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What a Mess
CDC has recommended to doctors across the country that any “non-emergency” health care is to be postponed. There are a lot of problems with this, of course, not the least of which is defining “non-emergency” in my line of work. Treating somebody’s blood pressure is not an emergency unless she strokes out tomorrow, in which case it apparently was an emergency after all. Oh, well. But anyway, I’m doing a lot of video-call medicine, which is the government’s idea of, um, I’m not sure what. But this is what we’re supposed to be doing. For now. Until they change their minds. Again.
I had an interesting video call with a patient of mine this morning. He’s a retired physician from New York City. Brilliant guy, but he can come across as abrasive and arrogant at times. I think it’s just his New York City mannerisms, coarse language, and his extremely frank approach to conversation which can be off-putting. I think he’s fundamentally a good person and he can be really funny if you can get past his gruff exterior. He’s also a very vocal and frequently hostile Democrat. He hates Republicans. But hey, he’s a wealthy New Yorker. What do you expect? And come to think of it, he hates lots of other people too. So whatever. He’s in his early 80s now and lives in an assisted living facility with his wife. I called him this morning because his recent labs showed some problems with his diabetes. He likes his gin and his ice cream, and glycemic control is a challenge for him. Particularly because he doesn’t listen to a gosh darn word his doctor says. Or his wife. Or anyone else.
The best I can remember from our video call:
Me: “Good morning Dr. Smith! Good to see you!”
Dr. Smith: “Good to be seen! You know what they say here in God’s waiting room – better to be seen than to be viewed! Ha!”
His wife Florence in the background somewhere: “Harold!”
Me: “Thanks for taking the time to talk with me, Dr. Smith. I just wanted to go over your recent labs here. Your glucose is a bit of a problem again, and I thought we could…”
Dr. Smith: “Hang on, let me put down my ice cream so I can take notes.”
Me: “Dr. Smith, it’s 8:15 in the morning.”
Dr. Smith: “Ha! I’m not eating ice cream! I just like pissing you off!”
Me: “So you’re not eating ice cream. And you’re not listening to me, either, are you?”
Dr. Smith: “Of course I am! Glucose! By the way, my daughter says hello!”
Me: “Um, ok, great. Ok, about your glucose…”
Dr. Smith: “She’s a nurse in a hospital outside of the city, and she’s been laid off, so she’s got lots of time to call and annoy her dear old Dad about meaningless $#!% like his glucose.”
Me: “Um…”
Dr. Smith: “She’s an orthopedic surgery nurse, and most of their elective knees and hips have been rescheduled, so she just sits around the house and thinks of ways to annoy me about…”
Florence: “Harold!”
Dr. Smith: “What’s bad is that her husband is a nurse anesthetist. Which I never understood. What the #$%& does he do all day, anesthetize nurses? Does he sneak around and hide propofol in donuts or something? I mean, what kind of #%$&…”
Florence: “Harold!”
Me: “Um, about your glucose…”
Dr. Smith: “I mean, if you want to be an anesthesiologist, go to $@#!ing medical school, right? What the…”
Florence: “Harold!”
Dr. Smith: “Anyway, what’s bad is that he’s been laid off, too, because they’ve rescheduled most of the vascular cases that he works on. So he…”
Me: “Are you even taking your insulin shots? Because your labs look like…”
Dr. Smith: “They’ve moved a big ship into New York Harbor to act as an overflow for the overcrowded hospitals. They’re supposedly refitting some of the closed schools into makeshift hospitals to handle overflow from overcrowded hospitals. They’re mobilizing the $#@%ing National Guard, now that they’re done shooting kids at Kent State, apparently. What a bunch of…”
Florence: “Harold!”
Me: “Look, I…”
Dr. Smith: “But they’re laying off all the #$%&ing nurses because the @#$%ing hospitals are empty because the #@$%ing politicians are %#&$ing around with…”
Florence: “HAROLD!!! Keep your voice down!”
