Hi readers!

I recently recorded a podcast with Leah Barrett of the Precarious Podcast and it just went live! We had such an interesting and enjoyable conversation.

We talk about my cancer journeys #1 and #2, how the love my patients showed me after my relapse gave me a reason to keep going even though my prognosis was poor, the importance of the doctor-patient relationship, how we can be healed even when we can’t be saved, and more. Listen here:

“I Have Reasons to Live”—Elana Miller, MD with Leah Barrett, MS LCSW on the Precarious Podcast

 

Hi everyone!

So we’re a little over a month into the insanity. How is everyone doing? I hope you all are doing as well as possible and staying safe.

For me, personally, it’s been up and down—I’ve already been self-quarantined since my stem cell transplant, so my daily life hasn’t changed that much. However, I separately have been struggling with graft vs. host disease over the last few months. I was improving initially from my transplant but starting taking a turn downward about two months ago.

Thankfully it’s a minor form of GvHD (so not dangerous) but it’s not minor in terms of how it makes me feel. My energy has disappeared along with my appetite, and I’ve lost a lot of weight. I feel nauseous and sick most of the time. And even for my introverted self, the degree of isolation—along with being physically ill—has me a bit depressed.

I think I’ll save the update on how I’m doing personally for a future post. I don’t want anyone to worry in the meantime, though, so just know I’m not doing terribly or anything like that. In case you’re interested, I have more frequent video updates on my personal life (and other topics) in my Life Teachings membership program.

What I want to share with you today is some thoughts on coping skills. We’re a little over a month into this crisis, and we’ve had some time to get a basic idea of how we act when things get tough. We’re in a period of collective anxiety and stress, and inevitably we’re going to have different personalities, tendencies, and skill levels for how to handle it. It’s human nature.

In my field of psychiatry, we talk about “defense mechanisms,” or strategies people use to cope with difficult or uncomfortable emotions. Defense mechanisms are generally split into two categories—”mature” and “immature,” or emotionally healthy and emotionally unhealthy. Basically, is the coping skill adaptive? Does it help the situation, or make it worse? Is it supportive of a person’s psychological functioning and their relationships, or not?

When the Coronavirus pandemic first became a reality in our daily lives, I was uneasy when I saw some of the less healthy defense mechanisms on display.

We’ve all heard of Denial—for example, if a person is diagnosed with cancer and then acts as if it’s not happening (not showing up to doctor’s appointments, changing the topic when a friend or family member brings it up, etc.). Denial is when a person deals with their discomfort or fear by pretending the situation isn’t happening.

I saw this manifest with the Coronavirus; even my physician colleagues weren’t immune. Posts on Facebook insisted “It’s just like the flu guys,” or “Wash your hands and you’ll be fine.” I saw otherwise responsible holistic medical practitioners claiming the virus was a manifestation of our minds and could be cured with green juice and positive thinking.

I saw Rationalization, which is when a person uses an intellectual and seemingly logical explanation to justify something they did that makes them uncomfortable inside—perhaps an action or behavior that is incongruent with their stated values. We all do it sometimes, myself included.

What I saw with Coronavirus was people engaging in, and then explaining away, what was clearly selfish behavior—not following social distancing guidelines because of the inconvenience, or hoarding toilet paper, food, and even worse, medical supplies, without thinking about the shortages they perpetuated.

That guy who hoarded Purell to mark up and sell on Amazon is a perfect example—his explanation for why he did it was not “The money sounded so good that I didn’t want to have to consider the effect on others,” it was “Well, you see the way that capitalism works is…”

I also saw Misattribution, which is when a person feels anxiety from one source but isn’t able to express it back to that source, and so they misfire it toward someone else—for example, if you feel stressed because of something your boss said, come home, and then snap at your child for something small.

The Coronavirus pandemic is a recipe for disaster in this regard, as many of us are simultaneously operating a hair trigger away from losing it, living at the very edge of our bandwidth.

What I’ve seen is people taking their generalized anxiety about the virus and misdirecting it to neighbors and others they come across in their daily lives, being overly harsh with those who may deserve a little bit of frustration… but not as much as is dished out. I understand it to some extent, and I get frustrated myself when people take unnecessary risks that could harm all of us. But the degree of anger I see is sometimes out of proportion to the offense. Instead of blaming the virus, we started blaming each other.

