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ADBOT LOVES YOU
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Apr 18, 2024 03:11
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- Solarin
- Nov 15, 2007
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https://twitter.com/KevinMKruse/status/1242543848645177346
How many of those jobs provide 100% coverage for all health related costs that arise from getting sick working in a pandemic + remuneration high enough to pay for the risks involved in going out and also give a 100% guarantee that the highest level of healthcare will be reserved for them for working on the frontline?
also how many will exist in 4-6 weeks once the panic buying winds down because people have no money left
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Mar 25, 2020 02:04
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- MadJackal
- Apr 30, 2004
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Day 3.
Code Blue right off the bat at 7:35. COVID in the ICU, transferred an hour earlier from another maxed hospital. From the chart: 67F with DM2, CAD, HTN. 5 days of cough and body aches, a little short of breath. She was seen by an ED physician just after midnight two days ago. Within 8 hours she had crashed and required intubation. Multifocal pneumonia with positive COVID. Officially admitted to that ICU 24 hours later. Transferred to our ICU 24 hours after that, and 1 hour later her Discharge Note for the Expired Patient was written.
She marks the first COVID patient I’ve seen die.
The anxiety I felt a couple days ago isn’t so bad now. It’s clear there was no avoiding this mass casualty event. Now there’s just work to do.
The thing about intubating a COVID case is it’s a high risk droplet bomb going off around the guys and gals most needed right now: intensivists, anesthesiologists and those badass ICU nurses who are all needed to tube people whose lungs are filling up with fluid. Hospitalists might be able to pick up the slack, but they haven’t the same muscle memory.
So as I’m watching this woman die in her closed glass box of an ICU room, a grizzled doctor with the swagger of an old intensivist says to no one in particular, “Is that a confirmed positive? Not going anywhere NEAR there!”
A nurse over to my left says, “We shouldn’t have to Code cases like this.” And it’s not with the same tone as “This is pointless,” it’s “This puts us in danger for nothing.” I stay out of the room, the extra manpower of one extra resident won’t be worth the PPE for chest compressions. But my chief resident is in there.
He’s a good guy; hope he doesn’t get sick.
(As I write this, I get a call that one of my patients has died. Non-COVID, was in denial about her metastatic cancer, COPD, CHF progressively worse shortness of breath but still wanted to be intubated. She got her wish and died within an hour or two still.)
Then a Rapid Response at 7:56. Then a Rapid Response at 8:01. Then a Rapid Response at 10:30. That last one was for the patient I just mentioned who passed, we put her on BIPAP and loaded her up with Lasix. Then a Rapid Response again at 12:30, again for my patient, watched the intubation occur. There was a minor discussion of where to put her, since the ICU and CCU were full. We’re in the process of transitioning the SICU into another ventilator bay.
Lunch arrives sometime after 13:00. Here’s one silver lining to all this: the community has gone out of its way to shower us with food. My lunches and dinners (residents know to always raid the hospitalists’ office and grab a plate before heading home to crash) have been Mediterranean chicken kebobs on Sunday, chicken piccata on Monday, and pizza today. It genuinely raises moral.
Another Rapid as I’m talking to some other residents and wolfing down a slice. Most of these Rapids have been for non-COVID cases. The ones that are about COVID cases turn into intubation events.
I was wrong yesterday when I predicted we’d become a majority COVID case hospital in 2 days. We crossed the 51% threshold today.
I was naïve when I thought I could volunteer for the resident-run COVID wing so that one less of my fellow residents would be put at risk. We’re all at risk. So now we have 3 residents and an outpatient attending looking over 10 confirmed COVID cases.
My census of 13 today has 5 confirmed and 1 suspected COVID patients. I wish we could make these cases voluntary, but all we can do now is limit exposure and spread out the cases somewhat.
