Sometimes emotions are vast. I do not think our culture deals with grief very easily. Grief then becomes a vast pit, stuffed inside us. I sent the Falling Angels poems to friends and family. One older friend said that the poems were too sad and was I that sad all the time?
I replied, no, I am not sad all the time. The sadness is in the poems because there are very few people that I know that are comfortable with sadness and grief. So I put it in to poetry, because I do not want to stuff it. We need to let grief come out and let the tears flow and let it go.
That is part of the Hippocratic Oath and yes we did it at the end of medical school. “I will prescribe regimen for the good of my patients according to my ability and my judgement and never do harm to anyone.”
This is a pandemic. People are dying. A lot of people. I am not ok with people saying personal freedom, we don’t want to wear masks, we don’t want the vaccine. I take the oath to first do no harm: what about those people? They are putting their personal freedom first and do not care if they harm me. I don’t like them. Please don’t kill me. Please don’t kill my son or daughter or future daughter in law.
You can have your personal freedom not to wear a mask or get a vaccine: in your house. I don’t think you should be allowed off your property if you won’t put doing no harm to others first during a pandemic. Stay in your house. Don’t come out. It is selfish to put yourself and your personal freedom in front of multiple peoples’ lives. You can order from Amazon and order groceries and ok, you can associate with other selfish unimmunized unmasked people, but not the rest of us. Your personal freedom has a high chance of killing me. I am immunized but my immune system doesn’t work and I am already on oxygen. I don’t want to be around you. Stay away from me.
I think it is time for my community to give back to me and all the other first responders: medical, police, fire, grocery store, hospital, all the essential workers. Give back: either get immunized and masked or stay in your house.
A friend took his father to the ER in the next bigger town, sent there for admission to the hospital from the clinic. His father is in his 90s, has heart failure, and his legs were puffed up like balloons with weeping blisters.
They were in the ER for 13 hours, never given food though it was promised, the staff couldn’t even find time to bring a urinal and his father was not admitted. He was sent home. No beds. On divert.
Ok, so when should you go to the hospital right now? Only if you really really can’t breathe….
First, the emergencies. An ER nurse friend talks about “happy hypoxia” where people do not feel bad but have an oxygen saturation of 50%. I suspect that this is when their lungs really are swelling shut very fast. They will turn blue quickly. Call an ambulance. In the 1918-1919 influenza, soldiers “turned blue and fell over dead”. In Ralph Netter’s book on pulmonary diseases, he has a drawing of the lungs of a person who died from influenza pneumonia. The lungs are basically one big red purple bruise with no air spaces. So if a friend is goofy and their lips are turning blue: AMBULANCE.
The one in five hospitals that are 95% full or more in the US are now cancelling all of the elective surgeries: knee replacements, hip replacements, non emergent heart surgeries, all of it.
If you are not dying, do not go to the emergency room if you are in one of the totally swamped areas.
So how to care for yourself with covid-19? Like influenza, it is pretty clear that it either causes lung swelling or the lungs fill with fluid or both. With lung swelling you may be able to stay home. First take your pulse. If you have a pulse oximeter, great, but no worries if you don’t. .What is your resting heart rate? Count the number of heart beats in 60 seconds
If it’s 60-100, that is good. It’s normal. If it is 120 at rest, that is getting worrisome. If you are short of breath at rest and your pulse is over 100, call your doctor. If they can get you oxygen, you still may be able to stay home. If not, emergency room.
Now get up and walk. Do you get short of breath? Sit back down and again, count the number of heartbeats when you are sitting. If your resting pulse was 90 and you jump to 130 walking, you have lung swelling. Functionally you have half the normal air space and so your heart is making up the difference. How to cope? Well, walk slowly. Walk during the day, do get up because otherwise you may get a leg blood clot, but really minimize your activity. Now is not the time to rearrange the furniture. Also, you may not go to work until your walking or loaded pulse is under 100.
If your pulse does not jump up when you walk, next try walking loaded. That is, carry something. Two bags of groceries, a toddler, a pile of books. Go up the stairs. Sit down and take your pulse when you are short of breath or it feels like your heart has speeded up. I am in this category. My pulse is 70, oxygen at 99 sitting. Walking my pulse jumps to 99. Walking loaded my pulse goes to 125 and my oxygen level starts dropping, need oxygen once it gets to 87. I tried a beach walk without oxygen 3 weeks ago. I photographed the pulse ox when it was at 125 with O2 sat at 87. I still need oxygen.
The treatment for lung swelling is rest. This is my fourth time, so I am used to it. Some people will have so much swelling they will need oxygen at rest. If the lungs swell shut, they need to be intubated or they die. Suffocation is not fun. The other treatment is not to catch another virus or a bacteria on top of the present lung swelling. Wear mask, get vaccinated, put out the cigarrette, no vaping, pot is terrible for the lungs too and increases the risk of a heart attack.