It’s not all bad, though—at the same time I’ve seen heartening displays of healthy coping strategies like Humor, Humility, and Altruism as others sublimated their fears into action. One student sidelined from college started a nonprofit to deliver food and supplies to elderly and immunocompromised people who couldn’t safely shop. Adept seamsters are hand-sewing masks for healthcare providers who don’t have enough. Online, comedians are entertaining us, musicians are singing for us, and DJ’s are throwing dance parties.

Look, we all are human and no one person is defined by one behavior, and none of us is defined by our worst moments.  We should forgive ourselves for our mistakes, and we should ESPECIALLY forgive others for theirs. Use what I’m sharing with you not to judge others, but to work on bettering yourself. Instead of going straight to habitual negative coping skills that may not be productive, take a pause and try one of these strategies instead:

1. Undoing: It’s what it sounds like—when you have a negative impulse toward someone, do the opposite action instead. For example, if you’re on the verge of snapping at a neighbor for not following the rules, leave a little gift (a puzzle or coloring book, maybe?) on their doorstep instead. It’s the “kill them with kindness” approach. Of course it’s reasonable and often needed to set limits with others. But even if others aren’t doing the “right thing” and following the rules… what can you do to bring out the best in them? Trust me, we all want to have the best brought out of us.

2. Anticipation: If you feel anxious and uncertain about the future, direct some of that anxiety into purposeful planning. It’s not possible for us to control the world, but we have influence over a small corner of our world. Use whatever control you do have to make contingency plans for the future, review your budget so you have a plan in case you lose your job, meal plan for the upcoming week, etc.

3. Humor: Sometimes humor is an unhealthy defense mechanism, like when a person makes a joke to avoid a difficult conversation, but it can also be healthy and adaptive. We all have to laugh sometimes, even in the most difficult circumstances. If you heard some of the morbid cancer jokes that get thrown around at home with my husband, it might make you cringe… but it helps us find moments of lightness even when things are hard. So be willing to seek out laughter and share it with others—maybe watch a comedy special one night instead of the news?

4. Humility: It’s important to know what you don’t know, or at least be aware of the fact that there are things you don’t know. I see this trait sometimes lacking in fellow physicians, partially because the medical education process often rewards overconfidence over humility, especially among men. It can be uncomfortable to acknowledge when we don’t know something, and indulging in feelings of superiority is a habitual way some of us handle it.

If you open yourself to humility, though, you will find it is a much more rewarding way to exist. You may be surprised by how much more you can know if you are willing to listen to people whom you might have otherwise dismissed. It’s also nearly impossible to change someone else’s thinking unless you’re open to changing your own. So just think: less lecturing of others about Coronavirus, and more listening. If you find yourself open to having your mind changed at unexpected times, then you’re on the right track.

5. Altruism: Altruism is the most wonderful coping skill of them all—to reach the point where you are able to derive happiness and strength through helping others. The best part is we don’t all need to do the same thing; we each can do what we’re best at based on our personal abilities and experiences. Altruism allows individuality. Imagine how much better the world would be if we all found satisfaction from helping others in the way we felt most skilled to do.

The strongest and most mature coping skills are all forms of Sublimation—of taking our difficult emotional experiences and transforming them into something good, both for ourselves and the world. It’s part of why I share my personal experiences with you all here; it gives me purpose to share my story in a way that might help another person. Honestly, it would not be tolerable for me to go through what I’m going through if I could not derive some meaning from it. I don’t believe everything happens for a reason, but I believe we can find meaning in whatever it is that happens.

I’ll end on this note, based on what I can tell you as both a psychiatrist and cancer survivor. Remember that everything ends. All good things end and all bad things do, too. Revel in the fact that your future problems may seem small in comparison to what you’re dealing with now.

I know how shocking it feels—this experience of waking up in a new world and wondering if it’s just some terrible nightmare. I promise you can handle it better than you think. The sooner you acknowledge you can manage whatever comes, the faster you’ll figure out specifically how. The situation does not need to change for you to change how you feel about it.

Now take that fear and anxiety and transform it into something good!

Help me improve this article! If you have any ideas of things to add, email me or leave a comment below and I will make updates. If you want me to credit you, leave a link to your website or social media.