I get a call that our 87 year old COVID patient is desatting on 6L supplemental O2 via nasal canula. So we put her on a non-rebreather. I get a call that she’s desatting down to the mid-80s when talking in long sentences despite the 100% oxygen she’s receiving via mask. The nurse is spooked, and the current plan is to do a Full Code should she tank. So the patient and I get to have The Talk.
The Talk is basically asking people if they want to receive (often futile) CPR that cracks their ribs as they die, or if they would prefer to be attached to machines when they die. But I don’t put it like that. I say things like “chest compressions” and “a plastic tube down your throat” but made it clear that if she were to be sedated for the intubation, she may never wake up. And despite our plans and treatments, her body is taking actions that will most likely (but we can never say guaranteed) going to end her life. Not today, but it’s a good time to put things in order.
The patient said her daughters want everything to be done for her, but she doesn’t want to be on machines when she dies. I said that was reasonable. She asked me what I would do, and what I would want for my mother.
I’m not proud of this next part.
I told the truth. I said that my mom and I have worked in medicine, and she would never want to be intubated if it was a long shot she’d ever recover. I told her I recently only rescinded my own Do Not Intubate order because were I to get COVID and need intubation, I’m a young, healthy guy who could survive it. But were I hit by a truck and braindead, I’d never want to be intubated. She said she’d call her daughter back and explain things.
I get a call later saying this very sharp 87 year old lady has signed the form declaring her Do Not Resuscitate / Do Not Intubate.
Intubation would have been the wrong choice here, I believe that. And I only told the truth (which I usually avoid by saying things like “it’s not for me to make you decide either way.”)
I helped the patient make her personal wishes count at the end of her life so she could die on her terms.
But, in the back of my head, I was also thinking I saved the nurses from having to witness a pointless and traumatic CPR and I saved one likely-inevitable ICU bed and a ventilator.
…
I don’t feel like writing anymore today.
MadJackal fucked around with this message at 02:08 on Mar 25, 2020
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Mar 25, 2020 02:05
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- Xaris
- Jul 25, 2006
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Lucky there's a family guy
Lucky there's a man who positively can do
All the things that make us
Laugh and cry
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loving loving the stories about how medical staff not being allowed to wear masks at hospitals. Slam this horror show psychotic poo poo right into my veins. We need to be writing the history books that future generations will look back on with confusion.
lol you think there's going to be future generations and that they'll have time to read history books instead of slaving away in the megadrought for half a potato
*there probably will be 2100 is going to be loving wild, and not even close in a good way, and im glad i wont be alive for it
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Mar 25, 2020 02:05
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- TwoStepBoog
- Apr 12, 2008
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employer just sent me a letter of safe passing
guess they know more than me
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Mar 25, 2020 02:05
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- Xaris
- Jul 25, 2006
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Lucky there's a family guy
Lucky there's a man who positively can do
All the things that make us
Laugh and cry
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Day 3.
I don’t feel like writing anymore today.
drat. it's going to be getting much worse over the next month and this is still early. it's sad we pretty much all called this back in jan 20th when the thread first started and it's playing out exactly as predicted and could have been avoided but NUMBER must go UP. goondolences
you're doing good work, moreso than any other goon, and i wish you well. let us know if there's anything we can do for you (probably not). has it mostly been older cases so far?
Xaris fucked around with this message at 02:17 on Mar 25, 2020
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Mar 25, 2020 02:09
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- pnumoman
- Sep 26, 2008
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I never get the last word, and it makes me very sad.
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Day 3.
Code Blue right off the bat at 7:35. COVID in the ICU, transferred an hour earlier from another maxed hospital. From the chart: 67F with DM2, CAD, HTN. 5 days of cough and body aches, a little short of breath. She was seen by an ED physician just after midnight two days ago. Within 8 hours she had crashed and required intubation. Multifocal pneumonia with positive COVID. Officially admitted to that ICU 24 hours later. Transferred to our ICU 24 hours after that, and 1 hour later her Discharge Note for the Expired Patient was written.
She marks the first COVID patient I’ve seen die.