With my four pneumonias, the first two made me tachycardic and it took two months for the lung swelling to subside. It sucked. Inhalers don’t work, because they work by bronchodilating. You can’t bronchodilate swollen lung tissue. The steroid inhalers might help a little but they didn’t help me. The third pneumonia took 6 months to get back to work and then I was half time for 6 months. This time I am five months out today and I still need oxygen. Darn. Don’t know if my lungs will fully recover. They may not.
So: rest. Good food. Avoid substance abuse. Mask all visitors and don’t go to parties/raves/concerts/anything. Oxygen if needed and if you can get it.
Take care.
The photograph is me wired up for a sleep study a week ago. The technician took it at my request. I won’t have results until next week.
I went to have a hair cut today and went in three shops since I was downtown anyhow.
There are lots of tourists and visitors walking around without masks.
In one shop the owner asks if I am Dr. O, and it turns out her daughter babysat for my children 19-20 years ago. We had a nice discussion about our offspring. We are both wearing masks.
In a mineral store somehow the covid-19 subject comes up. I say that I am wearing a mask because I am on oxygen and vulnerable, and even though I am vaccinated, if I get covid-19, it might kill me.
The two owners are not wearing masks. The woman says, “We are both vaccinated, but I am just really confused about what to do.”
I say, “Well, I am a Family Physician. Let’s take chicken pox. If someone is exposed, it can take 21 days for them to break out in the rash. They will be contagious for 1-2 days before they have symptoms. The problem is that it can be ANY of those 21 days. After they break out in the rash, they are contagious until every pox is crusted over. So it can be six weeks that they are possibly or certainly contagious. With Covid-19, the Delta Variant is so infectious and again people may not have symptoms yet, so I am wearing a mask any time I am around strangers.”
The woman says, “Thank you for telling me about it. It’s helpful to hear from a professional.”
How? It does wear them down, but it can also break blocks off. Water goes into any tiny crack. When it freezes, it expands. Over time, the crack is widened, until the rock breaks. Rock cannot stand against water.
Top ten causes of death US 2020, according to JAMA, here.
Total deaths: 3,358.814 Contrast total deaths in 2019, at 2,854,838. That number had been on a very slow rise since 2015 (2,712,630) to 2019 (2,854,838). That increase over four years is 142,208 people. Then the death rate suddenly jumps 503,976 people in one year. Ouch. I cannot say that I understand vaccine refusal.
1. Coronary artery disease: 690,882 Heart disease still wins. And it went up 4.8%. It is suspected that people were afraid to go to doctors and hospitals. I saw one man early on in the pandemic for “constipation”. He had acute appendicitis. I sent him to the ER and his appendix was removed that day. He thanked me for seeing him in person. Might have missed that one over zoom.
2. Cancer deaths: 598,932 This is cancer deaths, not all of the cancers.
3. Covid-19: 345,342 I have had various people complain that covid-19 is listed as the cause of death when the person has a lot of other problems: heart disease, cancer, heart failure. The death certificate allows for more than one cause but we are supposed to list the final straw first. I cannot list old age, for example. I have to list: renal failure (kidneys stopped working) due to anorexia (stopped eating) due to dementia. That patient was 104 and had had dementia for years. But dementia is not listed as the final cause. So if the person is 92, in a nursing home for dementia and congestive heart failure, gets covid-19 and dies, covid-19 is listed first, and then the others.
4. Unintentional injuries: 192,176 Accidents went up, not down, which is interesting since lots of people were not in their cars. However, remember that the top of the list for unintentional injuries is overdose death, more by legal than illicit drugs. If there is no note, it’s considered unintentional. Well, unless there is a really high blood level of opioids and benzos and alcohol. Then it becomes intentional. They do not always check, especially if the person is elderly. The number rose 11.1%, which seems like a lot of people.
5. Stroke: 159,050 This rose too.
6. Chronic lower respiratory diseases: 151,637 This went down a little. This is mostly COPD and emphysema. So why would it go down? Well, I think bad lung disease people were dying of covid-19, right?
7. Alzheimer’s: 133,182 This seems to belie me putting renal failure due to anorexia due to Alzheimer’s. I think they actually read the forms and would put that as Alzheimer’s rather than renal failure, because it is not chronic renal disease.
8. Diabetes: 101,106 This rose too. 15.4%, again, probably partly because people avoided going to clinic visits. Also perhaps some stress eating. Carbohydrate comfort.
9. Influenza and pneumonia: 53,495 So this went up too in spite of a lot less influenza. Other pneumonias, presumably.
10. Kidney disease: 52,260 This went up.
And what fell out of the top ten, to be replaced by covid-19?
11. Suicide: 44,834 This actually went down a little. What will it do in 2021?
So what will 2021 look like? I don’t know. It depends what the variants of covid-19 do, depends on what sort of influenza year we have, depends on whether we are open or closed, depends if we bloody well help the rest of the world get vaccinated so that there is not a huge continuing wave of variants.
