pressed hams

The remainder of yesterday, let's see.... Dylan accidentally deleted my Zelda character and was totally beside herself.  We watched an episode of Little House on the Prairie.  I went to bed at 9.  Only needed one benadryl to fall asleep.  Maybe tonight I won't need any.  I'm am ever so cognizant of a 2015 study that showed an association between antihistamines, and dementia, so I really try to avoid it,  but a girl needs her sleep before a day in the OR.  I'm definitely stupider than I was before residency, which I attribute to age and chronic sleep deprivation, and possibly also benadryl and maybe zyrtec?  But I am hoping experience will make up for the deficit at some point.  Ha.

Today was good!  I provided an extra set of hands for a difficult airway case (and I'd like to think some helpful suggestions also), and did one endoscopy case.  Got out early again, which is FINE WITH ME.  Had to cancel a case because new URI symptoms now prompt repeat Covid testing, so there was that.  It was surprisingly hard to do!  I kept second guessing myself that I should really do this, and it was MY decision, and my decision alone.  But I told myself that this was what the new policy told us to do, and that there was a reason for that.  I'm just so used to doing any case any time, it's a bit of an adjustment for me to make a decision that is based on public health AND the health of the individual patient.  I felt so fortunate to work somewhere where my decision was supported.  Luca made a similar decision at his work a few weeks ago, and slowly people are coming around to the idea that it was the right thing to do, and his employees freaking LOVE that he is prioritizing their health over work that is not urgent.

Had a couple of nice conversations with colleagues.  It was nice to talk to people again.  Sometimes I think everyone knows what I know about epidemiology and everything else (it's that damn imposter syndrome talking again), but then you realize they don't.  

Oh!  I am re-reviewing a manuscript on hospital HVAC systems that I sent back for major revisions a few months ago, and a) it is MUCH better now, and b) it seems much more relevant given present circumstances!  I saw the comments I wrote a few months ago, and it was nice to see that they still sounded intelligent after a few months had elapsed, so that was nice too.  I sometimes worry about that.  

Did Kahn Academy with Dylan again -- she passed the unit on shapes!  She was very proud of herself.  Up next: the coordinate plane.  She is also working on writing a story about Pupicorns, which are puppy-unicorn crosses.  It's very cute.  

One nice thing about the coming apocalypse (the global warming one, not the virus) is that my flowers have bloomed early.  This is a tulip from my garden.  I planted a new crop last year, and so far about 10 have bloomed.  This is my favorite.

I can tell you that ONE member of our household is absolutely delighted about the pandemic.  Miss Boo has most or all of her pack present around her at all times, and she is so happy!  Also, now that we can take her out every three hours, she no longer is having accidents.  She's beginning to have some trouble with stairs, and sleeps most of the day.  Now she gets to sleep on or under us.  She is thrilled.

Luca ordered a proscuitto crudo online and it just arrived, and he is very excited (it is from Verona, which he is just now realizing and excitedly discussing with his father who is still on lockdown in Italy).  I expect it will last about two weeks.  If that.  We're planning prosciutto on chicken, pizza, sandwiches, pasta.  My mouth is watering just thinking of it.  You all would be proud of me: I've been cooking occasionally.  These past two weeks I made Italian sausage with peppers and onions, and it was delicious.  With our new routines wherein eating out or at work is no longer an option, and near daily exercise (my daily step tally is routinely exceeding 10,000), Luca has lost 8 lbs, and I have lost 3 lbs.  Maybe it will stay off, maybe it won't, but if nothing else it is confirmation that we could do better with our daily eating habits when life goes back to whatever "normal" will end up being.

So things have been happening in our lives that have been good, even if the rest of the country is a f8cking dumpster fire. I also noticed that I used the work "nice" about 50 times in this post.  Given the circumstances, perhaps the phrasing A-FUCKING-MAZING would be more apropos.

brief

Dylan's schedule has shifted such that she now gets up at 8AM.  I got up at 6:15 partly to call in to our department meeting, and partly because I'm in the OR again tomorrow and Thursday and if I sleep past 7 it's hard for me to go to bed on time.  We did the no hug no kiss thing last night.  It kind of sucked.

A lady in our neighborhood wanted to organize block wide scavenger hunts for the kids to all participate in.  Since it wasn't clear what she meant, I'm the huge bitch who responded to the whole list serv not to organize group activities, if that was what they were planning.  Flocks of children were spotted running freely down an alley that the families on the street use as a communal playground.  I'm sure in their minds it's "allowed" *massive eye roll*.

Going to work on graphics for my paper today, and also rewrite the results and discussion, maybe run a few additional analyses.  Go for a walk.

