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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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.
So here’s what you need to know about E. coli, in an easily digestible thread.
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.
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.”
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.
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.
Many of you are angry at me right now. I think some feel I have turned and betrayed them, but that is not the case. I have gone to a medical conference to learn about Covid and to hone my craft. I’ve done so masked. I have also eaten in restaurants. The vitriol is so sharp.
The comment are cruel. I’ve been here before. I’ve weathered this intolerance and absolutism in the past. It was during the delta wave. It was from people who were scared and desperate. We built bridges then and found common ground to share.
I’ve been doing this for years now. Making space for people. Holding back preconceptions. Covid has changed during that time too. It’s faster and more evasive. The world is harder and more divisive. I will always advocate for the right things, but those original plans …