The anxiety I felt a couple days ago isn’t so bad now. It’s clear there was no avoiding this mass casualty event. Now there’s just work to do.
The thing about intubating a COVID case is it’s a high risk droplet bomb going off around the guys and gals most needed right now: intensivists, anesthesiologists and those badass ICU nurses who are all needed to tube people whose lungs are filling up with fluid. Hospitalists might be able to pick up the slack, but they haven’t the same muscle memory.
So as I’m watching this woman die in her closed glass box of an ICU room, a grizzled doctor with the swagger of an old intensivist says to no one in particular, “Is that a confirmed positive? Not going anywhere NEAR there!”
A nurse over to my left says, “We shouldn’t have to Code cases like this.” And it’s not with the same tone as “This is pointless,” it’s “This puts us in danger for nothing.” I stay out of the room, the extra manpower of one extra resident won’t be worth the PPE for chest compressions. But my chief resident is in there.
He’s a good guy; hope he doesn’t get sick.
(As I write this, I get a call that one of my patients has died. Non-COVID, was in denial about her metastatic cancer, COPD, CHF progressively worse shortness of breath but still wanted to be intubated. She got her wish and died within an hour or two still.)
Then a Rapid Response at 7:56. Then a Rapid Response at 8:01. Then a Rapid Response at 10:30. That last one was for the patient I just mentioned who passed, we put her on BIPAP and loaded her up with Lasix. Then a Rapid Response again at 12:30, again for my patient, watched the intubation occur. There was a minor discussion of where to put her, since the ICU and CCU were full. We’re in the process of transitioning the SICU into another ventilator bay.
Lunch arrives sometime after 13:00. Here’s one silver lining to all this: the community has gone out of its way to shower us with food. My lunches and dinners (residents know to always raid the hospitalists’ office and grab a plate before heading home to crash) have been Mediterranean chicken kebobs on Sunday, chicken piccata on Monday, and pizza today. It genuinely raises moral.
Another Rapid as I’m talking to some other residents and wolfing down a slice. Most of these Rapids have been for non-COVID cases. The ones that are about COVID cases turn into intubation events.
I was wrong yesterday when I predicted we’d become a majority COVID case hospital in 2 days. We crossed the 51% threshold today.
I was naïve when I thought I could volunteer for the resident-run COVID wing so that one less of my fellow residents would be put at risk. We’re all at risk. So now we have 3 residents and an outpatient attending looking over 10 confirmed COVID cases.
My census of 13 today has 5 confirmed and 1 suspected COVID patients. I wish we could make these cases voluntary, but all we can do now is limit exposure and spread out the cases somewhat.
I get a call that our 87 year old COVID patient is desatting on 6L supplemental O2 via nasal canula. So we put her on a non-rebreather. I get a call that she’s desatting down to the mid-80s when talking in long sentences despite the 100% oxygen she’s receiving via mask. The nurse is spooked, and the current plan is to do a Full Code should she tank. So the patient and I get to have The Talk.
The Talk is basically asking people if they want to receive (often futile) CPR that cracks their ribs as they die, or if they would prefer to be attached to machines when they die. But I don’t put it like that. I say things like “chest compressions” and “a plastic tube down your throat” but made it clear that if she were to be sedated for the intubation, she may never wake up. And despite our plans and treatments, her body is taking actions that will most likely (but we can never say guaranteed) going to end her life. Not today, but it’s a good time to put things in order.
The patient said her daughters want everything to be done for her, but she doesn’t want to be on machines when she dies. I said that was reasonable. She asked me what I would do, and what I would want for my mother.
I’m not proud of this next part.
I told the truth. I said that my mom and I have worked in medicine, and she would never want to be intubated if it was a long shot she’d ever recover. I told her I recently only rescinded my own Do Not Intubate order because were I to get COVID and need intubation, I’m a young, healthy guy who could survive it. But were I hit by a truck and braindead, I’d never want to be intubated. She said she’d call her daughter back and explain things.
