The worst has not begun and today, I found it hard to go on.

[mike carey]

Thanks for sharing this, @purplekow. It is both inspiring and terrifying to read. Kia Kaha (stay strong).

[amused1]

In my heart I am holding you close along with the doctors I work with. Hugs

[+ LS299B]

Hello Dr. PK,

 

Thank you! Your little drop of healing, hope, and compassion is now rippling through the thoughts and hearts of your bros in this forum. Consequently, we are re-telling your story and as we share it with others in our circles of family/friends, we are caught up in a wave of kindness, love, and deep peace that you started.

 

I often turn to music to help me reflect and sort things out. Here's a favorite based on a an old Gaelic Blessing. Enjoy, stay well.

[+ Charlie]

I discovered when I was young that one of the best ways to feel in control of your life is to write about it, which is why I have kept a daily narrative journal for close to a half century. It is not only helpful for us to learn what you are experiencing, but also helpful for yourself. It will also be a resource for you to go back to read in future years. I still sometimes re-read my journals from the 1980s, where I can see my own experience of the first years of the AIDS epidemic from the perspective of having lived through them. Years from now, it can also be a resource for future generations who will not have experienced it. Please keep writing as beautifully as you have here.

[+ purplekow]

Once again, last night, before bed, I checked the computer charts of my patients and again there was a patient whose condition had turned for the worse. The elderly woman who first triggered me to write had become more short of breath and was requiting more oxygen. During the day she had seemed a bit worse and I contacted her daughter to let her know about the developments and to set a plan for further care should things continue to worsen. That plan included the patient's wish not to have mechanical ventilation or cardiac resuscitation. That plan also included arranging for a FaceTime visit. Her daughter told me she had not seen her mother for two weeks as she was being extra careful not to bring the virus to her. Unfortunately, one of the patient's caretakers was not as scrupulous and came to work with upper respiratory symptoms. Soon after that day, the patient first became ill. Now it had been two weeks since she had seen her mother and as they are not allowing visitors to the hospital, she would not likely see her again. The daughter said that she really wanted to speak to her mother one last time and could a FaceTime be arranged. It is a sign of this situation that this request had already been completed several times before for other families, allowing family the comfort that would usually accompany a held hand and a stroked cheek, and perhaps an eye opening with a final loving look. Most of this is either impossible or unlikely with a phone visit, but at least there would be a chance to see her mother, a chance for her mother to hear her daughter's voice. That visit lasted about 10 minutes and the daughter was able to say: "Good bye Mom. Don;;t ever forget how much I love you.: The phone switched off and I am sure tears flowed on the other end, but on our end, the patient continued to breathe fitfully and she was given some morphine to ease the breathing and air hunger.

Several minutes later, the patient's son called and announced that he held the power of attorney and he wanted to know why more wasn't being done to help his mother. He lambasted the resident who had returned his call and told her he wanted his mother on higher flows of oxygen. Despite the residents reasonable answers, the son was having none of it and the call was terminated when he threatened to sue her and everyone else concerned in the care. Throughout that call the patient lay impassive and breathing without any difficulty, the morphine having worked, at least for now.

All that had transpired between 7 and 8 PM and now, at midnight, she was starting to breath fast again. She did require high flow oxygen and she appeared uncomfortable. She was given additional morphine and returned to her previous sedated state.

In between all this, two other patients were admitted both of whom, I saw in the morning.

One, a clean living, otherwise healthy 64 year old Hispanic gardener and the other a 90 year old who came with a swollen foot which was red. The gardener had been diagnosed with Covid 19 7 days ago and had very slowly gotten more short of breath. He was on no medications and so he was quickly started on the usual regimen for this disease. It is strange to say usual regimen for this as 7 days ago there was no regimen and 7 months ago there was no disease. He was responding well. He was alone here, his family back in his home country. We spoke a bit in Spanish, as despite his long tenure here in the US, 14 years, he said he spoke little English. I have found in the past the best way to get Spanish speaking patients to speak to me in English is to speak with them in Spanish. My guess is they figure if I am not ashamed of my American Spanish, they should feel confident in their English, which usually is more than sufficient. This time however, that technique did not work and so I got the remaining details in Spanish. He was definitely tired, a bit short of breath and requiting of oxygen but he did not appear to be in any eminent danger. He wanted something to eat and as it did not appear that he was going to need intubation, he was given breakfast. i told him: "Portanse bien" loosely translated as behave yourself. It garnered a laugh, as it usual does and I was out the door, ripping off the gown, the face shield, the gloves and the masks. These days those o us in the hospital do not get to breathe unmasked breath very often and so the seconds between masks is a treat, a possibly deadly one but a treat nevertheless l

