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

[Redwine56]

Not all Eucharists involve wine and bread and are performed by priests in robes @purplekow.

You've got that right @g56whiz. Dr. Purplekow seems like a remarkable and kind hearted person to me. Keep up the good work! You make us proud.

[+ g56whiz]

That is correct. The medical schools could educate more physicians here in the US, they choose not to do so. When I first started in medical education, there were about 15000 American graduates a year, that is about 40 years ago. As you can tell the number has not increased substantially. At that time, there were medical schools in the Caribbean, Europe and the Middle East training US students. In addition to that, you had the same influx of FMG physicians (Foreign Medical Graduates) plus all those US citizens who were training abroad. There was a program that probably still exists, in which after two years training abroad, US students could, if they passed proficiency examinations, transfer for clinical training here in the US. Schools would take up to about 5 of these transfers and there were about 114 schools at that time. Some did not take any. So basically US school were taking back the highest testing US born graduates, usually around 150 in total. Regulations tightened as a result of Venture capitalists taking an opportunity to provide education in small countries in the Caribbean mostly, and charge little for their citizens' tuition, gratifying the government and charging US students tidy sums. Those who have sharp memories of the invasion of Grenada during the Reagan era, know that one of the reasons used to send US troops into Grenada to topple that government, was the imminent risk of US medical students training there.

These relatively fly by night schools would get part time faculty from the US and organize a mostly large lecture series with most of the education coming from reading assignments. Some schools, such as those in Europe and Mexico were well established at training their own country's physicians, but these of shore schools had few clinical experiences and if students did not transfer out back to the US, the school would find clinical opportunities, usually at non university associated hospitals around the globe. The hospitals got manpower, the schools got training and of course, the lucrative tuition,

This was the 70s and 80s and US schools could have simply opened 20 or more positions per year each and that would have cut the need for these schools. A few more schools in underserved parts of the US would have done the trick too. They did not do that, but they made regulations for US graduates to return to the US from those off shore medical schools much more difficult and stopped the influx of US students who had circumvented the US system. Replacing those US grads were an even a larger number international graduates from foreign countries. That is where we are today except the world changed and those doctors may not get here,

The CoVid pandemic provided a convenient excuse for enacting the severe immigration restrictions Trump and his henchman Steve Miller have sought all along. The looming doctor shortage seems to be an unintended consequence. But it fits neatly into to the philosophical debate over healthcare with liberals insisting it’s a birthright and others insisting it’s a commodity that needs to be purchased like any other commodity.

[+ purplekow]

Well life has a way of surprising you. After four straight months of patient care of Covid patients, I was changed to an educational and administrative rotation for two weeks, When that two week rotation ended on Saturday, I felt pretty good. I had not been exposed to Covid patients for 2 weeks and I was generally feeling well, so I was ready to start my next rotation.

Saturday and Sunday I was on call for uninsured patients and I had about 12 patients in the hospital. Only two of the patients were known Covid patients. Both of them had come in with other complaints and in the ER, evaluation lead to the patient being tested and found to be positive for Covid. By the time I started, they were well known to be Covid patients with an unusual presentation. What now are routine precautions were in place.

Then yesterday, one of the patients on my service, a young man with a congenital disease and who was non communicative became sicker than he had been. He had come in from his group home with a single episode of vomiting but because he has had issues related to this in the past and because he had some minimal lab abnormalities, he was admitted. He did fine for the first 48 hours but he then was unable to eat and he needed a CT scan. A tube was placed in his stomach to give him the contrast material as he would not or could not swallow the contrast. Surpisingly, there was blood in his stomach and the tube placement irritated him enough that he reached up and grabbed the tube and pulled it out. This set into motion a vomiting episode which produced about a quart of blood. The bloody vomit coated the room and several people in it.

I called each of his parents about this and informed them of the events and let them know that he was stable. At that point, one of the parents informed me that they had Covid and that they had likely gotten it after a prolonged stay an ER with the patient two months ago. However, clearing of the virus had been slow. That parent had still been positive last week.

With this new information and with multiple person exposure from the vomit. I ordered Covid testing on the patient who had no signs of Covid.

Today the results came back positive for Covid.

Since masks and hand washing are not enough, the patient was moved to isolation and from now on will be seen with caretakers in personal protective equipment. In addition, all those exposed to him, the vomit and the room, are now being quarantined. So that one patient has exposed approximately 30 people directly just in the hospital and it is unclear how many in his group home and how many more indirectly. That stay in the ER which made his mother positive, probably made him positive. And just his branch has affected 30 more. How many branches are there off that one ER exposure is unclear. How many people will actually get Covid is yet to be determined.

Fortunately, I have not gone out to a restaurant, to a movie, to the beach that opened here in NJ. I always wear a mask outside of my home. I feel confident that if I was exposed through this, that at least, I have not exposed others, to the best of my ability to limit it.

