Unpacked: A psychiatrist explores and unpacks our collective experience of the COVID-19 pandemic

By Dr. Sara Coffey

The COVID-19 pandemic affected all of us, with individuals, families, and friends navigating the changing landscape in different ways. Many stepped into uncomfortable conversations and experiences that have lingering, lasting effects.

In Unpacked, Dr. Sara Coffey explores our collective experience to this life-altering, global pan

• Language: English
• Publisher: Argyle Fox Publishing
• Release date: May 7, 2024
• ISBN: 9798891240254

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Copyright 2024 by Sara Coffey, DO

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ISBN 979-8-89124-029-2 (Paperback)

ISBN 979-8-89124-018-6 (Hardcover)

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FOREWORD

Trauma can have lasting effects on the body and the mind. Many of us have likely experienced a traumatic event that impacted the body—perhaps a fall from a tree as a child or a motor vehicle collision as an adult. Such trauma may cause a broken bone or torn tendon. There is often an immediate response to this injury, such as a visit to the emergency room or perhaps surgery and a cast put in place. Following the immediate intervention, we need rehabilitation of the injured body part, a brief period of rest followed by strategic conditioning of the affected limb. This work can be challenging but ultimately aids in recovery.

When an emotional trauma occurs, similar efforts to heal are needed. The immediate response to the injury includes providing a safe, caring space for the individual. A gentle reminder that emotional trauma occurs and can impact us deeply, a normalizing of this experience. A reminder of the intrinsic coping skills the individual has—deep breathing, exercise, talking with friends or family. And just like the rehabilitation that occurs with a torn achilles tendon or broken collar bone, therapy for the mind can aid in the recovery of an emotional injury.

In trauma-based therapies, the trauma narrative is often considered an important—if not essential—part of the healing process. The trauma narrative is a psychological technique that allows us to make sense of the experience, to gain some mastery and control over a period of time in which we feel helpless and out of control. For many, the early days of the COVID-19 pandemic was this traumatic experience. It affected us all in some way. Many of us still need to make sense of that time. Unpacked is my trauma narrative, and it may echo yours. I hope it helps you understand, explore, make sense of, and come to terms with our collective experience of COVID-19.

March 11, 2021

Last year on the eve of my fortieth birthday, the world was consumed with news of the novel coronavirus. I’d just moved into a new home, and across the globe there was a stillness—an anticipation, a waiting, a tension, a holding of our collective breath.

My new home allowed for the expansion of my thoughts. It provided a safe harbor to explore, to be. Work slowed, I slowed, everything slowed. A collective pause. Life was thick like molasses, but not sweet. Heavy, dense, looming, it highlighted and exposed our worst fears. In a way it brought out our worst selves, in another way our best.

A year of the pandemic taught me about myself, my family, my community, and our collective human experience. This everlasting pause offered much-needed time to sit, to slow down, to be still. I am extremely fortunate and grateful for the opportunity it afforded me. However, for most people, the opportunity to slow down was not available. I am keenly aware that others did not and do not have this experience.

Although the pandemic offered an opportunity for reflection and taking stock, one thing remained clear: We all went through the storm, but we rode it out in different boats. Some of us chartered yachts to cross the Atlantic or climbed aboard sailboats, others crammed onto the passenger ferry hoping to make it across alive, while the majority grabbed anything that floated by.

This collective experience could have brought us together. Instead, it intensified the divide between the haves and have-nots, as communities of color, the elderly, and those without means faced far worse consequences than white, privileged communities. Essential workers pulled double shifts without hazard pay, as many of us phoned in orders and video conferenced from home in our warm pajamas.

March 11, 2020

The World Health Organization calls it: The coronavirus is a pandemic.

As a physician, certain things become second nature: Wash your hands, get your rest, an ounce of prevention is worth a pound of cure. As medical students, we learned the intricacies of organ systems. We were taught how the body processes energy on a cellular level. Under a microscope, we gazed on the delicate tissues of the human body—skin cells stained with pink and purple dyes, an abstract painting coming to life in the name of discovery and understanding. We participated in detailed exploration of the intricate differences between the rhythmic muscles of the heart and the strong skeletal muscles involved in movement. We gained a window into the earliest stages of life as we viewed the mitosis of cells dividing to create the complex systems that make us whole.

In my first year of medical school, an older student informed me, In medical school, you will forget more than most people learn throughout their lifetimes. After four years of medical school, I believe this is true.