The 90 year old who had come in with a swollen foot, looked to have a superficial infection and he could probably be treated with oral antibiotics. A test was done to check the blood flow in the foot and as that was sufficient and as the infection had already greatly subsided after one dose of IV antibiotics. we were going to tell him he was able to go home. It is interesting that this man was really very healthy for a 90 years old with only two medications, one for blood pressure and the other an occasional dose of the little blue pill. When I went in to see him, I told him that he was probably able to go home today he seemed genuinely happy. He then said, you know, I want to die. That stopped me in my tracks. Especially in view of other patients who now pleaded not to die. I asked him why he said that and he said that he had enough, that he was tired and that he did not feel the desire to go on.

I questioned him about suicidal thoughts and ideas of hurting himself and he had none of those. He simply wanted to give up. I told him I would have someone come to speak with him about this and that he would not be leaving, at least until then, On any other normal day, I would have spent more time with him, but there were other patients to see and updates to incorporate and residents to supervise. We contacted the psychiatrist who, agreed to speak with the patient as soon as possible.

So it was a long day, The elderly woman stabilized and was comfortable on morphine every 3 hours. the Gardner remained stable and felt a bit better later in the day. The elderly man with the Viagra as needed spoke with psychiatry and it came down to the fact that he was upset about living as his wife was dying from Alzheimer's. He though if he died, she would not know it, but if she died, his life would be over. He was kept overnight for further evaluation but he will likely go home tomorrow because the hospital is not a safe place for anyone, let alone a 90 year old. His foot was improving. The man who had told me he did not want to die did not die. He actually was fairly stable in the ICU. He was proning and his oxygen demands had not increased. His wife presented a particular set of social problems, but I will discuss that tomorrow.

When I woke up this morning, the radio announced the death figures for Cover in NYC.. There was an announcement that NYC would be out of respirators come Monday. The first doctor to die from this disease in the US was an ER doctor in NJ, the radio reported, though he had never been tested. My temperature was 97.5. It was time to get out of bed and face the day.

Edited April 3, 2020 by purplekow

[CuriousByNature]

@purplekow I cant express how much it means to be seeing this crisis through your very caring eyes. Your patients and colleagues are blessed to have you.

 

Yesterday I believe you mentioned that you would keep writing these updates as long as people were wanting to receive them.

 

I, for one, would like to continue reading these updates. They have provided us with a dose of humanity during very inhumane times. And for those of us who pray, these updates offer more opportunities for making individualized and specific supplications.

 

My ongoing concern is for your well-being. If writing these updates is cathartic or strengthening to your spirit, please definitely continue.

 

But if writing these updates is causing any additional trauma, or draining your physical/emotional resources beyond what your work is costing you, please prioritize yourself and consider stopping. Your updates are so very thoughtful, but we all need to be thoughtful as well - about the time and energy it must take for you to write them.

 

If you reach a point where updates are not possible, please continue to post a word here and there so we can continue to support you as best as we can. Even a couple of words, like 'hard day today', or 'doing alright' would be appreciated ?

[BgMstr4u]

Once again, Thank you so much, @purplekow . You are giving the rest of us a window into the reality of this virus, and it shows not only you but others as well doing good, solid, self-giving, self-sacrificing, heroic work. For which we are all grateful. And grateful to have a window into your world, which may also be ours at some point in all of this.

[+ honcho]

@purplekow , I'm glad your temperature is dropping (slightly), and am grateful for your narrative. I agree with CuriousByNature that if writing them is a net drain, that we want you to take care of yourself first ...

 

Appreciatively,

 

Keith.

[+ VictorPowers]

I love you PK! I hope you have been doing better since posting this thread!

[MikeBiDude]

All the best to you @purplekow your posts are sobering. I wish more people would realize the situation we are in.

[+ purplekow]

I keep looking in at the patient's chart at midnight. It seems that hour, when the nurse shift has been complete or nearly so, is a time when things are recognized. Last night was no exception. The gardener who was admitted earlier in the day and who was looking pretty good took a big turn for the worse. He was suddenly very short of breath and feverish and he could not prone himself because lying on his chest was painful for him. For the short periods he was able to prone himself, his oxygen levels improved enough to keep him from needing a ventilator. Now, the pain was causing him to breath faster and shallow and he was fatiguing and when he got off his chest to relieve the pain, the breathing became shallow as a result of the suboptimal positioning. He was evaluated by ICU team and though he qualified for ICU care, there were no beds there. His critical status led to an exchange of beds with an ICU patient coming back to his bed as he went to the ICU. This happens all the time under usual circumstances, but usually there are patients in the ICU who have been ready to move out but logistically have not been moved. This is not the case now in that all the ICU patients are ill enough to be there now.

