Practicing Within A Storm

[surgblumm]

Practicing Within A Storm

Robert M. Blumm, PA, PA-C Emeritus, DFAAPA

 

 

 

 

My wife and I have just completed a move from our home in New York to a new chapter in our lives in Charlotte, NC. After thirty-five years in the same village, we moved to an oasis in the south. We are experiencing a new manner of living as we enjoy the beauty of this “Queen City” and its many parks, sights, the gentility of the citizens and the slower lifestyle. I feel that I am finally at peace, with my old home sold, my bills paid, my retirement from forty-six years of practice and a new chapter of life. The serenity that is Charlotte is frequently of late interrupted at about 5:30 PM by clouds moving in: sudden and powerful heavy rain and hail, strong winds, thunder and lightning. Yes, my new city is very subject to sudden storms - which causes me to think of my fellow PAs and the storms that they are currently facing.

The big issues in this country at present relate to Covid-19 and back-to-school timing. Teachers are describing this dilemma as terrifying, with plenty of them petrified and panicked. Many are talking about a return to the classroom as if it were a wartime draft: forced to serve in a pandemic situation where their very lives are on the line, their families are left vulnerable and their futures potentially threatened by death, long debilitation and/or severe sickness. These teachers find themselves in a very real personal and professional storm that could devastate their lives and those of their loved ones.

In a recent article in Explore Health, the author Hilary Stenfeld writes of teachers fixated with doomscrolling, planning end of life decisions, writing their wills and goodbye letters to their loved ones prior to going to work. This causes me to reflect on the front line of health care in our nation, of PAs, NPs, physicians, nurses and technicians as well as all of those who have heard the call to duty and report to health care facilities every day. Are you as diligent as the teachers’ unions in safeguarding your future? Are you also writing your wills, enacting end of life plans, securing additional health insurance as well as disability insurance? Have you too, started doomscrolling every day before you start your shift or go to your office? Are you beyond concerned and becoming fearful? It’s a natural reaction living on the front lines of patient care. Just as I served in the capacity of combat medic in Vietnam with the responsibility of caring for my fellow soldiers wounded under fire: you too, are now combat health care professionals.

As you expose yourself every day to the possibility of viral transmission and personal risk, you are to remember that not every fever or cough or shortness of breath is Covid-19. We have been trained to consider a differential diagnosis that could be a life-threatening case of CHF or pneumonia or myocardial infarction or a CVA. The list is endless but, in times of great stress and an overload of patient encounters, it becomes possible for an expert healthcare provider to make a snap decision that starts them on a diagnostic quest which can become an explosive nightmare with a patient’s life on the line. In times like these, it’s unthinkable to not have adequate insurance for your health, your life and your medical practice. Family protections starts with these three - and a solid, secure malpractice policy should be an essential part of your plan.

As veteran clinician with an excellent practice record, I have on occasion required the support of my professional liability counselors and I was assisted quickly and efficiently with superior legal advice and direction. I never felt alone in my personal storm because I had the ****************************************************

Edited August 4, 2020 by ventana
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[Boatswain2PA]

COVID-19 is not the end of the world.  While it is scary, it's no more scary than HIV or MRSA.  We have learned how to care for sick COVID-19 patients in just the past 5 months, come the new year we will be even better and might have a vaccine.

I would hardly compare treating COVID-19 patients to going to WAR where there are sentient beings trying to kill you.

Enjoy NC.  I hope all those who FLEE from NYC would remember that what they are fleeing FROM was voted into office, and therefore ensure they don't vote for the same.

[MSPAC2]

6 hours ago, Boatswain2PA said:

COVID-19 is not the end of the world.  While it is scary, it's no more scary than HIV or MRSA.  We have learned how to care for sick COVID-19 patients in just the past 5 months, come the new year we will be even better and might have a vaccine.

I would hardly compare treating COVID-19 patients to going to WAR where there are sentient beings trying to kill you.

Enjoy NC.  I hope all those who FLEE from NYC would remember that what they are fleeing FROM was voted into office, and therefore ensure they don't vote for the same.

Seriously? That's what you got out of that? 

[Boatswain2PA]

21 minutes ago, MSPAC2 said:

Seriously? That's what you got out of that? 

What I got from Robert's writing is a lot of people are "terrified" of this virus.  Teachers are "terrified" to go back to school.  And providers are compared to soldiers in battle.  "Are you beyond concerned and becoming fearful?" is in there.

It is fearmongering.  No offence intended to Robert because fearmongering is a great way to get people to buy insurance (which is what it seems that he is trying to get us to do), but it is still fearmongering.

