purplekow

Rutgers University has a FDA approval pending saliva CoVid test. It can be done at home in about 2 hours. If the time for testing was down to less than an hour, would you hire an escort with the proviso that you both get tested at the time of the visit. Do the spit test, have dinner, read the test and then go from there? If so, who should pay for the cost of the tests since they are likely to run 30 to 50 dollars at the onset? Dutch?

Well today was back to the grind. Very surprisingly, I had ten new patients in the hospital and none of them are Covid patients. Two were tested and were negative and the rest came in for other reasons. It felt strange to see patients without all the gear and it took a bit of getting accustomed. I had mentioned that on Saturday, one of my patients in the ICU was being weaned from the ventilator after 30+ days. It was by no means certain that it would work. 37 years old and healthy when he came into the hospital, he has been through every treatment and every kind of manipulation. His body has been wreaked by the virus and yet he is hanging on, He is still CoVid positive. He has a step blood infection, he has failed weaning in the past, he had been in a medical induced coma for a month. But his respiratory status had improved again after the last failed attempt to wean him. His kidneys and liver were still intact. He did not appear to have any heart damage. So early Saturday afternoon, they disconnected him from the respirator. He was getting supplemental oxygen by high flow through the endotracheal tube and once he was connected, there was nothing to do but wait. Either he would fatigue and need to be placed back on the ventilator, or he would be able to sustain his own respirations. This is usually a very tense time in patient care, but in a patient who had been on a ventilator for as long as this patient, this was a critical time. The drugs from the medically induced coma will need to be stopped if he can breath and only then will we start to learn if he will have a return of mental functioning. The tube has been in place for thirty days and he will need to be tested to see if he can swallow and talk and if he is able to control his oral secretions. His musculature has been ravaged by inactivity and the process to return to even minimal functioning will take weeks of work. All that lies ahead if, and it is a big if, he can breath on his own. This morning I encountered the ICU specialist who has been caring for this patient. I congratulated him on having successfully gotten the patient off the ventilator, off the high flow oxygen and onto a simple nasal cannula. I said that he must feel that his efforts of the last month had paid off. He said that it was just his job and it was nothing special. Then he turned to me and said that every day for the last month he had gone in and greeted this patient, as he does with all his patients no matter their level of functioning, with a good morning or a good evening. This morning, two days after the tube came out, one day after it was clear that he could swallow again and hours after his oxygen was lowered to a simple nasal cannula, he told me he went in and said good morning and the patient hoarsely said good morning back. With that his voice broke and he turned and walked away. I think he may have been lying about it just being his job and nothing special. Intensivists deal with the sickest patients in the hospital and many of their patients do not do well. They are trained to keep an even demeanor. Successes cannot get you too high because failure is certain to follow and the fall from heights to depths can be too much even for these experienced doctors. But once and again, the words say one thing and the crack in the voice says another. Later in the day I read this doctors note. It read something to the effect of: He is alive. He said good morning when asked. No other history was available. The first three words of that note were totally out of character and they were as much of celebration as his doctor would allow himself to have. My guess is that he did not even sing along with Fight Song when it played over the loud speaker in response to the disconnection of this patient from the ventilator. This afternoon, the nursing staff washed and combed his hair, shaved his beard, changed the sheets and sat him up in a chair. They called his wife and for the first time in a month, she saw him up and alert and responsive to her tears. The nurses told me that he strained tightly to say: Honey Don't Cry. I am Ok. He did not say anything else, but really what else was there to say?

I binged all seven hours from midnight to 7AM. Enjoyed the first 5 episodes and then 6 and 7 just got too far from the narrative. The idea that some of the things done, particularly in the last episode would ever have happened is beyond belief. I guess when you make a movie about a movie with an unhappy ending and you change the ending of that movie, you need to make your movie about the movie, which should have a poignantly sad ending, have a happy ending as well. At the least, in the last episode they could have brought back some of the naked USC football players. That way I could have had a happy ending.

I agree, the only way to know is to ask. Something to the effect of: "I give great head and I expect to choke on your come at the end. Will you be able to come by oral alone?" One might even offer an incentive to help him along. If there is a dripping tip in my mouth, there will be a ripping tip in your wallet."