As it turns out, the least sick of the very sick was the patient who had been sent there last night. the one who had implored that "I do not want to die". He had been placed on a ventilator and had been doing better. Although patient's with Covid may need ventilators for weeks, he had been doing well when his tube caught on the bedsheets and was inadvertently pulled out. The patient was surprisingly stable after this and it was decided that placement of tube could wait. His blood tests had peaked and were trending down and he had been monitored for about 12 hours of the ventilator. In that time, despite his precarious situation, he had become the most stable patient in the ICU and he was the patient exchanged for the gardener.

It is almost like a game of ping pong, with patients going back and forth.

Throughout the night the both of these patients did alright in the new setting. The gardener was not placed on a ventilator, the proning seemed to get him to a point that he was able to oxygenate well enough and IV Tylenol took the edge off the pain enough to allow him to stay in that position for longer periods. He is now the patient on the bubble should a bed there be needed urgently,. He is also the patient who could be placed on a ventilator, it changes so fast. They have now extended the range of the ICU doctors to cover non-ICU floors, which are now accepting patients with ventilators under the guidance of the ICU physicians and with nurses who have had respirator experience. The ICU has now add nurses who have not worked with ventilators much so as to get them experience while doing so by teaming them with nurses with plenty of supervision.

Let me stop here and just say what an amazing job the nursing staff is doing. Dozens of young women and a few young men, taking care of these patients. I shudder each time I need to go into a room and gown up. They go into many rooms several times a day. They are there to bring the food, give the medication, adjust the intravenous fluids, clean the patients, evaluate the severity of the clinical condition on a frequent basis. They are talking with the patient, encouraging them and they are the ones listening to the stories and addressing the patient's questions and fears. .

There is not enough praise to be heaped on these people. They are the reason that we will come out on the other side. They are willing to come in each day and work until exhaustion and then, many of them go home and do it all over again in caring for their families. So I encourage you, if you know a nurse, text or call and express your admiration and appreciation. Ask them if there is anything you can do to help them. I try to remember to thank them when I am working with them and after this is done, I will be sure I do a better job of thanking them each day

I have the weekend off. I have called the covering doctor and she feels she has everything under control in our little corner of the chaos. The surge has not come, yet. The week ahead promises, by all accounts, to be the worst yet. I am getting plenty of sleep and have decided to open the carton of ice cream I bought for a special occasion. Take care of yourselves.

Edited April 4, 2020 by purplekow

[+ tassojunior]

I keep looking in at the patient's chart at midnight. It seems that hour, when the nurse shift has been complete or nearly so, is a time when things are recognized. Last night was no exception. The gardener who was admitted earlier in the day and who was looking pretty good took a big turn for the worse. He was suddenly very short of breath and feverish and he could not prone himself because lying on his chest was painful for him. For the short periods he was able to prone himself, his oxygen levels improved enough to keep him from needing a ventilator. Now, the pain was causing him to breath faster and shallow and he was fatiguing and when he got off his chest to relieve the pain, the breathing became shallow as a result of the suboptimal positioning. He was evaluated by ICU team and though he qualified for ICU care, there were no beds there. His critical status led to an exchange of beds with an ICU patient coming back to his bed as he went to the ICU. This happens all the time under usual circumstances, but usually there are patients in the ICU who have been ready to move out but logistically have not been moved. This is not the case now in that all the ICU patients are ill now.

As it turns out, the least sick of the very sick was the patient who had been sent there last night.

 

Thanks for being our guy on the front line.

 

I'm wondering why lying on your stomach is preferred. I know for those of us with sleep apnea it's good for moving the tongue and jaw forward to open the throat for breathing. Which also makes me wonder if there are any CPAP machines being used yet as a step down from a full ventilator. Is there a certain level of blood oxygen on an oximeter that warrants ICU or ventilator? Many of us are getting cheap $30 oximeters to tell early if there's trouble. My panic point to get help would be temp over 101, oximeter well under normal 95 and inability to hold breath for 10 secs. (But i'm taking my CPAP with me !).

[+ purplekow]

Thanks for being our guy on the front line.

