Month: May 2020

It’s a glorious day – pleasing, pleasant and extraordinarily picturesque – clear blue skies, cool summer sun flooding the neighbourhood, its subtle rim of gold soaking all in a glittery hue. The wild magnolias in full bloom, birds chorusing, squirrels wild and free. I take a moment to breathe in all that surrounds me, sigh and question my senses. Am I mistaken or there is actually an atmosphere of rejoice around me?
Inside me is a different story. The entire United Kingdom is in a state of literal clampdown . Only a week ago we were out and about. An aura of invincibility surrounding us. Guilty as charged, I recall how I spent the previous weekend, galivanting the city centre. The malls were busy, cafes bustling with life and laughter. All was well. There were talks about Herd Immunity and how the NHS is well prepared, adequately equipped and satisfactorily staffed, come what may – And indeed this cushion seemed comfortable enough to wrap around that fleeting anticipatory anxiety, if any.
I had loads to think about, I had poster presentations booked, a member ceremony to attend and a higher training interview to prepare. There was no time to think about Corona Virus. Life’s on as usual and surely it can’t be that bad. We just entered 2020 – It’s the 21st century. not godforsaken 1400s where plagues and black deaths were rampant. The documentary Pandemic not even loosely comparable to times as outstanding as today, Besides, NHS is supposed to be the world’s best healthcare system. The art of self-solace is a commendable trait, repression of a sort, may be not in factual sense, does help deal with difficult thoughts, circumstances and emotions and maybe it was just that I wanted to dwell on, at least for now.
It also helped that the depressive discussion of Corona felt quite distant geographically and was best avoided as it was nowhere close to home. Self-inflicted ignorance is sometimes a bliss – or so I thought. I recalled SARS and MERS and Ebola, and the hazy memory confirmed how they had been successfully curbed.
I realised how comforting this sudden solidification of confidence in todays’ human’s competency and capability was.
There is a degree of invincibility that humans take pride in. Most of the times it isn’t even intentional. Perhaps it’s a queer amalgam of deep-rooted fear, innate insecurity and a subconscious realisation of emerging calamity consequently refuted by humanistic feelings of self-confidence, resilience and a hint of denial.
Anyway, as we stood still, wastefully wondering and washing hands, things escalated rather rapidly. Let’s just say there was little opportunity to pause and ponder, as within what appeared to be a flash, the entire country was now in Official Lock Down.
Schools and businesses shut nationwide, flights floored, events cancelled. Definition of a responsible adult revised, terms like social distancing and self-isolation upgraded in vocabulary and chief medical officer becoming a household name. An absolute ban on non-essential travel, leisure and entertainment, challenging the very core of human autonomy. The same human who had been globetrotting, taking world as his oyster has now been restricted to his couch, frail and frustrated – swapping between various dull looking devices in name of entertainment and survival.
Being part of the NHS staff (more brain than chest – we’d explore further) , there’s little change to my roster or my routine. The commitments, the commute, the long days gradually stretching longer and lunch breaks shrinking away. Mood slightly morose but motivated nonetheless.
Work is still open- as – usual, busier- than- normal and bringing panic along to the corporation is not encouraged.
Storm brewing inside us, we hold our heads high, swallowing away the ever increasing – now almost constant nausea, clutching to this straw called hand sanitiser, and commence our shifts: another day, in a violent, vicious battle against this unexpected, unfamiliar force.
It’s astonishing how juxtaposed the two realities are, the world (as we knew it) of humans around and (inclusive of) me has come to a sudden halt. I expected the nature to rightly depict this. I envisioned sombre clouds and sullen skies. A part of me prophesied a true reflection of despair and despondency, as clearly human’s distress is bound to affect the wider world. Its baffling is how in turn the days have taken to be bright and glorious. The nature has come out to play and be merry. The sparrows dancing with swallows and the squirrels, the Laurels caressing the Ladybugs, the Ox Eyed Daisies and Forget Me Nots co existing in cohesion.
This is a sight of dreams, a sight so surreal, and most certainly never this palpably notable.
I cannot but wonder how, as human walked indoors, shutting gates behind him, did rest of the universe rejoiced in unison
For may be we stand answerable to nature, for the centuries of choices we made, at the expense of this earth and its inhabitants bar humans!?

‘Someone please tell me to stay home’!!
Its Monday morning and the Monday Blues engulf me like nothing I’ve known before. I am packing my bags for yet another week at work, trying my hardest to keep as calm as composed as I possibly can, making a mental note that I’ve completed all the necessary chores over the weekend, ensuring there are adequate supplies for my family in anxious anticipation of what may lay ahead in times of sheer doubt and uncertainty. Forlorn, fearful and heavy hearted I leave the home.
It’s dim and dark, the roads are deserted, streetlights appear brighter than usual. Birds have been a constant feature in this Covid consummated commute to work – ritualistically singing the morning tunes. God, where did we go wrong, I say a silent prayer, and sense one of my eyes welling.
