Covid-19: working in healthcare

So, should healthcare workers be required to have Covid-19 vaccines?

Yes.

What is the precedent?

Take tuberculosis, for example. Airborne, very contagious. I was born in a Knoxville, Tennessee tuberculosis sanatorium, because my mother coughed blood a month before she was due and got quarantined for active tuberculosis. Yes, the state could quarantine my mother. I was removed immediately at birth because tuberculosis doesn’t cross the placenta. The antibodies do, but the infection doesn’t. However, newborns usually catch it and die very quickly. I was lucky. My father and grandparents took care of me for 5 months. Then my mother was allowed out (after 6 months total) but was not strong enough to take care of me. So I was taken to my maternal grandparents for the next four months, and did not touch my mother until I was 9 months old.

My mother was taking 36 pills a day at home, because you have to use multiple drugs to kill tuberculosis. It develops drug resistance very very quickly.

Well, so what, you say?

Healthcare workers in the United States are routinely checked with a ppd for tuberculosis. If it is positive, you cannot work until further testing. If you have latent tuberculosis, you are treated. If you have active tuberculosis, the treatment is longer and more complicated, here: https://www.cdc.gov/tb/topic/infectioncontrol/default.htm

My cousin then said, “Well, you don’t have to show the tuberculosis test to go in a restaurant!”

Well, not right NOW, because currently tuberculosis is under more or less reasonable control in the US. Remember that guy who came in to the US with active multi drug resistant tuberculosis and knowingly exposed everyone on that airplane? Great. I remember reading about that and thinking what a selfish jerk he was. And then the group of unimmunized people who went to India and all got measles. The US at that time did not bar anyone from returning, but asked them to finish a 3 week quarentine before returning to the US. One person did not do that. There was a measles outbreak in the midwest which cost the CDC (and therefore you and me because those is tax dollars) millions to trace, quarantine and clean up. So there was discussion at that time about whether the policy should be changed and we should not allow US citizens with known infectious diseases to come in on airplanes. We DON’T allow immigrants in with infectious diseases: they are tested for tuberculosis if coming from countries where it is endemic.

So, if we had a huge outbreak of tuberculosis, we WOULD have quarantines and shut downs.

I have tested a patient for tuberculosis, about two years ago. Her son had been diagnosed with active tuberculosis. We tested her with a blood test and then repeated it in three months. Negative, hooray. In residency I also saw a case of miliary tuberculosis. That is where the tuberculosis is growing so well in the lungs that it looks like little grains of rice in the lungs on imaging. Not a good thing.

My cousin: “You shouldn’t have to put something in your body to work.”

If you have tuberculosis, you do not get to work in healthcare, because you can kill your patients. I think that this is a good thing, to not kill our patients.

I am submitting this to the Ragtag Daily Prompt: starspangled. Keep America Healthy, how about that?

Pull saw work

I need to work on my tree house.

The tree has grown. The walls of the treehouse are digging in to the bark in places.

I looked for my pull saw, but haven’t found it yet. I did find three saws. I did some trimming last night, but I was pretty tired and up a tree and didn’t take my oxygen up. I would saw a little bit then get short of breath and stop. The pull saw would be a much better tool for the job than the crosscut.

I have a swiss army knife with a saw and one of those emergency kit saw wires, that probably would make me swear if I tried to use it.

Now, where did I put the pull saw?

for a while

I am as happy as I am going to be
for a while

missing you

I’ve let you go
you know

I resisted
disbelief for a day
two days
three days

you were so loving
acted loving
more loving than anyone ever before

and gone
angel to demon
fallen
daily talk
to none

you have decided
to be a hermit
free
to do what you want

I let you go
and with my blessings

I want you to be happy

I am as happy as I am going to be
for a while

missing you

heart of clay

I look for a broken heart on the beach. I nearly miss it, but here it is. I nearly miss it because it is so large. A clay heart, broken all the way through.

Here is a stealthie with my foot for scale.

Shoe selfie for scale, at the base of the broken clay heart.