Covid is serious.  It is NOT the cataclysmic black swan event that I thought it could have been in Feb or Mar of this year.

What did you get from this that I didn't?

 

Edited August 4, 2020 by Boatswain2PA

[Cideous]

10 minutes ago, Boatswain2PA said:

What I got from Robert's writing is a lot of people are "terrified" of this virus.  Teachers are "terrified" to go back to school.  And providers are compared to soldiers in battle.  "Are you beyond concerned and becoming fearful?" is in there.

It is fearmongering.  No offence intended to Robert because fearmongering is a great way to get people to buy insurance (which is what it seems that he is trying to get us to do), but it is still fearmongering.

Covid is serious.  It is NOT the cataclysmic black swan event that I thought it could have been in Feb or Mar of this year.

What did you get from this that I didn't?

 

Gawd.....just wow.

[Boatswain2PA]

7 minutes ago, Cideous said:

Gawd.....just wow.

Where do you think I'm wrong.

[ventana]

 

 

15 hours ago, Boatswain2PA said:

COVID-19 is not the end of the world.  While it is scary, it's no more scary than HIV or MRSA. 

 

9 hours ago, Boatswain2PA said:

What I got from Robert's writing is a lot of people are "terrified" of this virus.  Teachers are "terrified" to go back to school.  And providers are compared to soldiers in battle.  "Are you beyond concerned and becoming fearful?" is in there.

It is fearmongering.  No offence intended to Robert because fearmongering is a great way to get people to buy insurance (which is what it seems that he is trying to get us to do), but it is still fearmongering.

Covid is serious.  It is NOT the cataclysmic black swan event that I thought it could have been in Feb or Mar of this year.

 

 

 

WHAT?

COVID does not equal MRSA

COVID does not equal HIV

 

I seriously do not understand how a professional health care provider could ever make such statements, seriously how do you support such statements beyond simple disregard for ALL the facts we know about this virus???

[PAinPenna]

Hospitals don’t get overwhelmed with HIV or MRSA patients all presenting at the same time . 

[rev ronin]

3 hours ago, mcclane said:

Again, accurate descriptions don't matter to this guy.

And by the way, moderators are actively pruning and manipulating threads to support this horseshit.

Actually, how about "trying to keep things from escalating based on gratuitous personal attacks"?

Sorry I didn't formally give you a warning or restrict your posting privileges for your conduct; I suppose I can get around to it later if you really want.

[Boatswain2PA]

3 hours ago, ventana said:

COVID does not equal MRSA

COVID does not equal HIV

I never said it was "equal" to MRSA or HIV.  From a personal level (Robert's original post is fearmongering on a personal level.  Teachers fearful to go back to school, healthcare providers fearful, writing wills, etc).

From a public/health resources perspective this had the possibility of overwhelming hospital systems, and it seems that some areas were indeed stressed, but we were collectively able to flex and support those areas.  Field hospitals were stood up (costing tens/hundreds of millions of dollars) and rarely or never used, the dreaded ventilator shortage was avoided, etc.

Even with the surge in the past few weeks I have not read of any hospitals that were overwhelmed. 

Furthermore, the death rate is plummeting.  Maybe the virus is becoming less lethal (something viruses are expected to do), but I think it is more that we now know better how to prevent old/sick people from getting it (masks, distancing...and oh yeah - don't put COV + patients back into nursing homes), and we know better how to treat them (Dex, proning, etc).  While the overall death rate drop is somewhat due to increasing in testing, I think there is also a decrease in hospitalization death rate.
 

1 hour ago, PAinPenna said:

Hospitals don’t get overwhelmed with HIV or MRSA patients all presenting at the same time . 

Yes.  Again, I was not equating COVID with HIV/MRSA, just saying that COVID isn't any more "personally scary" than HIV or MRSA. 

BTW - thank you for a real response in stead of the sophomoric "oh wow....can't believe you said that" postings devoid of counterpoints.

 

[Cideous]

^^^. Tell that to the families of the 165k Americans who have died from it in just 4 months.  It's going to be over 200k by Sept and god knows how high by Dec 31st.  I seriously hope you and your family are not affected by this, but from my experience it usually takes something like that to drive home the reality of a disease to those that call it fear-mongering.  And yes, teachers are scared to death right now.

[rev ronin]

11 minutes ago, Cideous said:

^^^. Tell that to the families of the 165k Americans who have died from it in just 4 months.  It's going to be over 200k by Sept and god knows how high by Dec 31st.  I seriously hope you and your family are not affected by this, but from my experience it usually takes something like that to drive home the reality of a disease to those that call it fear-mongering.  And yes, teachers are scared to death right now.

