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Darren Markland

@drdagly

9 Nov

This, among several evolutionary achievements has not only made #SARSCoV2 Delta a remarkable viral predator, but has also shaken our resolve about vaccination.

What you are looking at is a molecular catapult that smashes this virus into your cells. It’s the equivalent of a cellular trebuchet and it accelerates the rate of infection significantly. It’s this virological blitzkrieg that is the heart of our concern about vaccination.

There has been a lot of discussion about the utility of vaccination if people can still get infected and spread the virus. I think people have heard this enough to now doubt the effectiveness of these vaccines. Let me reassure you. They work.

Read 28 tweets

Darren Markland

@drdagly

8 Nov

Please file this under things I would never have thought needed to be said. Alcohol enemas are dangerous. #sigh.

Now, I feel I should temper my statement about boofing a bit. You see anything done without the proper instructions can be risky. So if you are going to but chug remember a few important points.

First. It’s going to take a lot less alcohol to get you intoxicated. That’s because you bypass the liver which does the lion’s share of metabolizing alcohol. You get hammered on a spritzer? Reduce the dose by about half.

Read 6 tweets

Darren Markland

@drdagly

26 Oct

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.

Read 5 tweets

Darren Markland

@drdagly

15 Oct

One of the most challenging aspects of the 4th wave has been the alienation and estrangement of families. Once our allies for shared decision making, many are skeptical of the medical management of COVID if not in complete denial it exists. Trust is essential in building rapport.

It is further amplified by isolation from our restrictive visiting policies. I miss the day where I could sit in the room with a family and explain what was going on. More importantly I could see the interactions and understand the dynamics of its members.

Daily updates, conversations about the weather, their participation in medical rounds all gave them grounding and trust in what we were telling them. That is gone now, and though we update family by phone or zoom it is a veil between us.

Read 4 tweets

Darren Markland

@drdagly

8 Oct

I had only known her while she was on the ventilator. Her case handed over to me with exacting details, her care detailed by vital signs and problem lists. It was only when we pulled those tubes from her mouth that we really saw her face and understood her tears.

“You look like you really need a hug.”
Though I knew she was still dazed from the delivery from her mechanical womb her eyes focused & she held out her arms, the tears intensifying.
Despite the gown, mask goggles & gloves, or maybe because of them, I knelt down and embraced her.

We chatted that afternoon. Some of it made no sense. I knew that her mind was struggling through the fog of weeks of drug induced coma.
I learned about her life, & her family. I could see her regret. I could feel her remorse. All I wanted was to tell her it was going to be ok.

Read 12 tweets

Darren Markland

@drdagly

30 Sep

So, we’ve reached 34 deaths per day from COVID. It’s a shocking number that really gets swamped over by all the other numbers. I’m going to describe the usual dying process in the ICU from this disease. I’m wearing my clinical hat, be warned.

The trip through the ICU is serpentine. We admit patients now who not only have low oxygen levels, but are in distress. Prior to that internal medicine physicians have been providing ICU level care on the floors.

They treat potential coinfections, mange noncovid aspects of patient health and importantly try to turn the course of the disease with steroids and monoclonal antibody therapy. If the trajectory is set, they come to the unit to be placed on a ventilator.

Read 20 tweets

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