Katie Dunlap, MD, MPH
Program: Psychiatry Residency, Child & Adolescent Psychiatry Fellowship (2015 alumna)
Faculty, MAHEC Psychiatry Residency; Perinatal and Child/Adolescent Psychiatry, MAHEC
Adjunct Faculty, UNC School of Medicine
Child, Adolescent and Adult Psychiatrist: Equinox RTC, Solstice East RTC and Journey Home East
Location: Asheville, NC
Living through this time has brought us all back to basics and pushed us into the future. It has been liberating to wear yoga pants to work and felt confining to be stuck at home. Coronavirus has blurred all the boundaries that used to add structure to my professional and personal life.
As a mother and a child and adolescent psychiatrist, I generally have some common ground with the families I serve and my own. Now, that commonplace has grown through our isolation and societal trauma, leaving no boundary un-blurred. I am sure I am not the only one who feels like a participant in the largest psychological experiment ever conducted. And like any good experiment, as a participant, I have not figured out which theory is really being tested yet. Is it a version of the marshmallow test or the Stanley Milgram experiment? How about the Good Samaritan?
Professionally, coronavirus has changed not only how I do my job, but also the roles I have taken on at work. I earned my MPH prior to medical school, following many years of service in the Peace Corps and in other international settings as a public health and community volunteer. Let’s just say, I was well prepared for the multitasking involved when I became a mother my intern year of residency at Duke. While those skills prepared me to balance life at home and at work, I had not used my population and systems-based training often until the past few months. Instead of just focusing on the mental health of my patients in residential therapeutic care, I started outlining protocols for staff, residents and other visitors to prevent an outbreak. Additionally, I am managing more of my patients' basic medical needs to decrease the number of primary care visits and trips off campus. My least favorite added responsibility is becoming my own IT support. Like many child and adolescent psychiatrists, I work at four different places that all chose different video conferencing platforms with their own set of issues.
Personally, my roles have expanded as well, and it is challenging with coronavirus' diminished boundaries to separate the personal from professional. Isolated from their own communities and classrooms, my kids have not only needed me to be their mom, but also their teacher and primary playmate. In 2019, I'm sure my kids would have described me as playful, but now, well into 2020, they talk about my nightly LEGO challenge wins and losses, the popsicle stick menagerie and metropolis we built and our exquisite princess tea parties. Like many families, we have come together in various ways. I have been impressed at how well my eight-year-old son and six-year-old daughter have been getting along with each other; however, their lows have been lower as their outlets have been seized. I do not need to be all things for all people, but I am not immune to feeling like I need to be all things and people for my kids in their shrunken world.
Like my kids, I have seen many regressions in my patients as the adolescent can no longer individuate and the school age child cannot establish the rules on the playground. Maybe we have all regressed a little without access to all our coping skills? Mine has been quite literal. To be productive, I set up an office (with two monitors and the ability to use four video conferencing platforms) at my parents' future retirement home just one mile from my house. During a Zoom treatment team meeting, I had the pleasurable interruption of my mom offering to make me lunch. The familiar intrusion and support of my mother's food is comforting during this time of uncertainty. I understand what regressions can offer.
My colleagues and patients get a small glimpse into my world through a camera’s lens, but some give me a much larger peek into their lives. Previously, I worked on an ACTT team for two years in rural western North Carolina. The value of being with patients outside of a clinic's room and in their homes was immeasurable. During home visits, I shared many intimate moments from giving a dog his monthly haircut to changing diapers and cooking meals. Then, these moments were experienced together and brought me closer to my patients through connection and understanding. But, when seen on a screen, not shared, the same moments feel dismissive or intrusive. Patients’ presence and attention to our appointments seem divided. I’ve wondered if patients forget that they are bringing me with them on their phone. Like screens in our personal lives, they can connect us when we are out of reach, but they can change something that is shared to something that is seen.
There are pros and cons to everything. Tele-psychiatry has brought me closer to some of my patients that live far away from my clinic and at the same time, I feel farther away from everyone. I have had more of my patients in residential treatment misuse their meds or attempt to overdose in the past two months than in the past two years. I did not see it coming, either. That is not to say that being in the room with them would have revealed a clue, "a tell," as to what they were planning. Sadly, their search for control and freedom is limited in options, but not pursuit. But it has been harder to connect, to catch their eye, to appreciate their restlessness, and truly sit with them.
Ironically, social distancing isolates us and changes our shared to seen moments while it unifies us. Of course, there are many disparities that still exist despite and because of coronavirus, but it brings the same uncertainty to our economy, impact of isolation, and future health as a population to everyone. I feel connected to my patients through our shared experience. My recently-turned eight-year-old son told me, "This is the hardest thing I have ever done." My friends' marriage ended and another's business closed. This is hard, and as I said, months into this massive psychological experiment, I am still asking myself, “What is the hypothesis?” I don’t know, but I am trying to come away with my own conclusions; I appreciate community, love spending time with my children and husband, and miss being with my patients.
Read other alumni reflections on their work and life in COVID-19 times.