Not too much else to report!  Will post again later if I have significant thoughts!

ETA:
OOH!  I thought of another interesting thing.  It seems that the marijuana business in our neighborhood is booming.  We keep seeing the local drug dealer out and about, definitely not practicing social distancing, as he goes from house to house (or apartment to apartment as the case may be) with his deliveries.  I guess the apropos public service announcement would be: 

"If you need to smoke to cope, then I guess smoke?  But please maintain social distance while exchanging goods for services, wipe off any packages you receive (coronavirus can live on plastic baggies and vials for several days) and wash your hands before consuming.  Avoid sharing joints and hotboxing.  Be aware of the risk that someone may have coughed on the leaves while they were preparing your delivery.  No data on whether fire kills the coronavirus currently exists, so consume with caution."

Disclaimer: OMDG does not endorse the consumption of illegal drugs.

ETA again:
We've been doing online grocery ordering for years now, but of course this has become more challenging in the time of C19.  There were no delivery times available at all (they allow you to book no farther than one week out) when I checked last night.  However, insomnia does have its advantages, for when I awoke randomly at midnight, I discovered that there were now openings available for next Tuesday, and reserved a timeslot.

THANK YOU TO ALL THE DELIVERY PEOPLE OUT THERE WHO ARE MAKING THIS POSSIBLE!!!

back

Well.  Day #1 back in the ORs, and so far I have survived.  I slept like crap last night, which was not unexpected, but the day itself was fine.

Am struggling with the messaging we are getting at work.  On one hand, I think it's AMAZING that our hospital is having us all wear disposable surgical masks all the time while in the hospital.  As far as I know, ours is the only one to have taken that step to protect their employees.

OTOH I am struggling with a) the anecdata presented to help us calm down (i.e. real things that happened, and nobody died -- wahoo!), and b) the use of a screening test as a way to make us feel reassured, without also telling us that as the prevalence of the disease goes up, the rate of false negatives will also go up to eh, 1/5?  1/6?  This means that we will all surely be exposed at some point.

Oh and also that they have so few masks, that we have to reuse ours for multiple days.

So. Yay.

I also discovered it's hella AWKWARD to be asked by a surgeon you've never worked with before what your PhD is in (Clinical Epidemiology), and then be on the receiving end of questions about why I'm not being used to do science on this epidemic.

Fortunately my phone rang and I was able to run out of the room.  However, the answer is likely the same as why I still don't receive critical emails from my department about.... anything (including this crisis), despite me having brought this to the right people's attention on multiple occasions.

- Mostly incompetence, but also:
1) I'm not a "real" attending nor a "real" fellow
2) Nobody I work with other than my mentor who is outside of the department understands what I do
3) And even if they did, they definitely DGAF.

Because I am a complete failure at diplomacy (or so I've been told), I still am unable to come up with a response to the surgeon's question that isn't horrible jaded/sarcastic/bitchy.

My soul hurt.  And it feels like blasphemy to feel that way because of course taking care of patients is important too, but also this critical care resource allocation stuff is basically my wheelhouse, and I want to cry at how little that skill set is valued where I currently work.  How much work I’ve done and how good I am at it, and nobody even cares.  And of course this is all my ego hurting and it feels like... wrong right now to have an ego of any kind, so there is literally nothing  else to say or do.

Also, one of my colleagues referred to us "smart people with MPHs" which I know was meant as a compliment, but I had no idea that he was actually including me in this since I don't actually have an MPH.  I'm afraid I came across as insufficiently grateful that he had noticed, completely inadvertently. *facepalm*

*****

Low point of the day (so far):

Our AP bought a bottle that sprays a fine mist of isopropyl alcohol.  She had been using it to disinfect her phone.  We paid for it, so technically it is ours but I know she still sees it at hers.

Because we have to reuse our masks, I decided to lightly spray mine with said fine mist, as a way of hopefully reducing the viral load on it at the end of every day.  There was not a lot left so I absconded with it to my room.

Later on she asked me if she could use my personal exercise mat to do her exercise class.  I'd let her use my yoga mat the previous week, which she had been spraying down with the alcohol spray.  I told her I would ask my husband if there was something else she could use to clean the mat after she uses it, but until he found something, the answer was no.  That I needed to use the sprayer to clean my mask.  Frankly, the idea of her using my mat kind of skeeves me out under NORMAL circumstances, and I didn't love that she was using my yoga mat anyway, but was trying to be nice. And does she really want to put her body where my germs have been?  Now?  Especially given what I just told you about negative predictive value and our dysfunctional health care system?

Guys, I felt f8cking awful and selfish.

