purplekow

He was an answer on Who Wants to Be a Millionaire tonight. Jane Fonda had a question as to which one of the following people did not play Colonel Sanders in a KFC commercial. Norm MacDonald. Rob Lowe George Hamilton David Spade. Jane did not know who Norm MacDonald was but did get the answer of David Spade, who she did not question who he was. So Spade is up one in the Q rating war with Norm MacDonald. Jimmy Kimmel who is hosting this brief reboot dropped that MacDonald was the celebrity who had won the most money on Celebrity Millionaire, which was $500000.. I believe. Jane herself could have had a $500000 question if she trusted her Phone A Friend and answered that it was Lima Peru not Reykjavek Iceland that was in the same time zone as NYC. She decided to walk with 125000 for her charity.

I have been back to work for a few days but I have not had time to report back here. I would think that most of you have Covid fatigue so perhaps a break from my posting here was just the cure you needed for that. That, and not watching any form of information at all. While I was off, I avoided all radio and television except for Netflix and HBO. The world seemed almost sane. Upon my return to work, things seemed under better control. I do not know if we had gotten used to the chaos or if during my time away, the chaos had magnified in my mind and the reality of it did not seem quite so enormous. That feeling lasted for about an hour and then the reality of the situation set in. However there is one particular episode that I would like to write about today and a group I would like to salute. I went into see a patient today who had been taken off a ventilator after 14 days. He was doing surprisingly well and he had been treated with all therapies availbable at this hospital except human plasma which was not available at the time he was his sickest. I gowned up. Gown, two masks, face shield, two sets of gloves and headed into the room. The ambient temperature was about 82 degrees and I later learned it was that way in most of the rooms because the patients tended to be cold and they only have a light sheet to cover themselves. The skimpy hospital gowns do not add much for warmth either. I spoke with the man, a nice guy from Peru who happened to be visiting a friend when he became ill and was brought to another hospital about 50 miles away. He had an endotracheal tube placed and as there were no ventilators available at that hospital, he was sent on an hour ambulance ride with someone or more like two people alternatingly pumping an Ambu bag. Ambu bags, for the uninitiated are rubber football shaped items with a valve to attach to an endotracheal tube and an entry port for oxygen which can be manually squeezed to pump air into the lungs, usually for short periods of time, but it can be done for as long as fresh hand muscles are available for the squeezing. I asked him about his recall of the preceding events and all he could recall was going to the hospital and then waking up here two weeks later. The drug induced coma had done its job effectively. As I was talking, there ws a knock on the door and I went to the door and was asked if I would deliver his tray and take his vital signs while I was in the room. I did so, waiting impatiently for the thermometer to beep once I had place it in the patient's mouth. I walked it back to the door and showed the result to the nurse outside. The machine which took the vital signs was then wheeled to the door so that they could be noted in the patient record. I spoke to the patient further and he told me he needed to urinate. I went to the door and got the nurse to bring me a urinal. She did so promptly and I brought it to him. He had some type of underwear