I get a call later saying this very sharp 87 year old lady has signed the form declaring her Do Not Resuscitate / Do Not Intubate.
Intubation would have been the wrong choice here, I believe that. And I only told the truth (which I usually avoid by saying things like “it’s not for me to make you decide either way.”)
I helped the patient make her personal wishes count at the end of her life so she could die on her terms.
But, in the back of my head, I was also thinking I saved the nurses from having to witness a pointless and traumatic CPR and I saved one likely-inevitable ICU bed and a ventilator.
…
I don’t feel like writing anymore today.
gently caress. Stay safe AND sane, frontline med goon. Godspeed and good luck
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Mar 25, 2020 02:10
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- Bert Roberge
- Nov 28, 2003
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cool graph, does she have one for a country with a lovely health care system where 100 million people are underinsured and don't see a doctor unless they're dying? how about for a country that responded a month too late and then quarter-assed it?
Did you read the graph correctly? Ann Coulter didn't.
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Mar 25, 2020 02:10
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- Stereotype
- Apr 24, 2010
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College Slice
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you're a hero
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Mar 25, 2020 02:11
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- Inceltown
- Aug 6, 2019
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Day 3.
Code Blue right off the bat at 7:35. COVID in the ICU, transferred an hour earlier from another maxed hospital. From the chart: 67F with DM2, CAD, HTN. 5 days of cough and body aches, a little short of breath. She was seen by an ED physician just after midnight two days ago. Within 8 hours she had crashed and required intubation. Multifocal pneumonia with positive COVID. Officially admitted to that ICU 24 hours later. Transferred to our ICU 24 hours after that, and 1 hour later her Discharge Note for the Expired Patient was written.
She marks the first COVID patient I’ve seen die.
The anxiety I felt a couple days ago isn’t so bad now. It’s clear there was no avoiding this mass casualty event. Now there’s just work to do.
The thing about intubating a COVID case is it’s a high risk droplet bomb going off around the guys and gals most needed right now: intensivists, anesthesiologists and those badass ICU nurses who are all needed to tube people whose lungs are filling up with fluid. Hospitalists might be able to pick up the slack, but they haven’t the same muscle memory.
So as I’m watching this woman die in her closed glass box of an ICU room, a grizzled doctor with the swagger of an old intensivist says to no one in particular, “Is that a confirmed positive? Not going anywhere NEAR there!”
A nurse over to my left says, “We shouldn’t have to Code cases like this.” And it’s not with the same tone as “This is pointless,” it’s “This puts us in danger for nothing.” I stay out of the room, the extra manpower of one extra resident won’t be worth the PPE for chest compressions. But my chief resident is in there.
He’s a good guy; hope he doesn’t get sick.
(As I write this, I get a call that one of my patients has died. Non-COVID, was in denial about her metastatic cancer, COPD, CHF progressively worse shortness of breath but still wanted to be intubated. She got her wish and died within an hour or two still.)
Then a Rapid Response at 7:56. Then a Rapid Response at 8:01. Then a Rapid Response at 10:30. That last one was for the patient I just mentioned who passed, we put her on BIPAP and loaded her up with Lasix. Then a Rapid Response again at 12:30, again for my patient, watched the intubation occur. There was a minor discussion of where to put her, since the ICU and CCU were full. We’re in the process of transitioning the SICU into another ventilator bay.
Lunch arrives sometime after 13:00. Here’s one silver lining to all this: the community has gone out of its way to shower us with food. My lunches and dinners (residents know to always raid the hospitalists’ office and grab a plate before heading home to crash) have been Mediterranean chicken kebobs on Sunday, chicken piccata on Monday, and pizza today. It genuinely raises moral.
Another Rapid as I’m talking to some other residents and wolfing down a slice. Most of these Rapids have been for non-COVID cases. The ones that are about COVID cases turn into intubation events.
