. . . is still present. A 9th grade student I am caring for in the school clinic was clearly depressed. Her PHQ-9 scored in the teens. She is sleeping on her aunt's couch as she attends a new school this year, having switched every year or two. Her mom who is homeless sees her routinely, but told her not to take the anti-depressant medication I prescribed and wouldn't pick it up. Thankfully she also had a grandmother in her life who lives an hour away, but sees her weekly, that intervened. Visits with the clinic social worker have helped.

Premed students in the Health Care Communication class I just finished teaching at Brown were quite eloquent about their own mental health challenges. In personal reflective responses to prompts about Trauma Informed Care and adverse childhood events (ACEs) they shared their own challenges and those of their friends. It has been a tough couple of years for them with the stress and isolation the pandemic has created but they are enthusiastic and idealistic about their future medical careers.

Physicians feel the stigma too. We seek help, but don't want to admit we need to. A March New York times op ed explored it and several colleagues shared it with me along with a note about how true it is. Are they willing to list depression or anti-depressants on their own forms? Of course not.

But we are hurting. The profession is overwhelmed. A colleague shared this JAMA Op Ed with all the clinicians at the clinic network where I work: We Are Drowning explores the overwhelm of grief and loss encountered in the emergency department day after day. Thankfully, the surgeon general and President Biden addressed burnout in health care this past week. I suppose owning it is the first step. Then I turned off the news last evening unable to listen to the reports from Texas, yet another school shooting and a congress that cannot act.

These are difficult times--a cousin-in-law addressed it well:

My latest sense of the state of our world right now is a fulminating disintegration of so many fundamental elements of our physical and spiritual world. Erosion of the planet with global climate change. Erosion of truth and sources of truth and news and justice systems and political systems to represent civil society. Our religious institutions are mired in horrible hypocrisy and abuses and political abominations, causing little public trust and value in religious leaders offering input to today’s crises.

I have been involved for many decades in faith institutions and dozens of ministries, BUT I have grown convinced that we are blinded by our busy-ness at small scale activities to address our global and galactic problems. My new expression to coin a new phrase is --- We keep busy putting up our Pup Tents in the Hurricane (and ignoring the hurricane) . Not only a hurricane … also a tsunami and a raging inferno of dis-information and chaos and authoritarian bullying of women and gays and minorities and spewing passionate diatribes against the most admirable and virtuous in our communities. . . (Thanks Bill)

We are weary. Hope is hard to rally? So how to move forward?

I stay with the basics. Find the delights in my day. See the beauty of regeneration as spring moves into full summer and the days grow longer. Find like minded folks. Identify ways to make the world a little better in my patch of earth.