British Prime Minister Boris Johnson on Monday delayed by a month his plans to lift the last COVID-19 restrictions in England after modelling showed that thousands more people might die due unless reopening was pushed back.
The move was due to the rapid spread of the Delta coronavirus variant, which is more transmissible, associated with lower vaccine effectiveness against mild disease and could cause more hospitalisations in the unvaccinated.
Models commissioned by the government showed that without a delay to the planned June 21 reopening, in some scenarios hospitalisations could match previous peaks in cases when ministers feared the health system could be overwhelmed.
Britain has one of the fastest vaccine rollouts in the world, with over half of adults receiving both doses and more than three quarters receiving at least one, which has led some to question why restrictions need to be extended.
As Johnson announced the postponement, Public Health England published data showing shots made by Pfizer (PFE.N) and AstraZeneca (AZN.L) offer high protection against hospitalisation from the variant identified in India of 96% and 92% respectively after two doses. read more
Are we seeing the difference between the lab (the vaccines work against this variant) and the real world (the virus is smarter than humans)?
Separately, can we infer anything about our future based on the English experience? If the variant virus is overpowering the vaccinated herd in the U.K., should we expect a raging plague here by the fall (with associated lockdowns, mask orders, etc., in Church of Shutdown states)?
Outpatient gynecology week begins at a clinic with two nurse practitioners. Two-thirds of appointments are routine obstetric visits; one-third are gynecology visits (annuals and acute problems). Sixty percent of patients are enrolled in Medicaid; the remaining 40 percent are typically uninsured, but a social worker employed by the hospital is tasked with signing them up for Medicaid. The office runs like a typical doctor’s office… except there is no doctor. In theory, the NPs can call the inpatient gynecology attending who will drive over (20 minutes) from the hospital, but this didn’t happen during my two days.
My first patient is an outgoing postmenopausal 54-year-old botoxed blonde presenting for vaginal itching. She divorced her husband six months ago and co-founded a rental business with her handyman, with whom she now files. Their first property on the market was the ex-husband’s former house. She reports that during the early phase of her relationship with the handyman, she had sex with her ex-husband “a few times, huge mistake”. She emphasizes that for the past month she has been faithful to her new lover, but reports vaginal itchiness and discharge. She is concerned that she may have an STD. “I just pray I don’t have to tell my ex-husband. The bastard would tell my [teenage] children to turn them against me.” The NP supervises while I perform a speculum exam. I swap the cervix then prepare a wet (saline) and KOH slides to analyze under the microscope. Urine sample tests negative for chlamydia and gonorrhea. We reassure her that she does not have an STD, just bacterial vaginosis (multiple clue cells under microscope are diagnostic) and prescribe a seven-day course of Flagyl (metronidazole) 500mg BID (twice daily).
The NP schedules me for all three gynecology visits so I can practice speculum exams (nurse chaperone in room) while she keeps on time with the short routine OB. I see two OB visits on my own before she comes in. The last patient I see jointly with the NP. She is a withdrawn 17-year-old G2P1 at 16 weeks presenting for her initial OB visit. She is accompanied by an older sister. I communicate the schedule of upcoming OB visits (e.g., 20-week anatomy scan, glucose tolerance test, bacteriuria screening, Rhogam at 28 weeks, etc.). “I’ll have to make sure I can get out of school and that my sister can drive me.” The older sister says that she hopes the soon-to-be-mother-of-two will stay in high school and graduate. “Is the father aware of the child?” The older sister responds, “Yes, he’s in school, but isn’t going to be involved. Our parents are going to take care of the new baby.”
After the visit, the NP recounted her experience as a nurse on the obstetrics triage floor. “We had a 12-year-old come in for a missed period. We asked the patient if she was having sex. No. Intercourse? No. Then a resident finally comes up and says: ‘Are you doing it?’ ‘Well yeah, I’m doing it.’ We immediately started to get worried about incest. Back in the day you’d get worried about a 12-year-old having sex. Now we don’t even bat an eyelid.”