In medical school, some might have described me as a gunner.

As defined by Urban Dictionary, a gunner is a person who is competitive, overly ambitious, and substantially exceeds minimum requirements. A gunner will compromise his/her peer relationships and/or reputation among peers in order to obtain recognition and praise from his/her superiors.¹

Hmmm . . . maybe that isn’t the best term to describe me. In my mind, gunner has a more affectionate undertone. Nevertheless, I worked hard in medical school. I went to class on time every day. I sat up straight, and professors told me they appreciated how well I paid attention in class. Showing up is 80% of anything. Eek! Just realized this is a riff off a Woody Allen quote. Maybe I need to rethink my quotes as well. That said, it’s true. Leaders show up. They are on time. They set expectations and hold themselves accountable so others can follow.

Suffice it to say, in medical school, I showed up. I learned—a lot. I sacrificed—a lot. I did not take a nap for four years. Nap time became study time. That’s how dedicated many physicians are to learning about the delicate and complex workings of the human body in order to ensure they can take care of their patients.

I am by nature an inquisitive, curious person. Science is a natural study for my mind. A scientist seeks to explore and understand the natural world and find answers. A scientist gathers data to further knowledge. In science, we seek the truth, but that truth changes. Science recognizes there will always be more to know. Science must remain open to the possibility that its initial conclusions were wrong. This belief drives further inquiry. It asks us to critique and be critical of what we think we know. I trust science and the institutions that support its work.

Science advances us. The remarkable transformative changes that have occurred since the late 1700s are due to the marvel of science. Science transforms our lives, our habits, our communication, our every moment of every day. I trust science, but I also know it’s not the driver of all things.

I read somewhere that the most rational individuals are often the most superstitious. Maybe this is true. I don’t know. I haven’t seen the data. Nonetheless, when 2020 was approaching and references to the roaring ’20s abounded, I had a cautious, uneasy feeling. The advice to Be careful what you wish for circled around in my head. Yes, the roaring ’20s were a boom for the United States, a profound moment of economic prosperity and cultural changes. But it did not come out of the blue.

Formally stated by Newton, For every action, there is an equal and opposite reaction. For all the amazing parties, lavishness, prosperity, and celebration from that era, there was a flip side to that coin. Prior to the roaring ’20s, World War I leveled economies across the globe, killing between 10 and 20 million individuals. And don’t forget—a global flu pandemic killed 675,00 Americans, and a depression further gutted the economy in 1920 and 21. In other words, the roaring ’20s brought some baggage with it, and as you know, history repeats itself. And although I am an n of 1—clinical speak meaning I’m the only individual participating in medical research—this rational, yet superstitious n of 1 was not enthusiastic to hear the comparisons to the roaring ’20s.

As a student, my curiosity of nature likely started my scientific journey, but my curiosity in people pushed me into medicine. I was presenting research on turtle populations during the Tri-Beta Biological Honor Society meeting in Madill, Oklahoma. I often waded into murky, fresh-water Oklahoma ponds to pull up baited rope nets loaded with turtles. Trachemys scripta, Kinosternon subrubrum, and Chelydra serpentina would look at me from the nets. It amazed me that a virtually lifeless, still pond was teeming with thousands of turtles, fishes, snakes, and other creatures. To this day, when I glimpse a farm pond in the distance, I think about all the hidden life it holds. As I learned, there is always something going on underneath the surface.

At the Tri-Beta meeting, I presented on our farm-pond studies. Our research showed that larger ponds supported more turtle species. Sort of an aquatic version of E.O. Wilson’s Theory of Island Biogeography.² Although I enjoyed the research findings, the real joy was the simplicity of the work while soaking in the beauty of nature. After we measured, weighed, and tagged new turtles, we loaded them into buckets and returned them to their marshy home. I often plucked a couple baby red-eared sliders from the bucket and kept them up front with me. As I paddled around the outskirts of the pond, I talked in an Australian accent to the baby turtles, as if I were deep in the Australian outback hunting large reptiles. My imagination has always taken me to exotic, exciting places.

Okay, let’s get back to my interest in humans. The Tri-Beta meeting took a couple of days. During downtime, young researchers and students explored the outdoors and talked about their observations. At one point, a group of us noticed a particular species of mushroom. While the others were ecstatic, I couldn’t have cared less. I was entranced with the changing leaves, the artistic way one tree cut across the path, and how my fellow humans reacted to their environment and each other. I knew then that I wasn’t cut out to be a biologist.