on, I am not sure from whence that came as most patients, at least male patients, go commando, He could not manage to get his equipment out of the briefs nor could he manage the get them down. He asked for an assist. I helped him slide them down. (now those of you who are making a porno movie in your mind from this should know....this was not at all sexy) and gave him the urinal. Unfortunately the prolong time in bed on a ventilator had made it difficult for him to stand and also made it difficult for him to arrange the urinal properly. I helped him up, setting off all sorts of alarms and then took the urinal and found just the right angle to allow him to urinate into the bottle without missing a drop. I then helped him back to bed and tried to turn off the alarms. Even with explicit instructions from the nurses outside, eventually one of them had to come in to show me how to do it. With the patient settled, I was able to leave the room and received a round of applause from the small group of nurses standing around the hallway. I had been in the room 7 minutes or so. My mask was fogged. My arms were sweaty. I was breathing heavily from the heat and the masks. I needed to sit down. One patient. 7 minutes. That was enough to have me needing a long drink of water and a 10 minute sit down. Now to the point. These amazing women and a few men do this for hours at a time. They get into and out of gear more than a dozen times a day. They are taking care of 2 to 4 of these amazingly sick patients and they do it hour later hour and day after day. They rarely get to sit and if they do it is to write a note or talk with a family on the phone. They give medications. They make clinical judgements that have life and death consequences. They make the bed, take the temperature, comfort the patient, talk with them and hear their fears. They listen especially hard because these patients do no have visitors and the only real sustained human contact they have is their nurses. I have seen nurses arrange FaceTime interactions for a family who wanted to see their matriarch one last time before she succumbed to the disease. They relay patient messages sometimes through translation services to patients whose families are hundreds or thousands of miles away. They need to answer the questions, get the medications, arrange the tests and get the patient orders from the doctors. They need to face the possibility of contracting this possibly fatal disease from patients who are unable to avoid coughing on them or who grab them unexpectedly. These are women in their 20s, many mothers of young children who come in to work every day, middle aged women who have seen it all and done it all twice. There are senior nurses, some back from retirement because they could not sit home and allow someone else to do it alone. I cannot express in words the admiration I have for these practitioners. They do not get a round of applause like I did when I managed to take a temperature and helped a man avoid peeing on the floor. They are getting some recognition now but not nearly enough. They are the cornerstones in this battle against this disease. These daughters, mothers and sisters are the front line, down in the trenches soldiers carrying the heavy loads and doing so willingly and without complaint. They deserve any accolade that might be sent their way and a hundred times more for each of the mercies they complete. So If you read this and you know a nurse text her, phone her, send her a card and give her a heartfelt but in these times, a virtual hug and a round of applause. It made me, someone who was only a 7 minute nurse, know that someone was watching and appreciating the effort, I think the 24/7 nurses deserve much more than that.

