Story time. I hope this isn’t too maudlin, but in the time of COVID, this seems to be the way we eulogize. Today I found out that my elementary guidance councillor died. It should have come as no surprise as he was also one of my patients.
I called his wife to express my condolences, but really it was to grieve over the phone with her. You see, this man was remarkable for so many reasons. Of course he was an amazing teacher, but he was also a force of nature.
I struggled in school. Our family moved around a lot because of my dad, & when we finally settled down, it was because of my dad. He got sick. My mom protected us, shielding us from the diagnosis. As a kid, normal is what you do every day. So I never clued in. Maybe intentionally
Ed had a natural affable smile. He knew how to read someone from a thousand yards. The man could build bridges over the most troubled waters. He did while most never noticed. That how he would get around your defences. The man was a rough cut empath.
I never knew he was helping me, he was just there for me. His mentorship was glacial, subtly and irrevocably nudging me in the right direction just by being there. He was the foothold that was always there no matter how slippery the rock face.
And like most dumb kids, I never appreciated it. I just took it for granted, as a seed takes in water. But with that rooting, and that gnarled momentum, I was good, no better than that, I was solid and motivated. And in the blink of an eye, 30 years passed.
He showed up in my office without an appointment.
“Look Ed, I can’t see you, we have a relationship, but I can refer you to someone else.”
“Balderdash”
“Sorry?”
“I won’t see anyone else, It’s you or the funeral director.”
“Your not that sick.”
“Last chance.”
“But”
“...”
“Fine”
It’s hard to switch roles, and to now provide the guidance to your hero. I struggled a lot with this early in our new relationship, but Ed was as practical as he was blunt. He asked good questions and called me out when I was vague. Our appointments always ran late.
Over the ensuing years, we worked out the best solutions we could with what we had to work with. Neither of us would pander to unrealistic expectations. He took a special joy in playing mind games with my staff. One appointment he spoke only in iambic pentameter.
But as time went by he became more frail. His hands shook, and we had to speak of serious things. As always, he would lead the charge.
“I am pretty sure I don’t want dialysis.”
“You don’t really know that much about it, give me a chance to go through it with you.”
In the end he gave it a try, but it wasn’t for him. His wife, who had been with him to every appointment, told me about his last days. I struggled, wondering if I could be brave enough to make the same choices they did. To grasp and control his coming death. It gutted me.
On the phone that day, it was she who consoled me.
“Ed didn’t care if you were the best kidney doc out there. He just knew that you would be there for him. He had a lot of doctors looking out for him but they came and went. He just needed a sounding board.”
So, here’s to the teacher who stays late, the councillors who reach out, the aunt who steps up, the boss who reaches out. Here’s to the allies who give us a firm step and solid hand hold, for though they may never know it, those acts of kindness matter. Immeasurably.
And now, when we are all so vulnerable I share this knowing that those of you who unwaveringly step forward to do the right thing when no one else is looking, will be rewarded. Especially if you do it in iambic pentameter. 🙂
Also, he was an accomplished stained glass artist. His tremor bothered him most as it made it hard for him to work. He gave me one of his last pieces. It took him ages to solder but he was determined. He dropped it off unceremoniously.
“Don’t break it, I’m not making any more!”
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Last night before I intubated a lovely man with COVID, he insisted on calling his boss to explain why he wouldn’t be into work on Mon. He was so short of breath I had to finish the call for him. In the aftermath I realized how this job was a lifeline for him. It left me unnerved.
More and more this shows me how disparities drive despair. Without financial support essential workers and the marginalized don’t have a real chance at avoiding these risks. These are the people in our unit. Privilege is protective. I’ve known this, but damn, this hits me.
Without meaningful social change, most of intensive care medicine is just a band aid.
We relish working with the sickest patients & are privileged to walk the most agonizing paths with their families. It’s the impending sense of being overwhelmed at any moment that is grinding us down. It’s that we are here again, as though we have not learned that’s demoralizing.
I am constantly amazed by the heavy lifting our administrators do to adapt and keep things running. They must be feeling this weight as much as we do. The added pressure of being in a leadership role must be immense. I hope they have support too.
You won’t hear it from them. That job doesn’t allow a lot of disclosure, but they are fine people, doing their absolute best in really difficult situations. It’s a job I could never hack, and it is essential to keeping our hospitals running.
As we speak our @CMOH_Alberta and health minister are betting on vaccinations to temper hospital and ICU admissions despite our exponential case numbers. That is a high risk wager if they get it wrong. Based on current hospitalizations and past experiences we should lock down.
This is a similar situation to last wave. Though I hold optimism that vaccines will save lives, using lagging indicators just means we wait for young people to start overwhelming the system. Even though they tend to have better disease outcomes, this remains a percentage game.
This is predictable math. To make infection control an all or nothing game is naive and irresponsible. Lock down now. Continue aggressive vaccination. Open up at 80% vaccine uptake, regardless of how low case counts are. Better yet push for #CovidZero.
The Covid situation in Ontario is making people pretty jumpy, so let’s focus on some positives.
- GenX showed up like crazy for their vaccination
- Our elderly are vaccinated
- We have had a 2 week head start
- Our population is younger
- We have lower population density.
Now let’s focus on what we can do about it in the short term.
- don’t let your mask slip.
- support and advocate for racialized and essential workers
- enjoy spring while following the rules
- push for #covidzero
- help curb vaccine hesitancy (be nice about it)
- take the jab.
When your brain isn’t overloaded, in those quite moments, think about long term solutions.
- wage disparity
- marginalized populations
- health and social equity
- socialized healthcare and health prevention
- mental health and addictions stigma
- political polarization
Everyone keeps telling you that the side effects from AstraZeneca and Jansen vaccines are rare and you should get the vaccine. I totally 100% agree with this, but trust is only part of the equation. So here’s what I know about #VITT or vaccine induced thrombotic thrombocytopenia.
Let’s start with the name, because it tells us a bit about the problem. Thrombocytopenia means a low platelet count, which can happen for many reasons, and thrombotic refers to the generation of blood clots. When you understand that platelets are what start most clots ....
You really are a leaky meat bag. No offence. Platelets are constantly plugging tiny holes in blood vessels and maintaining vascular health. They are kind of like clotting grenades. Super effective at what they do, but you don’t want them going off in the wrong place.
As #COVID19 escalates, & predictably hospital and ICU admissions follow, I am being asked to do more interviews. Please, let me be clear, physicians are not saying, “I told you so”. We have been here before, and this is all so predictable. It’s hard not to sound frustrated.
We want the best for our patients. We’ve advocated for plans that would have avoided this situation. We’ve seen other provinces do this the right way. We are left pleading with people to do the right things at great personal cost, but they are fatiguing from this harassment.
Most of us will make it through this alive, but we all will have scars from it. Physical, mental, social, financial, we will all be marked by these half hearted measures. Death is only one marker of this pandemic, but right now it’s the one I’m most focused on.