purplekow

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.

I must admit I cannot top as often or as diligently as I once did, but have found other ways to top rather than "switching".

Well Monday morning came and while for many who are not working, the weekdays and the weekends are one big blur, for those of us on the hospital schedule, weekends still have some meaning because some of us get the whole weekend off, at least once in a while. I had this weekend off which meant that this morning was like hundreds of other Mondays I have faced. Two days off and the grim realization that I have to go back to work, this time for the next 12 days. I had peeked into the patient records and I knew before I got there that there was about a dozen new patients and that the majority of them were Covid patients. I also knew that, although on Friday I had sent home three or four patients who had been as sick as you can get with this disease, including one man who had been on a ventilator for 14 days, that there were at least a couple of the new ones and at lest three of the already established patients who might be heading in that same direction. My call started at 6 AM, meaning any non-insured patients admitted after that hour would be mine. The first call came in at 6"05 waking me a full half hour before my alarm. Two patients admitted just after 6 AM who had been there overnight but who were awaiting test results before admission. I listened to the ER resident's report, agreed that the patients needed to be in the hospital. I gave some preiminary orders and headed back for that last 15 minutes before the alarm. The alarm lost a close race with the phone. Different ER resident and another admission. Sometimes the extra ten minutes sleep can be a blessing, a bit of a refresher before getting up and into the day and other times, like today, that extra ten minutes makes it feel that you have been on a 25 mile march in full battle gear though you have never left the bed. So by the time I arrived at the hospital an hour and tend minutes or so later, there were the residual number of patients from last weeks lists, the two days of patients which had been admitted to my service over the weekend and the three new patients from the morning. Twelve in total, 9 Covid, three not and then three more in the ICU who were not technically my patients at the moment but who I sent off to the ICU and who would return to my service if they ever left the ICU. I headed to the ICU to check in. One man, a man that I may have mentioned in an early post here, was completing his 20th day on the ventilator. He was a sturdily built Mexian landscaper who had never been in a hospital. He came in on the first day looking sick but not terrible but he got terrible in a few hours and he has been on a ventilator ever since. He needs medication to keep his blood pressure above shock levels and it is only his previous good health that is keeping him alive at this point. Sadly, his family is in Mexico and he is alone here in the US. IF he should pass, there is no one to claim the remains. No one here to mourn except the staff who have spent three weeks urging him to live. I am not a religious man but I said a prayer for him anyway, what could it hurt? The second man has also been in the ICU on a ventilator for two weeks. Also young and fit, 37, he is doing slightly better than the previous patient but his is definitely a touch and go situation. The final patient is a woman I admitted last week and who took a wrong turn and she kept on going, downhill. With the new emphasis on trying to keep patients off ventilators or to limit ventilator use, she was given every medication we have along with high flow oxygen, All to no avail. Friday before I left, I called her husband and took my phone into her room to allow her to speak with him. She does not have a cell phone. After a brief conversation, she said: "Te quiero mi amor". and that was the end. I have no idea if she has spoken with him since. It will definitely be a long time, if at all before she speaks with him again, I will only mention that of the remaining patients on the regular Covid floors, three went home and two went south. Both of the two who failed were offered convalescent serum and both refused. I expect both to be in the ICU, on a ventilator and remdesivir, before I return in the morning, It is unclear what was frightening to these people about the idea of convalescent serum. In at least one case and likely in both, the families had objections which they passed onto the patients. One patient had signed the consent and then when the IV fluid arrived, she refused. Fortunate for another patient who was a borderline candidate who got her dosage rather than wasting it. So it goes. New people, new treatments. Still seeing peaks and valleys. in admissions to the hospital and to the ICU but the number of deaths seems to have leveled off. Tomorrow is another day, Covid care went from being constantly changing to now a routine that the caregivers know by rote. Diagnose. Plaquenyl...probably not but some are still getting it. Zithromax...probably not but some are still getting it. Check the blood inflammation markers, are they going up or going down. Going down, watchful waiting, Going up, hold your breath and when they go too high make sure they have the anticoagulants and the statins and the famotidine (this week's newsmakers has been in use for weeks) the zinc and the vitamin C...what could it hurt. Check the oxygen demand and the respiratory rate. If it is going up give the Tocilizumab and high flow oxygen at 60 liters. Did it turn it around? Yes...breath a sigh of relief. No....convalescent serum, if they will take it. Then wait. Then the step into the abyss. Intubation, ventilation, remdesivir, Levophed, medically induced coma, feeding though a nasal tube and prayer. I read a study a few years back out of Duke I think, that they had patient's in the ICU for whom people prayed and a matched group who did not have a specific prayer group. The prayer group was not on site. The group did not know the patients and yet those patients did statistically better. Anomoly? God only knows. But that is when I started telling my patients that they should be a non=discriminatory, non=denominational acceptor of prayer. I do not believe it works, but I do it for each and every patient because in the words of the orange haired beach ball, "what could it hurt?" Even prayer from non-believers are heard if any are, one would think. So even you cynics and naysayers, if you have a few minutes and care to offer a quick. "Hey god, how about getting the guy in room 509 better" it may be the best spent part of your day in isolation.

