Wednesday, April 8, 2020

Start Button

I guess 3:30 is my new start button so at the risk of talking too much I suppose I'll continue.

We all got less than 24 hours notice about three weeks ago when they converted the doctor's parking lot into an outdoor COVID-19 testing site. But first, they painted sequential numbers in each spot. As I pulled into work some were still dripping and smudged with white paint. I walked into Bell's office. "What the holy hell?" 

"I guess they are giving us assigned spots."

I suppose the reasoning is that if enough people present to the ED with symptoms they can give them an assigned number to wait for the lonely (tech? nurse?) they have assigned to the lot to walk over and test them in the safety of their car. Whoever that is sits at a large table in full PPE. There's a port a potty by the stairwell. I've never seen more than three cars in the testing site. One of my employee/friends said she instinctively holds her breath every time she passes the lot on the way into work, but I reason, since I now park right above the doctor's lot and pass it on the way into work, that I am far enough away that social distance rules allow me to keep breathing. That may or may not change in the next couple of weeks.

I researched online and the outdoor testing site is a thing, so it makes sense - keep the symptomatic patients out of the hospital, send them home if you can, make them wait for test results. My best friend from med school's husband, who is an ICU nurse in Jonesboro, is currently grounded at home for 48 hours awaiting test results. It's funny - he's got cough and sinus and GI symptoms, so he got tested. She had to pass along her ED call for ophthalmology to another partner and ground herself until he is cleared. Yet our cytology supervisor, who has been grounded for a week with sinus symptoms, could not get a test in Little Rock because she didn't have a fever. She ended up going to some third party lab in NLR to alleviate her anxiety. And as far as I know, outpatient and ED testing is still with Quest, so there is a 5-7 day turnaround here in LR. The 24 hour Viracor is only if you are inpatient.

I follow a pathologist online who's medical husband tested positive a couple of weeks ago. He's nearing the end of his quarantine. It was scary for a while - he has some medical issues and they freaked around day 10-11 when the cytokine storm can happen, but he made it through at home and is now working in the yard with a cough. But the thing is he was not notified by the HD that he had the bug until a week after he tested. And she wasn't notified by the HD to stay home until he was almost over his quarantine. So without medical knowledge she might have been out and about as an asymptomatic carrier.

We've got our clinicians pushing hard for the serologic test - the one for the antibodies - but there isn't a good one out there yet. I was stressed about it when I checked on the status of the Cepheid PCR test with the micro supervisor yesterday. "Is it coming?" She rolled her eyes. "They are saying maybe by the end of the week. We've heard that a lot in the past few weeks, haven't we?" I asked her, "What are we going to do about the serologic test? I'm worried. The danger is, if we release the results of a bed test, and there is a false negative, that person can go walking around with a false sense of security and infect a bunch of other people. Then we are just creating a more dangerous situation during this thing." She replied, "If we get a serologic test, we are looking into it to make them happy, I agree there's nothing out there CAP recommends, we will only do it alongside the PCR test and release the results together. They have to submit the NP swabs alongside the blood sample. That way they can use the information together, instead of using the bad test as a solo piece of information." That makes sense, and gave me a lot of relief.

Surgical cancer cases are still running at a steady pace, but apparently a reporter called our hospital out on Sunday to our governor during a press conference for starting the OR back up so there was an emergency meeting and they were going to allow the cases this week to go through but next week is going to be dead again. This is just a public shaming technique. We are running very few OR's, and they are all cancer cases. Cancer should not have to wait a month for COVID to go through. I was talking about it with my partner Melody - if I was a patient with cancer during this pandemic I'd be freaking out. There is a point, there must be, when the invasive cells cross a lymphatic space and hit the bloodstream, rendering the tumor metastatic and high stage. It's gotta happen in an instant, overnight, what have you. It's a ticking time bomb, and it's not fair to put those patients on hold.

But decisions seem haphazard during a pandemic. Rules are not applied, at least in our country. This thing is rolling out so fast and our response is all over the map. So my thinking is that decisions made based on yesterday's information could change based on tomorrows. And all we can do is put one foot in front of the other and take it as it comes.

