Tag: Nurgle

Since I Have a Moment

It is currently stormy AF outside and the power keeps blinking. I usually1 sleep with two white noise machines going, and music playing in order to keep me from hearing things at night and waking up. The difficulty is, of course, that the white noise machines shutting off wakes me up, so I turn them back on and go back to sleep. Then the power blinks again. You get the idea.

Anyway, through the miracle of battery technology, I might as well take advantage of this unexpected up-time instead of just lying in bed and seething2. So what has been going on in my head?

The most confusing bit for me is that I feel both better and worse than I did, say, six months ago. I feel better because my mood is generally more stable (for the last few weeks anyway) thanks to getting a combination of meds that seems so work, having a therapist who is good at his job, and transcranial magnetic stimulation treatments3. On the other hand, the world in general, and the United States in particular, have managed to engineer a set of circumstances that are similar enough to the winter of 20204 that my PTSD is on Extra-Jumpy mode. I think I’m coping with the increased symptoms better than I would have if I didn’t have a few things working in my favor but it still isn’t much fun.

The coping methods include, picking up writing again5, and aggressively ignoring as much of the outside world as I can for the time being. I assume someone will let me know if any of the four or five things swirling around that could cause another pandemic actually does.

  1. This is a habit left over from working night shift. I have needed to continue doing it because I tend to be jumpy enough that nearly anything will wake me up. ↩︎
  2. I’m still seething but I’m not doing while lying in bed and I’m also doing something else, which makes the seething better somehow? I don’t know how these things work. ↩︎
  3. More on this when it isn’t 0330 during a windstorm. ↩︎
  4. I’m not going to go into a detailed list of the similarities between today and 2020 and today because it would likely cause my brain to spiral. It’s all the things you would think would be on the list and a few things that might be a bit more obscure. ↩︎
  5. No “I told you so”s from the peanut gallery, please ↩︎

Timeline

There have been some events recently that have prompted me to think about what happened when. As I have mentioned previously, my memory of the period between Fall 2019 and Winter of 2021-2022 is pretty vague. Kind of a big blurry smear. Blurry enough that when I sat down and started thinking about this, I was sure I had misplaced an entire year somewhere in there.

Completely by accident, I stumbled upon a possible explanation for why I might have expected there to be an extra year between 2019 and 2021, and why the first six months of the pandemic seemed like a lifetime. The possible explanation came in the form of a BBC News article about how, and why, children and adults perceive time so differently. The TL; DR, as I understand it, is that memories are more likely to come from new, interesting, or unusual experiences. The whole world is new for children, so their brains take a lot of memory snapshots. As we age, the novelty wears off and long stretches can go by without much film being used up. The TL; DR for the TL; DR is that children’s brains work more like high-speed cameras, running at 5000 frames per second, while adult brains tend to run at closer to 60 frames per second. Adult’s brains are still capable of running that fast, but it takes unusual, exciting, interesting, or otherwise high-alert types of situations. Like a global pandemic for example.

Below (I hope) will be an attempt to un-jumble some of this in my head. I make no claims about accuracy. A lot of these dates I had to look up because I couldn’t narrow anything down enough just by memory. It will also include some non-pandemic related events, just for reference. This is also incomplete. I may try to add more later and I might not.

Okay, fuck it. I’m done trying to get this damn thing to format in WordPress. Here is a link to a pdf. Share and enjoy.

Yeah, so I have PTSD

And generalized anxiety disorder as well, just for good measure (F43. 12 and F41. 1 for those tracking ICD-10 codes). I’ve probably had PTSD for a while now just based on the most common reaction I’ve had when I tell people this, which has been some variation of “Wait… you didn’t know?”

One of the funny1 thing about how my brain works is how it managed to have virtually every symptom of PTSD but somehow rationalize each and every one of them as being not only unrelated to PTSD, but as being completely separate issues that are unrelated to each other. Haven’t been sleeping well? I never sleep well. Been really irritable? Totally understandable, I’ve been busy and under a lot of pressure. Hyper-alert and anxious? I’ve been an ICU nurse for 20 years, being alert is part of the job and I’m just having trouble turning it off. Haven’t been able to make it through a whole shift at work because of overwhelming angst? Fatigue from cancer treatment combined with baseline laziness.

