April 20, 2020

Illegitimi non carborundum

Neither of my parents were in medicine. I did take a round about way of getting into medical school, not starting until I was 32. But the truth is, I was interested in medicine from a young age, because my father’s brother David AND his sister Mary were both doctors. I just couldn’t be bothered when I was in my 20’s. Eventually, I got bored with what I was doing and decided I needed a challenge. Medical school it was. I never looked back.

Both Aunt Mimi and Uncle Dave were supportive and encouraged me. They had practiced together initially in Troy, Ohio, until Aunt Mimi got married, raised a family, and eventually taught Family Medicine at Wright State School of Medicine in Ohio. Uncle Dave became an anesthesiologist. One reason I went to the University of North Carolina was that Uncle Dave had taught there. He still lived outside of Chapel Hill when I was in school, so I got to hang out with him while I was there. One of his favorite sayings was “Illegitimi non carborundum” translation from Latin meaning “Don’t let the bastards get you down”. Medicine can be frustrating that way, especially now. When I graduated from med school he gifted me with my first subscription to the New England Journal of Medicine. I have renewed it every year since, in honor of him.

The thing about medicine is that everything changes, making it important to keep up to date, which is another reason I keep getting the New England Journal. I learn so much, but I will admit that my eyes cross sometimes reading the abstracts of pathways of things like cytokines. Who knew how important they would be? But I look at every issue, read the abstracts of the research, study the case reports, look at the images, and sometimes am disturbed by what I read.

Two items in this week’s journal hit me hard. One is a tale of trying to obtain PPE for a hospital in Massachusetts. The other is about other victims of the COVID-19 pandemic. I found the first upsetting because I don’t think it needs to be that hard. I am disappointed in the federal response. Hospitals should be able to get what they need without begging or paying extra for it. Health Care Workers are dying because of these issues. I know there are explanations floating around, but the deaths make the excuses less palatable to me.

The second story is about how patients are putting off getting help for life threatening events because they are scared to go the ER. Many procedures are cancelled and treatments are postponed, for different reasons. One reason was to save room in the ICUs for COVID patients and another to save ventilators for COVID patients use, which are normally used for anesthesia in surgeries. But the cost of those postponements is huge. It can threaten their lives. People with heart attacks and strokes are not going to the ER, people with fractures aren’t getting treatments. Oncology patients are postponing needed surgeries and treatments. Some states and cities are citing high out-of-hospital deaths, much more than usual, attributed to people staying home to avoid getting exposed. This is collateral damage that no one wants to have. The truth is that most places without a huge outbreak like New Orleans or New York City have lots of capacity in their ER’s right now, since no one is visiting them. So if you or someone you care about has signs of a life threatening illness, don’t delay. An ER can be safer than going to the grocery store or Home Depot.

Make no mistake, people are suffering, whether it is from COVID-19, other health problems, or economically. Times are tough. Isolation is hard, and most everyone is doing their best and staying home. I try to understand what people are going through, I don’t like to play politics but I have to think that the people protesting the shutdown are misguided, and being influenced by others to go down a path that endangers more people, especially health care workers, and can prolong the shutdown longer as the infection spreads. I wonder if they could use that energy and ask Congress for more money to help the ones who are really suffering from lost jobs and income, the ones living paycheck to paycheck. Let’s face it $1200 doesn’t really go far, if you are paying rent or have a mortgage. That is what we really need- relief for everyone. Some countries are guaranteeing a basic income while this is happening. Some economic relief not tied to anything and not going to corporations but to people could make a huge difference for many and relieve some fear.

We are moving forward, we are learning more about how to deal with the virus, when hospitals aren’t overrun, patients do better, and remember that most Americans want to stay the course until it is safe. More ideas are coming of how to help and how to recover. Hang in there. We will get through this.

Wash your hands.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.nejm.org/doi/full/10.1056/NEJMc2010025

https://www.nejm.org/doi/full/10.1056/NEJMms2009984

https://www.cnn.com/2020/04/19/health/us-coronavirus-sunday/index.html

https://www.nbcnews.com/tech/social-media/conservative-activist-family-behind-grassroots-anti-quarantine-facebook-events-n1188021

https://www.washingtonpost.com/opinions/2020/03/20/coronavirus-is-upending-society-here-are-ideas-mitigate-its-impact/