The Masked Walkers on the Terry Trueblood Trail

Today we took another walk on the Terry Trueblood Trail. This time there was a different feel. We wore face masks and there were new signs directing one-way traffic in order to facilitate social distancing. We noticed a few people wearing masks, but not many more than the last time we were out there.

Sena got a kick out of picking up groceries the other day. The guy who brought out the groceries was wearing a face mask—just not covering his face. He knew the guidelines and could recite them, but he had complaints about the mask: “I can’t breathe!”; “It’s hot!”; “It fogs up my glasses!”; “It gets in my way!”

I heard that. But there’s a right way and many wrong ways to wear a face mask.

The Robins are Back

The robins are building their Hurrah’s nests in our back yard again. That’s about the only thing that has not changed. The COVID-19 (C-19) pandemic has changed just about everything else in our lives.

I wear a face shield now at the hospital. We’re told to wear it as much as possible, like putting on our clothes in the morning. Don’t we leave them on all day? The shield keeps you from touching your face, which is why it’s better than a face mask. However, I’ve noticed something about wearing the face shield for much of the day. Before I describe it, let me give you analogy: If you’ve ever worked detasseling corn when you were young a long time ago, you might remember what happened when you closed your eyes at night and tried to go to sleep. I saw corn fields—miles and miles of corn fields. When I opened my eyes, the vision would disappear. But as soon as I closed my eyes again, I saw the vast corn fields.

It’s crazy, but I have a similar sensory after-effect when I doff my face shield–sometimes I still feel the headband. The pressure of it is just the same as if I were still wearing it. I suppose it’s because I cinch it too tightly. But if I don’t, it slips down my brow, pushing my eyeglasses down my nose.

Another change—I’m a Consultation-Liaison (C-L) Psychiatrist, so I’m used to washing my hands in between patients in the hospital. Now, I’ve got something I’ve never had before–alligator hide patterns on the backs of my hands. They’re dry and cracked. I don’t count the number of times I wash my hands, but it’s a lot more frequent than I used to do. It’s not uncommon for health care professionals to wash hands 75-100 times a day in the C-19 era. I have to use hand cream conscientiously—something I almost never did.

I’m less comfortable being closer than several feet away from people. I tend to hug the walls and corners in stairwells, where I now encounter more people than I ever have before. I guess the message everyone hears is “Stand by me—six feet away if you please.”

I don’t shake hands anymore. The lines into the hospital sometimes lead to crowding while we wait to have our temperatures taken and answer the screening questions about whether we’ve had fever, cough, shortness of breath, etc. It’s perfunctory most of the time, because virtually always the answer is “no” and everybody is in a hurry.

I don’t carry my little camp stool with me anymore, which allowed me to sit down with patients and have face to face, eye level interaction. I’m distinctly uncomfortable standing over them because I haven’t done that in years. If there is a chair in the room, I’m hesitant to use it because, like the camp stool, I worry that it might carry C-19 virus on its surface.

I used to evaluate psychiatric patients in our emergency room by simply going there and seeing them face to face, either in their rooms or, when it was really busy (which is most of the time), in the hallways.

I just used a remote telehealth interface platform using an iPad the other day, which allows me to interview patients from my office, in order to avoid the risk of contagion. It was a little slow and awkward, and I was uncomfortable that a health care professional had to be in the emergency room to hold it up for the patient—who was covered in blood. I felt a little guilty.

I used to round with medical students and residents on our patients. We were the movable feast, a sort of MASH (Mobile Army Surgical Hospital) unit, more like Mobile Unifying Shrink Hospital (MUSH). Unifying means unifying medicine and psychiatry. The medical students are not permitted on the wards now, in order to protect them. It’s awkward rounding with only one resident at a time, although another resident can do other things like chart review and telephone relatives for collateral history. I get in the hospital earlier nowadays, and see many non-C-19 patients alone without trainees, preparing for the C-19 surge when I expect we’ll get many more consultation requests to help care for C-19 patients with delirium and depression. It’s a one-man hit-and-run psychiatry consult service and efficiency is mandatory to meet the demand.

I see patients by myself for another reason. Try as we might, C-19 positive patients will slip through the screens. Many are asymptomatic but contagious, and any test will have false negative results. The idea is to expose the least number of health care front line staff members as possible. Faculty capacity is stretched pretty thin, which is pretty much the situation everywhere. I have to choose. I’m older. I’m weeks from retirement. I’m afraid.

But robins don’t have the burden of choice. They obey their instinct every spring, just the same.

Terry Trueblood Trail Break

Today we took a break from the intensity of the pandemic and went out for a walk on the Terry Trueblood Trail. We were a little surprised at the crowd. There were more people there than we’ve ever seen before.

We’re social creatures. After a while, we get a little tired of everything being about coronavirus and making homemade masks out of bandanas and rubber bands. I made one of those—but I didn’t wear it out on the trail. Most people didn’t.

Sena bought me short sleeve shirts so I can be bare below the elbows at the hospital. I’ll think about it tomorrow.

Today we listened to the Eastern Meadowlark’s song and watched Tree Swallows kiss each other on the beak. We saw American Coot up close for the first time.

They were catching bass in the lake. Nobody wants to clean them so they just throw them back. The frogs are cheeping.

We found a little American flag laying on the walkway. We stuck it in the ground and watched it wave. The Tree Swallow nest boxes were stamped “Made in America.”

I wondered how all of these things came together on a sunny afternoon in the spring. I can’t figure it but it sure was nice.

First Day Back in the Saddle

Today was my first day back on the hospital consultation-liaison service and I’m a little tired. I put about 2 miles and 22 floors on my step counter, which was a nice pace for starters. It’ll get busier as the COVID-19 surge develops over the next couple of weeks.

Being in phased retirement means I’m away for weeks, sometimes more than that. The pandemic changed many processes and policies while I was gone.

I think the biggest challenge I had this morning was just getting used to donning and doffing the face shield. I passed many people in the halls who are wearing them. My clumsiness was a little embarrassing. It took me a while just to figure out how to adjust the head band. But those who recommend them are right–they keep you from touching your face, which the masks don’t do.

You may have seen my YouTube video and the post on how to trim beards so they don’t interfere with the seal of the N95 masks. I even shaved mine off. Come to find out, I’ll probably never have to wear one given the shortages of masks generally.

I’m learning a lot of things on the fly and that includes how to use electronic gadgets to facilitate remote interviewing in order to cut down on spread of the virus.

I saw a lot more people in the stairwells and elevators were much less crowded.

It’s a different world.

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