Julia Lunsford, MD
Program: Geriatric Psychiatry Fellowship (2014 alumna)
Clinical Assistant Professor
Medical Director of the Geropsychiatry Inpatient Unit
Department of Psychiatry, University of North Carolina at Chapel Hill
Location: Chapel Hill, NC
A Geriatric Psychiatrist in the COVID Zone
One of my favorite blogs about aging and the later years is "Life in the End Zone," written by a geriatrician and palliative care physician, Dr. Muriel Gillick. Topics range from nursing homes and caregiver burnout to frailty and polypharmacy, offered with eloquence and wisdom.
Whether you call it the End Zone, Chapter Three or Elderhood, this phase of life is one that most people try to avoid, and as a result, are typically unprepared for, even this geriatric psychiatrist who is just beginning to dip her toes in those murky waters. The fact that Duke accepted me into its geriatric psychiatry fellowship program and thus allowed a recreation of my professional self in my late 50s was an unexpected twist that offered renewed vigor and energy. My previous work had taken place in a quaint cottage surrounded by perennial flowers in my back yard, where I sat with patients, many of whom followed my own arc from motherhood to menopause, allowing for the kind of exploration that offered more questions than answers. The relaxed pace provided time for yoga, journaling and meditation, as well as attending my sons’ ball games and PTA meetings.
Now, six years beyond fellowship training, I am on faculty at UNC-Chapel Hill, where I care for older patients dealing with mood disorders and memory impairment, and help train bright and motivated medical students and residents. It’s been an incredibly satisfying and fulfilling chapter. Unexpectedly, however, another twist has emerged in the form of the novel coronavirus that has quite literally infected society, with life as we knew it dramatically changed. Terms such as “flattening the curve” and “social distancing” have become familiar nomenclature, while preserving PPE, increasing testing capability and anticipating the surge of COVID patients are the critical talking points in weekly virtual town hall meetings. In my department, we are taking some pride in having transformed our outpatient service to a robust tele-psychiatry presence in mere weeks, offering telephone and video visits to a population that is all the more vulnerable due to the burden of isolation and loss of normal routines on top of chronic mental illness.
Perhaps the real reason I decided to shift towards geriatrics was because of my aging parents, who allowed me to bear witness to the blessings and losses of their later years. My mother, now 93, has advanced dementia and is confined to a memory care unit, where I am no longer able to visit her due to necessary restrictions. I am told that she is doing well, and that if she were to clearly decline to the point of imminent death, I would be allowed to see her, but as Muriel Gillick and others have reminded me, dementia is typically a slow fade, and the final exit is not so clearly forecast. The kind and helpful staff have set up FaceTime opportunities, but for my mother, who never had experience with computers, cellphones or iPads, I think she is more confused than comforted by the fuzzy face and indistinct voice that somewhat resembles and sounds like her daughter.
As an older adult myself, I know that I am at higher risk for being afflicted, a fact that initially caused my leadership to try to keep me away from our geriatric inpatient unit. With no medical comorbidities, I suspect I may be healthier than some of my younger counterparts, but I also recognize that this may be part of my own denial of aging. In any case, I am once again seeing patients in the hospital, having my temperature checked each morning, wearing a mask that is changed every other day, keeping my distance, frequently washing my hands, and wiping off tables in between interviews. When I’m not in the hospital, I am on my computer in a home office that looks out over a lovely front yard that has derived benefit from one of the nicest springs in years with mild temperatures, frequent showers and more regular visits from its amateur gardener.
One of the reasons that I chose psychiatry was that I was drawn to patients’ narratives with their inherent complexity, often embodying a measure of paradox and uncertainty. The paradox in my own situation is that I miss the community of my colleagues, the intimacy of face-to-face contact with my patients and the cuddles and hugs with my two young grandsons, who live a mere four miles away (it might as well be 400 miles, as their father, my son, a second-year internal medicine resident, must be all the more careful due to his even closer proximity to the front line); but, at the same time, I have savored the unexpected time at home surrounded by trees, flowers and birds.
I have reclaimed parts of my former self that I didn’t even realize I missed – the self who wrote in a journal, went for morning jogs and bore witness to the re-emergence of plants awakening from their winter’s sleep. My husband and I have enjoyed more frequent strolls and in-home meals, working on jigsaw puzzles (something usually only done over a holiday break or week at the beach), and yes, choosing the next binge-worthy TV series to start. Zoom chats and virtual cocktail hours with friends and family have offered a new way of connecting and sharing.
Truly it has felt like the best of times and the worst of times. Jolted into a greater awareness of the impermanence of life, I am left with a sobering understanding of the frailty of all beings – not just the older ones – and a deeper appreciation of the precious and precarious nature of our existence. I yearn to get back to normal, but also realize that “normal” is just a notion, and maybe a faulty one at that. I do hope to hold my grandbabies soon – they grow up so fast – and I fiercely hope to see my mother again.
Read other alumni reflections on their work and life in COVID-19 times.