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

[+ purplekow]

Unfortunately, since this disease is so new, we have no way of knowing what the longterm effects of having the disease will be for young people like Jack after they have "recovered." According to yesterday's LA Times, people who have had even mild forms of the disease are showing clinical abnormalities in their lungs and hearts in follow-up exams.

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.

Edited April 29, 2020 by purplekow

[+ stevenkesslar]

Back from that place and back to work and hopefully back to save my patient in the black bikini underwear.

 

You have written many very humanizing and compassionate things. But this stands out. I find it very human and compassionate that some guy whose life you are trying to save is noteworthy because of his black bikini underwear. We should all be so lucky.

[+ honcho]

A solemn "Thank You" over the loud speaker system startled us back from whatever place our thoughts had taken us.

 

Thumbs up and applause don't seem to cut it for that post. You have my solemn thank you and prayers as well.

[+ purplekow]

Thumbs up and applause don't seem to cut it for that post. You have my solemn thank you and prayers as well.

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.

[+ g56whiz]

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.

When this is all over @purplekow, I think I'm one of many here who would be pleased to contribute to a go fund me campaign that would pay for your extended visit with the escort(s) of your choice. You'll have earned it. Plus I can only imagine what your Daddysreview write up will say.

 

Seriously PK, for those of us confined you bring us constant reminders of what it means to be human with some of the joy, irony and all of the sorrow that can entail. For me "thank you" seems woefully inadequate. Peace good friend.

[BasketBaller]

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.

I am so grateful for your posts. Here in quarantine, even watching the news, it can all seem like an abstraction and it's powerful to read front line reports. Plus, I know from our interactions here in the forums what an expansive and generous heart you have, so while I know this is difficult,, I would think that sharing with us would be cathartic. I'm praying for you.

[+ sniper]

If people are throwing clots, is it possible the initial "avoid NSAIDs" recommendation was misguided? People who regularly take NSAIDS might have a rebound effect of more clotting when they stop, no? And if someone was admitted to the hospital who had been taking an OTC NSAID for, say, joint pain you probably wouldn't normally bother to continue it, right?

I'm wondering if there was a chicken and egg problem in that initial warning.

[+ Just966]

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.

 

 

Thank you for your continued posts and hope that you do find some relief in writing them. Thoughts are with you and the others on the front line and really looking forward to the time that you are able to write more uplifting and happy posts on this issue. Take care and be safe in the meantime. Many of us on this forum are thinking of you.

Edited May 1, 2020 by Just966

[+ purplekow]

If people are throwing clots, is it possible the initial "avoid NSAIDs" recommendation was misguided? People who regularly take NSAIDS might have a rebound effect of more clotting when they stop, no? And if someone was admitted to the hospital who had been taking an OTC NSAID for, say, joint pain you probably wouldn't normally bother to continue it, right?

I'm wondering if there was a chicken and egg problem in that initial warning.

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.

[+ sniper]

Are they putting patients on blood thinners?

[+ purplekow]

Are they putting patients on blood thinners?

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.

[+ purplekow]

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.

Edited May 2, 2020 by purplekow

[+ purplekow]

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.

Edited May 2, 2020 by purplekow

[+ stevenkesslar]

Thanks for listening.

 

No. Thank you for being such a compassionate and dedicated professional.

[+ stevenkesslar]

Thanks for listening.

 

No. Thank you for being such a compassionate and dedicated professional.

[Guy Fawkes]

Fear is the greatest enemy.

 

If you have the virus, you already know how to treat it. More importantly you know ALL of the symptoms and a elevated temperature is only one.

 

You took a hotter than average shower. Your nurse had it right; Goto bed, Regain your Balance, and your Perspective. All Is Well.

 

You are far stronger that you'd ever expect! We are in awe of what your are doing.

 

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.

[Guy Fawkes]

Fear is the greatest enemy.

 

If you have the virus, you already know how to treat it. More importantly you know ALL of the symptoms and a elevated temperature is only one.

 

You took a hotter than average shower. Your nurse had it right; Goto bed, Regain your Balance, and your Perspective. All Is Well.

 

You are far stronger that you'd ever expect! We are in awe of what your are doing.

 

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.

[+ honcho]

Thanks for listening.

 

You still have all of our prayers, positive thoughts, and concerns ....

do let us know to the extent you can; we all care.

 

Keith.

[+ honcho]

Thanks for listening.

 

You still have all of our prayers, positive thoughts, and concerns ....

do let us know to the extent you can; we all care.

 

Keith.

[Islesguy]

The two times I never take my temperature is immediately after a bath or shower or immediately after eating. The latter because I only have oral thermometers. Taking your temp when your mouth or body will be artificially hotter or colder is futile and will only lead to anxiety and fear.

[mike carey]

I read PK's almost daily accounts with a mixture of horror and trepidation. Horror that this disease is having such a terrible effect in New Jersey and New York, as it has in Italy and the UK (amongst other places). I yield to no-one in my admiration of the work he and his colleagues are doing. Trepidation that those of us who are doing better than the US could so easily face the same situation that America does today if we aren't vigilant in our responses to the pandemic.

[+ nycman]

Again, thank you for posting PK. It’s always enlightening to read.