See  Part I of this post here: Love in the Time of Coronavirus

In my experience as a two-time cancer survivor I’ve learned that one of the best ways to deal with difficult circumstances is to transform your anxiety into action—to find a source of meaning and purpose during the struggle.

In the last week I’ve seen a really heartening trend, with people sharing ideas about how we can support our families, friends, and communities during this time of crisis. Here are a few ideas of specific actions you can take—it will help make the world a better place, but it will help you feel better, too:

1. Tip your food delivery driver extra—they’re putting themselves at risk to feed us all
2. Run errands for others who are elderly, immunocompromised, or otherwise at risk
3. Practice social distancing so we can all work together to flatten the curve—even if you’re young and healthy you could spread the virus to someone who’s not
4. If you’re sick or at risk of being infected, be careful to tie up your trash tightly to make sure to lessen the risk of exposure for your local sanitation worker
5. Remember that people who live on the margins of society will be the most impacted economically, so do what you can to support them
6. Give your cleaner the time off but still pay her
7. Give your nanny paid sick leave if you can afford it
8. Pay your hairdresser in advance for your next haircut
9. Pay your nail tech in advance for your next manicure
10. Buy gift certificates at your local restaurant, hair salon, or nail salon to use later to help keep them afloat
11. Instead of returning your theater tickets, donate the money to the theater so they can continue to pay their employees
12. If you know a marketable skill that can be done online (web design, coding, etc.), teach it to someone else
13. If you have money, share it
14. If you have time, share it
15. If you have a social network, support someone who doesn’t
16. Schedule a phone call or Skype date with someone who you suspect could be feeling lonely from the social isolation
17. If you’re single or live alone, partner up with a “Coronavirus buddy” so you have someone to share hugs with (as long as you’re each keeping your distance from everyone else)
18. Join your local Nextdoor to stay connected and keep abreast of neighborhood news
19. If someone around you coughs or sneezes, don’t immediately look at them like they’re a leper
20. Be kind to others when shopping
21. Practice patience with your friends or family who seem overly anxious, and support them without being invalidating
22. Practice patience with your friends and family who aren’t following all of the guidelines, and teach them how to do the right thing with compassion
23. Whatever the tone of your average social media post, make it 10% nicer (everyone’s under high stress right now so we can all be set off easily)
24. Be 10% more curious about other’s points of view than you normally are
25. Care 10% about the social good than you normally do
26. Share a roll of toilet paper with someone who needs it
27. Share a bottle of Purell with someone who needs it
28. Make a meal for someone who needs one
29. Only buy the food or household supplies you need so there’s enough available for everyone
30. Thank any doctors, nurses, or other healthcare providers you know for all the work they’re doing to keep us safe
31. Thank any respiratory therapists you know—they’re at very high risk for contracting the virus and help keep us breathing when we’re sick
32. If you have gloves or masks, especially N95 masks (the kind that filters small particles), donate them to your local hospital—doctors and nurses are already needing to reuse masks or make their own masks from office supplies
33. If you know how to sew, make masks to help hospitals with their shortages
34. Keep yourself as healthy as possible and avoid unnecessary health risks—the ER might not have the bandwidth to handle your broken arm from drag racing, for example
35. Postpone any elective procedures you have scheduled so the doctor’s time and medical supplies that would be used for you are available for someone else who needs them more
36. Donate blood if you can—there are major shortages right now because the Red Cross has had to cancel their blood drives
37. Share Coronavirus memes… because laughter, like Coronavirus, is contagious
38. Set up a “drop zone” on your doorstep for your food delivery person so they can stay 6 feet apart when they deliver your food
39. Keep yourself informed by checking the CDC website regularly—the situation is evolving daily and we all need to do our part to be informed citizens
40. Subscribe to an online news site to support the journalists who are working so hard to keep us in the know
41. Share your Netflix password with someone who needs some entertainment
42. Work to restore the sense of community we in the United States enjoyed in the aftermath of September 11, 2001; be more kind, civil, tolerant and patient with everyone you encounter
43. When this is all over we’ll look back and reflect on the role we played during this collective period of difficulty: set an example that you can be proud of 🙂

Have anything you want me to add to the list?  Leave a comment and let me know!