You may take the boy out of the hospital but you cannot take the hospital out of the boy. I have the weekend off but felt compelled to peak in on the computerized records to see how my patients are doing. I also made a quick call to the covering doctor just to be sure. This morning I had 14 patients in the hospital. 9 of them were actively on my service and 5 were in the ICU and under their care. Still, though I am not taking daily care of those five, I feel an obligation to know what is going on in their care for when they eventually return from the ICU to the regular floor. I have sent more than a dozen to the ICU, only two have returned. Well of the 9 I was caring for currently, I was hoping that two would go home, including a young man with Covid who has been in the hospital for two weeks but who avoided the ICU. He is a Mexican construction worker who has never really looked ill in the full two weeks he has been here, but who has continued to need large volumes of oxygen and who has been treated with the now standard regimen of Tocilizumab and Remdesivir and Convalescent serum. If fact, he has been in the hospital long enough to have been on the previous standard treatment of Zithromax and Plaquenyl. He is also getting anticoagulation and the newest kid on the block, Famotidine. Well, he is finally off the oxygen but for reasons unknown, he remains in the hospital. I expect he will go home tomorrow. Big victory for him and a welcome bit of good news for the team. The other man, who did not have Covid was discharged to home after a brief and uneventful hospital stay after passing out in the bathroom. This is the kind of patient who was the typical admission in the time before time stopped. Getting anyone out of the hospital is a victory now because hospitals are particularly dangerous places to be nowadays. The rest of the group are doing reasonably well and I expect several more to leave before the coming week is over. In fact, after the discharge of the CoVid patient tomorrow, the only Covid patients I will be following are the five in the ICU. So perhaps there has been a leveling off here in this one hospital, but NJ in general is still a major Covid center. I checked in on the five patients in the ICU. All are male including the man with the black bikini underwear. All are on ventilators. Three have been one ventilators for more than 3 weeks and the other two for less than a week. The persistence of this kind of distribution of ICU patients has me convinced that the only patients who will leave the ICU are the ones that do so in the first week. I scrolled through the patients and that conviction held up until the last patient. This is a 37 year old man who has been on a ventilator for 30 days. Each day I look in and each day nothing much has changed. Today though, for the first time, a glimmer of hope. His oxygen requirements have dropped. He has been breathing on the ventilator but on his own. In other words, he is making enough of a coordinated respiratory effort to trigger the ventilator rather than the ventilator persistently giving a breath every three to four seconds. He has had the medications for the medically induced coma reduced. Tomorrow, they are planning to stop those drugs, allow him to waken and test out his ability to breath off the ventilator. Should he pass that test, the endotracheal tube will be removed and he will be breathing on his own with supplemental oxygen. His kidney function is good. He has not had any discernible neurologic events. He has received supplemental nutrition through a feeding tube. All of this has kept his body fit enough to sustain itself. should he be able to breath on his own. When I read the note that this was all planned I gasped. The routine has been just about unbroken. Only 7 patients have made it off the ventilator at this hospital since this started. If he becomes the eighth, he will have been on the ventilator for the longest period of time, more than one month. His road is far from easy to travel from this point. But it looks as though he has crested the mountain. I hope he gets to enjoy the view. If he does, he will be returning to my team for the final parts of his treatment prior to going home.

You probably never danced with the love of your live as she wore a sexy red dress at a Black Tie Charity Event and sang the song softly into her ear as the only couple of the dance floor, If you start a thread that asks what song makes SamHexum emotional, I will be certain to include those two for you.

You probably never danced with the love of your live as she wore a sexy red dress at a Black Tie Charity Event and sang the song softly into her ear as the only couple of the dance floor, If you start a thread that asks what song makes SamHexum emotional, I will be certain to include those two for you.

Wow. This is amazing. A coverup or at the very least interference with the public's right to know. Someone should sue, preferably a relative of someone who died of Coronavirus.

Wow. This is amazing. A coverup or at the very least interference with the public's right to know. Someone should sue, preferably a relative of someone who died of Coronavirus.