Me: “And if you don’t keep your sugar down, you’re going to…”
Dr. Smith: “I mean, if this is a serious pandemic, why are they laying off nurses? Huh? How can you have a proper pandemic with empty hospitals?!? What a $#@%ing mess! It’s like Trump scheduled a plague and nobody showed up! I mean…”
Me: “Look, why don’t we…”
Dr. Smith: “And the doctors these days are even worse! They haven’t been laid off – they’re just not even bothering to show up! If there are so many sick people out there, why aren’t the doctors out there taking care of them? They’re all just sitting behind their computers doing video crap like they’re scared of some disease! Aren’t they supposed to be treating disease? What a bunch of panty-waists!”
Me: “Look, Dr. Smith, with utmost respect, why don’t you go #$@% yourself?”
Florence: “HAROLD!”
Dr. Smith: “See?!? That’s what I’m talking about! Where is that kind of spirit? When are today’s doctors going to stand up and take care of some sick people? Be a man! In my day, we wouldn’t have been hiding behind our computers and our charts!”
Me: “That’s because in your day, you had oil lamps and papyrus rolls, and you sent all your sick people to leper colonies.”
Dr. Smith: “#$%& you. I retired twelve years ago.”
Florence: “Harold!”
Me: “Look, we’re being told to do things like this. I don’t like it either. But I don’t see how…”
Dr. Smith: “Wait – hey that’s my daughter calling in. Gotta go. We’ll talk later.”
Me: “We?!? We’ll talk later? We haven’t even gotten to your diabetes yet! I haven’t said a #$%@ word since you’ve…”
Florence: “Harold, shouldn’t you…”
Me: “I thought you said all your daughter did was annoy you? Why are you…”
Dr. Smith: “Take it easy doc! I’ll get right on that sugar stuff. Great to talk to you! See you later.”
Me: “Right. Ok.”
This is a rough transcript of our call, partially because that entire conversation took about two and a half minutes – he talks really fast. Especially when he’s pissed off. Which he usually is, until he has enough gin and ice cream. And he never has enough.
But he’s really angry about how we’re handling this virus. To be fair, he’s generally really angry about all sorts of things. But in this case, he may have a point. Possibly for all the wrong reasons. But he may have a point. Hard to say.
I don’t know how far outside the city his daughter and son-in-law work, although he says they go to lots of Mets games (Another really classy Dr. Smith joke from a previous conversation: “Why do they call the hospital oncology ward Shea Stadium? Because that’s where the Mets win! Ha!”).
And I don’t know what the real situation is in NYC hospitals, and how much of this is a dad that’s just pissed off that his daughter and his apparently very patient son-in-law have been laid off.
But what he describes is similar to our situation in my area. Our hospital census is way, way down. And elective surgeries are one of the few things that hospitals actually make money on. They often lose money on each case of pneumonia or whatever, but they make it up with cardiac caths and hip replacements. I don’t understand how the hospitals are staying open, until I think about how much stimulus money is flowing down the streets of every city in the country right now.
But he probably has a point about all the elective surgeries. What happens when we start to reschedule all those elective knees, hips, carotids, aneurysms, and God knows what else? Some of those are typically booked a few weeks to a few months in advance. And then we don’t do any of them for three months. And then everybody wants all of them done at once. How is that going to work? In medicine, like in anything else, when you try to do too much, too fast, sometimes things go wrong.
My guess is that our rate of surgical complications will be unusually high for the second half of 2020. Blood clots, staph infections, pneumonias, and so on – many of which didn’t have to happen.
Of course, if they had been doing elective surgeries during this time, how many of those patients would have developed coronavirus? Probably some. Which would turn out worse? Hard to say.
Well, it’s hard for me to say. I suspect that Dr. Smith would declare which is worse, with absolute certainty. And maybe he’d be right. Hard to say.
But the longer we wait, the worse this is going to get.
I don’t envy whoever is planning all this.