For the last week I’ve been consumed with anxiety. It’s been on my mind and probably most of your minds, too. CORONAVIRUS.

Partially I’m worried for myself, as being a cancer survivor and recent recipient of a stem cell transplant puts me at a high risk for serious illness if I were to contract COVID-19. And when our healthcare system becomes overly taxed, which is inevitable, will I still be able to get my routine oncology care? What if, God forbid, my cancer were to relapse this year (which is unfortunately the period of highest risk for me), would my doctors be too preoccupied with their other patients to take care of me?

But much more than I’ve been worried about myself, I’ve been worried about all of us—about society as a whole. At first I was hopeful—maybe the pandemic could bring us together? Maybe it could instill in us a sense of community and camaraderie and common purpose, like during wartime or an alien invasion (according to every action movie I’ve ever seen)?

The problem, though, is that pandemics historically have not brought people together. When the enemy is a virus, it could be anywhere, or in anyone. The doubt and mistrust can infect every part of us, including our moral code. There has been a lack of clear leadership and no singular voice guiding us how to conduct ourselves when our individual desires may be at odds with society’s needs. In that vacuum some of our base instincts have taken hold.

I see the mistrust and suspicion seeping through on social media, first with the dismissive posts criticizing others for worrying. “It’s just like the flu, guys.” “You’re overreacting,” “Just wash your hands and you’ll be fine.”  In the last few days that tone flipped rapidly toward somber as most people have started taking it seriously. But then the anger came out. “Stop going to the gym, guys!” “You’re being so selfish!” “What’s wrong with people?”

It’s happened with my own family. When the news started turning I called my parents to see how they were holding up and was alarmed to hear they weren’t reconsidering their vacation to Hawaii next month. “It’s no big deal, honey. We’ve seen it all” (as I desperately tried to convince them otherwise, I had a sudden sympathy for how they must have felt trying to get me not to do dumb stuff as a teenager).

Otherwise normal people are hoarding food and toilet paper. First time gun purchases are up. This guy stripped a state’s worth of Purell from mom & pop shops so he could gouge customers by reselling it on Amazon at a massive profit. Suddenly every person around us is a potential enemy: Did she just cough? Is he buying all of the spaghetti? Why is he posting a photo at the gym? That’s so irresponsible! Won’t she just stop worrying and get off my back already? It’s not that big of a deal!

Let me backtrack for a moment with a brief story. A few weeks ago I wrote my first blog update in a while describing how I’ve been recovering from my stem cell transplant over the last few months. I wrote about how strict my husband has been about making sure I follow the anti-infection protocols at home to keep myself safe and protect my baby immune system and I jokingly used the term “Nazi” to describe him.

As I wrote the words there was a whisper in the back of my mind that someone might be offended by the joke, but I was tired and it was too much creative effort for me to come up with another phrase that packed the same punch I was looking for. For better or worse, when you’re an adopted half-Moroccan cancer survivor raised Jewish married to a half Ashkenazi half Persian Jew you feel entitled to make a lot of jokes.

Out of the 10,000 or so people who subscribe to my newsletter I received three replies from people bothered by the reference. The first person was quite harsh and called me abhorrent, among other things. That reply went straight into the trash, although it did give me minor stomach pains because it caught me off guard and no one likes to be on the receiving end of meanness from a stranger.

The second reply wasn’t unkind at all and was in fact otherwise complimentary but the level of offense felt a little dramatic, like I had done something terribly wrong. I emailed her back. Wasn’t “Soup Nazi” from Seinfeld funny? What about that recent Curb Your Enthusiasm episode with the antisemitic dog that only heels at “Heil Hitler”? She replied that she didn’t think Soup Nazi was funny at all, and I thought that was fair, because at least that was consistent. I disagreed but I understood her point.

It was the third reply, though, that made me realize I was wrong. It was so simple. It just took me a sentence to understand. She just described how she used to use the term “Nazi” as a joke, too, until her German immigrant husband explained to her why it was hurtful, especially for people living where it all had happened. She nicely pointed out that my (German) stem cell donor could be hurt by it, too.