Friday and I have the weekend off. I was looking forward to the break. Unfortunately, I have been having a difficult time with my own health. So many little things going on with me and with each one, I think, I got it. I got the virus. This rings a distant bell for me as I took care of many HiV patients back in the early days of the epidemic. Young men would tell me this as they came into my office. My office was not really a medical office but it served as the AIDS clinic because the nurses in the hospital clinic of which I was the director, refused to work in an AIDS clinic in 1984. So along with a few like minded physicians we started seeing patients in my administrative office which had a single exam room attached. They would come in, terrified. A look of fear and desperation that any of the people here who lived through that period saw on the faces of their friends, neighbors, lovers or relatives. I recognized it but I did not know it. I was not sleeping with men and so I felt a bit invulnerable to this particular human ravager. Now in 2020, I find myself thinking and even saying out loud when no one is around, "I think I got it." Fuck the numbers and the plans and the politics of it, when you think or say: "?I think I got it". all you have is fear and hope. One will win out in the long run but in the short run, it is anyone's guess what is going to take control of your thoughts. Today, fear won out in my cas, at least in the short run. After several hours of rounds and wearing a face mask almost continuously for 4 hours, I sat down to eat lunch. I took off the mask and felt a bit short of breath and with it a little bit of the cough I always have but now drives me crazy with doubt. Is this cough the same or slightly different, Is this just my allergies, or ACE induced cough or post nasal drip or is it more? Am I really short of breath or is it just exhaustion after walking around the hospital for hours when I am carrying far too much weight and after far too little sleep? The more I thought about it, the harder it was to catch my breath. I tried some meditation tricks, controlled breathing and extended breath holding. That seemed to do it. I ate s dry chicken salad sandwich and talked to a friend on the phone as I did. Were my words a bit more winded than usual? Did my friend notice it? Should I ask him if he noticed it? If I did ask him and he hadn't would there rest of the conversation be colored by his listening to see if I was winded? And what if he had? What would I do with that information? I finished lunch most of it in the garbage and walked out to my car. Lunch was at 2:45 so I decided that 3:30 was a good time to leave and I would write my notes on my computer at home. I got to the car and I felt a bit nauseated, a tiny spot of a headache, a slightly runny eye. Spring had sprung and pollen was everywhere. Probably just allergies. Probably just allergies. Probably just....allergies. And then I heard myself say it. I had heard it dozens of times from dozens of men who left this earth far too young and far too beautiful in every way and now I had said it out loud: " I think I got it" I got in the car and drove home. I called a friend and tried to distract myself with the conversation. Instead, I had a distracted conversation and begged off the phone before I blurted it out. I finally arrived at home. I tuned off the car and closed my eyes. I awoke an hour later. I felt better. I chastised myself. Do not put yourself through this. Worry is useless. Concern is appropriate and at this time, at that concern level, it was appropriate to go into the house, say hello to the dogs. Get naked at the door. Get into the shower and wash the remains of the day off of my body and get a nap. The shower was warm and revitalizing. I turned the water temperature up a bit higher and let the wall shower head pulsate on a sore spot on the lower back. I used the wand to thoroughly cleanse every hard to reach spot on my body. I let the rain head wash over me like baptismal waters and then, I got out to dry myself. I was looking for something in a drawer, it was important at the time and now I cannot even recall for what it was I was searching. The drawer had a thermometer tucked way in the back. This is not the one I use each morning to check myself but a different one. I decided to check if it worked and washed it off and popped it in my mouth. It beeped. I casually took it out expecting my usual 98.3 but it read 100. 100 fuck. I looked in the slightly steamy bathroom mirror. I saw it in my eyes. The fear. The trepidation. The desperation. "I think I got it". Now in that minute every patient I had seen who felt well and died soon after came to my mind. I could see them all. Fuck Fuck Fuck. Well maybe this thermometer was broken, let me go to my standard. I popped in my lucky thermometer. What an age we live in that one needs a lucky thermometer. 99.9. I had one other episode after a hot shower when I took my temperature and it was elevated, it was 99.5 but it quickly went down. I sat down. Probably the hot shower, I said out loud while the voice in my head said "I think I got it". Holy hell, "I think I got it" why else am I seeing these people? Are they here to comfort me or scare the bejeezus out of me? My bet was on bejeezus. My phone rang. My supervising MD was calling. I answered coolly. " Hello." "How are you doing I have a question for you". She started to ask about a patient from work and I just blurted out...."I think I got it". Then the whole story came out, the headache, the shortness of breath, the cough, the chicken salad, the car nap, the body aches, the sneezing and most damning of all, the fever. I left out the faces, even I could not face a public face to the faces. A calm voice of reason was not what I needed then, but that is what I got. It is probably just fatigue and the hot shower and the terrible dried out chicken salad you had for lunch. (The chicken salad was pretty dry). Take it again. Take your temperature again. I better use my lucky thermometer I said, as if that would make sense to her. We sat on the phone silently waiting for the beep like some ancient answering machine: "I may have contracted a really horribly deadly disease, please leave my temperature at the beep." And then. Beep. we both heard it. There was no denying it. 99.5. Two minutes later....99.3......one minute later,,,,,99.1,.....just to check again 10 second later.....99.0. Three minutes later 98.7. I knew that thermometer was lucky. At some point, she had hung up and I vaguely recall her saying to call her back when I regained my sanity and got some sleep. I closed my eyes, there they were, all the faces of 2020 and all the faces of the 1980s. There they were, in my head and in my heart and thankfully I was able to say goodbye to them as I fell asleep. An hour later, I came here, because "I thought I got it" but I wanted to tell someone: "I don't think I got it". And by telling you here that is what I think, I will think it. Thanks for listening.

