Fragile? It's All a Matter of Perspective

Managing a chronic physical health condition and working during COVID-19.

Posted May 22, 2020

Source: photo source: Pixabay

I wish I could do more, but even if I could, I am exhausted, and I do not know how I would. 

During this COVID-19 crisis, some of my colleagues still physically go to our clinic daily or weekly to work with consumers (individuals with serious mental illness engaged in their recovery) who are in crisis or unable to participate in telehealth appointments. However, I was able to shelter in place and work from home earlier than others in my department. 

I cannot be there because I am medically fragile.

Am I Fragile?

I consider myself strong, an advocate, an ally, and a leader. How then can I be fragile?

The CDC recommends that older adults and individuals of any age with serious underlying medical conditions shelter in place due to increased risk of contracting the virus. I have one of those underlying medical conditions — Rheumatoid Arthritis (RA) — and I regularly experience flares. Despite this, I push through when I can.  

COVID-19 unfortunately has me feeling fragile in other ways. I work at an inner-city hospital that serves primarily underserved and underinsured people in the behavioral health clinic. Being unable to show up in person to care for the people I am passionate about working with or supervise bright, eager, psychology and psychiatry trainees is deflating.

I overcompensate as a result of being physically absent. For individuals who can participate in telehealth, I initially offered to meet more than once a week, something I would never do unless they were in crisis. I volunteered to be on committees, offer support groups at all hours, work on publications… anything to be less fragile and show up!  

Working remotely has me chuckling when I reflect on those hectic workdays when I thought that telehealth would be easier, afford fewer distractions, and increase more productivity. But when COVID-19 happened, I recognized it was more complicated. 

When physically on-site and consumers missed their appointments, I was concerned and wondered if they were ok, but chalked their absence up to transportation problems, competing appointments, lack of childcare, etc. These days, when the same thing happens, I am slightly annoyed and think “all they have to do is join Zoom—they don’t even have to use the camera!” 

Ironically, I am more productive with therapy, writing, committee work, and the like. It has come with a hefty price, however. My last RA flare seemed more intense and painful. I still showed up for therapies, supervisions, and meetings, but was not fully present. I found myself in tears when off-camera just trying to push through. 

I felt too guilty to take a personal or sick day. I thought to myself, so many of my colleagues are on the frontlines with no break, no time off when they are sick, no recourse — so how can I not show up? That would only affirm my fragile status.  

As an African American psychologist, I also must be strong to show up for my community; 80% of COVID positive cases in GA are Black Americans. If I am not speaking up and being present for those who are marginalized and underserved, I am fragile.

The African American individuals I work with often do not have the financial resources to receive adequate care or the means to engage in telehealth. Some do not trust those in healthcare as a result of our painful past when black people were used as subjects for harmful clinical studies with and without informed consent (i.e., Tuskegee Syphilis study). I need to be present to balance mistrust with facts to work toward keeping our communities safe and healthy. I cannot be fragile. 

Overcompensating has backfired in ways I never anticipated. Being home with little need to prepare to travel to and from work or get dressed professionally below the waist killed my sense of routine. Without my routine, a regular sleep cycle is not required. I find myself looking out the window and thinking, “Wow, it is getting light outside, I need to go to sleep,” and then sighing as I realize, “You can’t sleep; it is time to wake up and prepare for work!”

I schedule consumers’ appointments back-to-back from 7 a.m. until 5 p.m. (with the occasional meeting and or trainee supervision in between). So, there is no time to eat or have a simple social interaction.

I do manage to go off video during meetings for bio breaks when I can. I tell myself, This is ridiculous. How can I preach self-care and support my consumers and trainees when I don’t take care of myself?  

Recently, some graduate students asked me, “Who takes care of you and other psychologists and psychiatrists during all of this?” I literally laughed aloud. My anemic response: “Well, we check in with one another during meetings and have more meetings to support our efforts." Underwhelming, to say the least.  

I know how to engage in self-care. I encourage those I work with to demonstrate compassion and respect. It’s time for me to listen to myself and be kinder all around.  This is challenging because working at home, homeschooling, and living at home can be overwhelming to say the least! 

I have managed to make one day each week a COVID-free day with no COVID-related emails, writing, meetings, etc. I attend church, garden, binge watch something, make a few masks, and play video games. Even during this one day each week, I feel like I am not doing enough and that I am not showing up because I am medically fragile.  

In the end, I am working hard to accept being medically fragile and not equating this with being functionally fragile. I find strength in sharing my vulnerabilities. And with a healthy dose of self-compassion, I can admit that I am strong, resourceful, and am a meaningful contributor. All of you are as well. 

By Erica Marshall-Lee on behalf of the Atlanta Behavioral Health Advocates