*****

High points of the day (so far):

- Finishing work early, and getting to do Kahn academy with my daughter after all
- Remembering how to do anesthesia after a 2.5 week hiatus (lol)
- Doing anesthesia again!  I really do love my job.
- Finding out my data request might be fulfilled by the end of the week!  (Better get cracking on my other manuscript!)
- A lady in my neighborhood asked me for change, and I offered her a sandwich.  She said yes!  Even if she sells it to buy alcohol or drugs, *someone* will probably eat it.  I feel like a hypocrite for even writing about it because I kind of feel like talking about it is like bragging, and negates the nice thing you did.  But I am writing about it because it made me feel so nice!  Honestly, it was probably the high point of my day.

So, lots of good things happened today too.  Savoring the last few days I have until I come down with this f8cking virus since it's just a matter of time.

for your viewing pleasure

Yesterday my mother-in-law, who lives in Italy just outside of Verona, and who has been on lockdown in her house for 6 weeks now, sent us this video.  Personally, I found it hilarious, and every time I need to calm down a little, I watch it.  Dylan finds it hilarious.  We must have watched it 100 times yesterday and each time she is reduced to a convulsing heap of giggles.

Yesterday, I got about 30 minutes of work done, and then spent the rest of the day playing The Legend of Zelda and The Adventure of Link.  We also went for a walk and exercised.  Our au pair made us chicken for dinner.  Dylan had previously prohibited anyone in the family from watching violent TV (which was super annoying, since basically every show that doesn't suck is violent except maybe The Office), and we finally got her to agree to let us watch Jack Ryan in exchange for more iPad time.  So we watched an episode of that too.  Yay.

My hospital has instituted a policy stating that everyone must wear a mask at all times.  Strangely, I found this comforting... until they told us they also need us to reuse the mask over multiple days, which drew my attention to the fact that they are worried about a shortage of even crappy disposable surgical masks as well.  It took a fair amount of mental gymnastics for me to rationalize why this is actually ok, and not going to make me less safe.  I must have arrived at some place of zen because I did ultimately fall asleep eventually.

Not too much else to report.  I have to go to work in the OR tomorrow, and I feel this weird mix of excitement and fear.  Of course I am assigned to the emergency OR, but hopefully there won't be anything SO emergent that we have to forgo COVID-19 testing.  I'm sort of looking forward to seeing people, but I am also worried that interactions with my colleagues will be... less satisfying than they normally are because people are so freaked out.  I am practicing calming mantras in preparation for being disappointed.  I have decided that every time I feel crappier as a result of talking to someone, I will watch this video.  And then I will disinfect my phone.  Haha.

Happy Sunday!!

would you?

Yesterday at about 4PM I heard loud happy voices from the house next to mine.  It's owned by a woman who is my age who lives by herself.  After the voices continued for some time, I opened my front door to take a look. 

My neighbor had invited her friends over.  Three adults, that I saw, and two kids. 

I closed the door in shock. 

Did I really see that?  Was she really having people over during this time? 

I opened the door again, and a few of them had spilled out into the common entryway that we share. 

"This is so disappointing, guys," I said.

They stopped and looked at me.

"I'm the person who is going to end up taking care of you if you end up in an ICU.  And you can't even pretend to follow the rules."

The man sneered at me, "Well we're ALLOWED to be outside."

"We both know you all weren't just outside," and I closed the door, as there was nothing further to say.

Later I got an "apology" text from my neighbor.  "These people are like family to me.  They are the only people I allow in my house, and I only go to their house." 

But the thing is, that doesn't actually make it ok. 

We get to walk around our neighborhoods, go for runs, ride a bike, because those activities are not intrinsically risky.  We risk losing those rights, as people have in other parts of the country, the world, because some people think to themselves,

"It won't matter if I play this pickup basketball game."

"My friends can come over because they are like family to me."

"I know I am safe, so I can do this."

"I'll just take this mask, and it will keep me safe.  It's not going to hurt anybody.  It's just a silly paper mask."

You know it's happening because when you leave the house to go for a walk, you see people driving in their cars alone wearing N95 masks, pickup basketball games happening in the park, hipsters at the dog bowl standing "six feet" apart playing fetch with their dogs and chit chatting, an impromptu concert on someone's porch with circles drawn six feet apart on the ground where you can stand because that will make the concert "safe."

When you do these activities, are you even aware that you're violating a rule?  Do you understand that the rules exist to keep us all safe, and just because you found a loophole (eg. standing six feet apart at a concert) that doesn't make it ok?

My other neighbor on the other side of my house loudly complained to me sometime last week that his parents, who live in Italy, got fined for walking on the beach the other day.  So unfair!  I shrugged. 

