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One Year Later: Finding Hope

February 24, 2021

By Andrew Penn, RN, MS, NP, CNS, APRN-BC
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

Part 1 of the "COVID-19: One Year Later" series

It was nearly a year ago that the ship arrived in port. I was working a shift at the San Francisco VA’s psychiatric emergency service on March 9, 2020, when I heard that the Grand Princess cruise ship was sailing through the Golden Gate. The VA is perched on a cliff above the Pacific Ocean, literally the very edge of the continent, so I went to the top of our parking garage and watched the white behemoth glide, feeling uneasily like a plague boat, under the Golden Gate Bridge.

That ship passing into the San Francisco Bay was a threshold moment—a place from which you know that the world as you knew it would be inalterably changed and that you must adapt to a new and unknown one.

Of course, the passengers of the Grand Princess did not bring the coronavirus (as we quaintly called it then, still unfamiliar with the language of spike proteins, respiratory droplets, and SARS-CoV2) to the United States. It had already been here for a while, disseminated like dandelion seeds from around the world, slowly germinating.

The world waited, uneasy, restless, for what would happen next. We stocked up on food. We wiped down doorknobs. We looked for leadership. We amassed toilet paper. We read about epidemiology and ventilators. We watched the denizens of Italy sing from their balconies in an exemplary display of the human spirit.

In that week before the shelter-in-place orders, I visited our glorious botanical gardens, where there is a phenomenal collection of magnolias that erupt in blooms of rich fuchsias and creamy whites. The neighboring camellias had shared a riot of pink pincushion blossoms in the slanting spring light. The place was awash with color and life. Yet, it seemed like death was imminent. The images of intensive care units in Italy and China were terrifying. My wife and I stopped procrastinating and wrote up our wills and advanced directives. It is difficult to remember now, as this pandemic has become such a mundane part of our lives, how imperiling and unpredictable it all seemed then. I texted a dear friend from the gardens, telling her about the flowering trees before me. We talked about what to do when the life seemed so foreshortened. “Bloom anyway” was her poetic response.

A week later, on March 17, San Francisco, along with the 5 other Bay Area counties, ordered the start of a shelter-in-place order, for what seemed like an eternity at the time—3 weeks. I was riding my bike home from the VA that evening and 19th Avenue, a main north-south artery through the city, normally choked with traffic at rush hour, was so empty that I could not see a car for a mile in either direction. The eeriness of the moment was palpable.

Spring in San Francisco is a glorious thing. The months of April and May bring the warmth that is decidedly missing when the summer fog rolls in and temperatures plummet to the low 50s in July. Privileged to have a job that I could do from home, on warm days, I would take my laptop and work in the backyard. A birdcall I had often heard, but never really paid attention to, was audible in the eerie quiet of a shuttered city. I later learned it was the white-crowned sparrow, a shrub-dwelling bird so indigenous to San Francisco that birds from different parts of town have a call distinctive to that neighborhood, not unlike the human denizens of my town. Suddenly, the ubiquitous song of a little bird that could fit in the palm of your hand, reminding me again, like the magnolias blooming on schedule, that nature is a constant and comforting presence. 

A year later, the disruptive changes that began in those bright days of March now seem routine. My commute now consists of a few steps between the bedroom and the kitchen table where a nest of laptops, lights, and a microphone allow me to teach, see patients over telehealth, and attend meetings each day. At the end of the day, this technology is set aside so we can eat dinner there before taking the dog for a walk. I wear a mask when I go out, but I mostly stay home. I still wash my hands a lot, but without the fear of death that once led me to sing “row-row-row your boat” to myself to ensure an adequate duration. There is toilet paper in the stores again. And as all of this normalcy occurs around me, the relentless odometer of deaths to COVID-19 rolled over to 500,000 people this week.

At the one-year mark, I turn again, as I did in March 2020, to writing to make sense of my world. Some of my thoughts from those blogs a year ago seem pollyannaish, even naïve. Like many of you, I am tired, I am frustrated, and I am weary. But, like you, I am still here. I have hope. Over the next couple of blogs, I’d like to explore what that means to me.

Andrew Penn, RN, MS, NP, CNS, APRN-BC was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. He has completed extensive training in Psychedelic Assisted Psychotherapy at the California Institute for Integral Studies and recently published a book chapter on this modality in The Casebook of Positive Psychiatry, published by American Psychiatric Association Press. Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing, where he teaches psychopharmacology, and is an Attending Nurse Practitioner at the San Francisco Veterans Administration. He has expertise in psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. As a steering committee member for Psych Congress, he has been invited to present internationally on improving medication adherence, cannabis pharmacology, psychedelic assisted psychotherapy, grief psychotherapy, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice.

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