Again, I don’t know how much of Dr. Smith’s tirade is correct, although I have no reason to doubt any of it, since I’m seeing the same thing here. But for once, he and I agree about something:
What a $#@%ing mess…
Published in General
Yes, this pandemic has harmed a great many things and a great many people.
My son who is an orthopedic surgeon in Charleston SC has not had any operative cases in 6 weeks and is only seeing patients one half day a week because everything is shut down in case there will be a surge in disease which clearly is not happening. I think the shut downs were because of the lack of PPE and potentially ventilators which were both controlled by Chinese manufacturing facilities. If there were enough protective gear to go around there would have been no rationale for shutting down outpatient surgery or dentistry. In talking with people in my former field of radiology, the outpatient MRI centers are only able to stay open if they have CT scanners or chest X-ray machines for potential covid19 patients. There will be a huge cost for putting our routine medical care surveillance on hold for three months.
I’ve got half of it figured out: You’re paying to read this stuff!
The other half is a problem. I’m not getting paid to write it. In fact, I’m paying just as much to write it as you are to read it.
I see a flaw in my business model…
There is a toll here. My father, 85, has been suffering from TIAs and irregular heartbeat. He has a monitoring implant he downloads daily to his cardiologist. There are medications for this which he has tried, but unfortunately, he does not tolerate them because of his advanced age as well as other medical issues. The key to all this lies with a lazy left ventricle. It can be coaxed to do its job with a new implant device called a watchman or something similar. He was supposed to have the implant inserted back in February, but it was delayed. Now they are telling him, perhaps August. In the meantime he continues to have intermittent TIA symptoms and other circulatory problems. His physical therapy has been disrupted as well. In general, he is doing poorly and I’m afraid that the decision to move him to either an assisted living center or to live with me is imminent. He has a live in GF (God love him at 85!) and that complicates things. She lives with him in his house in the Villages in central FL. In the meantime, everyone in the Villages is scared to death of COVID 19. They should take the word “Active” out of their claim to be an Active Adult Community.
If my father suffers a major stroke in the near term, we can undoubtedly lay part of the blame on our over-reaction to this Pandemic.
We had our first “tele-medicine” experience the other day, for an appointment with Mr. She. It wasn’t nearly as colorful as the one described in the OP, but the doctor (who’s a friend), and I (who worked for 20 years at the hospital his family practice group is owned by) had a heart-to-heart about many of the same points.
I heard a report on the news the other day about how many smaller hospitals are having difficulty coping because they cancelled all their upcoming scheduled care and have been waiting for the apocalypse in a part of the country where it hasn’t materialized. Units are closing down and people are being let go. The reporter described it as an “unexpected outcome” of the situation. Not unexpected by me. Saw that coming weeks ago.
What I can’t see my way through, though, is the situation described in the OP. What’s going to happen “after,” whenever “after” finally starts.
Dr. Smith is right. It is a [colorful expletive] mess.
I was thinking same thing, when your 80, with diabetes, and you know the rules and the consequences, do what you want. Kids can say things like, “I love you, and want you to live longer, but if you’re eating ice cream for breakfast, I’d like to join you as often as I can.”
I love Dr. Smith and the convo.
I had a little surgery on Monday, removed a small cancer from my right temple. So, they had me call from the parking lot before coming in. A nurse (or tech, I didn’t ask) came out and took my temperature before we went inside, also asked me if I’d had any cough, congestion, etc. When we got inside she used her gloved hand to push the elevator button and escorted me to the room where I was told to stay put. The lab test came back clear for the margin so we were done inside an hour and I could leave after being told to go straight home, not to stop at a store! Then, surprise! I was left to push the elevator button myself to get back down and even had to open the exterior doors myself. I guess if I get Cov19 on the way out it doesn’t matter so much ;>)
How much of this is real and how much is theater? I don’t think anyone really knows nor will we know until this thing is over. I do think much of it is designed to make us ‘feel’ safer. It makes me ‘feel’ like I’m being insulted, like I can’t take reality and have to be treated like an 8 year old kid.