 

I'm wondering why lying on your stomach is preferred. I know for those of us with sleep apnea it's good for moving the tongue and jaw forward to open the throat for breathing. Which also makes me wonder if there are any CPAP machines being used yet as a step down from a full ventilator. Is there a certain level of blood oxygen on an oximeter that warrants ICU or ventilator? Many of us are getting cheap $30 oximeters to tell early if there's trouble. My panic point to get help would be temp over 101, oximeter well under normal 95 and inability to hold breath for 10 secs. (But i'm taking my CPAP with me !).

Proning helps move the fluids in the chest to areas of the chest that do less oxygen exchange, freeing up more efficient parts of the lung and recruiting previously closed off parts of the lung. This was first observed on patients who had mechanical ventilation and has been generalized to all Covid patients. The data is mostly anecdotal but in my limited experience, you can see a very dramatic difference in oxygenation in a short period of time with the change to the prone position.

CPAP and Bi PAP have not been used as they are felt to aerosolize the virus and keep it in the air for longer periods of time. The thought now is that the virus already has a significant amount of aerosolization and that is why the recommendations are coming down from the CDC for all to wear masks of some type. The fact that our leaders and newspeople on TV on not wearing masks or are taking a "do it if you want to do it attitud" is probably making things worse. There is a segment of the population who will not wear masks no matter what. It is those that can be swayed by seeing examples on TV and by public pressure are the ones that will help slow the transmission. There are clearly exceptions. If you are out in a secluded area, the risk of aerosolized particles reaching you is minimal. Even with masks, the masks should be removed properly with the mask facing the ground to keep most of the viruses low.

NYC is thinking of using BiPAP for continuous ventilation as it may be a choice that needs to be made even with the aerosolization risk.

Edited April 4, 2020 by purplekow

[robberbaron4u]

I do not usually have a difficult time coping. Life is hard and mine has been easier than most. But today, I have just hit the wall. Working in a New Jersey Hospital is not nearly as difficult right now as working in a NYC Hospital. We have most equipment. We have beds. We have staff. We have patients and each day we have more and more patients. Right now the numbers are not overwhelming but they are increasing and more and more compromises are being made. Most of the staff are just doing their job. But there is an air of anxiety and trepidation hanging around every corner. There are hollowed shells walking the halls. Fear and uncertainty is everywhere. There are no laughs not even at jokes with a dark humor,

 

I went into work today and started the day as part of a physician conference call. The conference call was to inform us that the governor has given physicians immunity. This is not being widely publicized. Essentially, within the scope of good medical practice, we cannot be be sued for actions that previously would have been not only malpractice but quite possibly criminal. That is, we were informed of the plans for the upcoming ventilator shortage. It is not first come first served as it is in the toilet paper aisle. There is no hoarding or buying for a friend, When the respirators are 90% in use, which is the case in several hospitals in New Jersey, then patients are assigned a color code. Green patients are those that get to keep the respirators. Yellow are the patients about whom clinical status and general condition are favorable. Red are the patients that are first in line to have their respirators removed should others in higher categories need them. Blue, well blue never get the respirator from the onset.

 

I could barely contain my anger, fear, frustration, and utter disappointment. We knew this was coming, I knew it was coming but now it is here and it is a palpable real pain, physical, mental, emotional and spiritual. We were given guidelines as to what to tell family members when it is time to take their loved one off the ventilator. They do no have the final word. There is an appeals process, but that process can only last 30 minutes while the patient waiting for the ventilator is manually ventilated, Two more hours will be needed to clean the ventilator and reequip it.

 

Three people will take turns manually ventilating the patient, Oh did I mention that once you are assigned a color, the person coming off the respirator would have had to be on the respirator for 5 days, so theoretically long enough to turn the corner and get themselves into a higher color group. However, the decision as to who comes off the respirator is made by random computer selection of those in the lowest category.

This is not to say that the assignment of the color group is random.

 

Patient's are stratified by a variety of factors, age NOT being one of them.

 

Today, I had a new patient with possible Covid admitted to my service. She is 87 with a touch of dementia and lives at her daughter's home with a loving family. I spoke with her daughter on the phone to get information about her mother. She told me to try and do everything to help her mother but that if it was clear that there was no hope of her returning to her previous level of functioning, or close to it, that her mother had decided long ago that she did not want to live that kind of life.

