Jan. 20, 2021 – A New Year Begins

A few weeks ago, I stopped posting about COVID. With a new President coming in, led by science, I didn’t feel I could add anything new.

Then, last night around 2am, I received the following letter from “Dr. A,” who is working in an ICU in Southern California. He originally messaged me a month ago, and I asked him if he would be willing to share his experience.

Look, I know we’re all tired of this pandemic. I miss seeing my son and daughter and their families. Young people want to go out, celebrate, hug their friends. It’s maddening. Even though the vaccine is slowly rolling out, it’s tempting to throw caution to the winds. We’re tired of sacrificing.

I’m doing one more post on COVID to honor Dr. A. This is sacrifice. This is service. If you think it’s a burden to wear a mask, or you know someone of that ilk, read this letter.


Sorry for the delay in response.  I haven’t forgotten, I’ve just been busy.  I’ll do my best:

I’m currently working in the ICU.  We average 13 plus hours a day, six days a week, and while we’re at work we’re constantly moving.  I can’t speak much as to how people find themselves in the hospital. I don’t know much about most people’s stories before they arrive in the ward, and being in the ICU, most of our patients are sedated and ventilated so we don’t do so much talking about whether they believe in COVID or not.  We do have a good portion of a family – three members all with COVID, two in critical condition.  Regarding essential workers, I personally haven’t seen any but I know that earlier this year, we had a physician catch COVID and unfortunately pass away.  I didn’t personally know the person but it’s horrible to lose somebody you’re working with. Makes the front line feel like a front line.  Other than that, my hospital has been pretty good with keeping people safe.  We’ve had pretty tight rules and when somebody has a serious exposure or tests positive / is symptomatic, they quarantine and the others pick up the slack.  Few times entire departments have had to be turned over to completely new teams.  Lots of people being pulled from one rotation to cover in the ICU or another ward that needs help.  It’s a pretty dynamic process but that’s how medicine is- it’s constantly changing.  It takes a lot of flexibility but everyone who’s here wants to be here so there aren’t many problems getting shift coverage.

Regarding dealing with stress.  That’s a hard question, and everyone is different.  We are following the stay at home orders, so what sucks is that I don’t really know my coworkers out of work.  We don’t hang out when we aren’t directly working with each other.  I personally enjoy my alone-time, so I haven’t felt much difficulty having to spend more time alone.  The hard thing for me is being away from my family, who lives on the other side of the country, and not being able to visit them – partially because of COVID restrictions and not wanting to travel to potentially spread the virus, and partially because I physically don’t have enough time off work to make the trip.  

On the day to day, if I’m on a heavy rotation like the ICU I’m currently in, time flies pretty quickly.  I work 13 or so hours, drive home, have maybe two or three hours to eat, maybe do something relaxing briefly, and prepare for bed.  On my one day off, I usually sleep in to catch up, and spend most of the day relaxing.  The time goes by quickly so I don’t have much time to think about how much it sucks.  But here and there after work it kind of hits me and I’m like man, this is fucking crap.  

One day this past week was especially tough. I spent most of the day dealing with a critically ill COVID patient who was in his late 30s and previously healthy, failing all of his medical interventions and just getting worse every day.  And somewhere within managing that I had another non-COVID patient die on me kind of unexpectedly.  I was in the middle of setting up ventilator settings on this guy, when the nurse tells me Mr. X is desatting (desaturating – oxygen saturation levels in blood are dropping) while the respiratory therapist is suctioning him.  He was an older gentleman with no COVID but he was seriously septic with what seemed like a new bacteria in his blood cultures each successive day. I go in to evaluate him, and I listen to his lungs.  I’m not hearing breath sounds, I’m hearing fluid.  Mucus.  This guy was not oxygenating.  We suctioned out a good amount of it, but then his heart rate started slowing down. Within seconds his heart stopped.  I called for a crash cart (cart with critical medications and defibrillator for when a person’s heart stops) and we ended up working this guy up for a good hour before we decided to call it and pronounce him dead.  At that point, you call the time of death and essentially everyone goes back to work.  You call the family, call the chaplain, cover up the patient and clean up the room.  Then you go back to doing your work – because you still have other patients who are also in critical condition.

Usually during the workflow you don’t have time to ‘feel’ it. You kind of do the thing, work up the patient when their heart stops or whatever, then when it’s over you’re like well damn, he’s gone now.  But now I gotta go deal with all this other crap I gotta do to take care of the rest of my patients.  So you’re constantly moving from one thing to the next.  No time to think. I got in my car, four hours after my shift was supposed to be over, and blasted my angry metal music all the way home.  Sat in my car for a bit and cried thinking about everything that’s going on, before I composed myself and took the elevator to my apartment.  You shove away the feelings during the day cuz you don’t have time to digest what’s happening, then you go home and have silence and it just hits you. Then you compose yourself before bed because tomorrow’s a new day of this shit and that’s showbiz, baby.