Tuesday, April 7, 2020

Coping Skills

Last night while cooking, I was discussing healthy vs. non-healthy coping skills with my kids - Cecelia, now 17 and Jack, 14. It was two separate  one on ones, because when do you ever have two teenagers and a mom in the same room, on the same wavelength, in the mood for such a conversation. Jack was perfecting the cheese bread from the Brazilian bakery he learned to make last month to please his sister, and I was adding various ingredients to the canned refried beans to make them fit for serving with the frozen tamales from Trader Joe's. Oregano, Persian lime olive oil, cumin, fresh salsa, garlic salt. Not too spicy this week because my daughter's taste buds cannot handle it. Fresh sliced jalapenos on the side instead.

We came up with a few. Healthy - running, reading, gaming with your friends, art,  cooking. Unhealthy - drinking too much, working too much, over or under eating. Jack tossed in heroin, I had to agree. Cecelia listened silently, she seemed tired. Hell I'm not judging - we've all tried both sides of the coin. I guess that's why I find myself in front of this old somewhat healthy coping mechanism in the middle of the night.

Because what else are you going to do, in this ever-changing, unprecedented landscape? For two weeks our work ground to a halt. Then it cranked up slowly at the end of last week. Yesterday was insanely busy for a call Monday - I had 12 frozens between 9:30 and noon. Surgeries are slowly increasing - cancer is not an elective. Nor are appendices. Babies keep coming, so placentas are plenty. Gallbladders - debatable. Breast reductions can probably wait, but these are murky ethical waters, which will ebb and flow against the backdrop of the swell of this virus.

So there's normal work, and then there's new stuff. I met our new morgue attendant yesterday, and we discussed morgue capacity. I was impressed that she was aware that we could order a refrigerated morgue truck from FEMA and could get free delivery within the week. We discussed the worry about the funeral homes getting overwhelmed. I worried with a partner when to pull the trigger. I know of a hospital in Brooklyn that has two trucks. One in Tulsa that just ordered one. They have 12 deaths at that hospital. We have none. It can wait today.

The daily counts my chief group texts us suggest we are flattening the curve, but with the severe lack of testing who knows? We were supposed to bring the PCR test live in house Monday, but the DoD demanded 8% of the test from the company so they had a complete halt in shipping and an emergency meeting to re-allocate what they had already promised to labs across the country. Once again, as it has seemed for 2.5 weeks, we got our hopes up and are in another holding pattern. Our 24 hour turnaround through Viracor has been great, but we want on site testing with more rapid turnaround.

I was talking with two of my transcriptionists yesterday afternoon. One had a relative that was shaming Arkansas, like the rest of the country is right now, for not having shelter in place rules yet. But we shut the schools down before New York. And I'm just not certain we can control how all of this is going to pan out in certain regions. In China, it hit the male smokers hard. The Atlantic and The New York Times had cringey articles predicting doom for the unprepared, rural obese South. But our entire country is obese. If there's one thing I've seen over the past twelve years, it's that disease processes have predilections for certain regions, and they are often unexplainable, on the front end and on the back end. "Why does everyone in Searcy get bladder cancer," a respected urologist bemoaned once in tumor board.  I once read GI slides for a clinic up in Northeast Arkansas. I had never seen so much collagenous colitis in my life. "There's something in the water," I told a partner. The transcriptionist said, "It's like Erin Brokovich." Exactly. But we aren't going to get to the bottom of it. We have little control. We just have to sit back and see how it all pans out.

But control, or at least the illusion, is an  inevitable coping mechanism. So I read, and try to find information that will help our little corner of the hospital I find myself increasingly hunkered down in. I have not been to the doctor's lounge or the cafeteria in over a week. Contrary to popular belief it's like a ghost town with the restrictions and no visitors. Security is tight. When someone was praying over the code call intercom last week while I was running to the gross room for a frozen it felt apocalyptic. When I go to procedures in bronch lab wearing my N95 I curse myself when I pull out my phone or reach to move my glasses to alleviate the fog from the mask so I can see through the scope. I'm getting better, it's a learning curve. And we are adopting the best practices around for everything from rapid on site evaluation to developing protocols for Convalescent Plasma COVID-19 treatment.