Friday and I have the weekend off. I was looking forward to the break. Unfortunately, I have been having a difficult time with my own health. So many little things going on with me and with each one, I think, I got it. I got the virus. This rings a distant bell for me as I took care of many HiV patients back in the early days of the epidemic. Young men would tell me this as they came into my office. My office was not really a medical office but it served as the AIDS clinic because the nurses in the hospital clinic of which I was the director, refused to work in an AIDS clinic in 1984. So along with a few like minded physicians we started seeing patients in my administrative office which had a single exam room attached. They would come in, terrified. A look of fear and desperation that any of the people here who lived through that period saw on the faces of their friends, neighbors, lovers or relatives. I recognized it but I did not know it. I was not sleeping with men and so I felt a bit invulnerable to this particular human ravager. Now in 2020, I find myself thinking and even saying out loud when no one is around, "I think I got it." Fuck the numbers and the plans and the politics of it, when you think or say: "?I think I got it". all you have is fear and hope. One will win out in the long run but in the short run, it is anyone's guess what is going to take control of your thoughts. Today, fear won out in my cas, at least in the short run. After several hours of rounds and wearing a face mask almost continuously for 4 hours, I sat down to eat lunch. I took off the mask and felt a bit short of breath and with it a little bit of the cough I always have but now drives me crazy with doubt. Is this cough the same or slightly different, Is this just my allergies, or ACE induced cough or post nasal drip or is it more? Am I really short of breath or is it just exhaustion after walking around the hospital for hours when I am carrying far too much weight and after far too little sleep? The more I thought about it, the harder it was to catch my breath. I tried some meditation tricks, controlled breathing and extended breath holding. That seemed to do it. I ate s dry chicken salad sandwich and talked to a friend on the phone as I did. Were my words a bit more winded than usual? Did my friend notice it? Should I ask him if he noticed it? If I did ask him and he hadn't would there rest of the conversation be colored by his listening to see if I was winded? And what if he had? What would I do with that information? I finished lunch most of it in the garbage and walked out to my car. Lunch was at 2:45 so I decided that 3:30 was a good time to leave and I would write my notes on my computer at home. I got to the car and I felt a bit nauseated, a tiny spot of a headache, a slightly runny eye. Spring had sprung and pollen was everywhere. Probably just allergies. Probably just allergies. Probably just....allergies. And then I heard myself say it. I had heard it dozens of times from dozens of men who left this earth far too young and far too beautiful in every way and now I had said it out loud: " I think I got it" I got in the car and drove home. I called a friend and tried to distract myself with the conversation. Instead, I had a distracted conversation and begged off the phone before I blurted it out. I finally arrived at home. I tuned off the car and closed my eyes. I awoke an hour later. I felt better. I chastised myself. Do not put yourself through this. Worry is useless. Concern is appropriate and at this time, at that concern level, it was appropriate to go into the house, say hello to the dogs. Get naked at the door. Get into the shower and wash the remains of the day off of my body and get a nap. The shower was warm and revitalizing. I turned the water temperature up a bit higher and let the wall shower head pulsate on a sore spot on the lower back. I used the wand to thoroughly cleanse every hard to reach spot on my body. I let the rain head wash over me like baptismal waters and then, I got out to dry myself. I was looking for something in a drawer, it was important at the time and now I cannot even recall for what it was I was searching. The drawer had a thermometer tucked way in the back. This is not the one I use each morning to check myself but a different one. I decided to check if it worked and washed it off and popped it in my mouth. It beeped. I casually took it out expecting my usual 98.3 but it read 100. 100 fuck. I looked in the slightly steamy bathroom mirror. I saw it in my eyes. The fear. The trepidation. The desperation. "I think I got it". Now in that minute every patient I had seen who felt well and died soon after came to my mind. I could see them all. Fuck Fuck Fuck. Well maybe this thermometer was broken, let me go to my standard. I popped in my lucky thermometer. What an age we live in that one needs a lucky thermometer. 99.9. I had one other episode after a hot shower when I took my temperature and it was elevated, it was 99.5 but it quickly went down. I sat down. Probably the hot shower, I said out loud while the voice in my head said "I think I got it". Holy hell, "I think I got it" why else am I seeing these people? Are they here to comfort me or scare the bejeezus out of me? My bet was on bejeezus. My phone rang. My supervising MD was calling. I answered coolly. " Hello." "How are you doing I have a question for you". She started to ask about a patient from work and I just blurted out...."I think I got it". Then the whole story came out, the headache, the shortness of breath, the cough, the chicken salad, the car nap, the body aches, the sneezing and most damning of all, the fever. I left out the faces, even I could not face a public face to the faces. A calm voice of reason was not what I needed then, but that is what I got. It is probably just fatigue and the hot shower and the terrible dried out chicken salad you had for lunch. (The chicken salad was pretty dry). Take it again. Take your temperature again. I better use my lucky thermometer I said, as if that would make sense to her. We sat on the phone silently waiting for the beep like some ancient answering machine: "I may have contracted a really horribly deadly disease, please leave my temperature at the beep." And then. Beep. we both heard it. There was no denying it. 99.5. Two minutes later....99.3......one minute later,,,,,99.1,.....just to check again 10 second later.....99.0. Three minutes later 98.7. I knew that thermometer was lucky. At some point, she had hung up and I vaguely recall her saying to call her back when I regained my sanity and got some sleep. I closed my eyes, there they were, all the faces of 2020 and all the faces of the 1980s. There they were, in my head and in my heart and thankfully I was able to say goodbye to them as I fell asleep. An hour later, I came here, because "I thought I got it" but I wanted to tell someone: "I don't think I got it". And by telling you here that is what I think, I will think it. Thanks for listening.