I have a few things I turn to to make me feel better or help me cope.  One thing I look forward to is my nightly shower beer.  It’s just nice to be able to chill under warm running water and enjoy a beer.  On my off days I like to go on hikes, whether it’s alone or with my amazing girlfriend.  Just get lost in nature.  Good place to think but also to just take in the beauty in the world.  When I don’t have time to get lost in nature, I may go for a walk in town or watch a movie with my girlfriend.

Sacrifices in my personal life?  Well even without COVID the medical profession requires a ton of sacrifices.  Watching your friends grow up, move out, get in serious relationships, enter the work force, and start their lives.  We go back to school for another four years, picking up another four years of debt, then we start working a job that vastly underpays and overworks us. Yeah you’ll make 70K or so as a first year medical resident, but working 80 hours a week – the equivalent of two full time jobs means your hourly pay isn’t all that spectacular for what work you do.  I guess on the bright side you don’t really have time to spend the money, so that’s nice.  COVID on top of it all just cuts down on our possible coping mechanisms and really pushes our sanity and extends our work hours. Also, I just feel like a dick to my girlfriend – she traveled thousands of miles away from her home to be with me, and she only gets to see me for 3 hours a night awake, plus one day a week that I’m probably half asleep cuz it’s been a long week.  Honestly the medical system has always had inhuman expectations for doctors, and if anything, COVID is helping to highlight the weaknesses.


Describing this letter to my wife brought tears to my eyes. Reading it again does the same.

Quite a few of you wrote to me asking if I was OK and telling me they missed my commentary. I thank you for that. I started these posts at the end of March 2020 for a couple of reasons. First, there was a ton of misinformation out there, and I wanted to help spread science instead of lies. Second, I thought I could counteract the effect of the “bully pulpit” wielded by our thankfully departed #45. I vowed that I would stop posting about COVID as soon as I no longer had anything meaningful to contribute.

That day has come. Thankfully, we now have a President who is guided by science, who mourns the 400,000 Americans dead from COVID, who is determined to stop this plague. It’s not that the covid-deniers still aren’t out there, but their leader has been muted, hopefully permanently.

I also don’t want to divert the message from our public health officials and our federal government. Until noon today, that was too often a partisan, idiotic, and contradictory message. There will be mistakes in the future, sure. But it won’t be the dominant theme.

The truth is out there in abundance. It’s on our public health department web pages. It’s on the CDC website. And if you really want to get into the nitty gritty of virology, it’s on sites like microbe.tv.

Four hundred thousand people are dead as a result of the worst response to the pandemic in the world, led by someone who worshipped power and autocracy. But as of noon today, we no longer can blame #45 for future spread of COVID. It’s now up to us.


One final note. The title of this post is not just because we’re starting a new phase in the fight to defeat the pandemic. I spent this morning watching the inauguration of Joe Biden.

I’ve never been a flag waver. As any regular reader knows, I don’t go along with the whole notion of “American Exceptionalism.” Today, however, I felt that at least our country has a possibility of becoming exceptional.

I thought of my mother and father, who at the age of 23 and 26, saw Hitler become the chancellor of Germany in January 1933. Twelve years later, the Soviet army stormed through southwest Berlin, where their house was one of the few still standing after 260 bombing raids. My grandfather, who had been a well-known social democrat in the 1920’s, got along well with the Soviet officer who commandeered their house, which was probably why my mother wasn’t one of the 80% of Berlin women who were raped. The Jewish woman who had been hiding in their attic for four years was finally able to leave for America. The war was over, but their country was in ruins. After my grandfather committed suicide, they left for America as well, with a cash reserve of $18, to become a butler and a maid for one of America’s wealthiest families.

On January 6, 2021, I pictured living through what my parents did 80 years ago. For a couple of hours it seemed a very real possibility. Just as the inevitable outcome of Hitler’s antisemitism was World War II, the denouement of the white supremacy emanating from 1600 Pennsylvania Avenue was the attempted coup on January 6.

Unity sits on the shoulders of accountability. That’s the lesson of history. Anything else is a sham. It’s up to us to make sure our political leaders don’t forget that.

Finally, I admit I made a mistake when Obama was elected in 2008. I was elated. I figured I didn’t have to think about politics so much. Millions of us thought that, and in 2010, we got our first wake-up message.

I’m going to try to correct that. While I may not be active anymore on the COVID front, I do plan to be involved with local issues, in particular housing policy. I personally believe that’s at the root of discrimination and inequity.

I hope all of you find your own issues to get involved with. I’m also very mindful that many of you have never stopped being activists. No matter what your previous level of involvement, this is a new year. Resolve to be active locally. We can’t take democracy for granted. We have to fight for it, nationally and especially locally.

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