ONE YEAR AGO!

The world is in upheaval right now.  It's really something that has never been experienced before.

But,  one year ago, OUR LIVES were in upheaval.

The world wasn't at risk or isolating, but WE WERE....or rather, RAH was in a very precarious position.

BUT, he had a good surgeon and our family rallied around.  I cannot ever express the gratitude I have for each one of our five children who helped us so very much during those two weeks.

FAMILIES ARE THE BEST!

I am eternally grateful for: Jenni, Justin, Jeremy, Kristi, Jordan.

As I look back at how serious it all was, it's like a dream.  But there they were every step of the way, beginning with Jenni going to the doctor visits with us and reassuring us.

WOW!  I love this amazing family.

A RARE Sunday Visit

...I was so excited to go  out and visit somebody.

I dressed up and even put on lipstick!

But, then I put a mask on over it!  HA HA...signs of these crazy days in our lives.

But, there we were on a lovely Sunday afternoon at Sheryl's delightfully decorated home, taking a peek at her fancy table setting.

It was so fun!

Maybe we can do it again some day!  HA HA HA HA Ha

The Challenge!

Jenni challenged us all to write HAIKU during this time:

This was her email to us:

Didn’t you wake up this morning thinking it’s about time to write some Haiku? Me too!!! 😉😂

Here’s mine:

The world has gone mad

Things will never be the same

Coronovirus

End of the handshake

Rise of the toilet paper

Bangs are in again

Let’s hear yours.....

5/7/5 syllables 

From Allen:

Black bird broke her beak.

Window light deceived her flight.

Freedom bright, then night.

From Jordan:  (Who is in New York fighting for many lives in a Long Island hospital!)

April rains come down

Bringing economic frown

Disrupts precious Tao

Everyone alone

Thank god we all have our phones

to share and bemoan

Yet, even still, blooms!

World alight with spring perfumes

Refreshing communes

Soon twill be alright

We will hug and talk all night

Laughs about our plight

From Jeremy:

These Haikus were fun

I'm not sure I can play too

Bangs are in again?

From Loni:

HEY,  I’m almost there.

I am still trying to think.

Could be a good while.

From Kristi:

be safe, stay at home

if you don't, you could get sick  

or could break a bone

i really enjoyed 

all of your thoughtful haikus

my family rocks 

From Eli:

Sunday drive with fam

Very, very, very big waste of time

I feel sick; let’s go

From Amy:

Teenagers make drives painful

Don’t appreciate

Quality time with parents

We went to Kamas

Spied cranes, geese, ducks on

Soggy, muddy banks

And, Jenni finished it off:

Jeremy, Kristi

Amy, Eli, and dear mom

So so so so great!

I love our family, as Kristi says, our family ROCKS!

Tell That to the Health Care Workers!

Really... a LIE!?!?!?!?

One day, Jordan was so emotional in his hospital that he teared up at the deaths of people.  That fogged up his mask, which he can't easily take off and desanitize.

Tell that to the thousands of people who have died or suffered irreparable damage; like the young man who lost his leg to this LIE!

It's a challenge to stay home; it's a challenge to stay away from friends and even family; it's a challenge to have normal life disrupted; it's a challenge not to get to shop, golf, socialize, eat out, play in the parks, but it is DEFINITELY

NOT A LIE!

Letter From the Front Lines of New York State

Hello friends,

Just a quick update so you all know I am okay. Things are moving along in NY. First off, here's the important update: Acer rubrum had finished it's early spring flowering and has begun to set fruit. Magnolia × soulangeana is putting on it's amazing annual show, peaking here 2 weeks behind their Virginia siblings. Narcissus are everywhere and the early tulips are popping. Cercis blooms have still not erupted but Prunus and Pyrus are at peak bloom. So, all proceeding apace. The beautiful renewal of spring has come despite the human world seeming to fall to pieces.

Personally, I'm feeling good, staying rested and fed. Yesterday, I drove out through the Hamptons and saw beautiful Montauk. You will all be reassured - I can confirm the NY billionaires appear safely tucked away in the 9 million dollar oceanside mansions with their Bentley SUVs parked out front, intact and shiny as ever. The daily deliveries of french wine, spanish cheeses and fresh toasted paninis does not appear to have stopped as all the high-end charcuterie have signs announcing home delivery, phew. 

Back on earth, hospitalizations have clearly peaked, as have new intubations. Nursing and clinical staff levels are approaching par. There remains intermittent, critical shortage of supplies. As one missing item becomes available, others run short. Monday, we ran out of non-sterile gloves and called for more. Central supply said that's all we get until tomorrow. So everyone got a pair of sterile gloves to last the rest of their shift. Wasteful but better than nothing. No one should have to work in a covid ICU without gloves. There is a lot of make-shift protective gear being used. Everyone is wearing a different kind of N95. Masks are from hardware stores, ski googles from the garage and hair nets from salons are commonplace. People use whatever they can find.