I think the kids are doing ok. I worry about the lack of schedule and interaction but Cecelia is so type A part of me thinks this might be a good pressure release valve for her. An early, somewhat constricted summer. Jack's private school is creating more schedule by the week, much to his chagrin, but he seems to be getting in the groove. I'm lucky my kids are on autopilot. My mom friends with elementary aged kids seem super stressed and overworked. A micro tech was manically describing her 7 and eleven year olds school at home schedule last week. It seemed crazy. They need to just give up for the year, at that age.

Well now that the birds are chirping I'm going to try to squeeze in an hour of sleep before the OR cranks up again. Whew. That helped. Might have to keep that in mind over the next few weeks.

Thursday, February 15, 2018

Falling Apart

Do you ever feel like you have one foot in the grave?

I swear I've been eating so healthy for three weeks and I don't feel like there is any difference. My conclusion is that there is no way to lose weight after the age of forty. I guess I'll keep shaving off the calories and try to exercise more. Helps when you are not on call, which I am half of this month. I do think my body composition is changing some, and I feel good eating mostly fruits and veggies and nuts.

Last week half of my mouth went numb and I couldn't chew without extreme pain in my jaw. I self diagnosed TMJ syndrome, which my mom has, with consequent nerve damage that will hopefully get better. Web MD suggested not clenching teeth ever and stop chewing gum, which I did, but the numbness remained. I thought I was hiding it pretty well, although it still feels very weird to talk, but during a board meeting yesterday afternoon Dr. Music loudly declared, "What's wrong with your FACE? Did you go to the dentist?" and I turned to chief, who I had consulted last week but he said whatever I was feeling my face looked perfectly normal, and said, "See? I told you something was wrong. The chewing pain is gone but the nerve damage is still here. I can't feel half of my mouth." Then everyone spent the next 15 minutes dissecting my face. Their conclusion: my left eyebrow was lower than my right when resting, and maybe I had Bell's Palsy. This morning I was stopped in the hall and by Dr. Music and Chief and they thought my eye socket was now droopy. I laughed out loud. "I think it's a little better today."

But I'm faking it. It's scary. Paralyzed face can mean stroke and we all know my blood pressure is wonky. I called my bff doc who I remembered had Bell's Palsy once and she made me answer a few questions looking in the mirror about facial symmetry and concluded, "Well, it could be TMJ with nerve damage like you said. Or it could be Bell's Palsy. Either way, it started last week. So using steroids and antivirals is not helpful after 72 hours, according to the literature, if it is BP. I wouldn't do anything unless it gets worse. I don't think it's a stroke, but you can check your blood pressure a little more regularly if you want to. You should experience full recovery in the next few weeks or months."

If I smile my face looks normal. So I'm smiling a lot more than usual. I just beamed at everyone in the radiology suite for like 5 minutes while reading a smear on a lung mass. It's funny how people open up to you and talk more if you smile. Except if I overdo it I might start making everyone feel uncomfortable. There's a fine line between happy welcoming smile and psycho smile. Alcohol helps too. I wonder if that's a good enough excuse to drink at work. Probably not.

Friday, January 26, 2018

Just Because

I've been getting a lot of sleep lately. I don't know if it's this new diet or what. Really, it's happened all winter. I'll plan to watch an hour show at 8:30 and be headed to bed by nine. Penny Dreadful, which should have lasted a few days, has dragged on for much longer. 10-11 hours a night. It's like I'm hibernating or something. The one time I had to stay up until 11:00 to pick up C and some of her friends at a party I thought I was going to die. No waking early, no worrying at 3am, just zonked out. Monday I slept through my alarm and missed an early needle. Maybe if I lose a few pounds I'll get my edge back. Maybe not. Maybe my body is catching up on years of sleep deprivation. That might take a while.