I have been back to work for a few days but I have not had time to report back here. I would think that most of you have Covid fatigue so perhaps a break from my posting here was just the cure you needed for that. That, and not watching any form of information at all. While I was off, I avoided all radio and television except for Netflix and HBO. The world seemed almost sane. Upon my return to work, things seemed under better control. I do not know if we had gotten used to the chaos or if during my time away, the chaos had magnified in my mind and the reality of it did not seem quite so enormous. That feeling lasted for about an hour and then the reality of the situation set in. However there is one particular episode that I would like to write about today and a group I would like to salute. I went into see a patient today who had been taken off a ventilator after 14 days. He was doing surprisingly well and he had been treated with all therapies availbable at this hospital except human plasma which was not available at the time he was his sickest. I gowned up. Gown, two masks, face shield, two sets of gloves and headed into the room. The ambient temperature was about 82 degrees and I later learned it was that way in most of the rooms because the patients tended to be cold and they only have a light sheet to cover themselves. The skimpy hospital gowns do not add much for warmth either. I spoke with the man, a nice guy from Peru who happened to be visiting a friend when he became ill and was brought to another hospital about 50 miles away. He had an endotracheal tube placed and as there were no ventilators available at that hospital, he was sent on an hour ambulance ride with someone or more like two people alternatingly pumping an Ambu bag. Ambu bags, for the uninitiated are rubber football shaped items with a valve to attach to an endotracheal tube and an entry port for oxygen which can be manually squeezed to pump air into the lungs, usually for short periods of time, but it can be done for as long as fresh hand muscles are available for the squeezing. I asked him about his recall of the preceding events and all he could recall was going to the hospital and then waking up here two weeks later. The drug induced coma had done its job effectively. As I was talking, there ws a knock on the door and I went to the door and was asked if I would deliver his tray and take his vital signs while I was in the room. I did so, waiting impatiently for the thermometer to beep once I had place it in the patient's mouth. I walked it back to the door and showed the result to the nurse outside. The machine which took the vital signs was then wheeled to the door so that they could be noted in the patient record. I spoke to the patient further and he told me he needed to urinate. I went to the door and got the nurse to bring me a urinal. She did so promptly and I brought it to him. He had some type of underwear on, I am not sure from whence that came as most patients, at least male patients, go commando, He could not manage to get his equipment out of the briefs nor could he manage the get them down. He asked for an assist. I helped him slide them down. (now those of you who are making a porno movie in your mind from this should know....this was not at all sexy) and gave him the urinal. Unfortunately the prolong time in bed on a ventilator had made it difficult for him to stand and also made it difficult for him to arrange the urinal properly. I helped him up, setting off all sorts of alarms and then took the urinal and found just the right angle to allow him to urinate into the bottle without missing a drop. I then helped him back to bed and tried to turn off the alarms. Even with explicit instructions from the nurses outside, eventually one of them had to come in to show me how to do it. With the patient settled, I was able to leave the room and received a round of applause from the small group of nurses standing around the hallway. I had been in the room 7 minutes or so. My mask was fogged. My arms were sweaty. I was breathing heavily from the heat and the masks. I needed to sit down. One patient. 7 minutes. That was enough to have me needing a long drink of water and a 10 minute sit down. Now to the point. These amazing women and a few men do this for hours at a time. They get into and out of gear more than a dozen times a day. They are taking care of 2 to 4 of these amazingly sick patients and they do it hour later hour and day after day. They rarely get to sit and if they do it is to write a note or talk with a family on the phone. They give medications. They make clinical judgements that have life and death consequences. They make the bed, take the temperature, comfort the patient, talk with them and hear their fears. They listen especially hard because these patients do no have visitors and the only real sustained human contact they have is their nurses. I have seen nurses arrange FaceTime interactions for a family who wanted to see their matriarch one last time before she succumbed to the disease. They relay patient messages sometimes through translation services to patients whose families are hundreds or thousands of miles away. They need to answer the questions, get the medications, arrange the tests and get the patient orders from the doctors. They need to face the possibility of contracting this possibly fatal disease from patients who are unable to avoid coughing on them or who grab them unexpectedly. These are women in their 20s, many mothers of young children who come in to work every day, middle aged women who have seen it all and done it all twice. There are senior nurses, some back from retirement because they could not sit home and allow someone else to do it alone. I cannot express in words the admiration I have for these practitioners. They do not get a round of applause like I did when I managed to take a temperature and helped a man avoid peeing on the floor. They are getting some recognition now but not nearly enough. They are the cornerstones in this battle against this disease. These daughters, mothers and sisters are the front line, down in the trenches soldiers carrying the heavy loads and doing so willingly and without complaint. They deserve any accolade that might be sent their way and a hundred times more for each of the mercies they complete. So If you read this and you know a nurse text her, phone her, send her a card and give her a heartfelt but in these times, a virtual hug and a round of applause. It made me, someone who was only a 7 minute nurse, know that someone was watching and appreciating the effort, I think the 24/7 nurses deserve much more than that.