Someone told me about a room where they have PPE set aside for doctors. I went down to ask if they have any hairnets. It was just one guy sitting behind a table covered in reusable cloth gowns. Not surprisingly, that's the one item we've never run low on. There's always plenty of wrinkled, tiny yellow gowns. (See -Farley, Chris "Fat guy in a Little Coat") I asked if he ever gets anything else and he just shook his head slowly, with a mournful look. "But we have plenty of these gowns if you want one!"  (Many of you have offered to sent things up, which I appreciate greatly. Thank you. For now, I am okay. I reuse my personal PPE on a rotation, after letting it rest for five days).

From our clinical team, there is the usual parade of successes and failures. We had another extubation this morning. A 41 year old, previous healthy man, who had been intubated since 4/6. His kidneys have failed and he will likely need long-term dialysis but he is breathing on his own, awake and alert. And no deaths for three straight days!. (Well, not really... two people died on our service yesterday but I was off so...)

Today we started our first trials of convalescent serum. People who have fully recovered from Covid-19 have donated serum that we will now give to those who are sick. The hope is that the antibodies present will slow or stop the disease. The first patient in the hospital to receive it is one of ours, a 43 year old male intubated since 4/10.  We are very hopeful it will change the course of things. I'll let you know. Thank you so much for your well-wishes and for keeping in touch. I love you,

Jordan

He Never Met a Road....

...he didn't want to take!  (if it is out in the hoodies!)

On these rides, I can usually count on his to say two things:

1. It's not that far.
2.  I didn't think it would take that long!

But, another day in the outdoors just a few miles south of St. George, Utah.

And Other News From Across the Globe

UNBELIEVABLE!

This is the city where Allen and I lived for one year.  We would go to the McDonald's about once every three weeks to get my American food hamburger fix.  Of course, there are many McDonald's in the ginormous city, so this might not be the one that featured this sign.

The article went on to say that since the Chinese had read that Blacks are more likely to get the corona virus, this was necessary to prevent the spread.

McDonald's headquarters were outraged and closed the store temporarily.  The Chinese government also responded harshly against the store.

When will prejudice ever end?

Another Letter From Jordan in New York Amid Corona Virus

Day 6 - All in This Together

Friends, 

All the employees are funneled though a single entrance in the back. The bricks and hallways along the way have been covered with messages of support, thanks and optimism. "Stay strong!  Keep fighting!  It's us against Corona! You got this!" On day one they seemed quaint or inadequate, perhaps even a tiny bit gauche. But now I look forward to the little messages of hope as we come through each morning, a gauntlet of affirmation. We need all the support we can get. It helps. It helps more everyday.  I love that they constantly add to it, as more thoughts of love and support arrive.

We lost five people today, almost a third of our service. Sometimes, you can see the crash coming a mile away. The third death, Mr. H, had required increasingly large amounts of medications to keep his blood pressure up over the last 48 hours. His skin was mottled and gray. Even with the settings on his ventilator all the way up, he wasn't getting nearly enough oxygen.  I didn't know him as a person, just a name followed by a dizzying array of numbers, xrays and trends. Yet, when he finally crashed, I felt so sad. Completely gutted and weak. It's profoundly demoralizing to be so impotent. To come up blank, again and again.

Covid. I want to hate it, to blame it and to curse it. But's it's inanimate and unfeeling, A random, self-replicating packet of genetic material that is constitutively without intent or design. There is no malice to fault, no scheme to denounce. We have only its' devastation to behold. I made the silly mistake of crying today. It came right after our third code in less than three hours. I can't do that again. It just fills your N95 respirator with itchy, wet snot with no good way to clean it out without breaking down your PPE. That's dangerous and resource consuming -  so I lived with it. Like so many things in an ICU, it's gross...but what can you do? 

I'm proud of my team. Proud of their steadfastness and willingness to jump in. Codes, always a somber affair, have a new, added dash of terror. When patients lose their pulse, we go through the usual procedures-- which always start with chest compressions. It's a last-ditch effort to reverse things but it has become very risky for the personal involved-- you have to physically touch the patient and pump hard on their chest, 100 times a minute. These efforts indubitably aerosolize large amounts of virus widely and in concentrated form -- aimed straight at those doing the compressions. Yet, they keep jumping in to do it. Over and over again.

The doom will pass. There are signs things are looking better in terms of ER visits and hospitalizations. Headlines say were are at a peak here in NY. Surely, for each patient here there are hundreds, if not thousands, that have been infected and are recovering nicely. As terrible as this it, it is manageable. We never ran out of ventilators. The doctors and staff so far have (largely) avoided major illness. Everyone, inside and outside of the hospital, is collectively doing so much to slow this down. 