I leave at 3:00 pm for the afternoon gynecologic oncology lecture. Our attending goes over the common gynecologic cancers: ovarian, endometrial, and cervical. She summarizes: “Ovarian cancer patients die of malnutrition, endometrial cancer patient die of a heart attack [patients are generally obese with multiple comorbidities].” She continues: “Does cervical cancer run in families? After a pause, Nervous Nancy responds, “No, it’s not a genetic disease, it’s about behavioral risk factors — HPV exposure and smoking.” The attending answers: “You’re correct about the risk factors, but cervical cancer does end up clustered in families because failure to access the health care system runs in families. My cervical cancer patients have not been to the doctor in over 10 years, or at least haven’t gotten a pelvic exam in 10 years. Sometimes they have been seen by an internist a few times who just have given up performing pelvic exams in their practice. Cervical cancer patients die of renal failure, that’s a good death. Uremia, you just fall asleep. The patients are young, typically 50 years old but it’s a good death unlike ovarian cancer.” (The working lower middle class are in the worst shape for access, suffering from massive insurance co-pays and being ineligible for the various free care options.)
She describes the challenges of patients consuming online information and the Power of the Pink Ribbon. “I had a sister who sent me an article saying OCP [oral contraceptive pills] increase the risk of breast cancer. I followed the link and it cited a 2014 article assessing high-dose estrogen-only pills, which are never used now. It just shows you how much false information is online. This stuff can impact your health. OCPs actually prevent breast and gynecologic cancers.” She continues: “Now keep in mind the vast majority of women who get breast cancer do not have ANY of the risk factors we talk about. There is a high enough baseline risk that every woman over 45 should be getting a mammogram.”
[Editor: See “National expenditure for false-positive mammograms and breast cancer overdiagnoses estimated at $4 billion a year.” (2015), a study done using the insurance claim database that we have at Harvard Medical School. “Populationwide mammography screening has been associated with a substantial rise in false-positive mammography findings and breast cancer overdiagnosis.” Many of the lives saved from cancer that have been chalked up to mammograms were in women who did not actually have cancer. It turns out that waiting for a lump is as reliable a way of finding true cancers as mammography. Switzerland, which spends much less on health care and enjoys longer life expectancy, has eliminated routine screening mammography. The U.S. meanwhile, is doubling down on medical interventions. The government issued a February 11, 2019 recommendation to put all higher-risk women on aromatase inhibitors.]
On Wednesday, I am in a different outpatient clinic: the “resident clinic” for high-risk OB. This one is led by a 5’4″ no-nonsense PGY4. My first patient is an uncontrolled obese T2DM G3P2002 (type 2 diabetes; third pregnancy; two babies delivered at term; zero pre-term; zero miscarriages; two living children) presenting for her initial OB visit at 8 weeks. I go in first to get a history and complete a basic physical with doptone heart rate, waiting for the resident before beginning the pelvic exam. The unkempt diabetic single mom does not check her sugars. She hasn’t followed up with her endocrinologist because she owes $150 (she should be eligible for Medicaid, but hasn’t jumped through all of the paperwork hoops).
The patient describes vaginal discharge. We perform a speculum exam. I have to hold up several abdominal folds leading to a foul smell from candidiasis (yeast infection) while the resident performs the exam. We explain that she needs to use contraception if she doesn’t want to get pregnant again. “Those pills bad for the body.” (She may be correct; her uncontrolled hypertension is a contraindication for oral contraception.) The resident: “Yes, but it’s also unhealthy to keep having unwanted pregnancies, especially when you are overweight and have uncontrolled blood sugar.” She says she will consider contraception, but rejects the offer of an IUD insertion after delivery. The resident gets frustrated when her lecture on risks to the baby from uncontrolled diabetes is interrupted by incoming calls and texts on the Medicaid-eligible patient’s unsilenced iPhone X.
