Earlier this year, @bossletMD and I tweeted about how we were planning on handling the summer.

Winter is upon us.

As a critical care doc and a pediatrician with 4 school aged kids, and a winter of uncertainty ahead, here is how our family is approaching the coming months.

1/
I offer this as a point of reference for those struggling with how to handle the coming cold, not as a strict recipe others should follow.

This is OUR way- I don’t pretend it is THE way.

Some will think we are overly cautious, and others will think we are being cavalier.

2/
.@BossletMD and I discussed the underlying facts that will guide our decisions. They include:

Fact 1:
If I or my immediate family members (wife and kids) contract COVID, the odds are far in our favor that we would be fine.

3/
Fact 2: If we were to be infected, however, there would be a period of time (days if not longer) in which we would have no idea and would be infectious. We would be vectors of SARS-CoV-2.

4/
Fact 3: There are people with whom I would love to interact that would be in danger if one of us were to pass COVID to them. I don’t want to be in a position where someone I love who is in a risky group gets COVID from me or one of mine.

5/
Fact 4: Coronaviruses tend to spread much more in the winter, so vigilance will need to go up at a time when “pandemic fatigue” has set in for many. We are all tired. This is going to be hard.

Source: bit.ly/3olCair

6/
Fact 4 means that, while this summer was difficult, the winter will be far worse from the standpoint of not being able to do the things we want or see the people we love.

Properly respecting the virus is going to be hard.

Here we go. The following will be our guide.

7/
Winter precept 1: Our family will continue to hunker down. We will only venture out for necessary things, one of these being very occasional human interaction.

We have prioritized work, school, what few school extracurriculars exist, and visits with family outdoors.

8/
Winter precept 2: We will continue to try to spend as much time as we can outdoors. We generally stay in during the winter, but I am going to make a concerted effort to bundle the family up for cold-weather hikes and bike rides.

9/
Winter precept 3: Winter sports for us are generally indoor affairs and we will evaluate them on a case-by-case basis. Those places that are limiting crowds and requiring masks will be considered. Otherwise, a hard no.

Which will disappoint our kids.

10/
Winter precept 4: No winter break vacation for us. As someone who has seen this thing from the front line, it is just not worth it until we get a vaccine.

But I look forward to the day when I don’t consider travel and crowds risky for all of us.

11/
Winter precept 6: We will not share indoor meals with anyone outside of our immediate household members.

Anytime we are indoors with anyone with whom we do not live, we will wear masks.

In-restaurant dining this winter is not going to happen.

12/
Given the risk, I don’t see us doing Thanksgiving or Christmas this year with grandparents.

This is our “COVID year”- we are sacrificing this year’s celebrations so that we can have 20-30 more with grandma and grandpa. (h/t @mtosterholm)

This makes us all sad.

13/
Winter precept 7: We will not visit high risk family members unless the setup is considered low risk: outdoors, sitting 6 feet apart in lawn chairs without sharing any food or physical contact.

This means the weather will need to cooperate.

14/
Winter precept 8: We will obey any quarantines. We just finished a 2-week at home stint with our kindergartner and it was tough.

It will likely happen again.

But participating in society means caution with this virus.

15/
Winter precept 9: We will continue to hope beyond all hope that in-person school can continue.

In-person school has gone well and the kids’ moods are significantly better when they get to leave the house.

This means adults refraining from adult things.

16/
Winter precept 10: We will look forward to when a trusted vaccine is approved by the @US_FDA. We will trust scientists and encourage all of those who can to get it.

Only vaccine-created herd immunity will end these precepts and our winter of isolation.

17/
This is the winter of uncertainty. Let’s proceed with humility, the willingness to check assumptions regarding how things will play out, and grace for those around us who disagree with our decisions (within reason).

fin/

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More from @gbosslet

23 Aug
Inspired by @ETSshow and @ChrisLMosher, a #medtwitter #thread on “6 tactics to improve difficult conversations”

The following can apply to conversations with loved ones, colleagues, patients, teenagers, and pretty much any other human.

Warning: this one is kind of long.

1/
I do not suggest that I am the best communicator in difficult conversations. @BossletMD may tell you the opposite. But this is something I reflect on and work hard at to improve.