https://video.search.yahoo.com/yhs/search;_ylt=AwrEZ7bOsKxeSVwAqAIPxQt.;_ylu=X3oDMTByMjB0aG5zBGNvbG8DYmYxBHBvcwMxBHZ0aWQDBHNlYwNzYw--?p=you+were+wonderful+tonight&fr=yhs-dcola-015&hspart=dcola&hsimp=yhs-015#id=1&vid=90bcbbfb7e945696522b6fb4ab402462&action=view The first few strains on the guitar on You Were Wonderful Tonight by Eric Clapton makes my eyes well up and soon after the tears flow. Lady in Red by Chris DeBurgh also gets me from the first notes. Both of these are tied to very special moments in my life and those first notes take me right back there.

https://video.search.yahoo.com/yhs/search;_ylt=AwrEZ7bOsKxeSVwAqAIPxQt.;_ylu=X3oDMTByMjB0aG5zBGNvbG8DYmYxBHBvcwMxBHZ0aWQDBHNlYwNzYw--?p=you+were+wonderful+tonight&fr=yhs-dcola-015&hspart=dcola&hsimp=yhs-015#id=1&vid=90bcbbfb7e945696522b6fb4ab402462&action=view The first few strains on the guitar on You Were Wonderful Tonight by Eric Clapton makes my eyes well up and soon after the tears flow. Lady in Red by Chris DeBurgh also gets me from the first notes. Both of these are tied to very special moments in my life and those first notes take me right back there.

Pete Alonso of the NY Mets. He has a good head on his shoulders and his has a great set of shoulders. Power hitter, Rookie of the Year and a leader on the team, Won a million dollars during the All Star Game Home Run Derby and gave the money to charity. His salary for the year is 525,000. I am sure he has endorsements and big money will be forthcoming but still, at 25, an amazingly generous act.

Pete Alonso of the NY Mets. He has a good head on his shoulders and his has a great set of shoulders. Power hitter, Rookie of the Year and a leader on the team, Won a million dollars during the All Star Game Home Run Derby and gave the money to charity. His salary for the year is 525,000. I am sure he has endorsements and big money will be forthcoming but still, at 25, an amazingly generous act.

While I do think the availability of rapid testing is essential to getting this under control, as far as I am aware, the quickest test takes about an hour. Perhaps I am only dealing with hospital available tests and regulations that are done for the testing to take place in the hospital at which I work. I am sincerely asking if there are tests at this time that are readily available which can be done in minutes. Robert Wood Johnson Rutgers, the University System for which I work has a saliva test undergoing testing but it is not readily available to associated hospitals here in NJ. By doing a saliva test, that takes away the need for the nasal swab, which when done here in the ER, requires someone with an N95 mask and a negative flow room. Though the test may take less than an hour, the rigamarole to do it and get it to the lab and back brings the time from entry to discharge to more than 2 hours. Saliva test, if it works, would cut the time in half or even less time than that.

We have been using a variety of "blood thinners" from the beginning and more and more patients are being discharged home for additional weeks of medication. Large numbers of small blood clots are a major factor in the pathology of this disease, but there are much better choices than NSAIDS to use to try to limit their occurrence.