'Scary' is a value judgement.  The same numbers can be looked at as both horrible (4x annual flu deaths and rising fast... with FAR worse sequelae in those who recover) or not (it could have been worse).  I'm somewhat in the latter category, because I was expecting far more fatalities by now.

People have differing responses to fear-inducing circumstances they cannot control, ranging from catatonic paralysis to blase fatalism.  As long as they're both working off real data, and not ignoring actual numbers on some stupid pretext that Covid-19 deaths are being manipulated... it's kinda OK.  Now, it can be VERY uncomfortable to hear someone else facing a possible, at best partially controllable, risk of death in a very different approach as our preferred one, but that is not itself evidence of panic or irresponsibility.

For what it's worth, I haven't had anyone I personally know yet die of Covid-19; I would have expected to know at least one by now, and I think that is part of what's making things seem eerie and surreal.

[EMEDPA]

I work with 3 providers who were diagnosed with this and hospitalized.

The mother of a close friend died of this a few days ago. 2 weeks from dx to the family deciding to withdraw care in an urban ICU getting every imaginable intervention. 

I poo-pooed covid when it first came around. I was wrong. 

[EMEDPA]

I locked this thread yesterday. I did not remove or alter any posts. 

[EMEDPA]

2 hours ago, Boatswain2PA said:

 

Yes.  Again, I was not equating COVID with HIV/MRSA, just saying that COVID isn't any more "personally scary" than HIV or MRSA. 

 

Fair enough. You are entitled to that opinion. I wouldn't say I am "more scared" either, but I also signed up to work with Ebola patients. I figure I will do my best and if I catch it or anything else at work that it is the cost of being a health care provider. Like the cartoon character Super Chicken used to say, " you knew the job was dangerous when you took it". 

That being said, you can't catch HIV or MRSA by riding on a bus with someone who has them if they sit 4 feet away. The airborne aspect makes it more worrisome from a public health perspective. 

https://video.search.yahoo.com/yhs/search?fr=yhs-iba-1&hsimp=yhs-1&hspart=iba&p=youtube+super+chicken+knew+the+job+was+dangerous#id=1&vid=3c6dcf7910fda88f60d8a97b9a5b3e28&action=click

[rev ronin]

21 minutes ago, mcclane said:

You have numerous posts on the forum clapping your own back for not being the Huddle regarding moderation, but you took the time to follow me around the forum yesterday deleting, pruning, locking and unlocking threads in support of your little buddy. It would not surprise me at all if this was largely your doing, although you are only one of the mods in his fan club, you consistently appear the most prone to forum manipulation to assist his cause. Your invisible hand in moderation definitely needs called out on this because you absolutely do not adhere to any semblance of "transparency" in moderation. My hope is, and I see them posting, that the other mods have had it with right wing trash talk and intolerance on paforum and will take a moment to stand up to anti-science leanings and conversational propaganda.

Yep, we're not Huddle, but we don't let pseudonymous people post direct attacks on other people.  I hid one of your posts, and one of his--I didn't lock or unlock anything.  At least four separate moderators have touched this thread for two separate reasons, one of which has nothing to do with your and Boatswain2PA's competitive urination match. 

If you think I'm putting a thumb on the scale, it entirely your right to leave, but your assessment of the situation is at best partially correct, and I've already apologized for not formally sanctioning you, which would have included a direct comment on the removed content. On the other hand, if you want to remain an unrestricted contributor here, feel free to content on the content, not the contributor; the comment of yours I hid said absolutely nothing about the topic under discussion, just about Boatswain2PA's political perspective.

[GetMeOuttaThisMess]

Apparently some haven’t heard of the S. Texas valley hospitals being overrun and the San Antonio VA having to offer hospital services to non-VA clientele to cover for the overrun.

[Boatswain2PA]

14 minutes ago, GetMeOuttaThisMess said:

Apparently some haven’t heard of the S. Texas valley hospitals being overrun and the San Antonio VA having to offer hospital services to non-VA clientele to cover for the overrun.

Do you have more details on the overrun hospitals?  I got a locums offer from a hospital in far south Texas.  

What does "overrun" mean?  That is a very subjective term.  Does it mean not enough ventilators and ICU beds?  Is the death rate going up there?  I dunno, havent found anything to suggest that though. I think NYC hospitals were overrun at the beginning of this pandemic, but we surged a lot of resources there.  I would expect the same thing to happen there.

 

As to the VA hospitals helping, that is part of the national strategic plan for any health emergency.