I credit @vitaltalk for helping me notice my incompetence in these areas almost a decade ago.

2/
First, let’s establish that conflict is ubiquitous, usually unavoidable, and often is not pathologic.

Like a forest fire, it is often a catalyst for new growth.

So avoiding conflict at all costs is folly and a way to lead to let things fester.
3/
Read 19 tweets
8 May
Our Summer with Coronavirus

As a critical care doc with a pediatrician wife, 4 school aged kids, and a summer of uncertainty ahead, here is how our family is approaching the coming months.

Also, some GIFs.

1/
I offer this as a point of reference for those struggling with how to handle the dog days, not as a recipe that others should follow. This is OUR way- I don’t pretend that it is THE way. Some will think we are overly cautious, and others will think we are being cavalier.
2/
This plan operates under 4 assumptions.

(@BossletMD and I had to agree on the following, which was a discussion worth having)

Summer plan assumption 1:

If I or my immediate family members (wife and kids) contract COVID, the odds are FAR in our favor that we would be fine.
3/
Read 22 tweets
29 Mar
I have been chewing on the @SCCM @aarc_tweets @ASALifeline @APSForg @AACNme @accpchest “Consensus statement on multiple patients per ventilator”, published jointly on March 26:
bit.ly/2UIdrai

I disagree with the sentiment of this statement.
Here is why.
1/
The following come from a self-described medical minimalist and a skeptic when it comes to new medical technologies. I am far more likely to tell people to “slow down” than to “check out this new toy”. You can ask @GrahamCarlos @ryanboente @erinmcrowley @tjelle13
2/
The statement is not published in a format that allows for comment, or this would be a letter to the editor.

I agree with much of the substance of the statement- they point out issues well worth considering that need worked out before splitting a vent is definitively safe.
3/
Read 14 tweets
27 Mar
THREAD
#MEDED and #PCCM ADVOCACY HELP NEEDED:
The U.S. Citizenship and Immigration Services announced on March 20 the suspension of premium processing for H1B visas.
@ATS_BSHSR
@accpchest
@acpinternist
@APCCMPD
@AmerMedicalAssn
THIS IS A MAJOR PROBLEM.
1/
Premium processing is THE WAY that these trainees are able to have visas processed in a timeline that best prepares them to practice at their place of employment starting in July. Disallowing premium processing means a delay in their visa status, which delays credentialing.
2/
This is likely to lead to a 3-4 month delay in their being able to see patients at the conclusion of their training. This will effect 1200-1500 physicians who are completing residency here in the United States, most of which will be practicing in underserved areas.
3/
Read 10 tweets
5 Aug 19
This weekend I posted a #thread about #PersonalStatements. It got a lot of attention- much of it good, some critical.

In the spirit of a #GrowthMindset I decided to lean in to the criticisms and try and improve it.

#Meded
#Medtwitter
#MedstudentTwitter
The content of the original #thread was true to my thoughts about the topic, but was written in a way that did not give proper context to the role of the PS in the process. It was also completely tone-deaf in that the voice I used was condescending and mean. And that is not me.
So I’m considering that thread what @ANNELAMOTT would call a #ShittyFirstDraft. The following draft incorporates feedback from the @Twitter #meded community into something I hope is a bit more useful (and a lot more friendly).
Read 30 tweets
3 Aug 19
I’m a fellowship director who just finished reviewing over 400 applications for 8 fellowship spots.

The following is a #thread on writing a personal statements.
(Spoiler alert: I find 99% of them to be TERRIBLE.)

#meded
#medtwitter
#medstudenttwitter
1/
The following are MY preferences and proclivities. Some will ring true for other PDs, some may not. And Turi McNamee wrote very eloquently about this in @AnnalsofIM in 2012. pdfs.semanticscholar.org/94f4/4d6b3da42…
2/
I’m going to tag @davidschulman , @jennifer_jwm , @KristinBurkart3 , @DrMCMiles, @GenevaTatemMD, who are PD colleagues in #pccm, and @sanjayvdesai , @TKapetanos , @MitchGoldmanMD, @abbyCCim, @jenchoi_iu and any others who are PDs. I’d love to hear from them on this topic.
3/
Read 28 tweets

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