April 21, 2020

It’s been a while since I’ve posted. Working the first 3 weeks into our local covid surge left me more limp than I had anticipated. I’ve been off now for 10 days and  torn between wanting to write every minute that I’m not reading, and being so lazy I’m leaving a slug trail on the kitchen tile.

Three curated articles for your consideration, finishing with a brief bit of video humor. First up is a piece I wrote detailing the exhaustive work of trying to remain virus-free during a single 12-hour shift. Think of it as a trip to the grocery on steroids.  A Miracle in Evolution

With the sporadic protests leading headlines, some of you may be wondering, as my mother-in-law was, how to respond to those who think this is all an exaggeration. The next article is a short, sensible description of herd immunity and why that’s not a solution at this point. My reply to rob’s mom follows that (in italics).


I understand your frustration and anger. I have it too. We health care workers are out there every day putting our lives on the line, getting this disease, and some dying from it. That’s reality, not inflation. We report the data, not politicians, and we are not making it up, or the elaborate rituals we must go through to protect ourselves, our patients, and our families.  

The response boils down to a couple simple precepts you already likely know, and a little math. 
– We have no “natural” immunity. 
-Immunity comes from surviving the disease or getting a vaccine. 
-Best guess is around 1% of the people who get it will die. More elderly deaths but plenty of young healthy people, and some children. 
– Best guess is 1% of US population infected so far. This means many people do not yet know anyone who’s had it—especially in middle of country, where it has arrived last.  This leaves the impression on some that it’s exaggerated. 
-Vaccine for mass distribution is at least 9-12 months away, maybe more. Until then wave after wave of infection will circulate when/ where distancing is ignored or dropped without adequate testing and isolation.  
-No state has anywhere near enough tests to determine who is infected, or has been. If we had enough tests, and knew their reliability we could open up quicker by finding and isolating new cases right away.
– The great news is most people aren’t going to get terribly sick, and most will survive. But some will play viral roulette and lose, and no one can tell who. 
– The world population is 8 billion.  1% of that is 80 million deaths.
-US pop 330 million.  1% of that is 3 million. First wave 40,000 deaths so far (over about 6 weeks). A drop in the bucket. Guarantee as that number climbs, everyone will know someone who died unnecessarily. 
– For comparison, flu and pneumonia deaths in the US are 60,000 per YEAR. We are about to overtake that number in just 2 months of covid. 
-Those deaths will occur gradually, in waves, over 2 years (as happened in 1918 pandemic). Unless we open up everything fast, in which case the natural death rates will skyrocket to unnatural rates from health care system being overwhelmed.  (Look at Italy and Spain or UK 10- 14% death rates). 
So my suggested response is to simply say something like this: The virus doesn’t care what you think.  It will continue regardless. 
People will lose friends and family, and not just the old and weak. They can learn the easy way—by looking at what’s happened to others around the country and the world–or the hard way, by waiting for it to happen to them.  
When they start to see their behavior as contributing to the illness and deaths of those they care about, their attitude will likely change. However, putting other people’s lives in danger in the meantime by ignoring community safeguards is not acceptable.  We are all in this together.  
If they’re still not believers tell them they can come make hospital rounds with me, without a mask.
Hope that helps.  
To illustrate that point, this is a link to an unfortunate Ohio man whose story sadly shows the unpredictable, deadly consequences of not taking covid seriously. We must, all of us, continue to have faith in community and look out for one another. I do believe, despite the deniers, this smoldering crisis is going to overwhelmingly result in a more humanitarian future.
Finally, a laugh. A brief video of a conductor’s performance, as viewed from the symphony players. Enjoy.   https://www.facebook.com/100003698791769/posts/2003764786423462/

April 1, 2020

Hi there. How’s it going? Over here we’re at day 14 of our state’s lockdown. Holding up fine, with occasional gut-clenching bumps. Followed by determination to find joy. Like you, we’re re-discovering the delight of staying home, newly discovering just how possible it is to keep up with family and friends on a screen, and reconnecting with a simpler life. (If we don’t count trying to sterilize everything that comes into the house.)   🙂

A cough, or a sneeze has taken on alarming new significance, drawing stares, even condemnation, as well as embarrassment, and apologies. We saw a discarded N95 mask on the sidewalk. People avoided it like a leper.

As we settle in to cribbage, and scrabble, old movies, and long walks, exercising not only our physical habits, but kindness, compassion, and generosity, we wonder how long this might go on. How much things will change later. Afterward. Like after 9/11. Or all those assassinations in the 60’s. But much more vast. Global.

This post is (with her permission) from my dear friend Kathi Howard, printed in the Cleveland Plain Journal last week. I think it captures our collective sense of anxiety being at the edge of the unknown. Katherine is a School Psychologist and Director of Support Services at Old Trail School in Ohio.  She is a frequent presenter to schools and to professional organizations across the nation on a variety of topics related to learning and child development.