"Well, they're old," I said, "As long as they know that if they need to go to the hospital, they won't get a ventilator, and will probably die.  Alone." 

What do you even say to that?  At the same time, this guy visibly leans away from me while standing outside on his patio, when he is already 30 feet from me, because he is afraid -- since I am a doctor -- that I will get him sick.

People repulse me.  If we all die, if society falls apart, it will be because of this, and you know what?  We will deserve it. 

Would YOU have said something?  We all know that the guy I scolded last night went around talking to his friends and family about what a huge bitch I am.  I bet you wouldn't have said a damn thing.  Most people wouldn't.  Heck, you'd probably have gone out there on your front patio to hang out with him.  Maybe even share a beer.

I had a lovely conversation with a different neighbor, which was infused with some paranoia about the Federal government intentionally diverting PPE and supplies from blue states as punishment for not being Republican.  She's probably not wrong!  I tried to push those thoughts to the back of my mind for the rest of the day, but there they were at 5AM as I tossed and turned, unable to get back to sleep. 

As I struggled to fall back to sleep I kept thinking about this JAMA article I read yesterday on the most ethical way to ration ventilators.  And I say this with the understanding that perhaps I was not in the proper mindset to read this article to appreciate what it was trying to say, but all I could hear in my head as I read it were the voices of some self congratulatory dickbags pontificating about the "best" way to decide who lives and who dies if we run out of ventilators.  I work with people who write pieces like this (in real life) and in general find them to be decent human beings, but sometimes I read this kind of piece and it just.... makes me want to vomit.  Like, what makes YOU so special that you think YOU should decide?  Are you THERE?  At the moment of every decision?  The thing is, there ultimately is no perfect choice: all the options suck.  Please get off the backs of the people who are doing the best that they can. 

poo poo

Maybe it's because I'm on vacation now.

I keep reading all these angsty posts about trying to homeschool the kids while simultaneously trying to get work done, and I just want to share this, in case other people have had similar experiences:

I haven't felt angst about this at all.

My daughter reads independently for a few hours each day because she likes to anyway.

We do about an hour of Kahn Academy together.  We are doing triangles right now, and yesterday we started doing Biology as well.  I am really enjoying learning about how kids learn math and science these days!

I let her do some free writing on my computer.

She practices piano for 10 minutes.

If she resists, I get her to do these activities by offering 30 minutes of iPad when she's done.

As for her other time, she watches movies, plays with Legos, does origami, relaxes while taggie-ing with Gufo on the couch.

The education she's getting is probably horribly deficient in the areas of Social Studies and reading for comprehension.  If I felt really motivated I suppose I could get some materials online and force her to read stuff and then answer questions, you know, so she can ace some fucking future standardized test.  But, meh.  We're doing pretty well, and I'm enjoying this extra time I'm getting with her.  Why mess it up right now?

Oh yeah, she gets a TON of screen time.  And I think that's fine.

I think part of what helps is that I've let go of any expectation I have for myself of getting XYZ done by XYZ date.  I could legitimately make myself insane if I set goals for myself like: Write three grants between now and X.  Instead, I let myself sleep late (which turns out to be seven or so most days), exercise, and interact with my family fluidly as it comes up throughout the day.

As it turns out, I *think* I'll be able to submit a data request later today.  If not today, by Tuesday next week.

I do have a rough scaffold in my head about what I'd like to do next.  I should probably put it down on paper, so that I remember everything when I go back to the OR.

If this is NOT the situation you have with your job, if your manager is breathing down your neck with ridiculous expectations and anxiety over whether you're being productive enough, if you have a child who is younger OR more than one and they are loud and fight and constantly interrupt you, then I sympathize.  If you are surrounded by people who are freaking out at you all the time and displacing all of their anxiety onto you... God that is horrible.  I've been there, and it truly sucks.

This pandemic thing also really helped with some major decisions I've been stressing about lately A LOT.  Like how are we going to ready the house for sale when we are still living in it?  (Answer: We aren't!).  Are we going to sell it?  Maybe!  Who knows!  And that's ok as well.

I do find administrative tasks where I have to ask other people to do things for me extremely stressful, but that's nothing new.  On the positive side, the admin at my new place seems to run like clockwork UNLIKE ANY ACADEMIC PLACE I'VE EVER WORKED IN MY LIFE.  This helps a lot.  God I can't even describe how amazing it feels to be able to send an email and know that it will be addressed within a day or so, if not sooner.