Part of the cliff has recently collapsed. The heart must have broken during the slide. It will wash away in pieces now. Here is the cliff and you can see the scar of the slide. And the broken heart.

broken clay heart in the wall of the cliff, with the scar of a slide collapse

I tried walking the beach without oxygen. I did pick up rocks. I took a pulse oximeter with me. Carrying maybe three pounds of rocks, my oxygen saturations drop. Not well yet. 87 or below is not ok. It feels awful and exhausting too. Like being at a high altitude and not used to it. A pulse of 130 also does not feel great, normal being 70-100.

Pulse oximeter, with pulse 130 and oxygen saturation 87.

Thank goodness for the oxygen and the tanks that let me be mobile. Blessings and take care of your heart.

Oxygen testing

“If oxygen might help with chronic fatigue, as it has helped you,” a friend asks, “how do I get on oxygen?”

Complicated answer.

First of all, one of the things that is not clear, is what recovery looks like. I think I’ve had low grade chronic fatigue for the last 7 years compared to my “normal”. Now, will I get off oxygen? I don’t know. I am hoping for September but it may be that 7 years of low grade hypoxia means I have lung damage and no, I won’t get totally off oxygen.

They have apparently recently made the guidelines for oxygen more stringent. I sort of missed that update, even though I just recertified in Advanced Cardiac Life Support. You now have to have an oxygen saturation that goes to 87% or below. It used to be 88.

Now, you can test this at home with a pulse oximeter. In 2005 after the influenza, I held my saturations but my heart rate would go up to 135. Which means that I walked across the room very very slowly because a heart rate of 135 sustained does not feel good at all. Normal is 70-100 beats per minute. You can measure pulse with just a second hand, number of beats in a minute. For oxygen saturation, you need the pulse ox and it will measure both heart rate and oxygen saturation.

So: measure pulse and saturation at rest first. Write them down.
Then walk. I usually send patients up and down the hall three times then sit them down and watch the pulse ox. In some, the heart rate jumps up. If it’s over 100 and they are getting over pneumonia, I don’t want them back at work until it is staying under 100. Or if sitting they are at a pulse of 60 and then walking it’s 95, well, I think that person needs to convalesce for a while yet. They can test at home.

As the heart rate returns to the baseline, the oxygen level will often start to drop. Does it drop to 87? Describe the test to the doctor and make sure the respiratory technician does it that way and also they should do pulmonary function tests. Mine were not normal.

Now, what if the oxygen doesn’t drop to 87? We are not done yet. What does the person do for work or do they have a toddler? If they have a toddler do the same test carrying the toddler: they sit down, exhausted and grey and this time the oxygen level drops below 87. If they do not have a toddler, do the test with two bags of groceries. Or four bricks.

When I did the formal test, the respiratory therapist said, “Let’s have you put your things down so you don’t have to carry so much.”

“I’d rather not.” I said, “I want to be able to walk on the beach, so I need the two small oxygen tanks, my bird book, camera, binoculars and something to eat.”

“Oh, ok,” she said.

So I did the test with two full tanks of oxygen, small ones, and my bird book and etc. I dropped like a rock loaded. I think I would have dropped not loaded but perhaps not as definitively. Still hurts to carry anything, even one tank of oxygen.

We are making a mistake medically when we test people without having them carry the groceries, the toddler, the oxygen tank. My father’s concentrator is pre 2013. It weighs nearly 30 pounds. Now they make ones that weight 5 pounds. Huge massive difference.

Good luck.

long white gloves and an oxygen tank

I am invited to a Sinatra party, formal dress.

Let’s see. I have a sprained left shin. I fell on Monday, walking around a piece of property trying to find out if it had two streams. It doesn’t. It has one, three feet deep and over 18 inches wide. Who cares? Well, if it’s over 18 inches wide, it’s a salmon stream and to build a house you have to be 150 feet away. Which means you can’t because it cuts diagonally right through the property. Darn. I did not fall in the stream. I fell into a nice hole by a tree and rolled my left ankle a little. My ankles are pretty strong from dancing. It seemed fine.

So the next day I hike the beach twice, with my daughter and then B, maybe 6 miles. I am tired of hiking boots and try the toe shoes instead. “You have toe SOCKS?” said my minimalist daughter. “Of course,” I said, “Otherwise they are uncomfortable.”

Ankle is fine.

