I am a nurse at an acute care psychiatric hospital. Quarantine or not, patients and staff are at work every day, and because of my job, my family is socially distancing like we’re trying to win a prize. It’s painful. Our two kids are so outgoing that the people they regularly engage—at parks, in grocery store lines, or simply walking by our house—inevitably remark on their extroversion. Now, isolated, they appear to be wilting.

This Mother’s Day, our kids leapt from the breakfast table, excited by an unexpected event: cars pulling up and people disembarking with pans of quiche and croissants.

Hello hello, my seven-year-old flung open the front door, my three-year-old just behind her, both shouting wild greetings. People waved. And walked to our neighbor’s house. Then the quarantine quiet of our backyard broke with music and voices rising accompanied by laughter and the sounds of children playing on the other side of the fence.

COVID-19 is impacting our relationships as people disagree over interpretations of curve-lowering, but the pain I feel listening to my neighbors’ party is more complicated than the discomfort of others’ disregard for social distancing. From the back step outside our kitchen, I can see people hugging in greeting. I sit down, searching out the exact location of this pain. I want to vivisect it, examine it, name it.

It’s not just new work stressors: masks bursting with coffee breath, “non-essential” employees absent, or the emptiness of managerial gestures towards safety when no substantial measures have been taken (as of this writing my hospital is still not testing new patients on admission). It’s not just the barrage of conflicting information from leadership or the laughable fact that we are given single-use PPE and told to use it all day, with different patients, in order to conserve resources. It’s not the creeping, erosive uncertainties: What about the second wave? What, if anything, will keep our patients—who are largely homeless or in group homes and all with comorbid conditions—safe? What will keep our families safe when we work embedded in a sea of people during a pandemic?

It’s a different discomfort from the anger and disbelief of watching people in red hats protesting the quarantine because they believe public-safety policies infringe on their individual freedoms. And it’s not the gut punch of seeing friends’ children on playdates with families deemed to be “in their bubble” while scrolling social media. I have been angry when I see people put others at risk because they themselves “aren’t worried about getting sick.” I am worried that our medical system in Portland, Oregon, will be overwhelmed, like hospitals in other cities have been. But that’s not the pain I’m feeling.

Listening to my neighbors celebrate next door, I am simultaneously the child uninvited to the birthday party and a mother watching my children go hungry—not for food, but companionship. My first grader has regressed into epic tantrums. Her inarticulate howls feel appropriate for this moment when even adults have no words for quarantine’s alien circumstances, the shrill restlessness of an estrangement no aspect of our socially dependent society could have ever prepared us for.

Seeing my kids suffer, knowing how privileged we are that their only scarcity is companionship, makes me question my own choices. As I listen to the voices next door, I worry. Are we overreacting? Will we look back on this as a time that we hurt our children needlessly? Or, is the cost of overreacting cheaper than the price of potential recklessness? And what lessons are we teaching our children when we disregard our social duty to protect the vulnerable out of dislike for inconvenience? I don’t want my daughter to learn that her wish to see a friend is more important than the life of that friend’s grandmother, or the grandmother of the stranger that she randomly passed on the way to her friends’ house. More broadly, I want my children to appreciate that we live in a communal society, and just as we should expect to find joy, inspiration, and security in our community, we have an equal obligation to take care of each other.

I want my work place and my community to fulfill their obligations, and keep health workers safe by providing proper PPE, testing, and social distancing. Uncertainty is personally frightening, but it also pierces the larger awareness of systemic abandonment that many psychiatric health care workers already see our patients facing.

Whether or not we are in a pandemic, psychiatric patients survive childhood rape, neglect, and poverty; they live with homelessness and are assaulted over a damp bag of weed; they may believe their neighbors are poisoning them or that the mob is chasing them or that they cannot eat because a disgruntled deity has forbidden it. We care for patients tangled in social “safety nets” that have not caught them, nor the family members who came before them.

At my workplace there is colorful talk about our federal government’s mangled response to the COVID-19 crisis through delayed recognition, faulty information, and frequent rejection of science. But lack of trustworthy leadership in a crisis does not feel new. Many mental health workers, patients, and their families have already seen the government failing: when our patients sleep on the streets, when they are killed by cops, when they experience preventable diseases, or when their life’s possibilities disintegrate with a diagnosis because we still don’t have robust social support systems for people living with mental illness.

There is real grief in this. At the end of the work day, or sitting on the steps listening to someone else’s quarantine party, that’s what I’d name this hard sternal mass: grief.

How does one work in the service of restoring health within this sick system? What does it mean to be a nurse whose patients leave, only to return sicker because Oregon is in a meth epidemic and many care facilities can’t provide treatment for addiction, or because the patient was discharged to the streets and never took their medications? Or when you begin treating your patients’ children, who arrive equally crippled by in-utero drug exposure and poverty? What does it mean to teach your own children to follow a social contract when one is no longer recognized? It feels far lonelier than COVID’s quarantine; it is grief for a fractured country, failed leadership, for our own communities’ insufficiencies.

The pain I feel listening to my neighbor’s party on a beautiful May morning is of an almost existential isolation, of feeling far from the fires of other hominid cave dwellers, cold without the commingled breathing of my pack. When my family, with other Portlanders, ring bells and shout Thank you to essential workers at 7:00 p.m., my voice always breaks. Instead of bells and banging pots I wish we were all howling, brokenhearted, huge, and together.

Rebecca Pelton is a nurse at an acute-care psychiatric hospital in Portland, Oregon, where she lives with her family.