I am a drinker of Diet Coke but during this crisis I have given it up. I am drinking lots more very cold water and it seems to be doing quite well for me. I do miss the caffeine rush occasionally but I can go to coffee for that if need be. I used to drink four to five cans of Diet Coke per day.

We are using it. It is not a miracle drug but it is the best we have along with Tocilizumab. Notice what is not in that sentence? Plaquenyl (hydroxycloroquine). While still in use it is generally felt to offer little in the overall treatment and so Dr. Fauci appears to have been right when he warned at the WH press conference that the drug's effectiveness was only anecdotal. This drug does have good initial scientific evidence of effectiveness. Hopefully some people will learn that the science matters. Problem with Remdesivir is that manufacturing of it is very limited right now, the chemicals needed to make it are hard to come by and most of them are held in large part by China.

Interesting that since the CoVid pandemic, we have seen a drop in alcohol related admissions to the hospital to almost nil. Usually there would be two to three a day. About 13% of the people in the US have alcohol related problems. So staying home and drinking or not drinking seems to be keeping people out of the hospital. If they are drinking at home, they usually do not get seen, they pass out and wake up and start drinking again so withdrawal is not the problem. Alcohol induced pancreatitis and other toxicities not related to withdrawal are still a problem but those patients have not been showing up. Also people are not going to bars so alcohol consumption on a social basis is probably way down. I would guess police calls about street fights and public intoxication are way down as well. In addition, our usual cadre of drug seeking patients are way down. In order to get to be seen in the ER they have to go through a screening area in a tent outside the ER. Then they need to risk coming into a ER filled with Covid patients. They may be drug seekers but there are apparently barriers they will not climb to feed the habit.

The number of swine flu deaths in the US was about 13000. Worldwide it was much higher due to mostly deaths in China. Deaths being reported out of China with Covid 19 are much less a percentage of the people killed either because China became better adept of controlling the spread or because they are underreporting the number of deaths or because both are true. Clearly US deaths from Covid 19 will be several times higher than the Swine flu and with a much greater effort to control it. Worldwide, it is likely to exceed the number of deaths as well. This will certainly be true if the disease takes a hard toll on Africa which was relatively spared from the swine flu.

Well Lunch is over. We ate outdoors. He was in the house for a very short period of time mostly to use the facilities. All plates and utensils immediately went into the dishwasher and were washed at the hottest settings and will not be used for more than 48 hours. The last load of dishes was in there clean for at least one week. We kept social distances and spoke across the table about 8 to 10 feet apart. I will not be using that outdoor table for quite some time. Last time I used it was more than one month ago. So I feel as though this was a safe and sane encounter.

He was quite coherent when I saw him but not a big conversationalist. His body however spoke volumes. With social isolation who knows what is going on in people's lives. In New Jersey they considered Liquor stores essential and kept them open and gun shops were also deemed essential. . Nice to know that there may be drunk people able to buy a gun in this state. To the point, I have seen Steve on two occasions. One time we both had a few drinks and the next times, though I offered he declined. He was a nice guy but I did not go into a long history of his life. While his responses to you were odd, I would not be quick to attribute them to a chronic drug or alcohol problems. For example, I have made nonsensical responses to texts and phone calls when I was very tired or just woken from sleep or distracted by something else. It seems clear he was not at his best but there is not sufficient reason to assume to worst.

I have a childhood friend coming to visit today. I have an outdoor front porch where we will be sitting across a table from one another to eat. No common utensils. Social distancing and social discourse and then good bye. No touching. He probably will not go in the house unless it is to use the guest bathroom, which I do not use. He has been in virtual quarantine for weeks and I have not because of my job so most of the risk is his. Neither one of us is sick but of course the is not an assured situation. Is this risky behavior? Probably so but I believe the risk is minimal and it is the kind of risk we will all be taking when things open up again.

I remember liking hi at the time, now his jokes about the South Bronx seem insensitive.

Sorry that the window seems to have closed but time can play funny tricks. Keep his memory warm in your mind and perhaps some day you will have his body to keep warm in your bed.

I was of course assuming Coronavirus was not an issue. In my case though, I would probably be better off in Palm Springs on vacation than here in NJ working, even with a few days off.

I would be sitting at the pool at Canyon Club right now oogling the men and catching rays. I would probably be on my way to breakfast at Rick's with Vin Marco and some of the members here. Miss those pancakes and of course the hot sausage.

Been getting my dose of Meloni melons in his show Happy on Netflix. An odd show and he is not looking his best but that ass is still smoking.

first of all, maintenance while requiring work does not require the kind of work needed to get that physique in the first place. One escort I have seen a few times just dropped me a text with a video and he looks better than ever. I asked him what he was doing and he was just doing stretches and body weight exercises like pull ups and sit ups and push ups. Another escort with whom I regular communicate is out bicycling in some fairly mountainous terrain, 4 hours of 50 miles or so of bicycling will keep those thighs and butt in top shape and more ripped than ever.