I think the big red headline went overboard. I am not sure I this post was written by someone else and is being quoted or if it is the work of the poster. I am assuming that this is a quoted article and not one done by the poster. There are so many questions raised by that article that go unanswered, I am inclined to think the reporting is fairly shabby. Quoting an unknown resident saying people are being treated like guinea pigs is inflammatory. Many drugs are being used based on anecdotal data and without FDA approval. Technically, these drugs, including Plaquenyl which was widely extolled politically and in the media and which now has been widely discredited is one example. The reason that drug was used was based on anecdotal data and in that sense anyone who received the drug was part of an experimental trial. (So if you care to use the term guinea pigs to describe those people than there were thousands of people treated like guinea pigs). As for, and I am paraphrasing, residents hooking a patient up to a ventilator and setting the values too high, stopping her heart. This seems very unlikely. First, family practice residents especially inexperienced one, even under these conditions, do not hook patients up to a respirator. That would fall to the respiratory therapist or others with familiarity with controls and who would have been given doctors orders as to the settings for the respirator. A nurse who would also be following a doctor's orders about the settings may make changes once the ventilator has been initiated. It is certainly possible that the resident had given orders which were incorrect and that resulted in the delivery of the oxygen, but even under the dire circumstances that were going on in NYC, an inexperienced family practice resident would not be given that responsibility, nor would they be having hands on involvement in the physical changing of the settings. As to anesthesiology residents working as respiratory therapists, the anesthesiology residents, as part o their routine job work with ventilators in the operating room. There are aspects of the job of a respiratory therapist, specifically the actually therapeutic aspects which might be foreign to an anesthesiology resident, but the settings on a ventilator would be very familiar to them. I was a respiratory therapist before going to medical school. At the time, a degree in respiratory therapy was not required in NYC, though shortly after I started it was a new regulation. I had on the job training for two weeks and then worked nights alone at a large city hospital. There are certainly aspects of the job that could endanger a persons life if done incorrectly, I have difficulty seeing an error as egregious as one which would cost someone their life before anyone could intervene as even a remote possibility. Barotrauma, damage to the lungs including collapsing of a lung is a well established complication of being on a ventilator. CoVid patients seem to be suffering a larger percentage of this kind of lung damage. This is likely secondary to the trauma caused by the disease itself weakening the integrity of the lung and having the lung less capable of withstanding the pressures used to insure proper delivery of respiratory volume. So, while this article may have a basis in fact, the details seem shady and incomplete and as a result the article, for me, is misleading. Just to be clear, there are lots of people doing jobs that they have not done in the past, but that is not equivalent to those jobs being done by persons who are unsupervised and unqualified.

NSAIDS have a variety of negative effects in this situation. Renal failure would be worse. They decrease the out of the heart in some cases. They are irritating to the stomach and could cause ulcerations. They have negative impact on the liver. I would never say never in that initially there were warnings about steroids and now, in cases that have gotten quite bad, the use of steroids is considered especially in those on ventilators. However, for now, NSAIDs are not being used.

I considered not posting in this thread today. This forum and this thread in particular offer me an opportunity to sit down and gather my thoughts of the day and to write about it. At this time, that writing involves a lot of emotional unloading for me and hopefully a glimpse for some of you, into what goes on day after day at thousands of hospitals across the country and around the world. Sometimes though, I feel that I would like to write something uplifting and hopeful. Today, I hoped would be that day. As a state in Australia announced that it did not have a new case of coronavirus for the last 24 hours, I was elevated to hear the news. Soon afterward, a call came in about a new admission and along with the information about the patient's age, 57, sex, male and diagnosis, lymphoma, rule out CoVid, came the most startling bit of information, Room 607. Now usually that piece of information only holds significance if a patient is placed in a bed in one of the remote areas of the hospital which will entail a long walk each day to see that one patient. That was not the case here. Room 607 was significant in that it is right in the middle of the hospital on a Covid floor which was closed to admissions for the last 4 days, as empty beds started to accumulate and the patients could be settled into two floors rather than three. That he was on this floor meant that all the empty beds had been filled and a new CoVid floor was opened because the ER was overflowing with patients. There are vicissitudes in all lives and a hospital undergoes those same tidal changes when patient numbers wax and wane and then wax again. This wax however was more like several whacks to the solar plexus. Fourteen CoVid patients or Covid suspect patients had descended on the ER and the quiet of the last few days had not only been broken, it had been shattered with shards flying to every area of the hospital. So rather than writing about what might be a turn as April turns to May and maybe the darkness is lifting, it is just more of the same only different. Hope is a dangerous thing. It can sustain you through great personal trials but it is tenuous and its loss can leave you floundering, arms whirling, trying to grab something to hold onto and steady yourself. I went looking for that branch to hold onto in an unexpected place, the ICU. My patient from yesterday, the man in the black bikini underwear had been doing better and I decided to try and glean a sense of possible good from his improvement. I went to the ICU and headed to the bed where yesterday a patient of mine had died and vacated the space for this man, who was to be my beacon of positivity. The room was empty. I thought perhaps they had given him a different room but when I asked I was told he had been transferred to the second ICU. My heart sank, the second ICU was the home the patients who had been on ventilators for more that two weeks without signs of significant improvements. His transfer there meant that, at the least he had taken a turn for the worse and possibly, that the turn had resulted in his being placed on a ventilator. In fact, that is exactly what had transpired. He was doing well at breakfast, when I called to check and by lunch he was in need of a ventilator, but 3 PM he was the sickest patient in the first ICU and the one chosen to move to the second ICU to allow for an admission from the ER. He had fought the sedation given to ease the placed of the endotracheal tube and he had spiked his blood pressure to over 220 systolic. He was eventually able to be quieted, placed in a medically induced coma and moved to the second ICU. I could not convince myself that going to see him would make me or him feel any better. I left just as a patient was wheeling in to take his space. Over the loudspeaker came that horrible song, Fight Song, that is played now when a CoVid patient goes home or a Cover afflicted worker returns, That song, that victory seemed too small, but it was the only branch I had, so I grabbed it and held tight.