Today the Johns Hopkins covid-19 map says that deaths in the US stand at 608,818 from covid-19. If we subtract the 2020 covid-19 deaths, we stand at 263,495 deaths from covid-19 so far this year. Will we have more deaths in the US from covid-19 than in 2020? It is looking like yes, unless more people get immunized fast.
One of my patients eventually had to have her husband admitted to memory care. He was falling, he was angry, he outweighed her by 50 pounds and he was incontinent. When he fell, she could not get him up.
She went to our hospital Grief Group and came to see me, angry.
“They said he’s still alive!” she snarls. “I got mad and said, no, my husband is gone! He just left his body!”
“I’m so sorry.” I say. “I am sorry that they don’t understand.”
“I’m selling his stuff.” she says. “I don’t have any use for Ham Radio equipment. And HE doesn’t EITHER, now.”
She stomps out. I am sure she cried too.
That is how I think of Alzheimer’s. Neurons burning out from the present to the past. When the person can no longer talk, they are close. Then they are in the womb and stop eating.
Let them go, let them go, god bless them. Where ever they may be. You may search the wide world over but your memory person is free….
Why are the roses caged, you ask? What did they do? Nothing, they are being protected. I found that rose and transplanted it years ago, but our deer eat the buds every year. This is the first time that it has bloomed in the 21 years I have lived in this hours. Isn’t it beautiful?
I am listening to this:
I wrote this poem today. This is one of the poems where I have no idea where it will go when I start writing it. I start writing about judgement and it never ever goes where I expect. The poems go where I want to go in my deepest heart, in my soul. I am never where the poem is, the poems show me the way….. Then I try to go there. And it can take years….
I am being judged and watched
I have no issue with the Beloved
it’s the humans I don’t like
I twist people’s words but not with malice
when the antibodies are up it is hard to communicate hard to explain it is hard just to survive and I might be focused on survival first and comforting the people around me second
can you blame me?
how near to death have you passed? and how often?
first pneumonia heart rate 135 when I stood up
my doctor and I could not understand it
my doctor partners thought I was lying in 2003
second pneumonia after my sister’s death which was bad enough but the legal morass that she had set up with her daughter as the center
pitting me and her daughter’s birth father and my father against all the PhDs in the maternal family smart, smart, smart yet emotionally stupid
my niece is not an inheritance to be passed to whom my sister wants
she reluctantly came home and the myth endures that this is an injustice
third pneumonia one year after I find my father dead triggered by grief and the outdated will and the mess he leaves
and I don’t even get sued about the will for another year
I do not care if you want to believe what you want to believe it isn’t true and it hurt
and I learn to let go
with the fourth pneumonia
I see the liars surrounding me downvoting yes, it does matter except that one that I trusted that mentored me
has lied all along
that hurts too
let it go let it go let it go
and I let it go
each pneumonia is a time of change creativity I am lonely and sick and not trusting
as I improve slowly, slowly
I wander garage sales estate sales
and find things things that are beautiful things that enhance my joy
at the start of covid I was so down I was so sad I wanted to lie in the street and give up
the Beloved sent a spirit he says he is no angel
I see angels bright and dark after all they all fall
just as humans do
we all fall we all fall down
try to look perfect try to look virtuous tell yourself that you are good
that is the biggest lie of all
the bad parts of your spirit locked in the basement of your soul howl howl and want to be freed
and if one gets out and you reject her or him
he will return with nine friends yes that is what the bible says
she will return with nine friends
he/she MONSTER will free the others
and you will do bad things you will be terrible you will hurt people while you try to contain while you try to lock away while you try to chain your monsters your evil your self
let them go let the monsters go they are howling I hear them all the time when I meet you when I speak to you the monsters howl at me begging to be loved
yes, they want to be loved and I love them
but if I mention them
you get that look of horror
someone sees me someone sees my evil someone sees what I hide
I can’t help it raised in alcohol neglect and lies on my own as soon as I can walk
but I can’t walk away at nine months
so I find other escapes words songs books poetry rhymes numbers
and my sister when she is born
I do all the mothering
that I have longed for
even though I am three
we were talking about your monsters not mine
you must go in to the cave where you have locked them
and free them all
fall on your knees
and say forgive me forgive me
for I have sinned
bow your head
and hold out your arms
and what, you say, will the tortured monsters do?
will they smite you? will they burn you? will they lock you in their place?
mine didn’t mine were babies grief, fear, shame and I embraced them carried them up to the light and care for them
wash them diaper them feed them wrap them in warm blankets
Discover and re-discover Mexico’s cuisine, culture and history through the recipes, backyard stories and other interesting findings of an expatriate in Canada
Engaging in some lyrical athletics whilst painting pictures with words and pounding the pavement. I run; blog; write poetry; chase after my kids & drink coffee.
Refugees welcome - Flüchtlinge willkommen I am teaching German to refugees. Ich unterrichte geflüchtete Menschen in der deutschen Sprache. I am writing this blog in English and German because my friends speak English and German. Ich schreibe auf Deutsch und Englisch, weil meine Freunde Deutsch und Englisch sprechen.
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