I understand 42 is the new 32. Or is it 32 is the new 42. In any case, he is old enough to vote old enough to........ push his head down and have him suck me off.

And who knows more about Electronic Dance Music than librarians?

Would look him up on line and see what became of the one that disappeared. My father had a cousin, Frankie was my father's younger cousin about 40 at the time, who was the black sheep of the family, He was a con man and he was in and out of trouble with the law all the time. At one point, he was living in California with a rich older woman who may have been the attorney general of the state (my memory of this is vague as I was about 9 at the time but whoever she was, she was rich and powerful and he was living with her). He was a notoriously bad driver and he had several car accidents so the woman hired a chauffeur for him. Even though he was visiting NYC and did not have a car, the chauffeur came on the trip. My home at the time was about a 5 minute ride from what was then Idlewild Airport, So Frankie and the chauffeur stayed at our home. I slept in an attic bedroom with a pull out couch and Frankie and the chauffeur slept on the pull out. The chauffeur, Jimmy, his name just came back to me, was in his 20s and I remember being very impressed with his Popeye biceps and lean body and a nautical tattoo he had on the left forearm, During their first night, I awoke during the night and heard heavy breathing and in the moonlight from the window I could see some movement on the pull out couch. The heavy breathing stopped with a big sigh and I went back to sleep. The next day I asked Jimmy if he slept alright because I heard him breathing heavy. He said he was better than fine and that in a few years I would know why he was breathing that way. For the next three days I could not take my eyes off of Jimmy but I was not sure why. He was right, a few years later I knew why he was breathing that way but it took me a bit longer to realize why I could not take my eyes off him. I can still vaguely picture him now, crew cut, sandy hair, angular face, tattoo was an anchor, great guns and his pants were very tight, which may have been the style then, I have not thought about this in decades.

If you can't last long, you can't do porn.

This may look like its about baseball and it may initially sound like it is about baseball, but I don't think its about baseball as "Mike plays hardball....got the leather, got the lumber". "ball with the big boys makes him all cocky, he holds his own cause he's short but he is stocky". "mike doesn't chew cause I asked him not to, he took the hint and spat it out." And the after game singing in the shower and pile on the pitcher's mound". Coincidence that the catcher gets piled on by a bunch of guys on the pitcher's mound? As Artie Johnson used to say..."Very in-ter-esting"

No vaccines are 100% effective. In some years. the flu vaccine is only 20 to 25 % effective. They are designed yearly based on the expected strain to predominate. Some years there are two strains so the vaccine is only partially effective. Sometimes they totally miss the mark in predicting the strain and the vaccine has very limited effect. Others vaccines such as measles and mumps are very highly effective as the virus itself is very stable and the rest of the time, herd immunity protects us. That is why you do hear of only the rare outbreak of measles. Those outbreaks usually start in unvaccinated persons. There was an outbreak of mumps from a Jersey short bar a few years back. I treated two patients who had been vaccinated as children but as hard drinking thirty somethings their immunity did not totally protect them, They had mild cases of mumps and luckily it did not effect their testicles and reproductive capability. So as to a CoVid vaccine, it may be difficult to produce a vaccine if the virus has significant genetic variability over time. The different genetic strains of flu are the reason that there is a flu shot each season and each of them are different than the prior year's. The hope with CoVid is that some would become immune from the vaccine, some would be immune from past exposure, if exposure confers long lasting immunity which is not clear that it does, and many would benefit with herd immunity and the others who get the disease could be quickly diagnosed and treated. It is not to be expected that the disease will be totally eradicated, but as a public health issue, it is hoped that it can be contained and treated. While Sars has not been seen since the early 2000s, MERS (Middle Eastern Respiratory Syndrome) a less reported disease seen in Saudi Arabia, continues to be present mostly in Saudi Arabia with occasional cases elsewhere. This virus has a natural host in camels and so it has been difficult to totally eliminate the disease. It has the potential to be devastating, but it appears to be more easily held locally than SARs which spread worldwide.