As the hand sanitizer supplies at Heather Luing’s First Coast Integrative Psychiatry practice dwindled in early April, Luing began wondering if she was going to have to shut down. The clinic, located in St. Augustine, Florida, focuses on treatment-resistant depression and offers cutting-edge treatments, such as the nasal spray Spravato or transcranial magnetic stimulation, that require physician-patient contact.
“We really kind of take care of the sickest of the sick patients,” Luing said. “A lot of times our treatments are kind of a life or death situation.”
As restrictions tightened in light of the novel coronavirus, Luing knew she couldn’t simply convert to telemedicine as many practices did, but ensuring the safety of her staff and patients was paramount. Personal protective equipment isn’t typically needed in the clinic, and without established suppliers, she spent hours doing online research and chasing down recommendations to get the required supplies.
“I can’t have my employees coming to work and being exposed to multiple people without being able to stay safe,” Luing said. “Based on the procedures we do, we do have to have fairly close interaction. And sometimes prolonged interaction with patients, which of course increases your risk of transmission. It’s totally different from our normal practice, which is why we didn’t have mechanisms set up to have those things stocked.”
Luckily Luing didn’t have to shutter her doors. One of her staff members had a connection to Dollar General, and the retailer donated a case of hand sanitizer to the clinic, a gift Luing called amazing.
“Those good Samaritan deeds out there are really helping small businesses like this keep going,” she said.
Luing also works as the medical director at an inpatient psychiatric hospital that’s part of a general hospital in St. Augustine. Sanitary operation is difficult there; patients freely move between their rooms and the day room, patio and dining room.
“Patients basically have the run of the unit, so it’s a very hard place to contain an infection because of everything’s constantly being contaminated,” she said. “So that’s one of the big challenges: How do we keep people safe?”
Living in Florida, Luing is familiar with the hoarding behaviors that accompany an incoming hurricane, but she said the degree we’re seeing during the pandemic is unprecedented.
“This has been a scale I’ve never seen in my lifetime,” she said. “That kind of behavior, where even if you don’t need something you’re buying it anyway, [comes] out of what I think is a baseline of overwhelming fear of the unknown and the uncertainty. I think that’s one of the things that’s really going to wear on people is that unknown. How long is this going to go on? How is this going to affect my life? How is this going to affect my finances? So that’s a very hard thing for people to deal with.
“Frequently it’s actually psychologically easier to get bad news than to get equivocal news like, ‘We don’t know what’s going to happen. We’re not sure what that mass is,’ ” she continued. “Sometimes people actually cope with it better once they find out, even if it’s bad news. I think that’s part of what we’re seeing. We’ve never gone through anything like this.”
Luing said she was impressed with how her patients have dealt with the increased stress, speculating that it’s likely that the pandemic has been less derailing for them than the general population. She said the number of inpatient admissions has decreased, and those they’re seeing are for more severe mental disorders rather than depression or anxiety.
“If you’re well enough to stay home, people are trying to stay home, which I think is a good thing,” Luing said. “What I think we’re going to see is a secondary spike of mental health issues. People can manage the social isolation for a period, and then there’s going to be a breaking point where the stress becomes too overwhelming, so we’re kind of preparing as a psychiatric community for that second mental health peak.”
Luing, 42, has three children under the age of 12, and they’ve been doing school online since spring break. “We actually live in an equestrian neighborhood, so we’re lucky that we have a little bit of space,” she said. “The kids are wanting to be riding the horses more, which is nice. We did a family campout in the backyard. We’re trying to find some creative ways [to keep busy]. Kids are resilient; they’re handling it, I think, better than most adults.”
Having horses at home means Luing hasn’t had to give up that part of her life. She has two dressage schoolmasters as well as three young horses that were a product of her once active German Riding Pony breeding program.
“It is very nice [having horses at home],” she said. “I have to say I think for most horse people, horses are your form of therapy. It’s your way to unwind and connect. To not have those, a lot of people are separated from their horses if they’re in boarding situations, but mine are literally 10 steps from my backyard, so it’s really nice to have them there. I do think it’s one of the things that’s helping me cope with the increased stress at work. It’s not even so much riding, but spending time with them and being there and decompressing.
“It does have an effect on my riding,” she said. “I’m still riding my schoolmasters but not so much my younger, less predictable horse because your thought process is: I don’t want to get hurt during this period. We don’t need more people in the hospital. It’s not really a place you want to be if you can prevent it. Unfortunately, I think it has far-flung ripples into our lives.”