Nina Gaby, APRN-PMH, CNS

“She would (if she could) put her arm around the girl she'd been and try to tell her Take it easy, but the girl would not have listened. The girl had no receptors for Take it easy.”

Safekeeping: Some True Stories from a Life

Today from the sidelines, I talk to patients over a computer screen. My immunosuppressed lungs and I hide out in my kitchen, as I listen for clues from individuals I have not even met. I am a psychiatric nurse practitioner, and because of risk factors–age, medical vulnerability–I am no longer who I always have been. I am no longer in the clinic joking irreverently with my colleagues, maybe unraveling an emergency or two. No, today I am the smiling face in the corner of your computer screen, asking about side effects and if this isolation is making you want to hurt yourself.

Today’s “me” signs up for the state’s emergency task force but cannot pass the questionnaire. I am stunned by my own inadequacy–that my lungs are not only old but harbor granulomas in dark pockets, where a virus could hide and, to be frank, kill me.

The real me is on the front lines. Double shifts if necessary. Whatever it takes! No personal protective equipment (PPE)? No problem, I will make my own. Because the real me is the nurse who skidded through long nights in the psychiatric emergency department, slipping on urine from accidents when we could not get patients up out of their restraints fast enough to get them to the bathroom because there were not enough security staff to help us. Sopping it all up with dirty gowns from the laundry bin. Breathless from laughing so hard we almost peed on the floor ourselves, because what else was there to do?

That me fought the crack wars alongside the Black grandmas who were left to care for their children’s children in an epidemic of another decade. That me held the hands of patients in florid psychosis, swabbing their flushed faces of demons between injections of haloperidol and lorazepam. I did crisis and I did it well. I like to think somewhere someone’s life is just a little better for it. I know mine is.

Today I battle not only with unstable airways but with unstable internet connections that often refuse to send my electronic prescriptions to the right pharmacy, or do not work at all. I try to assess danger and safety and need over my ancient landline, which still works better than the stupid cell phone.

Directly overhead, F-35s fly, as if on cue for my 70th birthday. The planes are a Vermont thing; some deal with the government that drowns out my patients’ voices, and now my own thoughts as I take a break to trudge up the 7 acres of hill behind our house, as I do every day to stress my lungs and keep them pliable. The rumble in the sky deepens, and I look up into the blinding blue that was silent moments ago, except for the crows arguing with a songbird for top billing.

Neither the crows nor the songbird win as the fighter jets circle the state from the VA in White River Junction, south, and then back up over our tiny rural hospitals here in central Vermont, and finally back north, over me, to the teaching hospital in Burlington. Ninety minutes of fuel and fanfare to honor the first responders and those on the front lines, as I shield my eyes from the sun.

I pretend that they are in perfect formation over my head, as if to bang a pot or a pan just for me, alone on my little mountain. Yes, they might say. Happy Birthday! Take a deep breath and a bow, you badass, because you are still here.

is a writer, visual artist, and advanced practice nurse who specializes in addiction and psychiatry. She has been working with words, clay, and people for 5 decades. Her essays, fiction, prose poetry, and articles have been published in numerous anthologies, journals, and magazines, and her artwork is held in various collections, including the Renwick Gallery of the Smithsonian, Arizona State University, and Rochester Institute of Technology. She maintains a clinical practice in Vermont and has been on faculty at the University of Rochester, John Fisher College, and Norwich University.

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An immunosuppressed clinician realizes that limits does not mean that you are limited. 

Fighters

“As far as we can discern, the sole purpose of human existence is to kindle a light in the darkness of mere being.”


	I flip my phone on, as I tell my patients not to do when 

 takes over. No screens! I tell them. Sleep hygiene! I recount the basics as if they haven’t heard them a million times.

The phone lights up: 2:45. That’s really early, even for me. The Facebook icon shows its red circle with a number in it and I tap it even though I’m not supposed to. A GIF pops open: a teddy bear with a throbbing heart, arms akimbo, bouncing up and down with pink stars. It’s raining rainbows, throwing kisses. I smile deeply to myself and eventually go back to sleep.
	
