Month: December 2021

Another day, another surge

As has been noted previously, I have been putting in some hours doing contact tracing with employee health. This has been good in that it has given something to do that I can get paid for while I’m not at peak performance. This has been bad because it is a naked, unblinking look at the waxing and waning of the pandemic.

Over the last two days I was covering the afternoons on the covid symptom line, responding to people who have left voicemails reporting exposures or to get set up for testing when they have symptoms. I started at 4pm yesterday and found that there were “more than twenty messages”, according to the unjustifiably cheerful automated voice on the voicemail box. I spent four hours responding to messages, cleared 15 or 20 of them, and when I was done there were still “more than twenty messages” and I hadn’t gotten past messages left at 10:00 that morning. I did another four hours today, cleared another 10-15 messages, still had “more than twenty messages” in the queue and didn’t get past messages left at 11:30 yesterday morning.

The good news is that all the people I talked to that were positive for covid were vaccinated nd not terribly sick. The bad news is that there were maybe two or three that said they had been exposed at work and all the rest had a story that was some variation of “I got together with my family over Christmas and my [aunt/uncle/cousin/sister/brother/whatever] tested positive [the next day/a couple days later] and now I’m feeling sick”.

STAY THE FUCK HOME!

Back to it

Today was my first visit with Dr. Urologist in several weeks. The visit included another scope to check out how everything is looking and it turns out that everything is looking pretty good. There is no new weirdness and the old weirdness seems to be healing up quite satisfactorily. I was due for another dose of BCG but the treatment nurse is on vacation. Dr. Urologist said that he was perfectly okay with me waiting until she gets back to start treatment again so I’m off the hook until the middle(-ish) of January. This is news that is about as good as I was likely to get today.

Right now the plan is still 3-4 weekly BCG treatments, followed by another scope once the inflammation from that has gone down (a few months after the last dose) and then if that continues to look good, monthly maintenance doses for 6 months. If things continue to look good after that I should be done with active treatment and just be up for scopes once or twice a year to make sure nothing else weird happens.

As everyone is aware, nothing weird has happened for the last three years so I’m sure that everything will continue to be normal and boring going forward with no surprises or unexpected complications at all.

Christmas movies

Rational people who discuss the relative quality of Christmas movies (a rather small subset of people) almost universally1 agree that the two main candidates for the greatest Christmas movie of all time are Lethal Weapon and Die Hard. I acknowledge the argument for making a distinction between Christmas Movies and movies that take place during Christmas but that is a debate for another day.

What I want to talk about today is the inclusion of a third candidate for greatest Christmas movie of all time; The Lion in Winter (1968).

Based on the play of the same name by James Goldman, and adapted by him as well, the movie tells the story of Henry II of England’s Christmas court in 1183, and the interpersonal and political dramas among Henry, Eleanor of Aquitaine, their children, and their guests.

The script runs the whole emotional spectrum over the course of the movie and is full of sharply funny and poignant dialogue. The cast is full of enough heavyweight actors that it bends light2 and even the soundtrack is extraordinarily good.

It is not a perfect film by any stretch. The directing and cinematography are not great, by modern standards at least, but it is still a towering achievement that easily deserves consideration as a Christmas classic.

—-

1 I would argue that disagreeing with the idea of those two movies being among, if not at the top of the list could almost certainly be used as evidence that would exclude someone from the “rational” category.

2One of the more enjoyable parts of the movie for me is Katharine Hepburn’s performance. She plays Eleanor of Aquitaine, who was notoriously French, but not only does she makes absolutely no attempt at a French accent, she doesn’t even make any attempt to conceal her own, quite broad, East Coast/New England accent (in her first scene she mentions that she’ll be attending a “Christmas co-aaht”). In spite of that she gives a performance so compelling that it almost pulls you into the screen.

Apparently, mental health is a real thing

There is a possibility that I’m overgeneralizing somewhat with this, and I may also be doing some post-hoc revisions of my internal dialogue. That said, what follows feels true to me and has allowed me to resolve some very perplexing things that my brain has been doing.

For some time now I have been having a harder time than usual with work. I’ve been finding it increasingly difficult to go to work in the first place and once I’m there I have a really hard time staying. This is not an entirely new phenomenon, and is also not unique to me. Who looks forward to going to work and who is happy to be there once they arrive? Almost no one, that’s who. That said, this has felt very different than the usual vague malaise of dissatisfaction that comes from having to put down Animal Crossing and leave the house.

“Well of course you’re having problems,” you might say, “you’ve been in cancer treatment and dealing with fatigue from that. No one expects you to be at the top of your form!”

This is true. I have a very real physical medical condition and I have unquestionably been experiencing some physical side effects from my treatment. However, at this point there really isn’t any reason that these side effects should be as limiting as they appear to be and, if I’m completely honest, they probably aren’t as limiting as I have been allowing them to be.

As I have discussed here previously, my brain constantly tells me that I am malingering or exploiting the system somehow because, in terms of physical health, I likely could be working without any restrictions right now. The slow realization that there might not be an actual physical problem sapping my willpower and energy has kicked the “you’re just a lazy bastard” message from my brain into overdrive in the last few weeks

Again, though, I genuinely have been feeling like I’m incapable of working, and the worst scolding from my brain hasn’t made it any easier to keep pushing and just do the work, so WTF?

