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.

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