I was wrong yesterday when I predicted we’d become a majority COVID case hospital in 2 days. We crossed the 51% threshold today.
I was naïve when I thought I could volunteer for the resident-run COVID wing so that one less of my fellow residents would be put at risk. We’re all at risk. So now we have 3 residents and an outpatient attending looking over 10 confirmed COVID cases.
My census of 13 today has 5 confirmed and 1 suspected COVID patients. I wish we could make these cases voluntary, but all we can do now is limit exposure and spread out the cases somewhat.
I get a call that our 87 year old COVID patient is desatting on 6L supplemental O2 via nasal canula. So we put her on a non-rebreather. I get a call that she’s desatting down to the mid-80s when talking in long sentences despite the 100% oxygen she’s receiving via mask. The nurse is spooked, and the current plan is to do a Full Code should she tank. So the patient and I get to have The Talk.
The Talk is basically asking people if they want to receive (often futile) CPR that cracks their ribs as they die, or if they would prefer to be attached to machines when they die. But I don’t put it like that. I say things like “chest compressions” and “a plastic tube down your throat” but made it clear that if she were to be sedated for the intubation, she may never wake up. And despite our plans and treatments, her body is taking actions that will most likely (but we can never say guaranteed) going to end her life. Not today, but it’s a good time to put things in order.
The patient said her daughters want everything to be done for her, but she doesn’t want to be on machines when she dies. I said that was reasonable. She asked me what I would do, and what I would want for my mother.
I’m not proud of this next part.
I told the truth. I said that my mom and I have worked in medicine, and she would never want to be intubated if it was a long shot she’d ever recover. I told her I recently only rescinded my own Do Not Intubate order because were I to get COVID and need intubation, I’m a young, healthy guy who could survive it. But were I hit by a truck and braindead, I’d never want to be intubated. She said she’d call her daughter back and explain things.
I get a call later saying this very sharp 87 year old lady has signed the form declaring her Do Not Resuscitate / Do Not Intubate.
Intubation would have been the wrong choice here, I believe that. And I only told the truth (which I usually avoid by saying things like “it’s not for me to make you decide either way.”)
I helped the patient make her personal wishes count at the end of her life so she could die on her terms.
But, in the back of my head, I was also thinking I saved the nurses from having to witness a pointless and traumatic CPR and I saved one likely-inevitable ICU bed and a ventilator.
…
I don’t feel like writing anymore today.
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#
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Mar 25, 2020 02:11
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- Salt Fish
- Sep 11, 2003
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-
Cybernetic Crumb
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I just logged off twitch after hearing a streamer say that "maybe" trump's lies about easter are coming from a good place. I cracked, I pinged, I logged off.
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#
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Mar 25, 2020 02:12
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- Agrajag
- Jan 21, 2006
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gat dang thats hot
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Day 3.
Code Blue right off the bat at 7:35. COVID in the ICU, transferred an hour earlier from another maxed hospital. From the chart: 67F with DM2, CAD, HTN. 5 days of cough and body aches, a little short of breath. She was seen by an ED physician just after midnight two days ago. Within 8 hours she had crashed and required intubation. Multifocal pneumonia with positive COVID. Officially admitted to that ICU 24 hours later. Transferred to our ICU 24 hours after that, and 1 hour later her Discharge Note for the Expired Patient was written.
She marks the first COVID patient I’ve seen die.
The anxiety I felt a couple days ago isn’t so bad now. It’s clear there was no avoiding this mass casualty event. Now there’s just work to do.
The thing about intubating a COVID case is it’s a high risk droplet bomb going off around the guys and gals most needed right now: intensivists, anesthesiologists and those badass ICU nurses who are all needed to tube people whose lungs are filling up with fluid. Hospitalists might be able to pick up the slack, but they haven’t the same muscle memory.
So as I’m watching this woman die in her closed glass box of an ICU room, a grizzled doctor with the swagger of an old intensivist says to no one in particular, “Is that a confirmed positive? Not going anywhere NEAR there!”