I feel overwhelmed, almost queasy. Now somehow, I could relate what a soldier leaving for the battle field must have felt. Leaving your family behind, as you step out in the red zone. Intending to save lives. Intending to put yourself on the line to protect others. It sounded dramatic, and never in a million years I knew this would be my reality.
I am not a very brave person. I could hardly take swing too fast. The ‘ self-rotating Cup’ in the local theme park being my most explicit adrenaline inducting endeavour. I was more of a curled on the sofa with Nancy Drew kind of person. I never chose army or air force. I always knew I just wasn’t brave enough. Now as I find myself hurled in and around the frontline, with scarcely any arms or ammunition, missing even the basic personal protective equipment, I think of my 2-year-old – and wonder how in the world would I muster up the courage to fight this battle, battle on the outside, and a bigger battle brewing within my own self.
This decision however hard is different, whether it’s worth it I am not sure. What I am certain of is the how desperately people need us, in times so dire like these. The 21 one-year old girl with paranoid hallucinations who has stopped taking her medication. The 56 years old immunocompromised man with panic disorder now clutching for dear life as the world around him crumbles and this time quite literally – I might possibly be their (one of the very few) last resort(s)
Adam is my 7th * patient of the day (Mental Health reviews being far more elaborate, extensive and time consuming than Physical Health ones). He is worried and weary. He is 65 years old with underlying physical health co morbidities that render him vulnerable to the current pandemic. His anxiety is worse now, the feeling of impending doom- more real than ever before, sweating more severe, palpitations more persistent. Social Isolation has not been helpful to his already precarious mental health. He has not left his home since a week now; nationwide lock down meant no one has visited him either. He is unable to cope, has lost his sleep and appetite and has little hope for future, our conversation is desperate, options limited.
These indeed are the most testing times in modern day history. Tedious talks of risks and vulnerabilities. Non-stop news, minute to minute coverage of chaos and calamities, a tornado of unfiltered information, facts figures and fatalities – a strange mix of social media insurgence and depleted human interactions. Indeed, man stands alone, ironically ‘isolated’ fending desperately for himself.
As we whizz through hundreds of heart wrenching stories linked to the current biological apocalypse, harrowing tales from ITU, collapsing patients and dwindling staff safety and moral. This pandemic has affected patients and healthcare workers alike, this may be no less than a world war, if not worse. As Psychiatrists we are the biggest preachers of social interactions, and there is great fear, that the impact of desperate measures like Self Isolation and Social Distancing may bear dire, unprecedented consequences.
Its perplexing for both, us as professionals and our patients to fathom and familiarise themselves to these changes. In recent days we have seen a commendable surge in emergency mental health referrals; and there seems to be a very obvious trigger.
Ariana is 30 years old lady with a diagnosis of Autistic Spectrum Disorder. She has also struggled with low mood since last 10 years, it was reassuring to see that she was finally managing to do well in herself after years of struggle. One of the most important aspect of her contingency management plan was maintenance of social activities and routine. Her life now was organised neatly with several weekly events – she was learning sewing at a local community centre, and attended a craft class weekly where they made cards and gifts for people in hospitals, this added purpose to Ariana’s day, she had a routine, made friends and felt valued. The consistent social interaction, positive feedback and connectiveness was therapeutic, it gave her an identity that she felt belonged to and most of all a purpose and HOPE!
Covid 19 has impacted the world in more ways than just the respiratory system. The biological, social and economic collapse has inflicted a tremendous degree of psychological trauma, compatible only by ones as a result of warfare or natural disasters. The scale of this is widespread – both in terms of magnitude as well as mortalities, and this is just the beginning. I might not yet be the one intubating the covid positives, however my services help those who’ve been through the ordeal, have friends and family suffering and the ones struggling provides a holistic view of mental illness that focuses on the person, not just their symptoms.
The journey of through a Mental Illness is a tedious and at times torturous. There is little hope of complete cure, we base our prognosis on ‘recovery’ – it being the ongoing and ultimate goal depicting improvement. Therefore, more of a journey than a destination profoundly influenced by people’s expectations and attitudes and requiring a well organised system of support from family, friends or professionals. A structure that has fell through drastically due to recent viral calamity. As the world sinks deep in the fathoms of Physical Battle with a biological enemy, what’s imminent is the return of the psychologically wounded, War Veterans and Victims alike, in leaps and bounds.
What is extraordinary in this case however is how vulnerable does it make us – the healthcare workers to the enemy itself. Battling against the tide, blatantly exposed to the assailant, its exceptional how the wounded and healer stand equally susceptible, drastically defenceless, facing this uncharted malefactor.
It all is very terrifying and a part of me does desperately want to ‘stay at home’.
But as I can absolutely not, I beg please you do!!
NB (not real names, not real stories – but inspired by many similar events)