1/🧵 Christmas Reflection on Gratitude

My patient today - IN THE ICU on Christmas - said:

“I’m sorry for complaining, Doctor. I realize that if I have time to complain, I have time to say ‘thank you’ too.”

WHOA!
 
I will be w my patients today & throughout the Holidays…
2/ …many of these people are suffering #COVID lung failure that might end their lives. For them & for me, it brings into perspective what matters.

In the picture above (1st tweet), we are with a recovering pt, letting her see the 🌞.

It’s for #Hope & a vision of her future
3/🎥 “It’s a Wonderful Life”

We watched this classic last night and it helped me think of how we all must be in community to lift one another up during these hard times…see ending clip here ☺️

…this message never gets old!
4/ George Bailey, after contemplating ending his life, says, “Atta boy, Clarence.” It’s a moment of sincere gratitude to a friend who helped him.
 
USEFUL TOOL: Saying 3 to 5 things I’m grateful for is a realistic way to regear my thinking when I’m sad or distressed.
5/ No matter where I am, IF I pay attention, there are “angels” around me. Others help me replace worry w something that brings joy.

The Holidays can be very tough, which is why I take Christmas ICU rotations…to learn from pts & families.

To offer reprieve.
6/ Here we are together today…all of us working to convert suffering into healing. This offers me hope for 2022.

I don’t have to consider only woe.

I can choose to work toward solutions, one patient and one problem at a time & let others help me.

(btw N95s in pt rooms)
7/Final thought…a keeper from a #Sage

“Be at war with your vices, at peace with your neighbor, and let every new year find you a better woman or man.” 🎁
 
Benjamin Franklin, 1755 edition of “Poor Richard’s Almanac”

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More from @WesElyMD

23 Dec
1/🧵 Molnupiravir & Paxlovid are BOTH approved for EAU (emergency use) as pills for #Covid to reduce hospitalization and/or death if taken EARLY (w/in 5 days).

This ⬆️ our need for Rapid Tests!

Primary prevention is #Vaxx. 🤛

A few thoughts…

FDA - bit.ly/3ElTef1 Image
2/ Which drug? When? Why?

Both drugs reduce likelihood of you being hospitalized if you take them early. The actual scientific publication of Pfizer’s #Paxlovid is not out yet, so I’m waiting to read peer-review data before firm stance.

But...

bit.ly/3Jc0Nsp
3/ Molnupiravir - 👇 @NEJM paper & conclusion.

You might think the story is clear. But it’s not.

1st half of study period yielded strong results but 2nd half did not…see 1 & 2.

Only 3% difference, so 1 improvement for every 33 pts treated.

bit.ly/3FEJ377 Image
Read 9 tweets
23 Nov
1/🧵🎥 COVID & Thanksgiving Safety: 🍁

Use of Rapid Antigen Testing❓

I’m getting lots of QUESTIONS about eating Tgiving turkey w people who are not #Vaxxed. A very safe thing to do is have people cleared by a rapid Ag test.

Watch 2 min👇: @michaelmina_lab & I’ll unpack…
2/ It’s NOT a brain biopsy like PCR. More like picking your nose. 😂

Legit Rapid Ag tests you get commercially at a drugstore or online will tell you: AM I INFECTIOUS?

Am I shedding COVID virions in a quantity that places others at risk.

I’m NOT endorsing any one test here. Image
3/ PCR is the most sensitive way to detect COVID globally. @US_FDA & @CDCgov say so and that’s technically accurate. But (1) PCR takes too long & is not practical for YOUR purposes (outdated by the time you’re w mom). (2) PCR will stay positive way longer than you are infectious!
Read 8 tweets
17 Nov
1/🧵COVID Antibody Lunacy 🌚

Antibodies can NOT be used “rule out” #LongCOVID and should NOT be used to determine if you are immune or if the vaccine “worked.” This perspective in @JAMA_current outlines flaws in such thinking. I review highlights…👇

bit.ly/3ckYFQ0
2/ The FDA already stated we don’t have established thresholds to interpret Antibody tests.

They are NOT usable reliably to see if you were infected (esp after vaccine). The tests are not standardized yet & WHO doesn’t include in #LongCOVID definition.

bit.ly/3ljLpQK
3/ If you’re trying to prove you had COVID or #Vaxx response, don’t fall for $170 direct to consumer testing for routine Antibody checks. It’s not nearly that simple.

EG: #Vaxxed or previously infected people could test negative on some assays despite having immunity.
Read 8 tweets
11 Nov
1/🧵A patient told me he lost hope. A spouse got mad at me for being too direct. I needed #compassion & truth to restructure #hope toward what was possible. These tools can be taught, learned & modeled.

A story for you, placing compassion & hope side-by-side… Image
2/ Compassion and Hope must be modeled for students to learn…and must be part of every interaction with patients.
 
In my end-of-life conversations, while always remaining kind, I avoid providing false hope. Image
3/ I was once explaining to a daughter that her mother was dying on the ventilator, a conclusion I had come to over five days as, despite everything we had done, no reprieve was in sight. The once-placid daughter slammed her fist on the table, then raised it at me as I recoiled.
Read 7 tweets
10 Nov
1/🧵 End-of-Life: Thoughts
 
I was explaining to others how the end of my patients’ lives is often such a beautiful experience. They looked back at me with utter confusion. I could tell they thought I was crazy.

Since then, I’ve been thinking of what I should have said…
2/ I should’ve explained that too often in life I feel like I hold on to things I need to let go of. That sometimes I try and force solutions in relationships and all sorts of situations when I simply need to let go.
3/ I watch my patients often try and carry the weight of circumstances way past when it’s obvious the burden is too great bear. The only logical solution is to let go of the rock that is drowning them. To let life flow and take its natural course.
Read 13 tweets
8 Nov
1/🧵 #Coronavirus Words 📕
 
Words matter!

These 4 new words were added to the @MerriamWebster dictionary last month…
 
📍Breakthrough medical infection
📍super-spreader
📍#LongCOVID
📍Vaccine Passport
 
Defined below…
 
bit.ly/3H38mkb
2/ Breakthrough medical: infection occurring in someone who is fully vaccinated against an infectious agent — often used before another noun (as in “breakthrough cases” or “breakthrough infection”). Image
3/ Super-spreader: an event or location at which a significant number of people contract the same communicable disease (as in a “super-spreader event”). The term super-spreader originally referred only to a highly contagious person. Image
Read 6 tweets

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