And on schedule, the world is erupting with fragrant blooms and tender spring life. Bright-eyed babies are being being born, somewhere, every moment when we loose a patient. We will inevitably renew as we have always done- relying on persistence, thoughtfulness and love.  

     

Along the entrance gauntlet of encouragement, someone has posted the famous Mr. Rogers quote, "When I was a boy and I would see scary things in the news my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’”  I'm going to leave things with Fred and his quote for a while. I don't like writing every night anymore. It's too hard. I need to think about other things when I'm home. Tomorrow on my drive, I'm not going to think about what to say in an email and instead focus on cataloging the Latin names of all the plants I spot in bloom. Then I'll focus my brief evening on learning about those I couldn't name. Maybe down the road I'll send an update or two. Until then stay strong, enjoy spring.

I love you,

Jordan

Another Great Day in the Great Outdoors

Gunlock Reservoir is such a great attraction in the spring.

There are many falls going over the rocks, and it's just really unique and stunning.

Yesterday, we drove out there, but we didn't get out to walk across the dam because there are always a lot of people there.

So, I just took a picture from far away:

God created a magnificent world, for sure.

WELL, Now, That's a Fun Birthday Surprise

This is the front; I thought it was so lovely and all, painted by Jenni.

This is the back.  And, that was just SO EXCITING!
Thank you, dear daughters, I have always wanted to do this!

Letter from Dr. Jordan who volunteered to go to New York during Covid 19

Hello all,

Things are worse off here than I thought. Initially I thought maybe the Long Island hospitals wouldn't be as bad off and I guess that's true but this hospital (an underfunded, publicly supported academic medical center) has been severely impacted. I have a feeling this place was always under-resourced but it quite glaring now.

The surgical ICU, trauma ICU, cardiac ICU, pediatric ICU,  and rehab units have all been converted to adult medical ICUs dealing with covid patients, majority intubated.  I thought I'd get a little orientation, new badge, parking, maybe even a half-day learning the computer systems but instead was put straight onto the unit to lead rounds at 7 am. We ran all day. I am supervising a team of 5 interns, 3 residents and a critical care fellow in caring for 16-20 of these patients. They have all been working 100+ hour weeks. Medical students (all students actually) have been banned.

Since March 15th, this team has had only one patient extubated. Hospital-wide, 5 died yesterday. We've lost 2 today. I've lost count of the overhead 'Code Blue' or 'Stat Anesthesia' pages that indicate a crash since I arrived this morning but they are constant. I think other area hospitals are doing a little better (see resource comment above) in terms of extubating people.

Our team is still looking after the very first covid patient diagnosed on Long Island. He's still here, intubated since 3/11 and rather sick. There are constant shortages of critical supplies and medications but they have largely been able to adapt and improvise. The biggest shortage is personal, either because they are sick or have quit. Moral is low. Today, there were four RNs caring for our 16 patients (usual ICU ratio it 1:2 or even 1:1 for very sick patients). Apparently only 2 respiratory therapists came to work in the entire hospital today. I've yet to see one of them. They desperately need more help so it makes me feel good about the decision to come up, if only for a month. Everyone is hopeful this is the peak.

Needless to say, the place is primarily run by the residents who have continued to consistently show up. They are doing just about any and everything. Foleys, blood draws, medications administration, and vent management. When a iv pump runs dry, it is strange to see the the resident run to get it going again. There is just very little nursing support because they are stretched thinner than I've ever seen. They have the toughest job of all, they can't chart they are so busy keeping everyone alive. So far, we have enough ventilators for everyone (Currently 64 intubated patients and 70 ventilators). But that includes every 'ventilator' they can find, including anesthesia and bipap machines run as ventilators. The sicker patients get the proper machines - if you're still oxygenating OK you get by with the anesthesia machine. It's weird to see anesthesia machines all lined up in a row and connected to patients without an anesthesiologist watching each one individually.

Adventures aren't just happening at the hospital. Last night at 3 am my neighbor called EMS and I heard clear voices outside my window. An older man was breathlessly complaining of fever, chills and cough. The paramedics had him come outside (they didn't want to enter his house) and took his vitals and a brief history. Because his O2 sats were ok, they told him to stay home. Simple as that. Overwhelmed hospitals are reserved for sicker people. Earlier that night, around one, someone repeatedly try to break into my apartment - wait, did I drive to New York or Rio? Needless to say I didn't get much sleep last night and today was insanely busy.

Time for bed with the sincere hope that the demented homeless lady trying random codes on my front and back door locks doesn't come back again. It's been an insane start. My team is amazing and inspiring. They are working tirelessly and selflessly to help however they can, a truly Herculean effort. It's an honor to be here among them.

Jordan

Well, If This ISn't Just the CUTEST!

This just made me laugh when Justin posted this.  I love this kid, Miles.

Day Out in the Sunshine

The elbow hello.

Good friends, beautiful scenery, but staying six feet apart.

Beautiful background...

How much longer will this last?