A nurse over to my left says, “We shouldn’t have to Code cases like this.” And it’s not with the same tone as “This is pointless,” it’s “This puts us in danger for nothing.” I stay out of the room, the extra manpower of one extra resident won’t be worth the PPE for chest compressions. But my chief resident is in there.
He’s a good guy; hope he doesn’t get sick.
(As I write this, I get a call that one of my patients has died. Non-COVID, was in denial about her metastatic cancer, COPD, CHF progressively worse shortness of breath but still wanted to be intubated. She got her wish and died within an hour or two still.)
Then a Rapid Response at 7:56. Then a Rapid Response at 8:01. Then a Rapid Response at 10:30. That last one was for the patient I just mentioned who passed, we put her on BIPAP and loaded her up with Lasix. Then a Rapid Response again at 12:30, again for my patient, watched the intubation occur. There was a minor discussion of where to put her, since the ICU and CCU were full. We’re in the process of transitioning the SICU into another ventilator bay.
Lunch arrives sometime after 13:00. Here’s one silver lining to all this: the community has gone out of its way to shower us with food. My lunches and dinners (residents know to always raid the hospitalists’ office and grab a plate before heading home to crash) have been Mediterranean chicken kebobs on Sunday, chicken piccata on Monday, and pizza today. It genuinely raises moral.
Another Rapid as I’m talking to some other residents and wolfing down a slice. Most of these Rapids have been for non-COVID cases. The ones that are about COVID cases turn into intubation events.
I was wrong yesterday when I predicted we’d become a majority COVID case hospital in 2 days. We crossed the 51% threshold today.
I was naïve when I thought I could volunteer for the resident-run COVID wing so that one less of my fellow residents would be put at risk. We’re all at risk. So now we have 3 residents and an outpatient attending looking over 10 confirmed COVID cases.
My census of 13 today has 5 confirmed and 1 suspected COVID patients. I wish we could make these cases voluntary, but all we can do now is limit exposure and spread out the cases somewhat.
I get a call that our 87 year old COVID patient is desatting on 6L supplemental O2 via nasal canula. So we put her on a non-rebreather. I get a call that she’s desatting down to the mid-80s when talking in long sentences despite the 100% oxygen she’s receiving via mask. The nurse is spooked, and the current plan is to do a Full Code should she tank. So the patient and I get to have The Talk.
The Talk is basically asking people if they want to receive (often futile) CPR that cracks their ribs as they die, or if they would prefer to be attached to machines when they die. But I don’t put it like that. I say things like “chest compressions” and “a plastic tube down your throat” but made it clear that if she were to be sedated for the intubation, she may never wake up. And despite our plans and treatments, her body is taking actions that will most likely (but we can never say guaranteed) going to end her life. Not today, but it’s a good time to put things in order.
The patient said her daughters want everything to be done for her, but she doesn’t want to be on machines when she dies. I said that was reasonable. She asked me what I would do, and what I would want for my mother.
I’m not proud of this next part.
I told the truth. I said that my mom and I have worked in medicine, and she would never want to be intubated if it was a long shot she’d ever recover. I told her I recently only rescinded my own Do Not Intubate order because were I to get COVID and need intubation, I’m a young, healthy guy who could survive it. But were I hit by a truck and braindead, I’d never want to be intubated. She said she’d call her daughter back and explain things.
I get a call later saying this very sharp 87 year old lady has signed the form declaring her Do Not Resuscitate / Do Not Intubate.
Intubation would have been the wrong choice here, I believe that. And I only told the truth (which I usually avoid by saying things like “it’s not for me to make you decide either way.”)
I helped the patient make her personal wishes count at the end of her life so she could die on her terms.
But, in the back of my head, I was also thinking I saved the nurses from having to witness a pointless and traumatic CPR and I saved one likely-inevitable ICU bed and a ventilator.
…
I don’t feel like writing anymore today.
gently caress man...