After several obese women described by the resident as “simply refusing to take care of themselves, let alone their multiple kids,” I see a young immigrant couple. They earn too much to qualify for Medicaid, but found that insurance was unaffordable. The 24-year-old Indian 26-week nullip has a normal BMI, but was diagnosed with gestational diabetes at screening. The husband brings a notebook of sugar logs. I circle two fasting and one 2-hr postprandial sugar value that were elevated within the past two weeks. Wow! I present the patient to my resident. “If they are tracking their sugars, they have good sugars,” the resident explains. “For every five terrible patients, many of whom have several children in foster care, you see a couple like this one. I’m glad you were able to see them. They can’t afford private practice so they come here, and they will be terrific parents.”
The outpatient clinic employs a full-time Spanish-language medically certified interpreter and she is present for roughly 50 percent of the visits. Visits with a Mandarin-speaking patient and an Arabic-speaking patient are cumbersome. Within the hospital, full-time Mandarin and Arabic interpreters are available in person. From the clinic, however, we use a phone-based service for interpretation, but it isn’t nearly as efficient as having a live interpreter in the room.
[Career tip from the Editor: the typical certified interpreter earns about $35/hour, or $70,000 per year working full time.]
Jane is on inpatient pediatrics. “After rounds we sit at a table finishing notes on our laptops. After a while, she does UWorld questions. She is partnered with Awkward Arthur, a 5’5” Asian 28-year-old who has had to remediate following most clinical skills exams. “He keeps looking over my shoulder. I eventually ask if he wants to do questions with me. And he starts trying to show me up. He does this in rounds too. He seems innocent, but he is a total gunner.”
Statistics for the week… Study: 4 hours. Sleep: 7 hours/night (showtime for outpatient work is 8:00 am); Fun: 2 nights. We see an Americana jam-band at a church turned into a concert hall by a local foundation with Sarcastic Samantha and Lanky Luke.
Summary: Based on observed behavior and discussions with folks we met on the street, New Yorkers continue to regard their city, including the outdoor environment, as contaminated. However, instead of taking the obvious step of moving somewhere that isn’t contaminated, e.g., Zoom it in from Vermont or Hawaii, they continue to reside in NYC and attempt to protect themselves from airborne contaminants via bandanas, paper surgical masks, and other non-N95 masks (keep in mind that N95 works only if professionally fitted).
The city has a moderately post-apocalyptic feel. As in Boston, many retail spaces are vacant while marijuana-related enterprises are thriving. “Safety First: No Entry Without a Face Mask” on the door of a shop selling cigarettes and vaping products and some of the numerous marijuana-related trucks that we observed:
(The city is awesome for parents who were looking forward to discussing the crucial benefits of cannabis with their young readers.)
Roughly half of New Yorkers seem to wear masks on the sidewalk. The younger and less at-risk the person is from COVID-19, the more likely he/she/ze/they is to be wearing a mask. Mask usage is less prevalent within Central Park.
Vaccination does not comfort the anxious. Nor does actual experience of COVID-19 infection as a mild illness. For example, on East 90th street we encountered a group of locals who were taking the ferry to East 34th. One appeared to be a white woman in her 30s. She said that she’d had COVID-19 in the spring of 2020 and that it was comparable to a bad cold. She said that she’d been fully vaccinated. Despite this background, she stated that she wouldn’t use the subway system anymore, however, “because of COVID.” (Masks are, in theory, required on these ferries, but if you sit on the open top deck the enforcement is non-existent and compliance is only about 70 percent.)
What about being 18 years old, rich, white, and healthy? The Dalton School for Rich Kids says that you should be “unafraid” …. and fully masked:
Capitol One, powered by Pride and “face masks or covering” (a bandana is fine!):
Here’s the restroom in the restaurant section of the Time Warner mall at Columbus Circle (when will that be renamed?):
They’d gotten organized enough to block off sinks, but were not organized enough to fill the soap or paper towel dispensers (we were there at 6 pm on a Saturday evening, so there were quite a few hours left before cleaning/replenishing).
Evidence that almost everything related to COVID-19 is religious… here’s a restaurant’s “outdoor dining” area. It is fully enclosed with no windows. Air is provided by a standard AC/heat pump.
