Out of the frying pan…

and back to the COVID-19 unit. If it seems these COVID posts are coming closer together, you’re probably right.

We rotate therapy staff through there and the speed at which we rotate depends on how many of us are there at once. Last week there were three COVID Occupational Therapists all week, four on Monday. Once upon a time, there was one therapist for ½ days.

Instead of starting my week there, I ended it there. Saturday I saw three COVID patients. Two were incidental findings in patients admitted for traumatic injuries. All patients are tested on admission and isolated until a negative result comes back. These two were positive but asymptomatic. The third was sick enough to be admitted but breathing on their own on the third day and may be going home this afternoon (Saturday).

Saturday, January 8

Recommendations are in flux once again. When the delta variant blew through, I saw young, previously healthy, unvaccinated, and very sick people. Those who survived were here for weeks or months. Now numbers are up but severity is down. We got new recommendations last night.

PPE from “strongest” to “weakest”:
–For COVID+ patients, I wear a PAPR (Powered Air-Purifying Respirator), gown, and gloves. The PAPR sucks in room air, runs it through a filter, then delivers it to my hood. The filter is self-monitoring to let me know when it needs to be changed.
–I have the option of wearing a fit-tested N-95 respirator with a face shield instead of a PAPR. “Fit-tested” means I wore that mask, a hood was placed over my head, and a bitter-tasting substance was injected into the hood multiple times under varying conditions (standing still, moving around, shaking my head, bending over, etc). If I never tasted the bitter substance, I was now “fit-tested”. Any detection of the taste would mean starting the test over with a different mask model.
–For COVID- (negative) patients, I now wear a “well-fitting” mask. That essentially means an N-95 mask that has not been fit-tested but fits tightly and has no apparent leakage. (Why this? Because we just got a new model of N-95 that is way more comfortable than the one I was fit-tested for. No one has yet been fit-tested for this model but it looks promising. The mask I was first fit-tested for 20 years ago was not an option this time, though is now back in stock and less uncomfortable than my current fit-tested model. We are supposed to be fit-tested annually. I was fitted at the beginning of the pandemic and fitting should be available again soon. [Two years is better than 20 anyway.]) It is also “strongly recommended” that I wear an eye shield, so I do. A mask and face shield makes it hard for patients to hear me. The eye shield doesn’t have that effect. The N-95 is fluid-resistant anyway, so the shield is overkill for non-COVID patients unless you try to wear the same mask for a long time (as we did earlier in the pandemic when supplies were short).
–A standard “barrier mask” (surgical mask) is no longer considered adequate for any patient contact and some are saying only appropriate in your own office. As of today, that’s what I wear to enter the building.We’ll see how that changes on Monday.
–A cloth mask has not been acceptable for many months. We used to wear them in all parts of the hospital except patient rooms.

I’ve seen a bunch of anti-vax memes. Today I saw a batch of pro-vax memes. I couldn’t resist.

From Reddit via The Daily Kos
From Reddit via The Daily Kos

Thursday, January 13

An interesting week so far. The hospital gods must be on my side. I have seen several trauma patients with incidental COVID+ findings, so I feel at home. I’ve also seen patients whose trauma may have been a result of their COVID confusion; there’s really no way to know for sure. Tuesday I saw a young and otherwise healthy person who was sedated due to extreme agitation due to COVID. Wednesday that person looked great, except for the need for CPAP. (Continuous Positive Airway Pressure, which feels sort of like a powerful fan being blown into your mouth and nose at all times. It makes it hard to exhale.) They were up and around the room. We stood and looked out the window together. Thursday they were intubated and moved to the ICU. I’ve seen multiple people with brain bleeds – from major trauma, minor trauma, no known trauma. I saw them after a decompressive craniectomy (in which a chunk of skull is removed to allow the brain to swell, the skin is closed over it, and the bone flap is stored to put back later).

We are too busy to keep up. I have 15 patients per day. I can’t see that many. On Tuesday I had 12 newly-diagnosed patients. Most of them I passed on to a Therapy Assistant to see Wednesday, so I could see a dozen more new folks. Today I had a few that I had to leave until tomorrow. The eight hour day is not really an option; nor is seeing everyone who should be seen. Each day is a compromise. “Triage” is my middle name.

Today a bunch of suits came through the unit, led by the Director of Nursing. They stood by the nursing station to hear tales from the front. As I walked by, I heard the word “burnout” and the phrase “we can’t keep up” more than once.

Friday, January 14

One in every five patients in the hospital are now COVID+. We have the incidental finding (here for some apparently unrelated reason, asymtomatic, but COVID+), the here because of severe COVID infection, and the grey area in between. The person who fainted “for no reason” but is COVID+ may have fainted due to weakness from the infection. Do we know for sure? The person who had the ischemic stroke could be coagulopathic from COVID infection, but possibly just happened to have a stroke while COVID+. The person with bleeding on the brain after falling – did the COVID infection lead to the fall? The people with what we call “failure to thrive” (general malaise, lack of appetite, unable to care for themselves) and COVID-19 probably are failing to thrive due to COVID, or it may just be what pushed a borderline functional person over the edge.

At any rate, my COVID caseload keeps growing. It shrunk by two during the course of today. One went home, one died.

I’m not on Facebook, so count on others to read it for me and tell me of the stupidity therein. I’ve seen a lot from people posting anti-vax and COVID-denying memes that stop the day they are admitted. Then their posts are about how miserable they are. And then comes the inevitable post from someone else about the GoFundMe campaign to support all the children this person left behind.

I saw the posts from a person who refused the vaccine because its development involved a fetal stem cell line, then demanded treatment with monoclonal antibodies which were developed using that same stem cell line.

Another series involved people claiming that hospitals are paid a bonus for killing people with COVID treatments, so you should refuse to go to the hospital…then those people show up at the hospital only when at death’s door and wonder why the hospital didn’t save them – probably because they failed to use the proper doses of dewormer and bleach. There are those who seek attorneys to help them sue the hospital for failing to provide them with unproven and unapproved treatments they read about on Facebook. Yet another involved people telling their friend to refuse remdesivir because it kills people (and is one of the ways hospitals claim their bonus). Yes, some people treated with remdesivir die; but at a lower rate than those who don’t get the treatment. So if you show up at the verge of death, the hospital tries everything and you still die, was it the disease or the treatment that killed you? Why is that even a question?

I could argue with equal accuracy that you should refuse to drink water, as 100% of people who drink water die. (Not right away – that’s what makes it so insidious.) I could argue that, if you get pregnant, you should demand an abortion rather than being forced to bring a child into the world. We know that 100% of those who are born die – many only after a lifetime of suffering. Is it more humane to sentence one to a life of suffering, or to save it from birth in the first place?

Saturday, January 15

My eight day COVID week has come to an end. I’ve got nothing to say, but it’s okay (how’s your boy been?). (20)