a week
• Only take home to be laundered, placed in a clean zip-lock bag and brought back to work.
• Placing a cloth mask over other masks will help keep the other masks clean and last longer.
• The cloth mask should be able to be laundered in hot water and machine dried without damage or change to the shape or integrity of the mask.
• Here are some  YouTube ‘How To’ videos for making a mask:
• How to make a fitted mask – much like an N95:

https://www.youtube.com/watch?v=fySsaOojEVM

• How to make a mask with a filter:

https://www.youtube.com/watch?v=iNX0cRrYj6U

• How to make a great mask if you can’t find supplies:

https://www.youtube.com/watch?v=v8HNYKvlaN8

• How to make a mask with a handkerchief/napkin: 

https://www.youtube.com/watch?v=nauxXkljAVs

Face masks should fit snugly but comfortably against the sides of the face and bridge of the nose. Ideally, they include layers of fabric, preferably with a filter. Ideally they will allow for breathing without restriction. They should also only be touched when putting them on or taking them off. 

Please stay safe, stay home, and wash your hands.

Prayers for health care workers

As the impact of COVID-19 spreads, it is hitting close to home as the list of health care professionals that have died in service to others grows. Medscape keeps an updated list of health care workers who have died from COVID-19. I posted the link of Facebook previously, but it is worth sharing again. Unfortunately and sadly, it was updated again this morning as more names had to be added. For the most up to date list click here. 

Right now I feel the force of my two vocations, medicine and ministry, colliding. It is only through prayer and faith in God's sustaining strength that I can put my fears aside to serve those hospitalized with psych issues on my weekends on call. And it is through prayer that I respond to the growing list of those who have already died while serving others. Below are three prayers from Grace Cathedral that I find beautiful. 

Please, think about your physician or a health care worker that you know and offer one of the prayers below. We will all appreciate it more than you will ever know...

For Those Who Are Sick and Those Who Minister to Them

Gracious God, source of life and health: Jesus came to our disordered world to make your people whole. Send your Spirit on those who are sick and all who minister to them; that when the sick enter your peace, they may offer thanks to your Great Name; through Jesus Christ our Savior. Amen.

For Health Care Providers

Give your blessing, gracious God, to those whom you have called to the study and practice of the arts of healing, and the prevention of disease and pain. Give them the wisdom of your Holy Spirit, that through their work the health of our community may be advanced and your creation glorified; through your Son Jesus Christ. Amen.

For Emergency Workers

God our strong deliverer: when those charged with the urgent mediation of your healing power feel overwhelmed by the numbers of the suffering, uphold them in their fatigue and banish their despair. Let them see with your eyes, so they may know all their patients as precious. Give comfort, and renew their energy and compassion, for the sake of Jesus in whom is our life and our hope. Amen.

God and COVID-19

This past week I've read alot of  "theological" statements positing ideas about God during this global pandemic. Some of them just made my head spin as the theology inherent in these statements is full of holes and presents an image of God that is the antithesis of my understanding and experience of God whose own self definition is love. For example,  I read a statement from a physician a few weeks ago that said he didn't care about the lack of personal protective gear that our profession faces right now because God "won't let that happen to us." I read another statement that linked the timing of the spread of the virus to Lent as a way to increase our suffering and bring us closer to Christ. Goodness gracious.

The fact is that people have argued for thousands of years about where God is when bad things happen. And the bottom line is that there is no good, comprehensive answer.

James Martin, a Jesuit priest, wrote an opinion piece for the New York Times last week. In this piece he raised the following points (to read the full article click here):

• When we address the "problem of suffering" a distinction must be made between  natural suffering (such as hurricanes, cancer, and yes, this virus) and suffering that results from the actions of individuals. 
• All explanations for natural suffering in the end are "wanting in some way." Most common explanations include that suffering is a test (which Martin states is an approach that can make God out to be a monster) and that suffering is punishment for sins. 
• The confusion for believers comes down to the "inconsistent triad" which he summarizes as "God is all powerful, therefore God can prevent suffering.But God does not prevent suffering. Therefore, God is either not all powerful or not all loving. "
• The most honest answer to why COVID-19 is killing people is we don't know.
• Jesus' fully divine and fully human nature, biblical teachings on sickness and  healing,  and  of course prayer can bring comfort to Christians at this time.
• Those who do not consider themselves Christians can also view Jesus' life and actions as a model for care of the sick, that we should allow our heart to be "moved by pity" in our response to how we care for others during this crisis. 

Over the years I've thought alot about natural suffering. I see my patients who through no fault of their own have dopamine imbalances in their brains and thus live their lives with schizophrenia. I look at the ravages of the Paradise Fire and other natural disasters. And now this virus, the ultimate impact that we don't yet know.

While my beliefs essentially align with the above, I've often wondered about what role free will plays.  In seminary our theology professor wrote out several different areas that different theologians view as a continuum for ways of conceptualizing God. For example, some see God as a master clock maker, who brought the world into being and continues to control every aspect. The other end of this continuum is God created the world and then stepped back, letting creation evolve--a more hands off approach. The professor presented at least a dozen of these different areas, but one that especially intrigues me is free will vs. determinism. Do we have the ability to make our own choices, or is God determining every step? (For a full discussion of free will click  here). In my own thoughts, I've often wondered if nature itself has free will. What if free will did not only apply to people but to the natural order?  Can a virus' mutation be explained by the free will of the natural order? Can ultimate neurological function be explained by  the free will of  the developmental process? I am far from a theologian and will leave it for deeper spiritual thinkers to ponder, but it is something I've always been curious about. Maybe we limit the concept of free will if we only apply it to humans...

For now dear readers, stay calm, wash your hands, stay at home,  pray if so inclined, and care for each other with a heart driven by love...