 

When I went into see the patient, I gowned and gloved and on the way in , I noticed her lunch tray and decided to give a hand to the other staff by bringing it in. PPE (personal protection equipment ) is still sufficient but not plentiful so my act saved one set. I brought her lunch tray in with me and saw a pleasant looking woman who appeared about 15 years younger than her age. She had eyes closed and did not respond when I called her name. I put down her lunch tray next to her untouched breakfast tray and did my exam. She appeared to be comfortable and was definitely someone who was doing much better than her numbers (lab values vital signs and other measurable qualities). I went to leave and the empty breakfast tray and the new lunch tray just haunted me. I opened the packet for her utensils and the vanilla pudding put a bit on the spoon and placed it by her lips. She opened her lips and took a taste. Then another. Some of her fruit cup and then most of her mashed potatoes followed. A bit of meatloaf and then the rest of her pudding. She said nothing. She did not open her eyes, even as I tried to coax her to do so. Finally, on a bit of the meatloaf.

 

She refused to open. Another offer and another refusal and so I knew after 30 minutes of being fed, she was not taking any more. I said out loud to her, I guess that is it for now and as I left I heard her faintly say: Thank you. I turned and her eyes were open and then, a second later, they closed again. For that second they were so clear and blue and aware and I imagined her quite the beauty in her youth. After that second, she was back in that space where she was when I walked in, but she had let me know she was there.

 

Next week, her condition may worsen and she will be a blue. She won't get a chance at a life saving machine, She will likely pass alone in a hospital with a loving daughter sitting at home hoping for all the world for her mother to get better. Even if I could do more medically, which I cannot, I could not alter her course. Even now, the most I could do for her he be present, give her some pudding and hope that time and some combination of medications we are giving her make a difference,

 

I do not usually have difficulty coping, but today I hit the wall and next week this day will be the good old days when I had 30 minutes to spend with one patient.

I have no doubt a box seat in the diamond horseshoe of Heaven awaits you as your just due for your compassion.

[+ purplekow]

I did not realize how much I needed sleep but after my sexy prone nap, which I posted about elsewhere, I slept for 14 of the next 18 hours. Just awake enough to post on here, call some friend and relatives to check in and to eat a peanut butter and jelly sandwich. I awoke this morning. Temp 97.7, Breathing easily and feeling pretty good, which is about as good as I get. A nice hot shower after a steam and breakfast. Finally, having indulged myself, I decided to check in on my patient's at the hospital. I have had the weekend off and fortunately the surge has not been as overwhelming as we had been expecting. Quiet before the storm is the phrase that comes to mind. I checked in with the covering physician and things are going reasonably well. The hospital continues to be a place of cooperation and compassion despite the chaos the disease wrecks on the patients.

I have been mentioning three patients, well four, though there are others. So I will update you and discuss some of the issues which are resulting.

The jockey, who was one of my first patient's was able to go home a few days ago and a phone call to him indicates that he is doing well. He is not quite in the category of cured as he has not been symptom free including fever free for a long enough period of time, but he stands to be one of the lucky ones.

The elderly lady whose daughter did FaceTime and whose son caused a bit of difficulty with a threatening manner, is holding on but barely. It is not likely she will make it but we continue to offer the best treatment we can in view of the patient made decision to avoid ventilators. She is being kept comfortable with morphine on a regular basis and for the most part, she is making a slow and relatively peaceful transition to whatever is next.

The gardener who was placed on the ventilator is stable but clearly he is having a difficult time. He is oxygenating poorly despite medication and despite high pressures on the ventilator. HE is clearly at a critical time but it may be a week or more before it is clear which path he is going to be taking. I have mentioned before that 10 to 14 days on a respirator is not unusual. It is also not unusual for people to do poorly even after that time and effort. This man has a good a chance as any in his position having lived a clean and healthy life. He would be a green if we had started to assess ventilator status. A green, for those that are not familiar, are those patient's who by the nature of their progress and risk factors, would continue on a ventilator and not be placed in the pool of those who may be pulled off if others needed it.

The fourth patient, the patient who stated that he did not want to die, continues to improve. Some of his tests are better and the rest are stable. He is no longer on the respirator after his endotracheal tube was inadvertently removed. He does not appear to be in need of that kind of support right now. His breathing is slower and more efficient and things are looking well for him.

 

This brings me to a topic of great controversy. Religion, religious gatherings and the pandemic. The hospital at which I work is a secondary hospital for a community that continues to hold religious gatherings. This is happening across the country as there are 14 states which have specifically exempted religious gatherings from social isolation decrees. Working in the hospital, there will be news programs on patient televisions and these stories are a major focus at this time. At the level of the caretaker, how a person contracted the disease has not been a factor in the care that they receive. Whether it is the elderly woman whose asymptomatic caretaker gave it to her, or another patient who attended a church service that was specifically against public health policies, the patient gets the best care possible. What does happen though, is these stories wear people down. You hear nurses muttering what are these people thinking. You hear bits of hallway conversations in which there is anger and intolerance, not for the religious but for the religious leaders who encourage these gatherings. The dismay, the feeling of disrespect for the caretakers and the additional burden being placed on the medical community by those going to these meetings is multifactorial. The patient's will receive the care. The caretakers will do their jobs. All we ask of the public is to not make it more difficult. Take responsibility as though your life depended on it, because someone's does.