There were a few incidents which really made me think there was something more going on and my increasing dysfunction at work (documented in other posts on this site) was becoming unsustainable. I talked to my therapist, I talked to my primary care provider (actually I talked to Dr. Rando, MD because my regular PCP was booked out until the end of the month) and I got a referral to a psychiatrist. I’m off work until the middle of next month and when I go back to work I will not be returning to bedside nursing. As of the third week of February I will be a nursing supervisor at Swedish.

I’ll probably talk more about this new job later. I have a month to, as my father says, get my nervous system pulled back inside my body and then we get to find out if I can keep working as a nurse in any capacity or if I really have managed to blow out all my circuits.

1 Not like “ha ha” funny, more like “what’s that smell” funny.

I can’t even

“I think it’s hard to process what’s actually happening right now,” said Janet Woodcock, acting commissioner of the Food and Drug Administration, “which is most people are going to get covid.”

Woodcock pitched this as being a necessary acknowledgment when it comes to charting the path forward — recognizing that the focus now needs to be on averting the worst that widespread infections could bring in the near term.

“What we need to do is make sure the hospitals can still function, transportation, you know, other essential services are not disrupted while this happens,” she said. “I think after that will be a good time to reassess how we’re approaching this pandemic.”

Woodcock pitched this as being a necessary acknowledgment when it comes to charting the path forward — recognizing that the focus now needs to be on averting the worst that widespread infections could bring in the near term.

The Washington Post January 11, 2022 at 3:52 p.m. EST

As the Omicron variant spreads like wildfire across the United States, it’s likely just about everybody will be exposed to the strain, but vaccinated people will still fare better, the nation’s leading infectious disease expert said Tuesday.”Omicron, with its extraordinary, unprecedented degree of efficiency of transmissibility, will ultimately find just about everybody,” Dr. Anthony Fauci told J. Stephen Morrison, senior vice president of the Center for Strategic and International Studies. “Those who have been vaccinated … and boosted would get exposed. Some, maybe a lot of them, will get infected

CNN 9:04 AM ET, Wed January 12, 2022

We appear to have surrendered to the virus.

Just as a little thought experiment, imagine if omicron kills 1% of the people it infects (actually it’s higher than that). If, as the experts now seem to think, everyone in the country is going to get infected that’s an additional 3,000,000 plus deaths in the U.S. alone and that’s just from the virus. Add in the number of deaths from delays in receiving care for other non-covid health issues and who knows what kind of numbers we can put up.

Humans have lost, the virus has won, and it was almost entirely avoidable.

Maybe we deserve it.

I feel like I should put this here

I stumbled across this kind of randomly while wandering around the internets and, for a couple different reasons, thought I should share it.

As mentioned previously, I’ve had the pandemic right up in my face pretty much since the beginning. I’ve watched it spread, wax, wane, wax again and, most significantly I think, I’ve dealt with essentially nothing else in my professional life. My therapist pointed out to me recently that when you’re that close to something, it tends to look very large. Sometimes disproportionately so.

I am by no means downplaying what’s going on. We’re still really not in a good place when in comes to case numbers, rate of spread, and available hospital resources. Models are predicting that the omicron surge will peak in 2-3 weeks with close to 1,000,000 new cases per day in the United States. Keep in mind, too, that the official counts are still, very likely, drastically undercounting. This graph is wastewater analysis from Boston showing the increase in viral DNA in sewage. The spike from omicron completely obliterates the spikes from all the other surges we’ve seen so far suggesting that there are likely significantly more cases than have been recognized;

All that said, we have come a long way from the beginning and there is still hope that we can survive this with something that looks more or less like modern society relatively intact.

Now we come to what brought me here today;

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, biostatistician, professor, researcher, wife, and mom of two little girls. During the day she has a research lab and teaches graduate-level courses, but at night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions, rather than decisions based in fear. 

The most recent newsletter is entitled “There is good news” and is worth a read. Things are bad but they could be worse and they will get better. Eventually.

Anyway, read it and feel some momentary relief from the doom that I’ve been spouting.

https://yourlocalepidemiologist.substack.com/p/there-is-good-news

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!

Oh look!

