Preview: This blog is written in two different voices: one of a provider and then myself. It reflects my own strategy for managing the current uncertainty of our political future and the future of the country. This strategy involves going into “clinical mode” to distance myself from the feelings I am having. What is key for me is how I return to myself and anchor in the present.

We are a dying nation. That fact is hard for me to contemplate, much less to accept. The current inflammatory episode is really just one in a series of declines over the last 25 years.

Our collective memories are short. And, for those who were born in the intervening years, a lack of understanding of the chronicity of the situation is understandable. But for those of us who have been around for a while, there is a clear history.

History of the Present Illness

The nation presents with severe, rapid-onset gastroenteritis as evidenced by the emptying out of major systems of long-term employees from all three branches of government. Temperatures are high. Attempts since January 20 at calming the overall body have been met with increased inflammation, lowered resistance, and feelings of hopelessness.

Location

While the presenting complaint seems focused on one specific area (government), it is apparent to this provider, that all systems have been impacted, with the primary insult being to the Constitution. Additional areas impacted include civil servants, the Democratic party, immigrants (specifically those who are not white), LBGTQ persons, those receiving funding through USAID, and at-risk aging adults, individuals with disabilities, and children.

Aggravating Factors

Aggravating factors include suspected viral infections of data systems after exposure to foreign bodies. Additionally, formerly stable systems of checks and balances have been completely overwhelmed, leaving the body politic defenseless. Finally, the apparent neurologic impairment, as evidenced by anomial aphasia (inability to name the Gulf of Mexico or Mt. Denali), delusions and hallucinations (beliefs that countries are available for real estate development or want to “become the next state”), and impulse control (bullying and holding multiple press briefings), are all consistent with complete collapse of Executive functioning.

Relieving Factors

A variety of home-based remedies have been reported, including protest, marching, filing of law suits, and doom-scrolling on social media. These have been met with varied success.

Timing

The patient reports increased stress and overall breakdown of once functional systems since January 20. New outbreaks of pain and suffering occur daily, each accompanied by increased confusion. Regularly scheduled and historically stable rituals (e.g., hearings on nominations for Cabinet positions) have been disrupted by lack of factual information.

In spite of this, decisions have been made that undoubtedly have exacerbated the underlying disease process.

Consideration must be given to this being just one more in a series of inflammatory episodes that have their origin starting in 2016, and possibly even further back. Prior to that, there are indicators of long-standing, but well-controlled episodes of outbreaks (e.g., Tea Party, Reagan-omics, Citizen’s United, Mitch McConnell and the Republican Party) that have led to the cumulative sclerosis of democracy.

Severity

Patient presents at Level I (Crisis). Probability of intervention succeeding and returning this patient to a lower level of care is unclear at this time. Consultation with other professionals is recommended.

Psych Consult: Patient presents with fixed delusions, cognitive impairment, and poor impulse control. These symptoms appear to have been present for many years, and while problematic, do not seem to be causal to this episode.

Geriatric Consult: Multiple systems are involved in this presentation. Assuming this episode resolves, it will be necessary to thoroughly assess the compensatory capacity of the other branches (e.g., Legislative and Judicial) to sustain life. It is not clear the degree to which prior levels of functioning can be restored.

Oncology Consult: It is clear that this cancer has metastasized throughout all systems. There are only two options for treatment available: do nothing or provide comfort care. Referral to palliative and/or hospice care is recommended.

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Why the Nation Needs Palliative Care?

Palliative care involves levels of decision-making, care options, and collaboration with other professions with one end in mind:  ensuring the comfort and quality of life of the patient. We need to find ways to comfort ourselves and seek to find common ground on what quality of life means for EVERYONE in this nation.

Levels of decision-making include how much effort, money, and kinds of treatment to use. We are a participatory democracy. That means no matter how hard, all of us need to have representation at the table.

Care options include how long a treatment is offered, where treatment is received, and who and how treatment is provided.

Too many of us have given up on this country, either through lack of opportunity, racism, marginalization, or just fatigue. Others have given over leadership, succumbing to the promise that they will have a better day if they just let someone else call the shots.

There still are options, but we need to work together to assess the risks and benefits.

Collaboration includes not just professionals, but also people who are valued partners in helping make decisions about how you want to live or how you want to die. These include spiritual advisors, family members (if you want), specialists in the medical field, as well as alternative care providers.

We can’t let ourselves be fooled by the false promises of pundits, demagogues, and proselytizers. We can tap into the collective wisdom of our families, friends, experts, and spiritual teachings from every tradition and gain benefits for all.

What’s The Treatment Plan?

So here we are. The country is in crisis. What’s your plan? Who do you want to care for the nation right now?  Who are the “experts” you suggest we turn to for consultation? 

What options are available?  Do nothing? Become an Ex-pat? A civil war?  Constitutional amendments? Resistance?

What Lies Ahead?

In any crisis, the primary goal is to stabilize, then return to previous levels of functioning. Personally, I do not see our nation returning to previous levels of functioning any time soon, if ever.

We have some serious challenges ahead including recovery from what this Administration is doing to our reputation here and abroad.

This may take some time, since efforts by DJT and his Administration seem intent on obliterating all that we once took for granted.

First We Cry

We have a huge learning curve ahead of us. This is not unlike being on the receiving end of a cancer diagnosis. First we cry.

Then we do the hard work of learning what we need to know to take charge once again. We find allies, we drop hangers-on. We acquire new habits, new ways of thinking, and, if we are lucky, accept the changes that are necessary in order to survive.

Then we can begin to think about the quality of life we may be granted once we are out of harm’s way.