Next day I end up moving furniture. Ankle is a little sore.

Next day I hike a couple miles of beach in the morning and then a friend from Portland and I do the spit. We get to within a mile of the lighthouse, which means we hike 5-6 miles out on sand. It is gorgeous. I am limping on both feet by the time we get back, but left shin is worse. It’s really dumb to hike 14 miles in shoes that you have only worn once in the last year. I elevate my ankle once in the car.

View from North Beach

The NEXT day B and I are on a jaunt. My ankle now makes it known that it is NOT HAPPY with me. We stop at the store for fud, as my son calls it, and I get an ace wrap and wrap it. Later we pay $1.00 at a Fast Food Joint for a cup of ice water and I ice it. At his park unit he mows and I limp along the river until I am in the sun. Later we hike Rialto Beach. I wore my hiking boots. My ankle is not appeased.

Now we are at yesterday. I have tickets to the Sweet Honey in the Rock on line concert. At noon. Junteenth. Ooops, no, at 3 pm. Ooops, no, on the west coast at 5 pm. Then I can’t make the stupid ticket work. I am really really frustrated. Well. I send them emails, try to get a new password, I have the ticket number. I keep getting a 503 server OVERWHELMED. Dang. I give up after an hour.

But I am invited to a Sinatra Solstice Juneteenth Bash, formal dress up. In my town that means wearing anything you can think of. I put on a gray dress, sleeveless but it has little gray flowers with silver gray pearls in the middle, all over the front. I have above the elbow white gloves. My ankle has a snug wrap and I put on dark gray hose and silver shoes with a 1.5 inch heel. I won’t dance, too hard on the ankle. I have acquired a set of gray pearlish beads which is so long that if I do not wrap it around twice it reaches to my knees. Mysteriously enough, it has a clasp. Why does it have a clasp? So some giant can put it around their neck? I complete the outfit with lipstick and my oxygen tank. The tanks are lighter than the concentrator, though bulkier. They are slightly bigger around than a tall oxygen tank but are light. I change the tank before I go. A full one lasts about 3-4 hours.

It is an outdoor party, there is tons of yummy food and there is wine and mead but no beer. I brought one beer along with my contribution, so I nurse my one beer… and dance. My ankle does not like this, but the music is so fun. Our host sings sets intermittently and then there is a DJ. The above the elbow white gloves are very fun to wear dancing and I have to try not to whack people when I spin with the awkward oxygen tank.

One gentleman thanks me for dancing. He says I am having so much fun that he’s having fun just watching. Cool. I LOVE to dance. One woman says something about wanting to pick one of the gray flowers off my dress, and I say dramatically, “No, I shall not be deflowered!” A line that one cannot use often… People have wonderful costumes and feathers and gloves and hats. It is fun just seeing what people are wearing. People were asked to come only if vaccinated and I am mostly distanced. I mostly dance alone, but have a couple of dances with guys. It’s a bit tricky to spin without whacking them with the tank. Tank girl, heh, heh.

At last I get home. I got to the party at 6 and it is not dark when I get home. Maybe 8 or 8:30? I lie down on the bed with an ice pack, propping my pissed off shin up on a pillow, just for a few minutes. Crash and wake up three or four hours later with the light still on. I turn out the lights, move the ice pack and go back to sleep.

Long white gloves and an oxygen tank. I am so grateful for the oxygen. I feel better than I have in the last seven years….

….and today I might just rest the ankle.

Here is one of my favorite Sweet Honey in the Rock songs:

Sweet Honey in the Rock “breaths”

Happy Father’s Day. My father died in 2013, emphysema from unfiltered Camel cigarettes. Damn cigarettes. I miss him.

Sweet Honey in the Rock: Let There Be Peace

outfits inappropriate for work 3

Ok, maybe it is not inappropriate for work. But it would be a little weird for work… I was going in the woods with my oxygen tank. “Local doctor of 21 years found eaten by cougar, which then died because it couldn’t digest the oxygen tank.” Heh.

Listening to this, fabulous!!!

outfits inappropriate for work 2

When pneumonia nearly takes me out, I want COLOR. I think I managed it with this. The skirt is not only silly, but a little short for me to wear to work….