November 2, 2020

Tomorrow we’ll be far away

Tomorrow is the judgement day

Tomorrow we’ll discover

What our God in Heaven has in store

One more dawn

One more day

One day more

All the theater people who read these little essays of mine are busy singing that particular quote in their heads, if not aloud, frightening the neighbors, nearby pets, and passers by out on the street. All I can say about tomorrow is that I have done what I personally can do about the current state of the country and, as of tomorrow, we will have the government that we deserve as a people. Our current government has made it abundantly clear what they stand for over the last four years and if we choose to retain it, we will all be responsible for the consequences. If we choose to change it, we will all be responsible for forging a new path. I plan on taking a news/social media hiatus tomorrow evening and curling up with a good book. I’ll know the outcome soon enough and will live with the results like everyone else.

So where are we with the accidental plague diaries? Tired. Cases are increasing again locally and in the hospital. I’ve had three long term patients test positive since Friday. They are all, so far, doing well, but with the age and general physiologic condition of my folks, they are not out of the woods by a long shot. Despite the ominous signs, Alabama is doing better than a number of other places around the country. A quick skim of the headlines on my newsfeeds this morning revealed a lack of ICU beds in the midwest, the need for a fourth mobile morgue unit in El Paso, and a study tracing roughly 30,000 cases over the last month to infections spread by the President’s rallies. Someone was complaining today about how the virus keeps changing making it difficult to know how to react. This is fallacious. Viruses do not change their behavior. They don’t have central nervous systems, brains, emotion, reasoning, or anything else we might wish to anthropomorphize them with. What changes is our behavior and that is what determines how and where the virus can spread.

The significant uptick in cases over the last couple of weeks probably relates to back to school behavior, Covid fatigue which leads to people relaxing their guard and being more likely to head off to a restaurant or a small informal party, and colder weather starting to push more people indoors. These are all trends that started some weeks ago and it takes a while for the change in behavior to lead to a rise in cases. The rise in hospitalizations comes next. We’re already seeing it in some places and I am really worried about where we may end up over the next few months. We’ve got the equipment and the hospital beds. We’re running out of staff. There’s 168 hours in a week which means you need four full time shifts of workers to staff acute care beds. As nurses and other staff are getting burnt out, sick themselves, or are otherwise not able to handle the rigors of Covid related hospital and ICU work, we’re going to run out of bodies to keep the system going. Nurse staffing companies are offering huge bonuses to travel RNs at the moment due to demand (causing some regular hospital RNs to quit their jobs for the better dollars of the travel/PRN life) but even these inducements aren’t going to work forever. In the past, we imported a lot of nurses but the current administration’s crackdown on immigration plus Covid related travel restrictions are going to keep that from being a solution. 1700 health care providers dead so far. And the chief cause of death among active duty peace officers this year – you guessed it – Covid 19, not guns.

Number of geriatricians produced per year 1995-2010. Couldn’t find the data for the last decade

My little corner of health care is pretty stable at the moment but I have to wonder sometimes for how long. We’ve been trying to find some new geriatrics faculty for years but have had little luck. It’s a deeply unpopular specialty among American medical school graduates as it’s non-procedure oriented and not especially lucrative. It does not lend itself to being taught and understood in the standard four week rotation given to medical students and residents as the specialty is longitudinal and it requires months or years to understand how interventions actually work with patients and families. It requires a lot of creative, right brain thinking which physicians, selected for their ability to analyze and work with scientific rigor, feel very uncomfortable with. Doctors want answers. There aren’t a lot of them in geriatric medicine and you have to be able to look patients and families squarely in the eye sometimes and say ‘There is no science on this subject’ or ‘We have no data about this’ or simply ‘I don’t know’. I think the late fall, early winter are going to be hellacious when it comes to Covid cases. I just hope it’s not so bad that the health care system starts to fail in any appreciable ways. I think it may do so in certain localities where the number of ill people simply overwhelm the ability of the system to cope. I think we’ve got enough resources and resilience locally that it won’t be us but one never knows, does one. The one saving grace is that the protective behaviors against Covid will also be protective against other viral respiratory illnesses including flu so hopefully it will be a light flu season.

After much discussion, my family has canceled our usual Thanksgiving gathering. Too risky with octogenarian seniors, college students coming home from school and bringing buddies with them, travel exposures and the like. I am still going to go to Seattle in late November to see the family but probably after the holiday rush. My father’s 88th birthday is the Tuesday after Thanksgiving and so I will make that the centerpiece of my trip, that way I can travel on less crowded days making it safer for me and for him. We are having a family zoom on Thanksgiving night. I don’t know what I’ll do for dinner yet. I’m not wedded to Turkey. Steve and I, on our first Thanksgiving together more than thirty years ago, had Lasagna at a Swiss Restaurant in Mexico City so maybe it should be Lasagna in commemoration. I have a few weeks to think about it.

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