I'm finding I don't miss:
- Going out to restaurants (the food is usually only so so, and it's so expensive!  Exception: Sagami, Dock Street Brewery, Taco taco)
- Vacation planning (Vacations are so expensive!  Planning them stresses me out.  What if it's not fun enough to justify the expense?)
- Parties (I'm too socially awkward for these to be fun for me, but when I don't go I feel like I'm missing out.)
- Going to the theater or ballet (We maybe did these things once per year at most, and mostly just because we felt like we needed to do something.)

It kind of makes me wonder whether a lot of the things I make myself do because they are supposed to be fun really actually stress me out.  Maybe I need to better identify what gives me happiness, and do THAT instead of whatever some person on the internet tells me I'm supposed to like (nobody in particular, just in general).  In the past, I've really stood my ground about enjoying my work and that being ok.  Maybe I need to better own what I like to do for fun as well and just do that?

At any rate, next week I will most likely have to return to the hospital and will probably discover I'm totally full of shit.  I will be around some very stressed out people which will probably spread with greater infectivity than the Coronavirus.  Until then, I am resolved to enjoy the solitude WITHOUT SOCIAL MEDIA.

blow my whistle

Yesterday:

- I forwarded around a draft of the manuscript I've been working on, which was a big goal for this period of time.  It's not near ready for submission or anything like that, but a circulating draft is still a huge forward step.

- We had a conversation with the real estate agent who was completely reasonable.  He wanted to know if we're still moving (so far yes), and what the timeline might be.  I told him it was hard to say, but that I was hoping for July 1st.  However depending on what happens with this pandemic, it could be July 31st.  

- Read a couple non-reassuring articles about hospitals firing doctors and nurses for talking to the media about the lack of PPE.  One example, where a nurse had no PPE to take care of COVID patients showed photographs of her using trash bags to protect herself.  She ended up contracting the disease, telling the media about the situation, getting fired, and then dying.  I hope her family sues the shit out of the hospital for one of the OSHA anti-whistleblower statutes, and that her death was not in vain.  

- Also read that New Orleans is a new hot spot.  There were reports that people were like, "Oh wow, this IS really bad.  We were total assholes to this one doctor who told us we should prepare.  We ignored him, and we were idiots."  Yes, you were.  Next time listen. *headdesk*  Maybe now that this has happened in a red state, the orange one will stfu about opening up the economy again in a week.

- Was sort of looking forward to going to work on Monday, but after reading a post by Ana, I am not anymore.  What she describes sounds like classic [hospital where I work], and not very much fun.  I am girding my loins for difficult decisions that will be criticized by someone no matter what, and no support from my bosses.  Wahoo!  Sounds like a blast.  

- We have short turnaround testing for COVID now, which means we will probably start firing up the elective cases again.  Unfortunately, the test is only 75% Sensitive, which means a full quarter of cases would go undetected by it.  Which means that people who are bad at math will tell us that we are being histrionic if we cancel children with URI symptoms if they have a negative test, or if we want something other than a simple mask for intubations.  At least that is my fear, and judging from past experience, I am not going to be wrong.  My strategy for getting through this is to do what *I* think is the right thing, and discuss my decisions with a minimum of my peers.  That's how I got through training, and that's how I'll get through this too.  The culture of medicine is poison.

- I still have a cough.  This one feels like it's from post nasal drip, rather than searing chest pain with every inspiration though, so it's probably allergies or different crud.  I've been inside for two weeks though, so God knows where I got it.  

- I've been sleeping a ton lately.  Not unprecedented amounts (I actually slept even more during my staycations during residency), but I've been going to bed at around 9:30 every night, waking up at around 6:30, and then wallowing in bed until 7:30, so 9.5 to 10 hours per night.  It has been amazing.  

- We had a freaking amazing workout yesterday.  Went for a short (1 mile or so) run outside, and did a bunch of weights.  I did 55 push-ups, which is less than I was doing 2 months ago, but twice what I was doing a week ago, so yay!  Planning on going for another long run-walk today with the husband.  

- Was watching Little House on the Prairie again yesterday with Dyl, the episode where Mr. Edwards comes to Minnesota after his wife and daughter die of smallpox.  Depending on the strain, that killed 30-90% of people it infected.  So glad we eradicated that virus from the face of the earth.  Yay public health!

- We got an email saying that school will likely be cancelled for the rest of the year.  At least the at-home-studying has been going reasonably well.  Dylan told me yesterday she wants to be a doctor.  I said, "You know, you don't have to do that to yourself." She said, "But mommy, I want to."  Sigh.

ETA: Just came back from my walk, where I saw four separate individuals wearing N95 masks just to walk around the neighborhood.  One of my neighbors, in fact was wearing one.  I told her she was part of the problem and walked away.  I should learn to keep my mouth shut.