Coming home today I had a lot to think about. I say this not to seek sympathy, but it’s been a month since I last had a day off. For me and many of my colleagues it’s become a new normal. Watching young people die has become all too familiar as well. Not normal, but …
I spend my commute home telling myself that this is horrible. These deaths are preventable. That vaccines save lives. That those who fight them are the minority. I need to reinforce these walls, because it seems that the outrage is fading. That the news is stale. We’ve adapted.
I write these things down, as to mark the sand, for I worry that I too will adapt and begin to accept this. Be it fatigue or bombardment, eventually one must drop their head and tuck in their shoulders as if to bear the weight of loss. This wave has been especially brutal.
Not only by the numbers but in its plateau. This wave has held us under the water until our limbs trash, our lungs burn and our vision fades. I do not relish the irony that many drowning in it chose not to swim.
Perhaps that is why my journey home takes me in ever expanding arcs. I know that I will never accept this reality, & to bolster my resolve just takes longer, and those kilometres are essential right now. I will continue to tell their stories. I will be there to mark their graves.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
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.