Well, how much more obvious do I need it to be? I may be slow, but I’m not dumb. Of course I didn’t want to hurt anyone. The first two replies just made me think I had offended someone, which I’ve found is quite impossible to avoid when you have more than 10 people reading your stuff online. But hurting someone? Now I got it. I mean, I’m not a monster. That’s the last time I’ll ever make that joke again.

What a gift, isn’t it? To help change someone’s mind, to patiently guide them toward being a better person? To share your own story of growth, as she did, to help another person see it’s possible for them, too? I was open to this woman’s point of view because own self-reflectiveness made her credible. If we want to have the capacity to change a person’s mind, and therefore their behavior, we have to set the example first; we have to be the kind of person who is willing to change our own. Perhaps there are many ways to be persuasive, but the only one I know is to lead with humility.

I generally don’t try to change anyone’s mind about anything, except my patients, who are explicitly paying me to do so. It usually feels like an exercise in futility and an inefficient use of my limited mental and emotional energy. Believe it or not I am not a very outspoken person—my husband lovingly referred to me as a “mute” for a while because of how little I talk in group settings. I guess being a better listener than talker is what makes me predisposed to being a psychiatrist.

But I’ve started to feel differently now in light of the crisis we’re facing; the experience of having my own mind changed has shown me that to put that effort toward another person is a sign of respect; it is a gift through which we can demonstrate our love. We are currently experiencing a crisis and we are obligated to help those who need guidance.

I was still ambivalent about this post, though, until last night. My husband and I ordered PF Chang’s for dinner, and over Mongolian Beef and hot & sour soup I vented my anxieties about having a public voice about something in current events. I finished eating and opened my fortune cookie. It read: Others will follow your lead in the coming months.

Fuck. It’s on. Let’s do this.

There are basics we all need to know and follow: To start, follow guidelines on social distancing, not just for yourself but for the community. We need to flatten the curve, spreading out the infections over time so the healthcare system is not overwhelmed with a bunch of sick people all at once (we don’t have enough ICU beds or ventilators for all the people who will need them). Young people need to participate, too— while they generally don’t get sick they are likely the biggest spreaders of the virus, since they are the most active.

Don’t hoard toilet paper or food—the supply chains are fine, the issue is that everyone got scared at once and bought more than they needed. Care about yourself and your family, but don’t forget about your community or society as a whole.

Keep abreast of the news and CDC guidelines as the situation is evolving daily. Run errands for people who are elderly or immunocompromised. Remember that the people who will be most affected economically are those at the margins of society. Give your cleaner the time off, but pay her anyway. Tip your delivery person 10% more than you usually do. Be 10% nicer than you normally are, especially on the internet. If you have money, share it. If you have time, share it. If you have social support, share it. Sublimate your fears into action.

Whatever action you’re considering, envision that it’s not just you taking it, but everyone. Would the the result make the world a better place, or a worse one? This is an opportunity for us to support our families, our friends, our neighbors, or communities, and society as a whole. It is an opportunity for us to give help and also receive it. It is an opportunity to set an example for others by how we act.

Be patient with others as they get up to speed. Teach others without criticism or condescension. Lecture others 10% less; act 10% less superior. Be gentle when you tell someone they can’t visit or you can’t hug them. None of us wants to hurt anyone. We all want to be good people.

What we are all facing right now is scary and uncertain. It’s going to get worse before it gets better. Some will die, and many will suffer. There will be loneliness, grief, anger, and economic stress. It is a crisis. And a crisis is a chance for us to let our actions be guided by love—to become the people we have always believed and hoped we are.

I don’t know about you, but when I was a child I indulged in more than a few adolescent fantasies about what an amazing person I’d be if only given the opportunity—like I definitely would have been sitting with Rosa Parks in the back of the bus and hiding Jews in my attic during World War II. Well, now’s my chance. It’s all of our chances!

Sometimes a catastrophe is easier to handle than a minor inconvenience, and I speak from experience as a two-time cancer survivor. The stress of a minor inconvenience can be indulged, every aggravation played out in our minds, every annoyance yielded to—whereas the reality of a catastrophe demands action. It’s a make-or-break moment for all of us to discover who we are inside.

Love is not just a noun, it is a verb—it is an act. It is what you do. It is an energy that, once created, can never be destroyed, but is instead set forth into the universe in perpetual motion, where it will exist for all of us, always.