But you can’t get COVID, unlike in a restaurant’s standard indoor space, because it is outdoors.
The most orthodox Churches of Shutdown that we found are the art museums. Email from the Guggenheim Museum after after making a mandatory reservation:
You’ll need to wear a three-ply mask regardless of vaccination status — staff is required to, too — practice social distancing, wash or sanitize your hands frequently, and pack light as our coat check is temporarily closed. Please plan ahead and read COVID-19 Safety Measures: What to Expect When Visiting.
In other words, they are fighting against an aerosol virus by cleaning surfaces and not touching their (rich white) visitors’ backpacks. (from November 2020: “The Coronavirus Is Airborne Indoors. Why Are We Still Scrubbing Surfaces?” (NYT): “Scientists who initially warned about contaminated surfaces now say that the virus spreads primarily through inhaled droplets, and that there is little to no evidence that deep cleaning mitigates the threat indoors.”). Among the below, my favorite is the exhortation to “Report violations of COVID-19 requirements by calling 311 or by texting ‘violation’ to 855 9044036.”
(How was the art? Nearly the entire museum is given over to a TV screen in the middle and visitors are supposed to stand and watch TV. Re/Projections:
To emphasize the works on display, many of the rotunda walls remain empty during Re/Projections.
Conceived in the wake of the COVID-19 outbreak, these projects rethink the Guggenheim’s iconic rotunda as a site of assembly, reflection, and amplification.
Artist Christian Nyampeta considers new models for globalism based in reparation and the possibility of a common world in an age dominated by difference.
Featuring renowned love songs written by men and played by women and nonbinary musicians, Ragnar Kjartansson’s performance celebrates pop music while revealing a culture shaped by chauvinism.
Our visit coincided with Christian Nyampeta’s work. It is unclear how much in reparations the (overwhelmingly white) visitors will want to pay after shelling out $25/ticket to the Guggenheim.)
Email from the Metropolitan Museum: “Face coverings are required for all visitors age two and older, even if you are vaccinated.” In other words, they’re somewhat less strict than the Guggenheim in that a bandana is considered effective PPE and museum employees won’t be inspecting your mask to determine the number of plies. Where the Met has the Guggenheim beat is in requiring visitors to wear masks in outdoor spaces, e.g., the rooftop garden:
The museum employs an official mask karen for this garden and he would periodically remind the scattered folks on the roof to keep their masks on. He also hassled a mom and dad for walking 20′ away from their two-brat stroller while taking a photo. Separately, where is Big Bird’s mask? (or maybe this isn’t Big Bird due to copyright issues? Big Bird is yellow)
The museum was mostly empty, possibly a consequence of the reservations required policy (though, as a practical matter, nobody checked whether or not we had a reservation). The slightly tighter spaces in the museum are closed off for safety:
There are COVID-19-related signs roughly every 10-20 feet throughout the museum. And, of course, water fountains are closed. Here is a sampling:
If you’re passionate about 1 gender ID out of 50+, make sure to get to the Met between July 2 and October 3 for “The New Woman Behind the Camera”:
The New Woman of the 1920s was a powerful expression of modernity, a global phenomenon that embodied an ideal of female empowerment based on real women making revolutionary changes in life and art. Featuring more than 120 photographers from over 20 countries, this groundbreaking exhibition explores the work of the diverse “new” women who embraced photography as a mode of professional and artistic expression from the 1920s through the 1950s. During this tumultuous period shaped by two world wars, women stood at the forefront of experimentation with the camera and produced invaluable visual testimony that reflects both their personal experiences and the extraordinary social and political transformations of the era.
The exhibition is the first to take an international approach to the subject, highlighting female photographers’ innovative work…
Is it fair to say that referring to “female photographers” reflects cisgender-normative prejudice? Holding the phone just above a 6′ screen:
The Museum has a new Dr. Fauci section. Truth and Research:
What does Research tell us about the Truth regarding the origins of this most pernicious virus? The New York City government wants to remind you that it is Asians who are responsible for COVID. Times Square:
“Fight the virus, not the people” and “Stop Asian Hate”! Who are “the people” that we’re told to associate with “the virus”?
