“I know you’ve been avoiding me, I understand why. Your heart must jump into your throat when you see the hospital’s number come up on your phone.”
“Please tell me he’s getting better.”
“Your father’s heart is failing.”
“He promised to help me with my schoolwork.”
The tears are welling up in our eyes now, but I know how to block them.
“You have to do everything. He worked two jobs to keep me in school.”
He is shrinking now. Only anger bolsters his impossibly thin frame from collapsing. His fists are clenched.
I stumble for a second, seeing my son in the flash of his eyes. That connection swamps me with empathy. I can’t give into it, or I won’t be able to go through with what I need to tell him. So I brace myself. I break the connection by stepping back.
“We have been doing everything for over a month now. The dialysis is only buying us time, but his lungs are like concrete and he’s shutting down.”
“He meant to get the shot. I even booked him the appointment. He was just so …”
“Don’t agonize over the past, please.”
It’s then his rage gives way to defeat. He involutes as paper rends into ash and accepts this denouement. Because this is not the first time I have told him he’s loosing a parent.
• • •
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I looked into the room to see him pacing around the bed, guarding her. She was pale, and if not for the monitors I would have been worried she wasn’t breathing. My colleague had admitted her to the ICU in the early hours of the day.
“He’s adamant we do everything.”
I scanned the chart. She had been sick for years, in and out of hospitals for complications of long battled conditions. Things however were crescendoing. She was spending more & more time in hospital and each fight drained her more and more. This time it was a bladder infection.
She’d been stabilized over night, but there were things that needed to be done. Lines inserted, tubes adjusted, wounds probed. Hands laid. I must admit, it seemed daunting, and the mood in the room was heavy and still.
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.
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.