The next article is to remind us of how a doctor makes a diagnosis: “Not by testing alone!” I harp at my residents. It’s the full clinical picture. As we docs have known from the beginning, our current covid tests have been rushed to production without the usual quality controls. In a nutshell, a single negative covid test is not reliable. Not only do we need more tests, we need more reliable ones. That’s another reason we must continue social distancing to maintain control over spread. Read on.

http://If You Have Coronavirus Symptoms, Assume You Have the Illness, Even if You Test Negative https://www.nytimes.com/2020/04/01/well/live/coronavirus-symptoms-tests-false-negative.html?referringSource=articleShare

Next–what about those cloth masks? They are useful if we all wear them, but they are not particularly useful if only those without the disease wear them. First of all–who is that? We will not know the full extent of the population’s infection for many months, perhaps a year or more. The rapid spread suggests lots of people are infected without knowing it, and passing it on. Hence, if EVERYONE wears a mask, those with covid will be less likely to pass it on because the mask will collect their droplets and keep them there. That would be great. But if only those who think they’re not infected wear masks, droplets spewing out into the open can readily contaminate the outside of a cloth mask, and can be inhaled through it if moist, or passed onto mucus membranes when handling the mask in a non-sterile fashion. Bottom line–when we have enough masks for all 330 million of us, we should all wear them when in public until the pandemic is over. Until then, the utility is unclear, and the very real risk of depleting the currently limited medical provider stock of purchased masks cannot be overstated. Sew your own if you like, but watch videos about safe mask use first.

http://Should I Make My Own Mask? https://www.nytimes.com/2020/03/31/well/live/coronavirus-N95-mask-DIY-face-mask-health.html?referringSource=articleShare

Ah! Spring. Enjoy. 



Mar 28, 2020

Survived my first week in the ramp up to covid surge. We’re expecting, according to local epidemiologists, 1000 hospitalized patients in the Coachella Valley in the next 7-14 days. We hope they’re right, because maybe, maybe, we can handle that. A new field hospital is being set up in Indio for non-covid patients (good luck sorting that out as 1/4 to 1/3 of covid people are asymptomatic).

I slept well last night for the first time all week. Thank goodness. Not all the positive self-talk, relaxing music, or meditation has been able to quell the rising anxiety of risk. To me, my family, my friends, my patients, and all the people, yes all, in the world. Even those not taking this seriously. Part of medicine has always been taking care of people whose life choices we providers cannot understand.

I can mostly control my thoughts when awake, but there has been no letting go in sleep this week. I am banking sleep for the near future.

Today’s links are personal stories from others, as I labor to write my own. There has been so much well-wishing coming from those I know–and even those I don’t. I thank you, every single person in health care thanks you. But there are so many more across the country and the world who are at even more risk than we. They have no protective gear. Some of them too must go to work to support us. And some forced to stay home are facing poverty the likes of which we have not known here since the great depression. We providers are very aware across the globe of the importance of keeping the numbers of infected patients to a slow enough spread that we can medically handle them safely–for their survival as well as our own. PPE is in short supply everywhere. Generosity and stupidity in approximately equal measure, with maybe generosity winning. Please help us to help you by staying in. It is absolutely working in California–the first state to lock down. My hope is that with generosity we can support all of us economically with food and shelter, while we endeavor to sustain our lives as well. One without the other is no good either way.

I hope my words will help not only help inform us, but help connect us through these challenging times.

From NYT–hardship in America:


NYT a trucker’s perspective on isolation. Particularly resonant as Rob just spent 30 hours driving 2000 miles across country in 2 days to be with me. He slept in the car, packed his own food, walked the dog on lonesome roads, and gelled after every interaction with a gas pump, lavatory and waste container . I am so grateful for his presence. And the psycho-puppy, Sugar Baby, who, with time, is growing into her name. Just stroking her velvet coat transports me like nothing else. Her warm back pressed against mine through the night, and Rob’s hand holding mine were truly miracle drugs for sleep, and elixirs of life.

Please take care my friends.





Mar 24, 2020

Day 4 of my 7 day shift at Eisenhower. Census is still down (10 patients today) due to the general public discovering, suddenly, just how little they really need to be in the emergency room. We are grateful. Feels like the calm before the storm, and we fervently hope that the California lock down prevents a storm. A few of these patients are covid suspect, and my responsibility as we are not allowing residents to see these patients yet. We still have PPE (personal protective equipment), but like many health care workers across the country, we are concerned about running out.  Those medical staff working in other countries without PPE are predictably succumbing in higher numbers to infection. My chief resident is from the Philippines and following news there, where 2 young rural physicians have died of covid. One of our trusted medical sites is running a daily list of health care workers in the U.S. with covid-19.  https://www.beckershospitalreview.com/workforce/where-hospital-employees-have-tested-positive-for-coronavirus-march-16-20.html

We are devoted caregivers on the front lines, but we are concerned about the prospect of working without PPE, masks in particular. Everyone in direct patient care is talking about it. Most of the health care workers I know are dedicated to their patients, many sacrifice family, social and personal commitments throughout their careers to that end. However, in my lifetime, our doctors, nurses, therapists, maintenance workers, aides, ward clerks, cafeteria workers and doctors in training have not been required to put their very lives at risk when coming to work. Not since medical personnel were last drafted, about 50 years ago, has this been the case. If we lose our PPE’s, it is a moral dilemma none of us wish to face.

Rumor has it we’re getting our own test equipment here, but no one will say when. Presumably that would speed results up, but we don’t know how much.
Speed would be welcome.

Today’s next linked article is thought-provoking. If we had anticipated this event and started a selective lock-down of vulnerable people early (late January or early Feb), we could have limited the complete disruption of our lives and economy that full lock down has presented, and the end of which is not clearly defined. However, in much, if not all of the nation, we are too late for that. There are perhaps some rural areas that might still benefit from selective lock down, but that window is closing daily. I do hope that we are able to flatten the curve substantially enough in locked down areas to see a difference from those states not locking down, and that this will help inform how long, and how intensively or intermittently we must continue.


The last link is a unique look from outer space at how to manage isolation–from astronaut Scott Kelly who spent a year on the space station.


Sometimes the big picture helps. It’s a beautiful world, and our only one. Let’s take care of one another by staying in and staying well.