Covid-19 Diary III

Technology is giving us wonderful new treatments for illnesses but I have maintained a healthy scepticism for medical interventions having seen many fads come and go in psychiatry in the last 30 years

“You that seek what life is in death,

Now find it air that once was breath”

When Breath Becomes Air: Paul Kalanithi

“Mindfulness” is a hot topic in mental health circles these days. Originally associated with Buddhism (although it is by no means a ‘Buddhist’ concept), the idea itself is deceptively simple: paying attention to the present moment (without judgment). In actual practice, it is quite challenging. The human brain is hardwired to calculate and assess what to do by constantly comparing past experience and future expectations. This is a core function of the part of our brain called the ‘neo-cortex’ (the two big hemispheres of our brain) which we share with our primate ancestors but not with say, cats, dogs or lizards.

In other words, since birth, our brains function in the world by constantly comparing past and present experience and future expectations to work out what to do (now). This makes it difficult to just ‘be’, to be ‘in the moment’, ‘in the present’ etc. That feeling can be experienced when we are at our most relaxed: perhaps after vigorous exercise when the body’s natural calming chemicals (or endorphins) slow down the ‘noise’ in our minds and allow us to be in the present moment. Just before falling into a natural sleep and soon after waking up, refreshed, is also a good time to experience mindfulness to the full.

But always, the mind will attempt to race backwards and forwards trying to calculate all the possibilities and plan what to do next. The Buddhists even have a name for it: “monkey mind”, a playful and non-judgmental way to criticise a somewhat uncomfortable state of being.

As a psychiatrist, of course, I have dealt with far more extreme states of mind, in myself, my own family and friends and the people who come to me for help. The various mental health conditions that I help people with, ‘anxiety’, ‘depression’, ‘mania’, ‘psychosis’ etc represent more or less extreme versions of the same ‘monkey mind’.

So, when Covid decided to pay us a visit, in addition to handling the medical details of blood tests, CT scans, treatment etc, I also had the unenviable task of not just trying to calm down my own ‘monkey mind’, but also that of my wife, three teenage children and my elderly father who has never been shy of expressing his vigorous opinion about whatever catches his fancy.

My friend, Dr F and I were, naturally, most worried about him. Although he is almost 80 years old, he was an athlete in college, a national level swimmer and has stayed physically active throughout his life. Back in 1960s Pakistan, when few people had even heard of the scientific discipline of psychology, he made it his life’s work; and since then, has practiced, taught and written about it. In the early 1970s, he was the first one in our family to head off to the United States for an advanced degree in psychology. After coming back, he taught at some of the leading institutions of Lahore (and got into repeated trouble due to his strong opinions) and is now enjoying his well-earned retirement.

Like most elderly people, he has a few ailments: he is hard of hearing, forgets easily and is physically somewhat frail but when in his element, his eyes still sparkle and he can still hold his own in an argument. But 80 years old is 80 years old, and Covid has been felling people his age in the hundreds of thousands all over the world including in the most advanced countries in the world.

So, when Dr F recommended that we put him on a full complement of Covid treatments including intravenous antivirals, I had no grounds to argue. Getting him on board was a bit of a task since he has a life-long distrust of doctors and a strong belief in the power of the mind (naturally) as well as what is today called ‘complementary and alternative medicine’. He has struggled with an irritable bowel for 50+ years and has a fervent belief in homeopathy which he preaches to everyone.

Thankfully, his chest CT scan along with those of my wife and two sons showed no lung involvement which meant there was a high chance of full recovery. Nevertheless, following my friend Dr F’s recommendations, I started everyone on the “Covid cocktail” while struggling with my reluctance to use unproven treatments for a viral illness.

As a medical student and then a trainee doctor close to three decades ago, I had been taught that viral illnesses are usually ‘self-limited’, meaning there are no specific treatments for it other than rest and nutrition etc. More than thirty years later, nothing much has changed. Technology is beginning to give us wonderful new treatments for lots of illnesses but I have maintained a healthy scepticism for medical interventions having seen many fads come and go in my own specialty of psychiatry in the last 30 years. A statement from the Massachusetts Medical Society from 1860, sometimes attributed to American physician and poet Oliver Wendell Holmes says it best: “If all the medicine in the world were to be thrown into the sea, it would be all the worse for the fish and all the better for humanity”.

But, Covid has put all of our medical knowledge and everything we thought we knew about the world around us and ourselves in doubt. And while we have learned a lot in the last year since the storm broke, it is obvious that much still needs to be learnt.

So, I suppressed my natural scepticism and went ahead with Dr F’s advice. Once I had convinced myself, my father and my wife fell in line as well. It helped that after a day or two of feeling feverish and drained, our symptoms mostly subsided and it now became mostly a matter of waiting it out.

All around us though, the news was going from bad to worse. Next door in India, cases (and corpses) were piling up faster than crematoriums and morgues could handle them; there was ominous news of hospitals running out of oxygen and critical Covid patients choking to death while helpless doctors and nurses looked on. There was even more frightening news of new Covid virus ‘variants’ (mutations in the virus that happen as it spreads and that then allow it to evade the body’s immunity making it more deadly).

Our public hospital in Lahore had been full to the brim already for the last several weeks and it was not at all clear how Lahore’s overwhelmed healthcare system would handle another ‘surge’ of Covid cases if the ‘Indian variants’ came across the border. But for now, I tried to convince my ‘monkey mind’, we were all recovering uneventfully and it was important to be thankful for that.

To be continued

The writer is a psychiatrist, author of Love and Revolution: Faiz Ahmed Faiz and a Trustee of the Faiz Foundation Trust.

He can be reached at    [email protected] and tweets @Ali_Madeeh

Covid-19 Diary III