	It’s not supposed to happen this way, but when dread pours over and out in this new dark night of the soul, I’m just thankful for anything that makes it stop. But, and there is always a but, I am a mental health professional, a psychotherapist and a psychiatric nurse practitioner and I’m not supposed to be getting teddy bears in the middle of the night from people who once were my patients. Even though we all may be isolated, eyes are wide open in our collective insomnia.

Workers in other professions-teachers, financial planners, bartenders, regular medical providers-get to stay in touch with their clients, students, patients. They can become friends if simpatico, if there’s a connection. But we mental health warriors, once we have said goodbye, it’s supposed to be over. Enduring connection is assumed but never tested. “Termination” is a vital part of the therapeutic process; it is supposed to teach our patients how to end things with positive resolution. How to grieve and celebrate simultaneously, which sounds either a little Zen-koanish or too much like an Internet meme. Either way, it creates a different definition of community. We guard our hearts as well as our cell-phone numbers and email accounts. Our pool of contacts is sparser than others, leaving us perhaps with fewer options for connection in these quarantined times.

In my own therapies the termination process was never smooth. When I was living in a foreign country at age nineteen and trying to negotiate college, an 

, the early stages of alcoholism, and what I know now as “pseudo-individuation” from my enmeshed family, it was no surprise that I developed crippling panic attacks. I found a clinic in the teaching hospital a 45-minute bus ride from my apartment where I was assigned to a newly minted psychiatrist who suggested that I was attracted to him and gave me a sack of Valium. Obviously after the inappropriate medication intervention as well as unsolicited psychoanalysis, I never went back. It was 1970, so who knew? Not that panic is physiological, and two hundred Valium never did anyone any good, especially a budding alcoholic. Boundaries were often a moot point.
	
	Other terminations were messy and inadequate, and taught me all I needed to know about being a therapist myself.
	
	Decades later, I may have broken a few tiny rules in my own practice. I once accepted a Facebook friend not recalling she had been a patient. After working with a loving family who suffered terrible medical losses, they contacted me years later. We had lunch, and now make it a regular event when I’m in my hometown. When I closed my practice and moved to another state I stayed in touch with a patient for whom complete termination would have been unkind.
	
	Most don’t even want to stay in touch so it’s not the issue we were trained to think it is. Sometimes when we run into old patients, they thank us for saving their lives, ask for a pre-

 hug, and they go on their way, as do we, the day a little brighter for having done some good in the world.

Am I not supposed to appreciate the innocent reminders that I was a bridge to something better along the way, maybe to sobriety or to staying alive until the meds kicked in? Or as one young woman wrote, sending me a picture of her healthy family, “They wouldn’t be here if not for you.” If I were a construction worker and someone sent me a picture of their solid, lived-in home, “Still standing,” that would be OK, right?
	
	I’m at the end of my career, teetering in that awkward phase that Erikson calls Integrity vs Despair, or that we might rename now as “Am I going to die alone sharing a respirator vs where’s the light at the end of this tunnel?” Do I get to enjoy the periodic and often perfectly timed messages reminding me of connection and value? Should I set a boundary when a man, now my age, messages me to remind me that “Right now, in this moment, everything is OK” as I did with him decades ago when his defeats were overwhelming? His gratitude is as therapeutic to me as it is to him. As if there are not enough boundaries right now, two arms lengths separating us from the rest of us.

In the COVID-19 world there are new rules. I now see patients over the computer. They see my living room-I see their bedrooms. They hear my dog whining-I see their bathrobes. And in the collective unrest and dread, I cannot argue with the comfort of, regardless of who sent it, a bedazzled teddy bear in the middle of the night.

 is a writer, visual artist, and advanced practice nurse who specializes in addiction and psychiatry. She has been working with words, clay, and people for 5 decades. Her essays, fiction, prose poetry, and articles have been published in numerous anthologies, journals, and magazines, and her artwork is held in various collections, including the Renwick Gallery of the Smithsonian, Arizona State University, and Rochester Institute of Technology. She maintains a clinical practice in Vermont and has been on faculty at the University of Rochester, John Fisher College, and Norwich University. She reports no conflicts of interest concerning the subject matter of this article.

It’s not supposed to happen this way, but when dread pours over and out in this new dark night of the soul, I’m just thankful for anything that makes it stop.

Nina Gaby, APRN-PMH, CNS

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Fighters

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