March 26, 2020

Seattle’s Burke-Gilman Trail

And it’s time for number nine in Andy’s continuing saga of life in the time of the Corona Virus. For some reason, I’m hearing Revolution #9 from the White Album in the back of my mind as I’m writing this. For my younger readers, ask your parents… Maybe that was some sort of foreknowledge of events fifty plus years in the future. But enough with the Beatles references, time to plunge into thoughts of today.

The weather has been glorious the last few days so, after work, I have been taking some lengthy walks. My pedometer is happy and glowing green at my number of steps. I like walking. One of my thoughts about the new condo, assuming I ever get to move into it, is that it’s within walking distance of work and more days than not, I can leave the car at home. When I was in medical school, my apartment was about a mile away from campus and a straight shot on the Burke-Gilman trail so I would walk back and forth to class most days and it gave me about half an hour each way to totally clear my head and think about nothing. It was one of the things that helped me make it through medical school. Being a true Seattlite, rain never stopped me, but I did get a bit grumpy during my surgery rotation when I had to leave the house by 4 am to be in time to preround. I have a coffee cup somewhere that says ‘Not a morning person doesn’t even begin to cover it’. The hours were not the only issue on which surgeons and I did not see eye to eye.

I feel slightly like I’m in a state of suspended animation. The reality of the situation with the Covid virus still seems somewhat dreamlike in quality. Because I do not do inpatient work, I have not yet had to come face to face with it in any appreciable way. I know I will have to shortly. My aggressive social distancing is all about keeping myself healthy as a reserve unit so I can spell my colleagues in the hospital later. I hear stories through the usual channels. I have friends who have been diagnosed. I see the mounting statistics. I know what the numbers are for UAB and the Birmingham VA as part of briefings for the medical staff. Health professionals in this country, especially in smaller specialties like mine, are a tight knit group. We all have friends and colleagues all over the country who are telling us exactly what’s going on in New York, Los Angeles, New Orleans, Atlanta and so all of us are taking all of this very seriously, no matter our political leanings. The anger from colleagues at politicians who continue to downplay what we are facing and who do not take the tools we have to fight pandemic illness such as quarantine and social distancing seriously is palpable. We all know that many of us are going to get sick and some of us are going to die because of catastrophic societal and political failures far outside of our control and we want those sacrifices to have some sort of meaning beyond partisan tit for tat. The poem ‘In Flanders Fields’ keeps running through my mind.

A lot of you have reached out to me since I began writing these essays, wondering if I’m doing OK. I’m fine. I’m healthy, I have resources and my life experiences which include a lifetime in geriatric health care, two widowhoods, and surviving a previous viral pandemic have given me a strong and resilient psychic armor which allows me to deal with most crises with a certain level of equanimity. I’m also keenly aware of my own mortality and have been spending the last year or so putting life in order so if I should die prematurely, my family won’t have a huge mess to try and clean up. The last piece of the puzzle was the condo downsizing and I find it very inconsiderate of Covid 19 not to have held off for a few more months while that was finished up. I do appreciate the calls and the texts and such, especially in the evenings which are suddenly empty without rehearsals and performances and nights out to dinner with friends.

The Dance of Death on the old wooden bridge in Lucerne

I would much rather be writing another travel diary or something inoffensive about some silly societal trend but Covid 19 is what we are facing now. It’s real. It affects every one of us. No one is immune. The virus doesn’t care where you live, how much money you have, what your politics are, where you go to church, or what color your skin is. I was talking with a friend on the phone last night about the plague bridge in Lucerne and the moral of those paintings. Death and disease are implacable, cannot be reasoned with, and have no interest in human concerns. If you ever wanted to know what it was like to live in 14th century Europe, you’re finding out. I reread The Masque of the Red Death earlier this week. It’s a short story and easily finished up in half an hour. The wealthy and well connected, busy fleeing to Vail, Nantucket, The Hamptons, and other enclaves seem to be trying to recreate it. I haven’t read Camus’ The Plague yet but I think I ought to.

I posted a Washington Post article yesterday about decisions regarding DNR orders in the time of Covid 19. The article got some of its facts wrong when reporting on discussions at Northwestern in Chicago. While the article stated a blanket DNR order for Covid sufferers was on the table, this is in error. What is on the table, is an automatic DNR for those with Covid whose course suggests no hope of recovery and that those who wish to be resuscitated and have the possibility of surviving it will be coded, but only if staff have appropriate PPE on to prevent them from getting infected by blood and body fluids during the procedure. There’s a lot of misunderstanding about CPR and what it can and cannot do. It’s a medical procedure,like any other, although it can be administered by trained laypeople in the community. It was originally invented by the Norwegians to help fishermen who fell off boats in the North Sea and had cold water drownings in sub freezing ocean waters. In these young, healthy men with profound hypothermia as well as cardiac arrest, it was somewhat successful and it simply spread from this very specific use to general use in any sort of cardiac arrest.

Chance of survival by age – cardiac arrest

Currently, if you have sudden cardiac arrest outside of the hospital and you are found down and CPR is started, your chance of survival to leave the hospital is about 4%. If your arrest is witnessed and CPR is started right away, your chances double to about 10% (which is why we train the population. It does make a difference). if a defibrillator is available, and is applied within a couple of minutes, the chances go way up to about 35% which is why defibrillators are now so widespread. If you are in the hospital and arrest with trained medical personnel nearby, your chance of surviving a code blue is about 10% if you’re under 60 (even with the presence of a defibrillator – it’s so much lower because the population arresting in hospitals is so much sicker). It’s about 7% between 60-80 and it’s under 3% if you’re over 80. That’s surviving the procedure. Surviving and returning to baseline health is much, much lower. It doesn’t work anywhere near what the public, raised on a steady diet of television medical dramas, believes. Health care providers know this which is why most of them once they turn sixty or so make their advance directives DNR (Do not resuscitate).

We’re not very honest about death in our society. That’s particularly true of the Baby Boom generation who have spent decades declaring themselves forever young and immortal. Most of the Boom is now over sixty and in a few years, the elder boomers are going to be in their eighties. That’s just the way time works. This is one of the themes of the book I’ve been working on. Going to have to put it on hold until we see just what sort of an effect Corona Virus is going to have on the Boom physically and generationally in regards to their self perceptions. I get death. I’ve seen too much of it over the years. All the gay men of my generation did. And, when the acute phase of that pandemic was over, we came back stronger than ever and much more integrated into society. Here’s hoping that all of our experience with Corona Virus end up with some positive results on the other side. I’m optimistic about the human race. I think it will. I think we’re going to reprioritize what’s actually important in life and that those new priorities are going to launch a new creativity and a new worldview that we, with our inside the box ways of thinking, can’t yet imagine.

Stay well.

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