One of the more peculiar aspects of NYC and COVID today is that the stay-in-NYC New Yorkers assert that they’re lives are completely back to “normal”. Yes, they’re wearing masks indoors and out, avoiding the subway, mostly not working in offices, not going to concerts or theater, etc. But this is indistinguishable from the way that life was in 2019. In some ways, they seem to be correct. Traffic leaving Manhattan on a Sunday was bad and traffic returning was terrible, with at least 5 miles of parked cars jamming the approaches to the Lincoln Tunnel from the New Jersey side.
The cost of an Uber is up roughly 50 percent:
Inequality continues to be a public health emergency at Teterboro (ancient V-tail Bonanza in front of a Gulfstream V):
(Excellent service as always at Meridian and parking a four-seat piston-powered plane is cheaper than parking a car oin Manhattan! (parking fee waived with purchase of 20 gallons of 100LL) My standard tip of $20 for the line guys will soon be insulting; inflation is already at 8% per year.)
On the way out we did the Skyline Route down the Hudson at 2,000′, turned around at the Verrazzano-Narrows Bridge and came back up at 1,500′. If you don’t count LaGuardia Tower and Newark Tower, a good time was had by all!
Happy Middle of Pride Month! Here’s an educational video for children:
Note that the leaders among the sexual relationships on parade are monogamous, e.g., starting with a family anchored by two mommies (the unhappiest situation for children, statistically, even worse than divorced hetero parents). Eventually the video gets to polyamorous relationships, e.g., “Ace, Bi, and Pan” or a group of “Kings and Queens”, but they are not front and center. Should this video be memory-holed for implying that there is something superior about sexual monogamy relative to polyamory?
Part of a screen capture from my guiltiest secret (i.e., that I own an iPhone (my excuse: the camera and hardware/software behind the camera)):
Was this change to the rainbow flag because software robots at Zillow were reading my blog and Facebook posts (none since February) and learned about my passion for everything LGBTQIA+? Or did everyone else with Zillow on an iPhone get pushed this update as well? (And what about users within the Android Free State? Do you now support Pride via your icons?)
Separately, here’s part of a LinkedIn profile after the user’s current and former employers swelled with Pride:
Related:
Profiles in Corporate Courage (would Zillow join Apple, Google, P&G, Mercedes, and Microsoft in limiting their advocacy of LGBTQIA+ in countries where LGBTQIA+ sex acts are illegal?)
Gynecology rotation starts at 7:30 am in the outpatient surgery center. The chief texted the previous night to skip hospital rounds and just meet the team at the outpatient surgery center for the first 8:00 am case (this is an inpatient week, but if there are no scheduled surgeries at the hospital we go with an attending to the outpatient center). I appreciate the extra sleep! Our first patient is a 27-year-old who had an unfortunate uterine perforation after IUD placement by a Planned Parenthood Nurse Practitioner. “I think it was her first IUD placement. Looking back, she was so nervous.” After a brief physical, we have about 30 minutes before the OR is ready.
Did it hurt getting the IUD placed? “It hurt so bad, but they told me that’s expected. Over the next week, the intense pain got better, but I just kept having these sharp lightning bolts of pain once or twice a day.” She saw an Ob/Gyn for a regular check up three months later who ordered an abdominal x-ray that showed a “T”-shaped device in the right upper quadrant.
The 70-year-old attending arrives. She meets the patient and confirms the consent is signed. I grab gloves for the attending, the intern and myself. We perform a laparoscopic removal of the IUD. It was lodged in the omentum requiring three port placements (three holes in the belly). Throughout the entire procedure, the 60-year-old anesthesiologist, a former dentist, tried to convince me that anesthesia is the best route. “Hospitalists are miserable,” he began. “They have 80 patients, they work 12-hour shifts. It’s not good for the patient, but it’s the way medicine has gone. In anesthesia, we have only one patient at a time, and we are done after you leave the office. And the physiology is just awesome.”