Only problem is some of them will not be by the end of the day.

Yes we have extracorporeal oxygenation and have tried it but that is not usually a long term solution. Things do seem to be slowing down just a bit at the hospital at which I work and we are getting more and more therapeutic options. We are doing an in-house 150 patient study on the effectiveness of hydroxychloroquie vs placebo vs hydroxychloroquin + zithromax We are also starting to use antivirals and convalescent serum but the anti IL 6 drug Tocilizumab still is the one showing the most benefit. We have success in getting a few more people off the respiratory. Still only 4 out o 56 with 27 still on ventilators but as of last week we had not gotten any people off. We are also intervening to try to avoid artificial ventilation. We have had a few people be right on the edge and then turn around with the Tocilizumab. As for me, I was told to take the rest of the week off and to return next week. While there is a relative lull and there is a full staff, they are trying to give people time off so that people will be fresh if there is a further surge. NJ is still seeing increased cases though NY seems to have leveled off. While I understand the reasoning, I tried hard to convince the powers that be that I am fine and to give someone else time off. There are definitely inspirational people working a lot harder than I have been. But, while I have been a general most of my professional life, now I am not a general and so I am acceding to the request, with a noted protest. At the hospital they have changed the song for success to (This is my) Fight Song. Now there is discussion of changing it again because it is loud and harsh. So while the idea of a victory song was a good one, finding the right one has been a bit of a challenge. So I will be calling in each day should there be an unexpected event such as a provider illness or a critical surge but I have off until next Tuesday. I cannot help to think that I would have been leaving for Palm Springs and would have been there until Tuesday. My house is not bad but I do miss the fun and the interaction of Palm Springs Get Together. Hello to all the guys and next year is a plan.

Cats seem to be prone to covid19 though it is not thought that animals can pass it to humans. As for dogs, at one one dog was tested and found to be positive but why it was tested and if the test was reliable, I have no knowledge of that. I have made arrangements for my dogs should I get sick or pass. I think being home with a dog is great but you do need to watch out for separation anxiety. If you do decide to get a dog, I would make sure you left the house for some time during the day to get it used to being alone. Or get two and they will have each other. I have had as many as seven dogs at once and they Ade the most difficult times of my life bearable.

Talvin was a hot escort and I am sure he is a hot guy in whatever profession he is pursuing now.

Matt, Tocilizumab is being used in a variety of places. Antivirals are also being used in some places here in NJ with some reports of success. We are starting convalescent serum protocols this week. I am sure Dr. Fauci is aware of these drugs but as for the rest of the administration, who knows. Tocilizumab is not a cure all but in the right setting at the right time we have had success with it. The last thing that would be needed is for someone in a position of power to start talking it up as a cure all and suddenly the use of the drug becomes inappropriate. At my hospital, I as the primary care provider can only request that the ID specialist give permission for it to be used. I have done so three times and all three times it has been beneficial. In fact, all three have gone home after looking for all the world as though they needed to go on a ventilator. It is used to prevent cytokine storm which is a result of the damage that the virus has done and it does not kill the virus at all, so if you are not in danger of imminent cytokine storm, it is not of use. There is also an investigational drug. Otilimab which is a GM CSF inhibitor. (Granulocyte Monocyte Colony Stimulating Factor) inhibitor.. GM-CSF also induces a rapid production of white blood cells to help fight infection and may be overproduced in CoVid. The drug is probably being used but I am not familiar with it in CoVid or otherwise. There are several of these drugs used for multiple sclerosis which are designed to inhibit immune response. They all have toxicity but may be worth the risk in Covid but I have not seen data about it.

I watch Politician with Ben Platt. Interesting considering it is set in a high school. Platt's character has oldertwin brothers, in their 20's, who are seen infrequently without shirts. They are hot but not on screen enough to make it worthwhile to watch for them alone.