I've changed my primary news source to The Guardian this year. It's very progressive. They just feel more objective and comprehensive. Plus the website to The Atlantic got all wonky at work and I can't read it anymore. I'm still paying for it and can get on my phone, but I never read it on my phone. Isn't it weird how there are things you do on your phone but not on your laptop or desktop, and vice versa? I once opened Facebook on my laptop last fall and was completely overwhelmed with the format. I only do that on my phone.

I'm so excited!!!!!!!!! Do more exclamation points convey just how much? All winter I've been studying Paganism through Celtic Myths and Legends (Ellis) and other sources online and studying the science of trees in The Hidden Life of Trees (Wohlleben). Trees communicate, parent, and befriend. I've even imagined, especially during tree position in yoga when I'm trying not to fall over, that in a former life I might have been a tree (it's harder to fall over if you have roots). And now I'm headed to hike ancient forests in Whistler, BC. There is a molecular pathology conference called CAMP that I've been eyeing for years. Since molecular advances are the hot button topic at Tumor Board it makes sense to brush up. At least they were last fall, dunno about now, the hibernation thing has kept me away for a few months. It can't hurt.

They even have snowshoe guides that will teach you all about the ancient forests and medicines and herbs and belief systems at the time, while you are hiking through beautiful ancient forests. And Margaret Cho is performing Wednesday night! Not in the ancient forests. I need to try to figure out how to get tickets. The hotel looks like a dream fairy tale hotel, not a real hotel. Or maybe a little bit like the one in The Shining. You could come at it from either angle.

Did you know that just like a solar and lunar sign, we all have Celtic tree and animal signs too?  Mine are  hazel and a salmon. Salmon! According to Druid tradition, it is the Oldest Animal. And the hazel tree has significance in being at the heart of the Otherworld. Fascinating stuff.

Happy Friday!!!

Friday, January 19, 2018

DeWorm the World

Fizzy from A Cartoon Guide to Being a Doctor reminded me yesterday that I was already published in something that is not a major medical journal (the benchwork is fun but the formatted writing is a pain in the ass) - she published me! Under my blog name, years ago. She has made an impressive few grand off of the book and she donates it all to a charity called Deworm the World - it helps pay for medications to treat parasitic infections in children in developing countries. I ordered it yesterday, first accidentally the kindle version (which was available yesterday) and then the paperback version. I believe I let her use some of my old old tales from this blog, but I can't remember, so I'm super excited to find out and help Deworm the World. If you want to contribute to this awesome charity you can at the link above or by buying Fizzy's book, in which I contributed here.

I talked to my friend at Cleveland Clinic. Apparently Springer is a great place to get a publication going but they give the author and the editors no control over the book cover or pricing. If only I had googled it I would have raised a red flag. Oh well. Live and learn. And I am getting a free copy, I found out, after I ordered it.

Wednesday, January 17, 2018

Mixed Feelings

So I have mixed feelings over the launching of our blog book, link here

First of all, the cover is not us, the Mothers in Medicine blog, at all. But I learned sometimes you have no control of cover, as in this case. It appears they are marketing it as a textbook, by the outrageous price that has made it inaccessible to family, friends, and book clubs. Are they marketing it to medical schools? If so, the idea of making a med student have to pay $40-$50 dollars to read it makes me sick to my stomach. Again, I just learned pricing the book is sometimes out of control of the author and editor.

So if you have a bunch of money to spare, go get our book at that link up there. If you don't, you are welcome to borrow mine, as soon as I order it myself. Doesn't a contributor even get a free book before publication? How cruel is this world? Or you can just follow the blog. Honestly most of what I have written was cobbled from past blogs - it took less than an hour to put together the day of the deadline because I am the queen of procrastination. But I'm still going to get it anyway because it's my online family and I want to read all the others.


And by the way, if there are any profits to be made here, not a dime will come to any of us, including our amazing editor.

Doctors Make the Worst Patients (Part 2)

Read it, over at MiM