[+ Just966]

I did not realize how much I needed sleep but after my sexy prone nap, which I posted about elsewhere, I slept for 14 of the next 18 hours. Just awake enough to post on here, call some friend and relatives to check in and to eat a peanut butter and jelly sandwich. I awoke this morning. Temp 97.7, Breathing easily and feeling pretty good, which is about as good as I get. A nice hot shower after a steam and breakfast. Finally, having indulged myself, I decided to check in on my patient's at the hospital. I have had the weekend off and fortunately the surge has not been as overwhelming as we had been expecting. Quiet before the storm is the phrase that comes to mind. I checked in with the covering physician and things are going reasonably well. The hospital continues to be a place of cooperation and compassion despite the chaos the disease wrecks on the patients.

I have been mentioning three patients, well four, though there are others. So I will update you and discuss some of the issues which are resulting.

The jockey, who was one of my first patient's was able to go home a few days ago and a phone call to him indicates that he is doing well. He is not quite in the category of cured as he has not been symptom free including fever free for a long enough period of time, but he stands to be one of the lucky ones.

The elderly lady whose daughter did FaceTime and whose son caused a bit of difficulty with a threatening manner, is holding on but barely. It is not likely she will make it but we continue to offer the best treatment we can in view of the patient made decision to avoid ventilators. She is being kept comfortable with morphine on a regular basis and for the most part, she is making a slow and relatively peaceful transition to whatever is next.

The gardener who was placed on the ventilator is stable but clearly he is having a difficult time. He is oxygenating poorly despite medication and despite high pressures on the ventilator. HE is clearly at a critical time but it may be a week or more before it is clear which path he is going to be taking. I have mentioned before that 10 to 14 days on a respirator is not unusual. It is also not unusual for people to do poorly even after that time and effort. This man has a good a chance as any in his position having lived a clean and healthy life. He would be a green if we had started to assess ventilator status. A green, for those that are not familiar, are those patient's who by the nature of their progress and risk factors, would continue on a ventilator and not be placed in the pool of those who may be pulled off if others needed it.

The fourth patient, the patient who stated that he did not want to die, continues to improve. Some of his tests are better and the rest are stable. He is no longer on the respirator after his endotracheal tube was inadvertently removed. He does not appear to be in need of that kind of support right now. His breathing is slower and more efficient and things are looking well for him.

 

This brings me to a topic of great controversy. Religion, religious gatherings and the pandemic. The hospital at which I work is a secondary hospital for a community that continues to hold religious gatherings. This is happening across the country as there are 14 states which have specifically exempted religious gatherings from social isolation decrees. Working in the hospital, there will be news programs on patient televisions and these stories are a major focus at this time. At the level of the caretaker, how a person contracted the disease has not been a factor in the care that they receive. Whether it is the elderly woman whose asymptomatic caretaker gave it to her, or another patient who attended a church service that was specifically against public health policies, the patient gets the best care possible. What does happen though, is these stories wear people down. You hear nurses muttering what are these people thinking. You hear bits of hallway conversations in which there is anger and intolerance, not for the religious but for the religious leaders who encourage these gatherings. The dismay, the feeling of disrespect for the caretakers and the additional burden being placed on the medical community by those going to these meetings is multifactorial. The patient's will receive the care. The caretakers will do their jobs. All we ask of the public is to not make it more difficult. Take responsibility as though your life depended on it, because someone's does.

 

 

Thank you again @purplekow for your ongoing thread that gives us that first hand glimpse at what so many people are facing on the frontlines and the need for rest of us to do our part by staying home. I hope that you have as good a weekend as possible and get some well deserved rest and good meals before heading back. Your post also emphasizes the fact that many front line staff, when off, are also not ever really off as you think of your patients, check their results and maintain contact with those covering your pts when off. Take care, stay well and thank you!