So somewhere else, someone is talking about .05% of their local population having tested positive. as an argument to open Well, as in this case, not everyone is tested, not everyone who tests positive tells you they have and not every exposure is limited to the one person who has it.

 

It is my sincere hope that I have not been exposed and infected. It is my sincere hope that if I was exposed that I have not exposed others. It is likely that if I was exposed and was infected, that I will be in the group that have mild cases. If I am not, I hope that I am in the group of more severe cases that get better without hospitalization, also likely. If I am in the group that gets hospitalized, I hope I am not one of the ones who goes to the ICU, about 60 60. If I go to the ICU, I hope I am one of the ones who is not placed on a ventilator, 40-60. Should I be on the ventilator, I hope I am the one in five that survives it. If not, this thread will memorialize my passing.

 

Now, tell me why you need your haircut. Is it worth it to get a manicure to face a world of so many ifs. Why would you not respect others and yourself more than risking your life because you are bored. Why shouldn't your government to try and protect you?

 

I know there is likely exposure to the virus now, even with precautions in place. Why would you want to increase your risk. Why would you want to possibly place yourself in the position in which I find myself.

[+ purplekow]

Thanks for you good wishes

[+ honcho]

It is my sincere hope that I have not been exposed and infected. It is my sincere hope that if I was exposed that I have not exposed others. It is likely that if I was exposed and was infected, that I will be in the group that have mild cases. If I am not, I hope that I am in the group of more severe cases that get better without hospitalization, also likely. If I am in the group that gets hospitalized, I hope I am not one of the ones who goes to the ICU, about 60 60. If I go to the ICU, I hope I am one of the ones who is not placed on a ventilator, 40-60. Should I be on the ventilator, I hope I am the one in five that survives it. If not, this thread will memorialize my passing.

 

I join you in your hopes and wishes. I also hope you'll share with us in a few days the results of a test ..

[+ purplekow]

I join you in your hopes and wishes. I also hope you'll share with us in a few days the results of a test ..

Am getting both antibody and regular test tomorrow, but would need another test in two weeks if these show no active disease and no antibodies. It is disconcerting to sit here feeling perfectly well knowing it is possible that there is already a virus in my system which could potentially end my life. I was tested for HIV in the past and the first time I was nervous but even with that I knew it was something that would eventually make me ill. This is more a Mack truck hitting, when it hits. Having seen what can happen, first hand multiple times to people in much better shape than I am and people with much fewer risk factors, it rumbles the foundation of the philosophy that tomorrow is another day. Now it is tomorrow is another day but is it another day for me. The benefit and the curse of this is, there is no control over what will happen at this time, Eventually perhaps the course can be altered, but right now, it is just sit and wait.

One other benefit, I was starting to get very horny and was playing with the idea of perhaps hiring down the road. I think this news has taken every last drop of testosterone out of my system.

Edited May 26, 2020 by purplekow

[+ purplekow]

Well I would like to thank those that asked privately how I was doing. I am still in quarantine but will be out on Sunday. I was tested for antibodies and I am negative and my Covid test is negative. In the pursuit of caution, I am completing the full two weeks of quarantine.

Good news. In addition, it should be stated that the hospital has seen a marked downturn in the number of new cases and the administration has been able to close down floors which were changed to Cover floors during the worst of it.

At one point, we had three ICUs and most of the patients in those ICU were on ventilators. We had had over `100 patients on ventilators related to CoVid and less than 15% survived. That sounds terrible, and it is, but compared to other facilities, that number of survivors is actually high. We did well in keeping people off vwentilators so compared to the number of cases seen, the number who needed to go on ventilators was low and the overall death rate was low and the ventilator death rate was low. We were lucky to be part of the medical trials with medications that seemed to help.

So äfter having 3 ICU filled with CoVid, about 28 patients at maximum capacity, we now have one unit and only 5 patients on ventilators. Part of that number now is related to the return of surgeons. They are now willing to come to the hospital and do a tracheostomy on a patient. Those patients can be moved to Long Term Ventilator Hospitals, driving the number toward acute cases with chronic cases moved to essentially a specialized rehab facility.

We also had three floors filled with CoVid patients and now two of those have been closed. One has reopened as a regular care floor and the other is being sterilized. The one remaining unit is for patients with Covid but not requiring intensive care. Right now there are only 2 patients in that unit.

So as of today, after having as many as 120 Covid patients in the hospital at the peak with a peak of 30 ventilator patients, we have less than 10 patients and less than 5 on ventilators.

We now test all patients coming to the ER. We are starting the drugs of Tocilizumab and Remdesivir early in the course and we are using convalescent serum as soon as a patient has e symptom which will allow them to be part of the study, So this is all looking very good, This is where wee should have been a month ago or more, but we are here now. Still, this does no mean this is over. I have had two patients die this week and one newly placed on a ventilator.