I honestly don’t think most of America really understands the

horrors that have happened in Tristate area.

 

Your writing is raw and at times painful to read, but it is vitally

important. People have a way of wishing away things they find

uncomfortable to accept. The truth must be held up to the

light of day regardless.

 

You are a Hero. Stay strong.

[+ purplekow]

You may take the boy out of the hospital but you cannot take the hospital out of the boy. I have the weekend off but felt compelled to peak in on the computerized records to see how my patients are doing. I also made a quick call to the covering doctor just to be sure. This morning I had 14 patients in the hospital. 9 of them were actively on my service and 5 were in the ICU and under their care. Still, though I am not taking daily care of those five, I feel an obligation to know what is going on in their care for when they eventually return from the ICU to the regular floor. I have sent more than a dozen to the ICU, only two have returned.

Well of the 9 I was caring for currently, I was hoping that two would go home, including a young man with Covid who has been in the hospital for two weeks but who avoided the ICU. He is a Mexican construction worker who has never really looked ill in the full two weeks he has been here, but who has continued to need large volumes of oxygen and who has been treated with the now standard regimen of Tocilizumab and Remdesivir and Convalescent serum. If fact, he has been in the hospital long enough to have been on the previous standard treatment of Zithromax and Plaquenyl. He is also getting anticoagulation and the newest kid on the block, Famotidine. Well, he is finally off the oxygen but for reasons unknown, he remains in the hospital. I expect he will go home tomorrow. Big victory for him and a welcome bit of good news for the team. The other man, who did not have Covid was discharged to home after a brief and uneventful hospital stay after passing out in the bathroom. This is the kind of patient who was the typical admission in the time before time stopped. Getting anyone out of the hospital is a victory now because hospitals are particularly dangerous places to be nowadays. The rest of the group are doing reasonably well and I expect several more to leave before the coming week is over. In fact, after the discharge of the CoVid patient tomorrow, the only Covid patients I will be following are the five in the ICU. So perhaps there has been a leveling off here in this one hospital, but NJ in general is still a major Covid center.

I checked in on the five patients in the ICU. All are male including the man with the black bikini underwear. All are on ventilators. Three have been one ventilators for more than 3 weeks and the other two for less than a week. The persistence of this kind of distribution of ICU patients has me convinced that the only patients who will leave the ICU are the ones that do so in the first week.

I scrolled through the patients and that conviction held up until the last patient.

This is a 37 year old man who has been on a ventilator for 30 days. Each day I look in and each day nothing much has changed. Today though, for the first time, a glimmer of hope. His oxygen requirements have dropped. He has been breathing on the ventilator but on his own. In other words, he is making enough of a coordinated respiratory effort to trigger the ventilator rather than the ventilator persistently giving a breath every three to four seconds. He has had the medications for the medically induced coma reduced. Tomorrow, they are planning to stop those drugs, allow him to waken and test out his ability to breath off the ventilator. Should he pass that test, the endotracheal tube will be removed and he will be breathing on his own with supplemental oxygen. His kidney function is good. He has not had any discernible neurologic events. He has received supplemental nutrition through a feeding tube. All of this has kept his body fit enough to sustain itself. should he be able to breath on his own. When I read the note that this was all planned I gasped. The routine has been just about unbroken. Only 7 patients have made it off the ventilator at this hospital since this started. If he becomes the eighth, he will have been on the ventilator for the longest period of time, more than one month.

His road is far from easy to travel from this point. But it looks as though he has crested the mountain. I hope he gets to enjoy the view. If he does, he will be returning to my team for the final parts of his treatment prior to going home.

Edited May 2, 2020 by purplekow

[samhexum]

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.

 

Ditto. And I'm just isolating in my apt, except to go get the mail, or meet my pot dealer downstairs for a delivery, but I'm sure each surface I touch has given it to me. I don't know how you & other healthcare workers do it. I couldn't even come close to being so selfless.

 

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.

 

Ditto again.

 

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?

 

Is it my 65(ish) extra pounds, or the 40 years of heavy pot smoking that have left my lungs in crappy shape, or just my totally sedentary life?

 

 

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 a dry chicken salad sandwich and talked to a friend on the phone as I did.

 

Is there a piece of music you can listen to that calms you down and makes you feel mellow? Maybe put something on your phone that you can listen to when feeling more stressed than usual.

 

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 feel awful for you. I don't believe that 'thoughts and prayers' malarchy, but if I did, I would for you. I know that doesn't help, but it's all I can offer (unless you want a hit off my joint ).

 

 

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 wish I had words...

 

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'll give you the 'Mazel Tov' I wasn't in the mood to give Anderson Cooper for his kid.

 

Thanks for listening.

 

Anytime. I'm up all night. If we knew each other I'd tell you to call anytime. If you come here and are feeling down and just need to vent or express your thoughts, and you see me online, send me a message. I may not have anything wise to say, but I'll be a sympathetic ear. I wish you peace and contentment.

Edited May 2, 2020 by samhexum

[+ sync]

Most upsetting about the virus for me, beyond the ugliness of its symptoms, is the speed with which it takes its victims from mild discomfort to death. There must be many thousands of victims who have passed without having had the opportunity to make their final arrangements.