[+ tassojunior]

[thickornotatall]

Yesterday I watched a PBS documentary that I had recorded the night before. As the first few moments were being narrated I thought to myself, "OMG, this is now." It was about polio a disease that struck everyone and every place randomly. Even one of the most privileged people in the USA , Franklin Delano Roosevelt, could not escape its clutches. Roosevelt began a warm water clinic where other polio patients could be given treatment to attempt to recover from polio. Eventually Roosevelt asked his law firm partner, Basil O'Connor, to take control of the rehab clinic and to begin a campaign in order to secure funding to maintain it. Because the country was in the grips of the Depression attempts to get funds from the wealthy was not enough, so he reached out to the public who was now suffering the most from the epidemic and through various means asked for each person to send a mere 10 cents to the White House to fund a way to find a vaccine against Polio. I never really knew what the March of Dimes was but it arose from the thought that it was everyone, including the government, that had to work together to cure polio. It took a long time to find a vaccine. I highly recommend the documentary.

 

https://www.pbs.org/wgbh/americanexperience/films/polio/

My cousin Dennis contracted polio in the late 1950's. He was about 10 at the time. I remember him in an iron lung in their dining room with a mirror so he could see everyone. There was a sign on the front door that read Quarantine Polio!...I could see him through the window but couldn't talk to him. Eventually he was deemed well enough to shed the iron lung...He walked with a brace on his left leg.. Later on in life the polio made a comeback with him. He needed a brace and a cane.. He died in his sleep at age 60.

A very sad ending to a tragic life...

Edited April 7, 2020 by thickornotatall

[rvwnsd]

...This brings me to a topic of great controversy. Religion, religious gatherings and the pandemic. The hospital at which I work is a secondary hospital for a community that continues to hold religious gatherings. This is happening across the country as there are 14 states which have specifically exempted religious gatherings from social isolation decrees. ...All we ask of the public is to not make it more difficult. Take responsibility as though your life depended on it, because someone's does.

 

Thank you for the update, PK. For me, this is more meaningful and helpful than the endless barrage of "news" and statistics.

 

When I was a kid in the 1970's, my very religious aunt couldn't get to Mass but still wanted to celebrate. The answer? "Mass for Shut-Ins," a televised Mass every Sunday morning. Seems like we could do something like that in 2020.

 

PS: I hope this reply does not stray into the realm of "Religion and Politics." I've self-reported it to the mods so they can make a decision and remove it, should they deem it out of bounds for this forum, rather than move this entire thread to the "Politics" forum.

[MikeBiDude]

When I was a kid in the 1970's, my very religious aunt couldn't get to Mass but still wanted to celebrate. The answer? "Mass for Shut-Ins," a televised Mass every Sunday morning. Seems like we could do something like that in 2020.

My Jesuit Alma mater started doing just that, streaming noon mass on sundays from the high school chapel.

[TruthBTold]

My cousin Dennis contracted polio in the late 1950's. He was about 10 at the time. I remember him in an iron lung in their dining room with a mirror so he could see everyone. There was a sign on the front door that read Quarentine Polio!...I could see him through the window but couldn't talk to him. Eventually he was deemed well enough to shed the iron lung...He walked with a brace on his left leg.. Later on in life the polio made a comeback with him. He needed a brace and a cane.. He died in his sleep at age 60.

A very sad ending to a tragic life...

 

Yes, that is very sad. I recall that the documentary recounted that the majority of the victims were children. However one of the people that were interviewed was a man who was a child when his mother was struck with polio. She was removed from the home fairly quickly and placed in a sanitarium. He was not allowed to see her for a. long while and she like many others was placed on a respirator/iron lung. As you mention when she was allowed to return home she could only see him through a mirror attached to the respirator. She eventually was taken off the respirator and placed on crutches. However she did not have the same demeanor he remembers when he was a child. The whole thing was very sad.

[Jomo]

@purplekow If you don't want to answer this question, I understand. Has your hospital tried any of the anti malaria drug for treatments on your COVID-19 patients?

[TruthBTold]

@purplekow If you don't want to answer this question, I understand. Has your hospital tried any of the anti malaria drug for treatments on your COVID-19 patients?

 

I don't think that there have been any completed clinical trials such that doctors can recommend that it be used to treat patients.

[+ WilliamM]

Peter Navarro has stepped up the arguments for drugs already available for other illnesses to fight COVID-19. He is not a doctor, and has other duties in the Trump Administration.

 

Arguing with Doctor Anthony Fouci is fine in private, but not when those "discussions" inevitably become public.