History was never my jam either, but people always fascinated me. As an introvert and observer, an empath and daughter of a social worker, I was drawn to human suffering, emotional experiences, and mental health. So, this biology undergraduate turned her attention to human behavior. I took psychology classes and started a part-time job with child welfare and quickly realized I was moving toward a career working with children and families. I spoke with developmental pediatricians, child psychologists, and psychiatrists to learn what each role entailed, how these professionals supported children and families. I wanted a glimpse of my future and ultimately decided to go to medical school to become a child and adolescent psychiatrist.

Suffice it to say, medical school is a haven for introverted, observant, curious minds that aim to please. Most thrive on devouring information and have a streak of narcissistic inquiry into the self. From the vascular system’s known elaborateness to the expansive list of things yet to be known, the study of the human body’s physiology and its interactions with viruses and bacteria present endless possibilities.

When entering my second year, I asked my neuroanatomy professor how we could spend an entire semester dissecting the human brain. On the surface, the brain resembled a mass of homogenous tissue with little distinction between any particular parts. It appeared a spongy, squishy substance without much to investigate. My neuroanatomy professor looked at me knowingly. A semester to study the complexities of the brain, he said, would hardly do it any justice. How true his words ring to this day!

I ate up medical school. I studied hard. On any given night, my room of despair noted the progression of afternoon to evening libations: cups of coffee were followed by hot tea and water and a glass of wine or chamomile tea to end the night. I sometimes sat for eight hours a day, only to sit for several more while highlighting notes in vivid pink, yellow, orange, and green. Resembling a contemporary art piece, my notes were vibrant, geometrical, and bursting with color. I read and reread notes on histology, pathology, physiology, virology, and pharmacology. During lunch break I might watch 30 minutes of Cops (the only show our local station had on at the time) or a brief section of a movie I rented from the library. I watched movies like I read books back then, one scene at a time. This ensured I spent as much time as possible learning. Early on, I put a lot of pressure on myself. I needed to learn all I could for my patients I would care for down the road—patients I’d never met who would depend on me to know the answers, to help them heal, to improve or even save their lives.

The first year of medical school is like undergraduate school on steroids. Most of the time is spent in an auditorium of tens or hundreds of students. The knowledge base you’re forced to acquire is broad and deep. To attend medical school, students must first take classes in basic sciences to ensure a foundational knowledge. Expertise in these sciences is tested via the MCAT (medical college admission test). In full disclosure, I took this test three times. After my first attempt, my scores weren’t high enough to get in. The second time made me a candidate. The third made me a competitive candidate.

By the second year of medical school, it’s time to incorporate that knowledge to understand the clinical presentation of potential patients. Clinical skills classes are led by an attending physician—a physician who completed all medical training. These physicians present case descriptions to medical students, and it was our job to figure out what was going on with said patient.

Clinical Vignette: A 57-year-old male presents to the emergency room with acute (sudden) chest pain.

Differential (medical speak for what the problem could be): heart attack, esophageal spasm, costochondritis, muscle spasm, GERD, panic attack, pulmonary embolism.

Physicians are taught to triage care. Emergent care gets priority. In the scenario above, heart attack is the most emergent concern. Time is tissue, and if a 57-year-old male has a blocked coronary artery, blood supply to the heart is limited. When the heart isn’t receiving blood, heart tissue is slowly dying. In an emergency room, you quickly take vitals: blood pressure, pulse, and oxygenation saturation (the amount of oxygen in the blood). You might strap electrodes to the patient’s chest to visualize the heart’s electrical firings. Concerned about a heart attack? Put an IV in the patient’s arm and get labs for troponins. (Elevated troponin levels could mean tissue damage.)

All of this gets done rapid-fire in the ER. Mr. Jones gets brought to the ER, his symptoms and medical history displayed on a large white board. Mr. Jones is awake but scared, supported by his wife of nearly 40 years. Speaking with him, you learn that his father died of a heart attack at about the same age. Mrs. Jones indicates that her husband rarely goes to the doctor. Despite having uncontrolled high blood pressure, he refuses to take medication. Taking it causes him to use the bathroom too frequently, so he does without. On top of that, he’s smoked a pack a day since he was 14.

While you scramble to diagnose and treat Mr. Jones, the ER keeps hopping. A multi-vehicle collision occurred blocks from the hospital and several victims get brought in. This is the life of an ER doctor.