We have just started a study of antibodies in the personal in the ICU. One would expect ICU personnel should have higher rates of antibody formation than the regular population simply by the likelihood of contact. After the complete the ICU they are planning on testing on the other Covid units and then on the non CoVid units to check for percentages there compared to the study of the state. Now it is conceivable that the numbers for hospital personnel will not be higher than the population as a whole because PPE is actually doing exactly what it is supposed to do. But realistically, based on some data that suggested in some countries health care workers represented 10% of the hospitalizations, it seems that the antibody levels in the hospital workers should be higher with the areas seeing the most CoVid patients having the personnel with the highest rate of immunity. I do not know I this study plans to include a CoVid test to see I people have both the disease and antibodies, which should be the case. After all, the viral load should trigger antibody formation and as the antibody formation goes up, hopefully the viral load will go down. But until the infection is gone the antibodies and the virus should be present simultaneously. This study will be done in all due haste and answers should be forthcoming in a few weeks.

This disease is definitely more than a lung disease. The coagulation problems are well known. Patients are having strokes and large emboli to the lungs as well as small emboli. Children have been showing emboli to the toes. Today was a rough day as far as that particular concept goes. A woman I spoke of only days ago, the one who took a deep dive and wound up in the ICU and for whom I made a call to her husband in which they exchanged "te amo mi amor" just prior to ending their conversation. Well soon after that, she was placed on a ventilator and then one day later her kidneys started to fail. She was placed on dialysis which helped initially but the disease was relentless and she died today, 6 days in total in the hospital. It is always difficult when a patient dies, but she was younger, in her 50s, married and a mother of a teenager and on the day she was admitted, I expected her to leave in a day or two. Hers was perhaps the most aggressive course I have seen this disease take and it was horrifying to observe. As she was passing, her son was on the phone asking to speak with her. She was far beyond being able to speak and she was pronounced at about 2:17. By 3:17, another patient of mine, a 54 year old, trim very welled tanned man who had been doing well was admitted from the floor to her space in the ICU. Yesterday on morning rounds, I had kidded with him that he looked like he was sunning himself on the beach. He was lying flat on his stomach, the preferred position. He was breathing easily. He was wearing a pair of black bikini underwear and he was able to converse easily. By the afternoon sign out rounds, he was requiring much more oxygen but generally was still comfortable and lying prone. His course proceeded down hill from there. This morning his condition triggered a code sepsis, indicating low blood pressure, high respiratory rate and poor oxygenation. By the time I got to the room, his oxygen had been pushed to the max. He could no longer lie prone due to discomfort and he was breathing at a rate of about 36. Still, when I spoke with him, he told me he was feeling alright and that the increased oxygen had helped. Indeed, his oxygen saturation had gone from 78, precariously low to 96. He did have some chest pain over his lower throat. His pulse was rapid and his cardiogram was slightly abnormal. He had blood tests taken and the ICU team evaluated him but there were no beds available and as he was doing better. he was left on the floor. He received a second dose of Tociliizumab, he had one two days ago. He had received convalescent serum during the night which initially was considered as a possible cause of his worsening but it became clear that this was the disease not a drug reaction. Our new protocol would allow him to start on Remdesivir, the drug in our arm of the trial had shown a major positive effect in 31% of the patients. Not the miracle numbers reported, nor the shut it down ineffective numbers reported elsewhere. But, he needed to be in the ICU by protocol in order to started the ten day course and there was no bed. I suggested that perhaps a 95 year old might be moved out, but there is no way for ventilated patients to be out of the ICU. A new ICU floor would need to be opened and staffed and that would take time. The administration was not leaping obstacles to do it either. He stabilized. The tests for a possible heart attack were suggestive but not definitive. His oxygen demand stayed stable. And then at 2:17 a bed became avialable. And in an hour he was there and she was gone. He has remained stable at this point and so far, no ventilator, no definitive heart aattack but no decrease in oxygen either. By 3:17 when he