At this juncture it is important for the narrative that I mention my longstanding prejudice when it comes to mental health. My poor opinion results from long years of dealing with the healthcare consuming public, which certainly has no shortage of people with genuine, serious issues, but also no shortage of people just trying to game the system. The way my mind works, it comes down to Sick or Not-Sick. You can’t objectively measure depression, anxiety, and trauma so they probably aren’t real. Intellectually I know this is nonsense and when it comes to patients I try hard to stay aware of this bias and to not let it affect the care I provide.

When it comes to myself, though, it is something of a blind spot. Deep down, I don’t completely accept the notion that my mental health is a real thing that can actually affect how I approach the world. Again, intellectually I know this is nonsense but that seems to be how my brain wants to see things.

Keeping all that in mind, my thought process has been something like the following;

Stage 1

  • The only valid reasons for me being unable to work are physical ones.
  • I’ve been feeling very limited in my ability to work.
  • Therefore, something must be physically wrong with me.

 Stage 2

  • The only valid reasons for me being unable to work are physical ones.
  • I don’t physically feel all that bad, really.
  • I still appear to be limited in my ability to work.
  • Therefore, I must be faking it. 

Stage 3

  • The only valid reasons for me being unable to work are physical ones.
  • I still don’t physically feel all that bad, really
  • I still appear to be limited in my ability to work.
  • This doesn’t feel at all like I’m faking it.
  • ???

The explanation, of course, is that my first assumption is faulty. I really am limited in my ability to work but at this point it’s for mostly psychological and emotional reasons, not physical. 

In February of 2020, an emergency room doctor at Evergreen Medical Center in Kirkland was infected with Covid. His condition deteriorated quickly and he was transferred out of the ICU at Evergreen to Swedish Cherry Hill so he could be put on ECMO. He was the first Covid patient on the west coast, probably in the whole United States, to be put on ECMO. That was my unit and I was one of the lead ECMO specialists.

I lost count of how many more Covid patients we put on before I left Cherry Hill. They all were insanely sick1, insanely complex to care for and most of them died, as did most of the Covid patients we had that weren’t on ECMO.

This went on non-stop.

For months.

And it still hasn’t exactly stopped yet.

There was a lot of non-Covid unrest at Swedish at the time as well, of course, so I had plenty of reason to be discontent before I left. Given that mental health isn’t real, I attributed my angst to the external situation and didn’t think about it past that.

Since then I have changed jobs two more times for a total of three job changes in the last 18 months or so. Each of the jobs ended up feeling unsatisfactory for one reason or another and, like I had at Swedish, I felt compelled to leave. True, the working conditions weren’t (and aren’t) ideal but I’m also starting to think that there is an underlying current of mental disfunction that is making it nearly impossible to get comfortable and settle in.

The point is that it has been a difficult couple of years and perhaps there could be some lingering trauma that I’ll probably need to deal with at some point.

For all my airs of professionally detached objectivity, I may be merely human after all.

Looking after my mental health has never been one of my strong suits but entertaining the idea that I could be mentally fatigued enough to impact my job performance has been something of an eye-opener. It explains a great deal of what I’ve been experiencing and it has already helped me to get the asshole part of my brain to shut up every now and then. Beyond that, I’m not sure if this shift in thinking will make any difference or not.

This post was very long and has an unsatisfying conclusion. It also may not matter because, hopefully, I will be changing jobs again in the near future.

But that is a story for another day.

————

1 I’ve talked about this before too, although I can’t remember if it was here. I don’t think it’s possible to convey the actual reality of how sick these patients were/are to normal (non-medical) people. Even most medical people, I think, fail to grasp how sick they are. The best analogy I’ve come up with is that caring for these patients is like trying to keep someone who is on fire alive but you have to do it without being able to extinguish them. I love doing that kind of work but it is exhausting under the best of circumstances.

This is the best thing I’ve listened to in a while

This is another one of those musical finds that more or less randomly dropped into my lap. I’ve been listening to a lot of music lately. I listen to music while I’m doing homework, I listen to music while I’m doing contract tracing, I listen to music when I’m trying to settle my brain before bed. I have pretty extensive music collection but looked at from a broad perspective there are really only five or six genres of music represented and recently it’s all been feeling a little stale.

Some time ago, and I can’t even remember where I heard about it, I downloaded the Boomplay app. For those not familiar, Boomplay is kind of Spotify for the African continent. My exposure to afro-pop is limited to the very small collection of artists that have broken in to the U.S. market to some extent so I was expecting to be able to find something new and (hopefully) interesting.

In one of those tiny sparks of serendipity, the first song that was playing when I switched it on was this

Angélique Kpasseloko Hinto Hounsinou Kandjo Manta Zogbin Kidjo is a musician, actor and activist who was born in Benin in West Africa and that is the extent of what I know about her.

In 2018 she released a cover of Remain In Light by the Talking Heads. The whole album.

It. Is. Amazing.

One of the best ways to get me hooked into a song is to take an element that is familiar and transforming it into something very different, DJ Shadow using a sample from El Condor Pasa (If I Could) in You Can’t Go Home Again, for example, or Diane Birch’s Velveteen Age EP. Remain In Light is one of my favorite Talking Heads albums (along with almost all the others if I’m honest) and it works surprisingly well as an afro-pop album. It is also unquestionably something different, even if all the songs are more than 40 years old at this point.

At some point in the near future, once I’m able to stop compulsively listening to this album, I want to dig in to some of her other material. I’m hoping more discoveries await.