As medical students, we ask our attendings for additional information. What do the patient’s heart and lungs sound like? How about his physical appearance? Is he in distress, comfortable, or somewhere in between? What is his pulse ox (amount of oxygen in the blood)? Do we have his labs back yet? If so, how are his troponins? What did his EKG show?

The attending physician facilitator explains that the EKG indicates ST elevation (a common pattern indicating cardiac injury) and elevated troponins. Also, Mr. Jones is turning pale.

You and your team start treating the patient for acute myocardial injury, a.k.a. a heart attack. You call in a cardiology consultation. Shortly after, Mr. Jones gets whisked away for a cardiac catheterization to clear his blocked coronary artery. Your speedy, astute, clinical decision-making saves the day. Mrs. Jones later sends your team a box of chocolates and a thank-you card. She insists this was a wake-up call for her husband, who is also a father of three and grandfather of four. Mr. Jones now takes his blood pressure medication every day, and he hasn’t smoked in a month.

This is what being a doctor is about. You see a problem, identify the problem, and treat the problem. Problem fixed, life saved—done.

I wish medicine were that easy. I wish there were always a clear disease presentation with obvious treatment plan that was always successful. Unfortunately, that’s rarely the case. Of course, common things happen commonly. But the textbook presentation of medical ailments is rarely textbook. Diseases are sneaky and present differently for everyone. Diagnostic tools aren’t perfect either. Interpreting EKGs and X-rays is a subjective task. One of my favorite teachers in medical school, Dr. Golijan (Poppi), taught us not to order tests or studies if we didn’t know what the result would be. Why? Because the diagnosis is entrenched in the patient’s history. As physicians, it’s our job to uncover a patient’s medical history and use clinical skills and expertise to examine a patient. Neglect a patient’s history, and the clinical exam may throw you a curveball.

Throughout my time in medicine, I’ve learned that it’s unrealistic to expect a quick diagnosis based on labs or imaging. I often field questions from friends and family who have concerns about a delayed diagnosis. Patients have asked me to order labs or an MRI to ensure nothing is wrong with their thyroid or their child’s brain. I wish it were that easy. But it’s not. Medicine is not easy at all.

The human body is complex. Chronic diseases are common. Patients take a lot of medications. Technology is becoming more advanced. Yet, we still rely on history. Diagnosis still takes time. We can still be wrong. The diagnosis may change as new symptoms unfold or as the patient responds or doesn’t respond to treatment. This is hard for patients and families. It’s also hard for physicians who want to see, identify, and treat a problem with ease.

Such uncertainty is particularly difficult in a world where everything comes quickly and we expect immediate gratification. Why can’t you order a test to see what is going on? Why can’t you give him an antibiotic to treat his cold? What about an MRI to ensure it is nothing in his brain? Why can’t you do more? These are difficult questions that rarely have easy answers.

This lack of certainty, which clashes with the public’s hunger for certainty, worried me as the WHO warned of a global pandemic.

March 2, 2020

Travel from 26 European countries canceled due to coronavirus.

In February, my friends, husband, and I traveled to Mexico for an adult-only vacation. While heading home, we received updates from United Airlines: Anyone who traveled to China or another at-risk country needed to contact their point of destination. I didn’t think much of this. We had a friend living in China who said things weren’t too bad. Several of us, myself included, thought it was just hype.

By the time March rolled around, it was apparent that this was something to be concerned about. President Trump started screening travelers arriving from high-risk countries like China, South Korea, and Italy. He canceled travel. The United States had seen a few coronavirus cases, but the disease hadn’t burrowed into the American consciousness as a cause for concern.

The early days of the pandemic were odd. For the most part, the virus had little impact on my fellow Americans. For others, doomsday scenarios were coming true. While some of my family members stockpiled canned foods and brainstormed ways to keep safe, others seemed unaware of the coronavirus. It was a weird juxtaposition that intensified as the chasm between camps grew through 2020. Early on, news of Democrats politicizing the coronavirus made headlines. However, it was hard to imagine how politicized the pandemic would become.

In early March, children were still in school. I sent an email to my children’s principal, suggesting the school suspend the share table. This well-intentioned way for students to share food was also a great way for elementary students to share germs. The school year had started with my son getting the flu. He then got pneumonia and picked up a stomach bug that ran rampant through the school. It made sense to limit sharing anything students put in their mouths.

The United States was in a particularly unique situation. A situation that started with the 2016 election, when Hillary Clinton became America’s first female presidential nominee. Her credentials were strong compared