[Ajac]

I do not usually have a difficult time coping. Life is hard and mine has been easier than most. But today, I have just hit the wall. Working in a New Jersey Hospital is not nearly as difficult right now as working in a NYC Hospital. We have most equipment. We have beds. We have staff. We have patients and each day we have more and more patients. Right now the numbers are not overwhelming but they are increasing and more and more compromises are being made. Most of the staff are just doing their job. But there is an air of anxiety and trepidation hanging around every corner. There are hollowed shells walking the halls. Fear and uncertainty is everywhere. There are no laughs not even at jokes with a dark humor,

 

I went into work today and started the day as part of a physician conference call. The conference call was to inform us that the governor has given physicians immunity. This is not being widely publicized. Essentially, within the scope of good medical practice, we cannot be be sued for actions that previously would have been not only malpractice but quite possibly criminal. That is, we were informed of the plans for the upcoming ventilator shortage. It is not first come first served as it is in the toilet paper aisle. There is no hoarding or buying for a friend, When the respirators are 90% in use, which is the case in several hospitals in New Jersey, then patients are assigned a color code. Green patients are those that get to keep the respirators. Yellow are the patients about whom clinical status and general condition are favorable. Red are the patients that are first in line to have their respirators removed should others in higher categories need them. Blue, well blue never get the respirator from the onset.

 

I could barely contain my anger, fear, frustration, and utter disappointment. We knew this was coming, I knew it was coming but now it is here and it is a palpable real pain, physical, mental, emotional and spiritual. We were given guidelines as to what to tell family members when it is time to take their loved one off the ventilator. They do no have the final word. There is an appeals process, but that process can only last 30 minutes while the patient waiting for the ventilator is manually ventilated, Two more hours will be needed to clean the ventilator and reequip it.

 

Three people will take turns manually ventilating the patient, Oh did I mention that once you are assigned a color, the person coming off the respirator would have had to be on the respirator for 5 days, so theoretically long enough to turn the corner and get themselves into a higher color group. However, the decision as to who comes off the respirator is made by random computer selection of those in the lowest category.

This is not to say that the assignment of the color group is random.

 

Patient's are stratified by a variety of factors, age NOT being one of them.

 

Today, I had a new patient with possible Covid admitted to my service. She is 87 with a touch of dementia and lives at her daughter's home with a loving family. I spoke with her daughter on the phone to get information about her mother. She told me to try and do everything to help her mother but that if it was clear that there was no hope of her returning to her previous level of functioning, or close to it, that her mother had decided long ago that she did not want to live that kind of life.

 

When I went into see the patient, I gowned and gloved and on the way in , I noticed her lunch tray and decided to give a hand to the other staff by bringing it in. PPE (personal protection equipment ) is still sufficient but not plentiful so my act saved one set. I brought her lunch tray in with me and saw a pleasant looking woman who appeared about 15 years younger than her age. She had eyes closed and did not respond when I called her name. I put down her lunch tray next to her untouched breakfast tray and did my exam. She appeared to be comfortable and was definitely someone who was doing much better than her numbers (lab values vital signs and other measurable qualities). I went to leave and the empty breakfast tray and the new lunch tray just haunted me. I opened the packet for her utensils and the vanilla pudding put a bit on the spoon and placed it by her lips. She opened her lips and took a taste. Then another. Some of her fruit cup and then most of her mashed potatoes followed. A bit of meatloaf and then the rest of her pudding. She said nothing. She did not open her eyes, even as I tried to coax her to do so. Finally, on a bit of the meatloaf.

 

She refused to open. Another offer and another refusal and so I knew after 30 minutes of being fed, she was not taking any more. I said out loud to her, I guess that is it for now and as I left I heard her faintly say: Thank you. I turned and her eyes were open and then, a second later, they closed again. For that second they were so clear and blue and aware and I imagined her quite the beauty in her youth. After that second, she was back in that space where she was when I walked in, but she had let me know she was there.

 

Next week, her condition may worsen and she will be a blue. She won't get a chance at a life saving machine, She will likely pass alone in a hospital with a loving daughter sitting at home hoping for all the world for her mother to get better. Even if I could do more medically, which I cannot, I could not alter her course. Even now, the most I could do for her he be present, give her some pudding and hope that time and some combination of medications we are giving her make a difference,

 

I do not usually have difficulty coping, but today I hit the wall and next week this day will be the good old days when I had 30 minutes to spend with one patient.

I am sitting here crying, I care for my 92 year old father and your post has put things in perspective. I thank god that he is still with me even in the most difficult of times. Also thanks for bringing me to tears seriously it is cathartic to feel something other than anger which many will attest to from my many Trump posts. Trump goes on about wanting to be appreciated for what he has done, screw him you and the people on the front lines are the ones who deserve appreciation. You have my deepest appreciation your post reminds us that these aren't just numbers to be quoted by a government they are people who are loved and matter.