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Mar 25, 2020 02:13
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- Miles Vorkosigan
- Mar 21, 2007
-
The stuff that dreams are made of.
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COVID-19 DEATHS IN TERRITORIES OF THE THIRTY YEARS WAR CIRCA 1632
Habsburg states and allies:
Holy Roman Empire: 158
Austria: 10
Spanish Empire: 3000
Hungary-Croatia: 14
Poland :10
Lorraine: 70
Total: 3262
Anti-Habsburg states and allies:
Dutch Republic: 240
Scotland: 16
Saxony: 1
Sweden: 41
Brandenburg-Prussia: 0
Total: 298
(roughly)
Just pretending the perfidious Bourbons had nothing to do with it I see
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Mar 25, 2020 02:13
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- 703
- May 11, 2007
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Contains Carbon Monoxide
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I hope you find this therapeutic, it's a terrifying, depressing read that leaves a mark and thank you for sharing
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Mar 25, 2020 02:14
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- Salt Fish
- Sep 11, 2003
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Cybernetic Crumb
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Literally the most disturbing part of this for me is experiencing it under the shadow of knowing 50% of americans think we're doing great.
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Mar 25, 2020 02:15
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- Shadowhand00
- Jan 23, 2006
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Golden Bear is ever watching; day by day he prowls, and when he hears the tread of lowly Stanfurd red,from his Lair he fiercely growls.
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Toilet Rascal
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…
I don’t feel like writing anymore today.
The DNR at the end made me tear up. I'm glad there are organizations and restaurants out there delivering food to you guys. I don't know what else to say but thank you for posting and stay strong.
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Mar 25, 2020 02:15
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- Thoguh
- Nov 8, 2002
-
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College Slice
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employer just sent me a letter of safe passing
guess they know more than me
What state or country are you in?
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Mar 25, 2020 02:16
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- Solarin
- Nov 15, 2007
-
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appreciate your posts
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#
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Mar 25, 2020 02:18
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- dex_sda
- Oct 11, 2012
-
|
Day 3.
Code Blue right off the bat at 7:35. COVID in the ICU, transferred an hour earlier from another maxed hospital. From the chart: 67F with DM2, CAD, HTN. 5 days of cough and body aches, a little short of breath. She was seen by an ED physician just after midnight two days ago. Within 8 hours she had crashed and required intubation. Multifocal pneumonia with positive COVID. Officially admitted to that ICU 24 hours later. Transferred to our ICU 24 hours after that, and 1 hour later her Discharge Note for the Expired Patient was written.
She marks the first COVID patient I’ve seen die.
The anxiety I felt a couple days ago isn’t so bad now. It’s clear there was no avoiding this mass casualty event. Now there’s just work to do.
The thing about intubating a COVID case is it’s a high risk droplet bomb going off around the guys and gals most needed right now: intensivists, anesthesiologists and those badass ICU nurses who are all needed to tube people whose lungs are filling up with fluid. Hospitalists might be able to pick up the slack, but they haven’t the same muscle memory.
So as I’m watching this woman die in her closed glass box of an ICU room, a grizzled doctor with the swagger of an old intensivist says to no one in particular, “Is that a confirmed positive? Not going anywhere NEAR there!”
A nurse over to my left says, “We shouldn’t have to Code cases like this.” And it’s not with the same tone as “This is pointless,” it’s “This puts us in danger for nothing.” I stay out of the room, the extra manpower of one extra resident won’t be worth the PPE for chest compressions. But my chief resident is in there.
He’s a good guy; hope he doesn’t get sick.
(As I write this, I get a call that one of my patients has died. Non-COVID, was in denial about her metastatic cancer, COPD, CHF progressively worse shortness of breath but still wanted to be intubated. She got her wish and died within an hour or two still.)