I'm not trying to infer that covid isnt serious, it's just not the black swan event that it first looked like it could have been.  And the fearmongering in the media (and other places) is pretty intense.

[ventana]

25 minutes ago, Boatswain2PA said:

 

I'm not trying to infer that covid isnt serious, it's just not the black swan event that it first looked like it could have been.  And the fearmongering in the media (and other places) is pretty intense.

I have worn a mask since march

we have isolated pretty strickly, as has by community, and we are still getting new cases -  in my opinion the fear is real and justified.  Elderly are isolating for months, I am telling them to not come out till next year!  

This is not mrsa, flu or HIV

This is a novel virus, that is airborne and even with decimating our economy, states of emergency, hospitals cancelling all elective procedures, massive mask and social distancing efforts it is still spreading - I would suggest the only reason it has not turned nuclear is that many in society are doing everything possible to prevent this from happening - it is not due to it not being dangerous or fatal.....

 

Also, I am greatly concerned with the following

1) our testing, both Dx and AB stink - everyone seems to have forgotten how crappy these tests are

2) our reporting system (not good before this) is now way worse, we have NH's that are not reporting, we have NH reporting and not getting data transmitted through the reports (both real happenings with in 30 miles of my practice)   Now we have the CDC stepping out of the mix.... 

 

 

We gotta keep holding strong and letting science and medicine guide our way, and not hyperbole and ancedotal stories....

[GetMeOuttaThisMess]

Do you have more details on the overrun hospitals?  I got a locums offer from a hospital in far south Texas.  
What does "overrun" mean?  That is a very subjective term.  Does it mean not enough ventilators and ICU beds?  Is the death rate going up there?  I dunno, havent found anything to suggest that though. I think NYC hospitals were overrun at the beginning of this pandemic, but we surged a lot of resources there.  I would expect the same thing to happen there.
 
As to the VA hospitals helping, that is part of the national strategic plan for any health emergency.
I'm not trying to infer that covid isnt serious, it's just not the black swan event that it first looked like it could have been.  And the fearmongering in the media (and other places) is pretty intense.

https://www.kvue.com/mobile/article/news/deep-dive-texas/veterans-health-administration-offers-service-for-full-capacity-border-hospitals/269-9b8f9352-905c-4de7-9210-e8b461b87422

Not my source for the story but it covers the jist of it. I saw story yesterday I believe it was either DFW local station or ABC World News.


Sent from my iPhone using Tapatalk

[Boatswain2PA]

28 bed hospital is pretty darn small, can see how they could get overwhelmed.  But the VA hospital stepped up according with the plan and has excess capacity.  Doesnt seem too catastrophic to me.

 

In my local area the hospitals closed down the Covid ICUs and wings for a while, but recently reopened them.  The local news reported on this like it was the end of the damn world as the hospitals were "Preparing to be overwhelmed!!!!!" by this SURGE in cases being reported.

Cases are way up, hospitalizations are up a bit, ICU usage up a bit, but death rate is plummeting.  Hospitals arent even cancelling elective surgeries.

 

[turnedintoamartian]

I recall the sentiment among public health experts that if we do enough of the the right things and are able to limit the catastrophic possibilities many will say we went overboard.

Here we are I suppose.

[LT_Oneal_PAC]

6 hours ago, mcclane said:

******* this isn't the Huddle. It's YOUR huddle. And I have no doubt that what you really want is "engagement" with your bad faith arguments and propaganda. "Just like HIV...." - "Public health = Politics by definition..." or whatever else is running around your facebook feed this week.

For full transparency, this warning is made public. This is your final warning to act civilized, or at least be funny with your comebacks. The next post devoid of substance to contribute to the topic and contains personal attacks will result in a ban.

[ohiovolffemtp]

It seems to me that the thrust of the current containment strategy is masking plus more targeted closures vs the "lockdowns" that were ordered in the states where I live and work during the first phase of COVID-19.  From my limited personal experience, it seems like the urban areas are still what's being hit - to a lesser degree the suburban areas.  However, the rural areas that I have contact with have had minimal to no cases.  I don't know if this is possible, but I wonder about increasing the granularity of the public health restrictions so that areas where people are naturally more spread out have less restrictions.  Actions at the statewide level don't seem to be target enough.  The other problem is that metropolitan areas often cross state lines, so there seems to be poor coordination at that level.

[ohiovolffemtp]

LT Oneal,

So can I quote Henny Youngman in responses to posters I don't like?

A man goes to a psychiatrist. The doctor says, "You're crazy" The man says, "I want a second opinion!" "Okay, you're ugly too!"

Yes, I know you'll have to ask either your parents or Google who Henny Youngman was.