Occam's Razor

My wife volunteers one day a week at our local hospital’s emergency department. During the worst of the covid-19 pandemic she was told to stay home, but for the last six months or so she’s been invited back. She’s heavily gloved and double masked and of course has all her shots and boosters. She mostly cleans bays in the E.D. and tries to lower stress by offering patients snacks and drinks.

When she was allowed back there were still a lot of covid-19 cases coming in. There are procedures to isolate these patients in special rooms. My wife can’t clean these rooms. A special technician in something like a spacesuit comes in and uses a large machine to shine ultraviolet light all over the place. This kills the virus better than wiping down surfaces.

There’s still a lot of covid-19 out there, but it’s been around long enough where most cases don’t require hospitalization or a trip to the emergency room. Most days though when she is there the place is bursting to overflow. What she’s been seeing most of this year are people having mental health crises.

In better days, these people would go into a local psychiatrist ward, but there’s no beds for them; they’re all taken. So they end up in the E.D. As my wife can attest, there are a lot of mentally struggling people out there.

In a recent case she related, an adult son took his mother to the E.R. because he couldn’t deal with her craziness. He just dropped her off; his mom was their problem now. Confused and disoriented, all the bays were full so she was placed on a gurney in the E.D. hallway. She was triaged as best they could handle her, but she decided she was going home. Dressed only in a hospital gown she made a beeline for the exit to be stopped by a security guard who was hastily called in.

Most of these patients “graduate” to a hospital room. That doesn’t mean they get much in the way of treatment, at least for their medical condition, but at least they can be effectively monitored. A staff psychiatrist might come by once a day, but everyone’s waiting for some bed to open up somewhere in a facility that can treat these people. Naturally, many of these people are poor, underinsured and in some cases, even here in Massachusetts, uninsured.

Nationwide, it’s adolescents though who are disproportionately affected. Suicide is now the second cause of death among adolescents. Parents are left holding the bag trying to keep their kids functional while waiting months for a therapist, which often they cannot afford. Ending up in an E.D. is something of an act of desperation, but an E.D. visit can easily become a traumatic episode to a child who is already having problems coping with life.

It’s pretty clear that, at best, the pandemic made things worse. For many adolescents, a healthy self-image comes from relationships occurring mostly at school. That was suddenly taken away with classes held online. Making it back after months online trying to get an education didn’t help much either. It wasn’t the same. There were new protocols and masks. For many, the pandemic turned their whole lives upside down. It was a huge burden placed on all the other burdens that come with adolescence.

I might well have had a mental health crisis too when I was a teen had I gone through what teens today are going through. I suspect it would have helped that I am naturally introverted, but that doesn’t mean I don’t need some regular company other than my wife and cats. One thing I didn’t have to worry about were school shootings. Nuclear war was a theoretical but existential threat. Worrying about sudden death from some crazed gunman, largely unprotected by a society that placed the rights of gun owners over the lives of kids probably would have been enough of a trigger.

We live in a crazy, topsy turvy world now. In some ways it strikes me that it’s entirely logical that so many teenagers can’t keep it together. They face myriad stresses I never had to face. My biggest concerns were overcoming my shyness so I could get a date and pimple control.

I can keep it together today because I’m introverted and relatively isolated. I have my wife as my primary company and a supportive community of seniors nearby. I don’t have to struggle to raise a child anymore; she’s 32. I don’t have to worry about rent increases and soaring food costs. I find inflation somewhat concerning but we have the assets to see this through.

But we are the exception. Most people are struggling, anxious and nervous, and this is inculcating a general public mental health crisis. There is too much personal and global risk and it affects almost all of us. We’re becoming unmoored as a society. It seems like this mental health crisis is a harbinger.

I don’t know how my wife continues to keep volunteering at the E.D. It’s one of the last places I would volunteer. I already know that my capacity for dealing with this kind of stress is not large. She reports the staff there is stressed too and burned out. It’s been a true hell of a last few years, but emergency departments are usually challenging places to work. There’s just little to no downtime there these days.

I can already sense that regardless of how much the pandemic wanes over the next year, our local E.D. will be mostly the same a year from now, and about a third of the people in it will be trying to cope with a mental health crisis in a place not really equipped to deal with the depth and breadth of the problem.