In COVID-19 Lockdown: Reflections, Regrets, and Confessions

By Larry Climo

I graduated from Yale but wasn’t there for the graduation ceremony. My older brother got married that day and I was his Best Man. His wedding day had been scheduled long before and I’d never bothered to think about those dates. My bad.

My time at Yale-Timothy Dwight was spent trying many things and excelling in nothing. My major was the Division Major, Culture and Human Behavior, an interest I’d had from my teens and that remained with me ever since.

Albert Einstein College of Medicine followed. That was a different story. I was startled and distressed to learn that my new classmates were already far ahead of me. They had significant pre-med preparation in college and Einstein’s courses were pitched to their level, not mine. I barely got through that first year finishing at the bottom of my class. I failed the second year but was permitted to repeat it and did. From a holding-my-breath mind-set I shifted to an open-your-eyes attitude when I created for myself a six month elective at Warlingham Park Hospital in Surrey, England. It was a mental hospital with an innovative social approach to treatment that included a program for alcoholics involving something called LSD.

My general medicine internship came next. I was disinterested in the military and opposed to the Vietnam War so I shouldn’t have been surprised when, during that internship, I received my draft notice. They saw I was a doctor and advised I apply for an officer’s commission which I did and became a 1st Lt. in the Army Reserves and was allowed to complete that internship, following which, promoted to Captain, I was given my orders: basic training and then Vietnam. During basic I volunteered for an unusual State Department initiative, a counter-insurgency program was aimed at repairing South Vietnam’s depleted Healthcare System. Most of their doctors had been drafted, public healthcare was disappearing, and civilians had no reason now to deny Vietcong the food, shelter and recruits they kept coming for. Their government had abandoned them. The idea was that American medical teams, filling in here and responsible to the Vietnam Minister of Health, would motivate the Vietnamese people to heartily approve of their now caring government and give them a good reason to deny the Vietcong the support they kept counting on. The VC would no longer be like fish in a sea of nutrients. They’d now be fish stuck on dry land and gasping for air and the Saigon government would hurry on to victory. I was sent to the Central Highlands, home to Montagnards, where my military orders might clash with my Hippocratic Oath but I was now Br’er Rabbit in his Br’er patch. Thorns that could touch and hurt were merely culture differences and behaviors that informed and enlightened.

No one died in Vietnam on my account. I completed my tour and came home.

I’m back at Yale now for my psych residency. I marry Diane, start a family, and try to grow a beard. For my psychiatry training I get to practice on veterans, Yale students, and locals.

Post-doctoral study follows and I’m now at the Austen Riggs Center in Stockbridge, an open-door hospital for troubled youth from wealthy families. The hospital provides long-term care, and talk-therapy is its primary treatment. I train, join the staff, get promoted, and, from time to time, find myself marching to a different drummer. (One size doesn’t fit all. For example, I learn that sometimes one must get oneself out of the way of healing for healing to happen.) A new Medical Director brings his own people. I’m given notice.

Now, it’s Diane’s time to pursue her new career, a teacher of the deaf. I take a position at a nearby State Hospital that, in contrast to the prior one, features locked doors, dysfunctional and sometimes murderous adults, and families with no money and no interest. Here, medication is the primary treatment. There are so many clashes between state policies, patient rights, and effective treatment that my mantra, in deed and thought, becomes: “I’m doing what I feel is right. You take your best shot at me.” I’m often in court. The State Hospital gradually empties and finally shuts down.

Still on the State’s payroll I’m now on the staff of a Mental Health Clinic in an immigrant community with a high crime rate. My patients, many of whom are my former State Hospital patients, are all poor and most Spanish speaking so I learn that language. I begin carrying a concealed weapon. I don’t carry because of that community’s reputation. That wasn’t the tipping point. The Columbine High School massacre wasn’t the tipping point, either. Neither was the recent shooting at a local hospital where a surgeon encountered his wife’s lover visiting her there (she was a patient) and killed him. One of my responsibilities was to check on former state hospitalized patients where they were trying to live alone. When they stopped answering their phone or knocks at their door by case workers, their monitors would become alarmed and I’d be called to go to their door, too. That wasn’t the tipping point. And, it wasn’t my house-calls to Group Homes either, where a client with a psychotic mental illness had been drinking alcohol, and anti-psychotic meds were withheld by state caregivers, inviting a psychotic relapse. And it wasn’t the decision of that local hospital, where the surgeon had murdered his wife’s lover, to take a stand against gun violence by declaring guns forbidden inside the hospital including those carried by their security guards. Or, that my Clinic Director made the decision that our own security guards be unarmed as well, even though there was direct access to doctors in their offices by walk-ins that routinely included angry disability-benefit seekers who blamed the psychiatrist for their being denied benefits because the State Disability Office told them that the doctor’s report was the reason for their denial (i.e. don’t blame us), so they’d burst into my office and vent their fury. No. My tipping point was my Clinic’s new emergency protocols. Here’s what staff was to do in the event someone entered our Clinic with a hand-gun. The new protocols were clear. Immediately notify the psychiatrist on duty. Got that? That psychiatrist was then instructed to approach the gunman and, in a “quiet, non-threatening voice”, ask for the gun. It called to mind a medical school classmate who had done that very thing some years earlier at a different mental health clinic. He was shot dead on the spot.

The State stops funding “consulting” doctors like me and I’m now paid by the Clinic. The Clinic gradually spirals into bankruptcy until its administrators, loosing money by the millions and desperate to find a buyer, begin discretely letting doctors go to reduce expenses and improve the optics of their finances. Their medical director is deliberately kept out of that loop. I’m that medical director. Blind-sided by an abrupt two-week notice to leave after 20 years of service (that opens the door to a buyer), in shock and embarrassed, I make myself disappear.

I begin traveling around the country as an itinerant healer, filling in at places where a psychiatrist has just retired, left, or died, wherein they needed someone to come quickly to temporarily hold a place – be a “locum tenens” – until they can find a permanent replacement. Diane, now retired, comes with me on those adventures of two to six months. In contradiction to conventional wisdom it is on those assignments that I observe unexpected and unheralded benefits to patients for having as their psychiatrist someone who is a stranger, an outsider, and always about to leave. Who knew? That’s not the way it was supposed to work.

From there I wound down my work-time and then retired. Not long afterward we downsized and moved to Lincoln, Massachusetts where Diane and I settled into a condo and began making new friends and where I received a request from the Psychiatric Times to write a column about whatever I wanted to. So I did.

Now, in COVID-19 Lockdown, I have family in reach, Diane at my side, and ample time to relax, reflect, and keep writing. Ever since college, writing has been a reliable friend for my figuring stuff out and making sense of things, including myself. Sometimes I’d share what I learned. I long ago discovered that writing forces me to think slowly and then deeply and that has made it a helpful partner throughout my career and life. I’m a January-baby, after all. Of course I’m wired to look back while looking forward while also looking inward and then managing it all living in the moment.

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