Darren Markland Profile picture
Sep 15, 2021 9 tweets 2 min read Read on X
She was a single mother of three girls.
Between the school closures and night shifts she hadn’t found the time to get one shot, let alone two. She did make her daughters lunches that day. They were on the kitchen table.
Her eldest called 911 when she slumped over the sink and couldn’t get up. That’s where the paramedics told me they found her, with one of her children trying to give her a glass of water.
She was so ashen they didn’t think they would get her to the hospital in time. They went with lights and sirens.
Her heart stopped as they transferred her to the stretcher. I could hear the ER staff running the code. Fully gowned and practiced, they were had her back in minutes. I could tell by the color of her lips and the frown on the respiratory therapist’s face that it wouldn’t last.
I walked over to the room and started looking through her history on the computer. She had been sick for days. There was a positive covid test in her file from days ago. In the room they start chest compressions again. Another round of epinephrine.
I know the ER doc. She’s the kindest soul I know. Her eyes plead with me to take her to the ICU.
“We keep getting her back.”
“Yes, but we can’t oxygenate her”
“But …”
“We both know the mortality of a COVID arrest.”
I cut her off before she tells me about her children.
I write a note in her chart. I try not to make eye contact with the paramedics who brought her in, in desperate fear that they will tell me more personal details of this young woman. That they will make her real. Of course I flinch.

“Where are her children?”
“Grandma has them.”
I reflexively clench my jaw knowing that her children are sick.

“Was grandma vaccinated?”

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More from @drdagly

Jul 20
Today my HVAC guy taught me how to be a better physician. As you know, it’s stinking hot in Edmonton right now, and though the heat doesn’t bother me much, we are a family of Vikings and it’s my job to help my ginger spawn survive. Cue the ominous silence from our AC unit.
I perform my due diligence. Thermostat, on batteries fresh, settings correct. Furnace blower fan, operational. Condenser coil, clean and intact. Exterior unit, not blocked by dead porcupine. Breakers reset and on. Still nothing. Now I’m faced with call the poor HVAC guy.
I’ve used the same guy for years. He’s just an honest good guy. I know he’s gonna be insanely busy, but Mr Hobbes is already in the basement and panting so I make the call. It rings forever and goes to voice mail. Dammit. I am considering dropping the dog off @slav_metalurges.
Read 15 tweets
Dec 13, 2023
I get asked a lot about how to fix medicine. There are many people out there who are far better equipped to answer that question, but I think we need to acknowledge some fundamental truths.

Medicine evolved out of our capacity to care for those outside of our immediate family.
It required compassion but also an inherent understanding that collective well being is beneficial for us all. In that sense it is indelibly connected with social structure. Disparities in wealth & justice distribution are huge social determinants & drive heath care consumption.
TLDR: Education, taxation, reconciliation, and justice reform are crucial players in improving health. All longterm things. What are short term solutions? Risk reduction through guaranteed income and housing.
Read 11 tweets
Sep 12, 2023
So here’s what you need to know about E. coli, in an easily digestible thread. Image
It a common bacteria, that resides in our guts and those of most animals. We live in harmony with it, but it’s always looking for an advantage. It wants to travel beyond the colon, but fortunately a combination of physical and immunological barriers keep the pickle in the jar.
As an ICU doc I see what happens when bacteria escapes the colon. Pop an appendix, perforate a diverticulum, or get sucker punched in the belly and leak. Stool in the abdomen leads to abdominal sepsis and without surgery it can be lethal . But that’s not what happening here.
Read 23 tweets
Feb 12, 2023
I get the call from the emergency department.
“He’s was near death, but we stabilized him.”
They start reciting the story. It’s a well worn script we both know all to well.
“Unhoused,
Addictions,
Lost to follow up”
I feel it. That blend of anger & frustration I must control.
“He’s pretty unkempt, but his beard is immaculate.”
And at that point my heart softens.
“We don’t have a name yet. We think he had a seizure.”
“Does he have a tattoo over his heart?”
Pause
“Yes”
“Is it a church bell.”
“Y-yes”
Sigh.
“I’ll be right down.”
It’s Ted*
I’ve known him for at least a decade.
“He needs dialysis.”
I remember the scarred inscription from when I put his line in 4 years ago.
“Don’t fuck with my salvation!”
“I promise you, I won’t go near it.”
“It’s a god damned masterpiece.”
“It’s the Mona Lisa’s smile.”
Read 15 tweets
Jan 6, 2023
Some difficult truths when looking at our struggling medical system. We are failing because we are the safety net before the brick wall. When social systems like education, mental health supports, disability services and fair taxation are purposely dismantled this is the fallout.
Our hospitals are full of patients with complex medical issues who no longer have the social supports to survive anywhere outside of the hospital environment. Many are homeless, frail or suffering from complications of addiction. These issues have not occurred overnight.
COVID has been a major player. Many of our frailest patients have become so directly as a result of the damage this virus can do. It was as if we “promoted” a significant fraction of our population into dependency over the past three years.
Read 10 tweets
Dec 8, 2022
It’s nice to have ⁦@KmarkovCTV⁩ looking into these numbers for us. edmonton.ctvnews.ca/covid-19-in-al…
This graph I think is incredibly important. That it shows progressive increases in hospitalization reflects multiple simultaneous stressors. Worsening mental health, addictions, toxic opioids are part of this, but I have been seeing something more concerning.
I’m seeing people get sick, usually from Covid, but never get well enough to leave the hospital. They suffer cognitive issues, protracted delirium bordering on early dementia, strokes, heart attacks and pulmonary emboli. They have one set back after another.
Read 8 tweets

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