Well today is the last day of my break. I received a call from the doctor covering for me. She told me that the mother of six who seemed destined for the ICU responded well to the tocilizumab and improved almost immediately after given the drug. She continued to improve over the weekend. We also used anticoagulation on her. If those meds did anything or if she was just destined to get better you can never be sure, but I will be using that combination again. Another woman in her 50's also seemed to turn around yesterday after the tocilizumab. I had mentioned previously that this is a interleukin 6 inhibitor. Interleukin 6 stimulates cytokine release. Cytokines are vasoactive and inflammatory chemicals usually released in a control manner to fight infection but in this disease they are released in a manner called cytokine storm and though the infection is hindered, those chemicals worsen the damage. So the key it to get the cytokines under control at the proper time. In addition, we have been using anticoagulation to help treat these patients. The patients are noted to have an elevation of a substance named D Dimer which elevates at the time of blood clots in the lung. The CoVid patients do not have large clots, pulmonary emboli, but it is thought there are many many small clots which cause oxygenation problems and which cause the D Dimer to elevate. So now, when we see the D Dimer elevating, we are adding anticoagulation to try to prevent as many of those small clots as possible. None of this is standard, but so far we have had some success. While I was on the phone with the covering doctor, she started to have a catch in her voice. It was clear she was becoming emotional and I asked her what is wrong. She told me they had just played "the song" and she was still getting used to it and hearing it gets her emotional. What has happened is, someone came up with the idea that each time someone is discharged or has the tube removed from their throat, the play a brief burst of a song over the intercom. Today they were using Oh Happy Day. This is a new idea since Friday and I think it is a wonderful way to let the people in the hospital know, that there are successes. They only use the first two lines. (oh happy day, oh happy day, oh happy day oh happy day). Just a brief break in the efforts. Kind of like hearing a bell and knowing an angel got its wings. We also had the first person make it successfully off the respirator. I believe I had mentioned a healthy 60 year old gardener who came in and looked good and then in the morning was admitted to the ICE and placed on a ventilator. Well, I think it is 8 or 9 days later and he was extubated. The first one to get off the ventilator. I had been posting here that people were not getting off the respiratory. Now general reports are coming out that 80% of the people on respirators or even more are NOT making it off. So the plan now is to do everything possible to keep patient off the ventilator. So we are using more of the Tocilizumab to assist in that. I am rested and physically able to go back. Mentally it is still a struggle, but I am sure I will be ready in the morning. https://video.search.yahoo.com/yhs/search?fr=yhs-dcola-015&hsimp=yhs-015&hspart=dcola&p=oh+happy+day+song+you+tube#action=view&id=12&vid=ddd71b238b7b91fee7bada6b29e4aff0

Well even though I have the 4 day break, I am still receiving phone calls about the new admissions. Things seem to have slowed down this afternoon. The ER has usually had 30 to 50 people being treated and a dozen or so waiting admission. The first all I got today was at 6:30 PM and there is only one other patient awaiting admission. An Easter miracle? Wealthy are predicting that here in New Jersey the pack should be between April 10 and April 27 so we are in the midst of the period when a slow down should happen. Maybe this is a sign of that slow down. People have been doing social isolation and perhaps that is turning this a bit around. So a rare glimpse of good news. Stay safe. I will be back to work Tuesday so I am gearing up with lots of sleep and getting ready.

I. checked in to the hospital to see how the team was doing and if anything was new with the patients. Good news for the two men who were not discharge on Thursday, they both improved and arrangements were made for hoe oxygen, The hospital administration was convince that it made economic sense to send these men home on the oxygen at the hospital's expense than to keep them in the hospital for oxygen with the hospital picking up that bill. After a long discussion of precedents and numbers, the administration relented. It is better for the patients to be home and better financial for the patients to be out o the hospital. A one time expense for an oxygen concentrator is worth it.