Then a Rapid Response at 7:56. Then a Rapid Response at 8:01. Then a Rapid Response at 10:30. That last one was for the patient I just mentioned who passed, we put her on BIPAP and loaded her up with Lasix. Then a Rapid Response again at 12:30, again for my patient, watched the intubation occur. There was a minor discussion of where to put her, since the ICU and CCU were full. We’re in the process of transitioning the SICU into another ventilator bay.
Lunch arrives sometime after 13:00. Here’s one silver lining to all this: the community has gone out of its way to shower us with food. My lunches and dinners (residents know to always raid the hospitalists’ office and grab a plate before heading home to crash) have been Mediterranean chicken kebobs on Sunday, chicken piccata on Monday, and pizza today. It genuinely raises moral.
Another Rapid as I’m talking to some other residents and wolfing down a slice. Most of these Rapids have been for non-COVID cases. The ones that are about COVID cases turn into intubation events.
I was wrong yesterday when I predicted we’d become a majority COVID case hospital in 2 days. We crossed the 51% threshold today.
I was naïve when I thought I could volunteer for the resident-run COVID wing so that one less of my fellow residents would be put at risk. We’re all at risk. So now we have 3 residents and an outpatient attending looking over 10 confirmed COVID cases.
My census of 13 today has 5 confirmed and 1 suspected COVID patients. I wish we could make these cases voluntary, but all we can do now is limit exposure and spread out the cases somewhat.
I get a call that our 87 year old COVID patient is desatting on 6L supplemental O2 via nasal canula. So we put her on a non-rebreather. I get a call that she’s desatting down to the mid-80s when talking in long sentences despite the 100% oxygen she’s receiving via mask. The nurse is spooked, and the current plan is to do a Full Code should she tank. So the patient and I get to have The Talk.
The Talk is basically asking people if they want to receive (often futile) CPR that cracks their ribs as they die, or if they would prefer to be attached to machines when they die. But I don’t put it like that. I say things like “chest compressions” and “a plastic tube down your throat” but made it clear that if she were to be sedated for the intubation, she may never wake up. And despite our plans and treatments, her body is taking actions that will most likely (but we can never say guaranteed) going to end her life. Not today, but it’s a good time to put things in order.
The patient said her daughters want everything to be done for her, but she doesn’t want to be on machines when she dies. I said that was reasonable. She asked me what I would do, and what I would want for my mother.
I’m not proud of this next part.
I told the truth. I said that my mom and I have worked in medicine, and she would never want to be intubated if it was a long shot she’d ever recover. I told her I recently only rescinded my own Do Not Intubate order because were I to get COVID and need intubation, I’m a young, healthy guy who could survive it. But were I hit by a truck and braindead, I’d never want to be intubated. She said she’d call her daughter back and explain things.
I get a call later saying this very sharp 87 year old lady has signed the form declaring her Do Not Resuscitate / Do Not Intubate.
Intubation would have been the wrong choice here, I believe that. And I only told the truth (which I usually avoid by saying things like “it’s not for me to make you decide either way.”)
I helped the patient make her personal wishes count at the end of her life so she could die on her terms.
But, in the back of my head, I was also thinking I saved the nurses from having to witness a pointless and traumatic CPR and I saved one likely-inevitable ICU bed and a ventilator.
…
I don’t feel like writing anymore today.
goddamn dude. stay safe. you're a good guy, remember that.
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Mar 25, 2020 02:19
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- Atrocious Joe
- Sep 2, 2011
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Day 3.
...
I don’t feel like writing anymore today.
Thank you for relating what it's like to actually be treating people during this shitshow
thanks for posting these and stay strong
unironic F for all medical workers everywhere
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Mar 25, 2020 02:20
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- Taintrunner
- Apr 10, 2017
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by Jeffrey of YOSPOS
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i made chicken katsu curry over ramen noodles and drat it's good
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Mar 25, 2020 02:24
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- BeefThief
- Aug 8, 2007
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We live in an economy
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Mar 25, 2020 02:25
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- Adbot
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ADBOT LOVES YOU
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Apr 18, 2024 03:11
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