The 19 year to who I had coronavirus exposure tested positive for antibodies and then negative for Covid in a short period of time, so he is back home. It is likely that my exposure was minimal or none. Still the concern I had was real and it remains real.

Judging by the Influenza pandemic of the last century and the expectations of medical experts, a second wave is likely.

It is not certain but it is likely. We all hope that the experts are wrong but we are preparing as though they are right.

My advice to those who ask for it: continue to use social distancing. If you want to limit this, continue to use a mask and encourage others to do so, so as to prevent spread should you be an early symptom patient or an asymptomatic carrier. Take reasonable personal precautions. I can continue to use take out rather than eat in. I limit my elective contacts to people I believe are being judicious about their health. I am hoping my judgement on that is good. I will not be going to the beach, the movies, the dine in restaurants for quite some time. I do not know when I will electively take a plane again, I will be doing masks and frequent hand washing and Purell and I will be doing food shopping at off hours.

I am at high risk and I have seen what this virus can do to those at high risk and even those who are not. I am not anxious to test its virulence and resilience, I suggest you all take the same precautions. .

Once again, I encourage you to be vigilant. More than 110000 people have died in the US. More will die. You are your best advocate to prevent your becoming one of them.

This situation is a lot easier for me as I was always a homebody. But those of you who are social butterflies, consider staying in the cocoon a bit longer.

[CuriousByNature]

Well I would like to thank those that asked privately how I was doing. I am still in quarantine but will be out on Sunday. I was tested for antibodies and I am negative and my Covid test is negative. In the pursuit of caution, I am completing the full two weeks of quarantine.

Good news. In addition, it should be stated that the hospital has seen a marked downturn in the number of new cases and the administration has been able to close down floors which were changed to Cover floors during the worst of it.

At one point, we had three ICUs and most of the patients in those ICU were on ventilators. We had had over `100 patients on ventilators related to CoVid and less than 15% survived. That sounds terrible, and it is, but compared to other facilities, that number of survivors is actually high. We did well in keeping people off vwentilators so compared to the number of cases seen, the number who needed to go on ventilators was low and the overall death rate was low and the ventilator death rate was low. We were lucky to be part of the medical trials with medications that seemed to help.

So äfter having 3 ICU filled with CoVid, about 28 patients at maximum capacity, we now have one unit and only 5 patients on ventilators. Part of that number now is related to the return of surgeons. They are now willing to come to the hospital and do a tracheostomy on a patient. Those patients can be moved to Long Term Ventilator Hospitals, driving the number toward acute cases with chronic cases moved to essentially a specialized rehab facility.

We also had three floors filled with CoVid patients and now two of those have been closed. One has reopened as a regular care floor and the other is being sterilized. The one remaining unit is for patients with Covid but not requiring intensive care. Right now there are only 2 patients in that unit.

So as of today, after having as many as 120 Covid patients in the hospital at the peak with a peak of 30 ventilator patients, we have less than 10 patients and less than 5 on ventilators.

We now test all patients coming to the ER. We are starting the drugs of Tocilizumab and Remdesivir early in the course and we are using convalescent serum as soon as a patient has e symptom which will allow them to be part of the study, So this is all looking very good, This is where wee should have been a month ago or more, but we are here now. Still, this does no mean this is over. I have had two patients die this week and one newly placed on a ventilator.

The 19 year to who I had coronavirus exposure tested positive for antibodies and then negative for Covid in a short period of time, so he is back home. It is likely that my exposure was minimal or none. Still the concern I had was real and it remains real.

Judging by the Influenza pandemic of the last century and the expectations of medical experts, a second wave is likely.

It is not certain but it is likely. We all hope that the experts are wrong but we are preparing as though they are right.

My advice to those who ask for it: continue to use social distancing. If you want to limit this, continue to use a mask and encourage others to do so, so as to prevent spread should you be an early symptom patient or an asymptomatic carrier. Take reasonable personal precautions. I can continue to use take out rather than eat in. I limit my elective contacts to people I believe are being judicious about their health. I am hoping my judgement on that is good. I will not be going to the beach, the movies, the dine in restaurants for quite some time. I do not know when I will electively take a plane again, I will be doing masks and frequent hand washing and Purell and I will be doing food shopping at off hours.

I am at high risk and I have seen what this virus can do to those at high risk and even those who are not. I am not anxious to test its virulence and resilience, I suggest you all take the same precautions. .

Once again, I encourage you to be vigilant. More than 110000 people have died in the US. More will die. You are your best advocate to prevent your becoming one of them.

This situation is a lot easier for me as I was always a homebody. But those of you who are social butterflies, consider staying in the cocoon a bit longer.

Thank you for this very encouraging update. I am really glad you are doing well.