April 17, 2021

I’ve been exhausted this week. Tired to the point of forgetting to set my alarm yesterday and waking up twenty minutes after I should have been at work. I did prove that I can be in a patient room within fifteen minutes of opening my eyes in the morning and I was able to get my schedule back on track but I haven’t done anything like that in years. Usually, on the mornings when I don’t have to get up, I wake up within about twenty minutes of my usual alarm time and then, when I realize I can sleep in, I roll over and go back to sleep for a while longer. The weariness this week, however, has been bone deep. I figure it’s due to the one two punch of Pirates of Penzance being over and having finished the book and gotten it out to my first group of beta readers. I have little on my schedule the next few weeks other than usual work things so I’m going to listen to my body and try to unwind.


We passed three million Covid deaths world wide this weekend. The US total continues to inch up as well and is now at 567,000. It’s not racing upwards as badly as it could, likely because new cases are more likely to occur in healthier and younger individuals, older populations being more likely to have received vaccines at this point, but it’s still on the upswing. It wouldn’t be so bad if the US character regarding health care weren’t out in full force. We’ve more or less decided as a society to allow the vaccine to do all the heavy lifting for us so we can all get back to our usual lives. And the current administration has done a phenomenal job of getting the vaccine out. Half of US adults have now had at least one dose and somewhere between three and five million jabs are happening daily.


US culture has always had a quick fix mentality when it comes to health care. People come to us, as healers, expecting a pill or a shot will take care of whatever ails them. While this may be true of common infectious diseases of the young, it’s certainly not true of the disease processes of aging and body neglect such as diabetes or atherosclerosis. Successful treatment of these generally requires lifestyle modification, prudence and moderation in regards to such things as diet, exercise, and sleep, and a willingness to partner with us for the long haul. Most Americans have difficulties with these concepts. Successful primary care physicians, like myself, have to figure out where the boundaries are between what we can control and help with and what are the responsibilities of patients and their family systems. Those who don’t negotiate that tightrope successfully generally don’t do well with ambulatory care. It’s difficult and most doctors who work with inpatients have, at best, a limited understanding of it. Unfortunately, it’s the inpatient docs that have political clout and the ear of administration.


It takes roughly six weeks from the first shot, no matter which version you get, until you develop full immunity. (Shot one, then shot two three or four weeks later, then two more weeks until full immunity develops for Pfizer and Moderna – Six weeks after the single shot for Johnson and Johnson). Six weeks ago, we were in early March and vaccine was just beginning to become more widely available after having been reserved for health care workers and at risk seniors. The people given vaccine the first week of March have only just become fully immune. Everyone who has received them after that isn’t there yet and we’ve only really opened up the vaccine lines to all comers in the last week or so. We’re not going to have significant population immunity until Memorial Day. This is why it’s so important to continue to wear masks indoors with other people and keep up the social distancing. We’ve still got a ways to go.


The vaccine isn’t 100% effective. There have been roughly 5,800 covid cases in the US in individuals who were previously vaccinated. When you divide that out over the 125 million of us who have been shot up so far, that’s a very small number. The majority of the cases have been mild but 78 of those 5,800 died of the disease. Don’t let all those good habits built up over the last year go to waste yet. It’s going to take a combination of the vaccine and proper social behavior to restore things back to a semblance of normal, not just vaccine alone. There are very few quick fixes in medicine outside of antibiotics and some surgeries.
Sometimes, though, the fixes are unique and idiosyncratic and dependent on the individual. I learned long ago never to argue with success when it came to my patients. Some years ago, an elderly man came to see me. He had an obvious dementia to which he and his family were somewhat oblivious (even when the family had taken him for his drivers license renewal and the examiners insisted on a road test and the first thing he did was drive the car into the dumpster, none of them was willing to admit that perhaps his mentation had changed in his ninety years). When I asked him why he had come to see me, he told me it was because someone had replaced his nose with a metal valve and he was afraid that when he slept at night, someone was going to close it off and then he would die. I sympathized with his plight and asked him how he might prevent that. ‘Oh, I have a sure fire way’ he said. ‘Before I go to bed, I wrap a plastic bag around my head and then rubber band a washcloth over that. Then I put two scoops of vanilla ice cream on the washcloth, put on a stocking cap and go to bed. Works like a charm’. I was a bit taken aback – the only follow up question I could think of to ask was ‘Does it have to be vanilla? Will other flavors work as well?’. He was so pleased with himself, that I let him and his family work all of that out… including the laundry.


Today was Prince Philip’s funeral; he missed completing his hundredth year by only a few months. Her Majesty looked very small and frail and alone. I expect her to go on for a few more years but its likely that her public schedule will be greatly reduced. My cousins, the Earl of Snowdon and Lady Sarah Chatto were amongst the cortege, looking decidedly middle aged. I guess that means none of us is young anymore. I wonder what will happen when the Queen dies? She’s been on the throne for nearly 70 years. Few are left with adult memories of life under any other monarch. I expect the institution of the monarchy will survive. It’s one of the things that makes Britain Britain.

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