Covid19 and any other flu-like virus is no fun and I don’t want to have it but I also know that my immune system will likely defeat it.
Welcome to my world. When this is over and we start back doing surgery, if I survive, I will let y’all know how it’s going. I need Dr. Smith to come hangout at my hospital for a while. Maybe he can help straighten some things out.
Some elective procedures could be to correct a serious, but not life-threatening, problem.
I contacted a friend and found out he was allowed to get his pacemaker operator (deemed essential). The idea that a politician decides what job is essential or not is bad enough.
Oh, abortions and sex-change operations are essential . . .
If your posts and comments are not the property of Ricochet, you can always collect and publish them.🙂
I hear you. It is especially frustrating to be treading water on, and treating at home as best I can, a number of Mr. She’s conditions (he’s 81), because the hospital/doctor’s offices are “non-essentially” essentially shut down, at the same time as there is almost no-one actually at the doctor or in the hospital, because I’m not in a part of the state that’s been hard hit. I daresay that, if the situation were different, and the hospital was bursting at the seems with Covid-19 patients, and people were queuing up and down the hall at the doctor’s office, I’d feel differently. But it isn’t and they’re not. So the services and facilities are severely underutilized, and patients with other conditions, at all severity levels, are not getting the care they need, because the hospital has devoted all its resources to being “ready” for something that, at this point, doesn’t look as though it’s going to be a major stressor.
There’s also been an impact of my ability to talk to, put in place, schedule, or follow through on, having a carer come into our home a few times a week to help me out, both from a reluctance to take on new patients on their end, and a reluctance to have “strangers” who are circulating among elderly and sick people come into the home, on mine.
Well where’s the fun in that? Hehe . . .
I use the “Good to be seen!” joke all the time. One of my favorites. It’s a bad dad joke that I use with my estate planning clients….
I’d also suggest that Florence is deserving of some sort of award.
I say “I’m on the right side of the dirt.”
Perhaps a long paid vacation to visit her daughter and son-in-law in the Gobi Desert, Madagascar, or New Zealand?🤔
I don’t think the real facts will ever be known. We know that things are being mis-counted now, and counted differently by different areas/authorities, etc. What reason is there to believe that these mis-counts etc will somehow be corrected later? Quite simply, it would be impossible.
How often do you talk about politics with your client’s Dr. Bastiat. Wouldn’t people be so concerned about their odd growth or their favorite Aunt’s hip replacement that they never bring up politics? You seem to mention the political affiliation of people quite alot. Is it just that you write about the rare occurrences?
I never bring up politics with my patients. It’s generally not relevant to our conversation, and it can create separation in an environment where I’m trying to work closely with someone.
My patients sometimes bring up politics with me. Like Dr. Smith above. You’ll note that I wanted to talk about diabetes, and I never mentioned politics. Dr. Smith did.
I write about a lot of things on Ricochet. But I often write about politics. So those essays, if they mention a patient conversation, will generally mention one of the conversations in which the patient brought up politics.
I find the only patients that bring up politics to me have similar views as I do. I must have some invisible Trump 2020 tattoo on my forehead. I never initiate those conversations.
As a patient, I never bring up politix with a health-care worker. But the last time I took my mother to her cardio doc, his parting words were “You’re doing great! I wanna see you next year when we have a new President.”
Jay Nordlinger once mentioned that people who never talked about politics for a decade or more eventually discovered that they were Republicans. Almost universally, it’s left wing people who bring up politics.
This, I think, is not so universal any more – possibly in reaction. I do find that even when not explicit, in your face comments, that people from center/right are in these days more likely to expose their opinion on this or that subject. Or, I don’t know, maybe I wear a sign around my neck.
You probably do and say things that make sense, obviously a dead give away that you are Conservative ;>)