arrived, there were two other empty beds being cleaned. One patient had died unexpectedly. A sudden drop in oxygenation and an arrhythmia that could not be converted. The other had died after being in the ICU for 30 days. He had been given every drug and treatment and he had been watched with utmost care, as you would expect would be the case for any patient, but this was not any patient. He was the only doctor who had been admitted to the ICU since this had started. Sixty eight and a pediatrician he had retired in January and he had gotten sick in April. He lived in a community which is well known not to follow social distancing for religious reasons. He had been a member of the staff of the hospital for more than 35 years but he was not well known there as most of his practice was outpatient and his main office was a 25 minute drive away. Still, his profession, his long stay and his several significant improvements followed by disappointing worsening left the nurses, doctors and the rest of the staff devastated. There was a minute of silence requested from the overhead and the hospital went disconcertingly quiet with only the whirr of ventilators and the beeping of heart monitors merging together to play a dirge for his passing. There were many tear-filled eyes. Most of them were, I suspect, not specifically for him but for each and every one of those who had passed since this started and for each and every one of us still there working. A solemn "Thank You" over the loud speaker system startled us back from whatever place our thoughts had taken us. Back from that place and back to work and hopefully back to save my patient in the black bikini underwear.

I have a fantasy about very muscular men who are shorter than I am. It is a completely different fantasy than the one I have for muscular men who are taller than me. So, while some may not find necessarily look for short men as a preference, I can work with what they bring to the bedroom. Because I am a heavy man, I do need a man with some bulk to his body, no matter the height.

We all need to see this. It is the goal we have for each and every patient we treat.

First you should know that I am caring for those patients who present to the ER with no local doctor and usually with no insurance. I am the assigned doctor, So the population I see tends to skew younger as I am not seeing, by and large, older patients who have medicare. While sometimes I do see older patients, they are either away from their primary care doctor, say visiting a child or or some reason they do not qualify for medicare. So the patients I am seeing are mostly men, in their forties and fifties with a few in their thirties. The patient's who are on other services seem to be men more than women and more in their sixties and seventies, we have two patients on ventilators right now who are in their 90s and the families, despite being warned of the likely poor outcome after a prolonged treatment, insisted on everything being done, The cost for these two patient alone will like approach is not exceed one million dollars. Most of the patients I am seeing are Hispanic. This number is certainly out o proportion to the Hispanic population in the area and it is even out o proportion to the number of uninsured patients in the area. This has me considering whether there is a genetic predisposition to these people becoming sick or perhaps it is more a social predisposition. My ability to work in Spanish has been a big advantage for me as I do no need to rely on telephone translators. I think the patients also appreciated being spoken to in their main language, though, as I have said before, one of the fastest ways to get these patients to speak English is for me to speak Spanish to them, For those familiar with his press conferences, my Spanish is significantly better than Mike Bloomberg's but I still think it probably grates on the ear of native speaker. As for today's activities, while the admission numbers have been down, three of the patients I admitted yesterday were transferred to the ICU during the night. Two of them were teetering on going to the unit when I left last night but the other just took a nosedive. These rapid nosedives are what I find the most disturbing about caring for these patients. Some patients perk along with perhaps a slow downhill change which can be aggressively treated to try and prevent placement on a ventilator. The few patients that I have had that have nosedived, have done so out of the blue and despite intervention, they have wound up on ventilators and usually for a prolonged period. None of them have come off the ventilator though I did care for one man who came off the ventilator after two weeks, he was not my patient at the onset, he was admitted directly to the ICU. He did go home to great fanfare and of course, the song of the day which is now stuck on Fight Song despite almost universal disdain for that choice. Thanks to all who have contacted me about these posts. I am glad that you have found them useful.