by

On vaccination: rock stubborn

A friend in his 30s was working on my car the other day. “Are you immunized?” I ask. “No.” he says. “I wish you’d get immunized,” I say, “Also, I can’t ride in the car with you because if I get the Delta variant, I’ll probably die.” He responds, “I hate doing what other people tell me to do.” “Oh,” I say, “Oppositional defiant, just like me. Fine. Don’t get the vaccine.”

Two days later I text. “Don’t get the vaccine today. Or tomorrow.”

I hear back. He got vaccinated the day I sent the text. I don’t know if it was me saying don’t do it, or me getting out of the car and staying a good ten feet away after that. Please don’t kill me, not today, ok?

Maybe we should try it nation wide. “DON’T GET VACCINATED. DON’T DO IT TODAY. OR TOMORROW.”

Unvaccinated thirty year olds are getting really sick and getting intubated and dying. One in five hospitals in the US now is 95% full, on divert. I used to heave a sigh of relief when I was in residency and we were on divert. That meant no admissions until beds opened back up. We are full. But one in five is really bad. Virginia Mason in Seattle is on divert. Our rural county has more covid infections than we’ve had the whole time, mostly unvaccinated. About 15% vaccinated. We are starting to see the breakthrough infections, around 8 months after the vaccine. Makes sense, because the vaccine riles up the immune system for 8 months and then quiets down. I am 8 months out, no immune system, high bleeping risk. The head of the heart lung bypass part of Virgina Mason was interviewed. “We have been full for ten months (?or a year) and have turned away over 150 patients.” So heart lung bypass could save lives in covid. But it takes round the clock two ICU nurses and the ICU nurses are burning out, quitting, dying. If they get too tired, their immune systems don’t work, they are more at risk for covid and they could die. The nurses and the doctors KNOW this. So…. how many unimmunized people are you willing to die for? Just curious.

Kids have been at home, quarantined, small groups. So then they started school or daycare or even a few more playdates and hello: when you get them together, they trade viruses. There is an outbreak of RSV and other viruses. RSV won’t kill most kids but some babies need the hospital and it can kill premies. And the beds, remember, are full.

Now the AAFP is calling for emergency authorization for kids age 2-11 to get the vaccine. Because they are dying too and there bloody won’t be room in the hospitals at this rate. Or well, you can build a tent, but if you don’t have any ICU nurses, the tent is not too helpful.

For the governors saying “No mask mandate at school,” yeah, well, I think they should refuse the vaccine and refuse treatment and refuse intubation and refuse oxygen.

Meanwhile, I am hiding under the bed. Roll up the sidewalks, lock the doors, I am sorry not to be useful but I am not useful dead. I could telemedicine if our area gets shorthanded enough. I suppose I should call the hospital and say that. They aren’t that desperate… yet. We have four ventilators last I checked. And 32,000 people in the county and we are the only hospital. Bummer.

I am in a physician mothers Facebook group. The stories are getting grimmer and grimmer. A physician put up the list of hospitals she called to try to transfer a patient: over 30. All no. Another is in North Carolina and got a call from Texas to transfer a patient. But… they were on divert. No.

Take care. Don’t get your immunization if you are against it. Whatever.

by

Swimmers

There were long distance swimmers out going parallel to the shore on my last beach walk. Four of them. Women, because voices carry over the water. Brrr, but wearing wet suits. Good for them, I’m jealous.

I had my big camera with the serious zoom. The swimmers would stop to talk.

swimmers in the sound at North Beach

They don’t look tired or cold or stressed, do they? They were ending their swim back at North Beach.

by

Fuzzy Poet Doctor and the small child

I think I finally understand what I have been doing in clinic all these years. And not just in clinic. As a theory it explains both why patients, nurses, hospital staff and specialists really really like me and my fellow Family Practice doctors, particularly the males, and the administrators, really really do NOT like me.

I am on a plane flying to Michigan a few weeks ago. Double masked. N95 with another mask over it. Sigh.

A friend keeps saying that he can see into me. He can, but he can see thoughts. Not feelings. I am wondering if I see feelings. But I see the stuffed feelings particularly, the ones that people keep hidden. They are like clouds.

And then I think, oh.

I automatically scan any new person for their small child. The inner small child, who is often damaged and hidden. The small child is hidden under those stuffed feelings, which I think of as monsters. In Ride Forth, I am writing about pulling every monster feeling that I can find stuffed out and letting myself feel them. And that people do not like seeing me like that. Their monsters attack me!

Except that the monsters don’t attack. The monsters come to me and say, “Please, please, help me. I want out. The small child needs to heal.” The monsters lie their monstrous heads in my lap and weep.

Now WHY would I develop this skill? That is weird.

I develop it because my parents both drink. The myth in the family is that it was my father. But my mother’s diaries and also her stories make it clear that she drank heavily too. I think they were both alcoholics. And she told two stories about me trying to get someone to get out of bed to give me food as a toddler. As jokes. But it is not a joke. I have food insecurity. At every meal, I think of the next one and whether there is food available. My daughter has it too….. epigenetics.

I think that the only way I could love my parents was to have compassion for them. Once you see another person’s damaged small child, then how can you not feel compassion for them?

With patients I learned to be very very delicate and gentle about asking about the cloud. Just gently. Sometimes people open up on the first visit. Sometimes they shut tight like a clam and I back off. Sometimes they return the next visit or the 3rd or the 8th or after a couple years… and say, “You asked me about this.”

It’s nonverbal communication. The reason why I take the WHOLE history MYSELF at the first visit is for the nonverbal communication. When the person doesn’t want to answer a question, veers away from a topic, switches subjects: there is my cloud. That is where the hurt is. That is where the pain is.

The first cracks in the United States medical system collapse are appearing. Not doctors quitting, not nurses, but medical assistants. Here is an article about how clinics all over can’t hire medical assistants. Because there are tons of jobs, employers are offering more money, why would you do a job where you may well be exposed to covid-19 if you can do something else? And make as much money or more….

The cracks will widen. Ironically doctors are doing what I have done for the last ten years: “rooming” the patients themselves. Ha, ha, good may come out of it, after the disaster. Which is getting worse fast. If people don’t put their masks on and don’t social distance and don’t get vaccinated, I predict more deaths in the US this winter then last winter. Sigh. And in the US we will run out of medical assistants, doctors and nurses.

It is ok to gently ask a patient about that cloud. It is not polite to “see” it in a Family Medicine colleague or and administrator. I can’t “not see” it. I can’t turn it off. However, on the plane my behavior changed even before I could put all of this into words. The words are that I have to be as gentle with everyone as I am with patients.

And the trip felt so odd. I was putting this into effect before I had words. That is how my intuition works. But everyone, absolutely everyone, was kind to me on the trip. A Chicago policeman helped me in the train station and was super kind. It was weird, weird, weird, with bells on. It took me a few more days to be able to put it into words.

Problem intuited, after 60 years of study. Implementation of solution proceeds immediately. Logical brain struggling to catch up, but results satisfactory long before logical brain gets a handle on it.

Pretty weird, eh? I think so. My doctor said that an episode of Big Bang Theory could be written just by following me around for a day. I think it was both saying that I am smart AND that I have no social skills. But I have implemented the social skills program already. She’s just upset that I gave her justifiable hell two visits ago and also…. I do hide my brain. Because sometimes colleagues are jealous.

But maybe they should not be jealous. Maybe they can learn it too. Maybe I can teach. Maybe….