Now that I’ve neglected this to the point that no one is reading anymore, it’s safe to post again.

The truth is there hasn’t been anything happening on the cancer treatment front, I’ve more or less settled into a routine with work, and my mental health is better overall than it’s been in quite a while. Of course that has meant I haven’t needed to whine about anything here. And I pretty much still don’t but there are definitely things on the horizon.

Looming largest in my mind right now is another covid surge. I’m sure any number of the none people reading this have heard me lamenting that I couldn’t do another year of covid and it’s looking like another year of covid is a good possibility. Having spent no small amount of time ruminating on this, right now, from a mental standpoint I think I actually could do another year of covid. I would certainly be happier to not have to but, strange as it may seem, having a couple months mostly away from the bedside may have allowed me to recharge my batteries a little bit. Well maybe not another year of covid, maybe six months. I don’t know. Anyway, the point is I could definitely do one day at a time which is more than I would have been willing to say a few weeks ago.

As an aside – there really isn’t enough information on the omicron variant to make any definitive statements about what the next year is going to look like. What is noteworthy is that in South Africa, where omicron was first identified, the delta variant was pretty much the exclusive strain being passed around and omicron is out-competing it and is on it’s way to becoming the new dominant strain. It is a deeply concerning variant and an excellent reason to get your vaccine booster ASAP if you haven’t already.

Anyway, this revelation that stopping to rest for a while can replenish one’s stores of mental and physical energy is the latest in a series of startling discoveries I have made recently now that my brain has had time to reboot.

The first of these came to me maybe two weeks ago. I believe I have lamented here before that I didn’t really know what to do with the advice to “make time for yourself”. The foundation of my difficulties was that I had more things to do than time to do them and it was impossible for me to make time for anything else. Short of actually making time (see any number of science-fiction stories to learn why that isn’t a good idea) I genuinely couldn’t comprehend how I was supposed to “make time for yourself”.

My revelation came while putting together a to-do list for the week. As was usual, I knew there wasn’t going to be time to get to everything so I was triaging and prioritizing what I really had to get done and what I could let slide and it occurred to me that I could just put myself on the to-do list and treat it the way I would any other project. And that the time-for-myself project didn’t always have to be the one that got dropped when it came down to prioritizing for time. If I had been on the road to Damascus I would have fallen to the ground. This was a revolutionary technique that I could use to try and…

…right… make time for yourself… like everyone has been telling you to…

Ahem.

Right. So I’ve been making time for myself and the world hasn’t ended yet.

I can’t even with this

This popped up on one of the nursing forums I lurk on so I can’t absolutely vouch for its authenticity, but it seems unfortunately plausible. Someone wants to put themselves on extracorporeal membrane oxygenation at home rather than get vaccinated.

As a point of information, this is what someone on ECMO looks like:

I assure you there is a patient under all that equipment

And just for further fun, this is what happens when a component on the ECMO circuit fails and you have to swap it out for a new one:

That was a real patient (I was filming) and once my two colleagues there put the clamps on the circuit the patient was, by some quite reasonable definitions, dead and wasn’t really alive again until they took the clamps off.

So yeah, go ahead and do this at home. Good plan. WAY better than getting vaccinated.

Edited to add – Looking at the picture and video above, I am almost positive they are the same patient. I remember when we were getting set up to change the oxygenator there was a great deal of unease because the patient was entirely dependent on the pump to keep his blood circulating. His heart was not actually beating at all.

A normal person with even a minimally functioning heart will produce a tracing on an arterial blood pressure line that looks similar to this;

The red line there measures the pressure changes in an artery (usually the radial artery in the wrist, the same place you feel for someone’s pulse) with every beat of the heart.

If you look closely at the two monitors in the picture above that have an art-line tracing on them, you will see this;

Those lines are, in fact, flat. This is not all that unusual for people with bad hearts that have a pump doing all the work for them but what it does mean is that if something stops the pump, like someone clamping the circuit so they can change the oxygenator, all the patient’s blood pressure goes away. Not “low blood pressure” but “no blood pressure”.

So again, go ahead. Do this at home. What could possibly go wrong?

If you want to learn more about extracorporeal membrane oxygenation, check your local library!

Or just ask and I’ll talk about it for as long as you’ll let me.