As the OR is prepared by the nurse, surgical tech, and OR tech,s for the next case, we head to post-op to talk to our recovering patient. After a brief conversation with the patient and her mother, we head to the nurse’s station where the intern is instructed to prescribe 10 OxyContin 5 mg. “It’s crazy how much opioid pills we still give out. Epic defaults to 30 pills for a prescription,” says the attending. “I still have dozens of narco left over from my breast cancer surgery. Everyone is talking about the opioid problem and how doctors created this monster, perhaps, but I still blame the government. They started to adjust reimbursement rates based on patient-reported pain scales. No wonder the ED gave out Oxy like candy.”
Before our next procedure (hysteroscopy, camera through the cervix into the uterus to look for, and possibly biopsy, cancerous polyps), I chat with the attending about the future of Ob/Gyn: “Ob/Gyn was a beautiful field because it combines surgery with long-term patient relationships. I am the primary care provider for a lot of my patients. We’re succumbing to the specialization tsunami. I’ve been grandfathered in, but most hospitals require you to choose a track: gynecology or obstetrics.” She continued, “The days of having clinic in the morning with two afternoons of gyn surgeries alternating with a week of obstetrics are ending. Administration is chipping away at the scope of practice for every field.”
After a total of three procedures, I leave the outpatient OR at noon to attend lectures at the hospital on urinary incontinence by a “UroGyn” (Urogynecologist, 4-year OB/Gyn residency followed by 3-year fellowship).
The next day starts with hospital rounds before surgery at 6:30 am in the main hospital OR. We have two laparoscopic fibroid removals and a hysterectomy scheduled. Dr. McSteamy is the attending. He is a 37-year-old whose recent marriage occasioned despair among the residents (all female, except for one gay guy, a junior resident, who shared their grief). The chief, now four years out of medical school, struggles with basic laparoscopic techniques, incorrectly locating the ureters, a critical item given the risk of damage during the procedure. She also has a six-month-old at home, which might explain some of her deficiencies, but her parents have moved here to assist the software engineer husband in taking care of the baby. She is trying to find a job next year as a general practitioner in a smaller hospital setting.
During the second hysterectomy, the junior resident gets a page for two ED admits. He and I step out to evaluate a 24-year-old bartender with a three-day history of excruciating labial pain. She had a similar episode several years ago. Her right labia majora is swollen, erythematous (reddened), and extremely painful when she walks or moves. As I prepare to present the findings to Dr. McSteamy, I look up management of Bartholin abscess in my trusted Comprehensive Handbook of Obstetrics and Gynecology by Zheng, a $30 book that fits into a scrubs pocket. The bartholin glands, located at 4 and 8 o’clock in the vaginal introitus, secrete lubricating fluid through a small duct. Some women develop a blockage in the duct leading to an enlarging cyst that becomes infected. Once McSteamy is out of surgery, we head down as a team to examine the patient. We then gather supplies (numbing medication, Wort catheter, scalpel, iodine prep) to drain the abscess. Before we go in, the ED attending asks if the resident has performed one of these. No. Dr. McSteamy then describes the procedure. The ED attending also wants to watch as she has never seen one performed. We transfer the patient into an ED procedure room with stirrups. The resident injects lidocaine in the 3 cm labial abscess and she cries out in pain. After 5 minutes, the resident makes a small incision in the labia, which results in screams and “sorry, sorry.” He then slips a 3 mm-diameter drainage catheter into the abscess. She is supposed to leave this in for 2-4 weeks, but the attending admits that most will fall out within a week. If this happens again she might consider getting a bartholin gland excision or marsupialization surgery (turns the gland inside-out) to maintain duct patency.
Friday morning: round on two post-op patients and then am sent off to study before a mandatory class meeting at 1:00 pm. Nervous Nancy is in the student lounge watching Grey’s Anatomy on her phone. She is on outpatient Ob/Gyn week and was told not to bother driving to the clinic today. “Whenever I get nervous before exams, I instinctively watch Grey’s Anatomy. My excuse is I might learn something from it while calming my nerves by binge-watching.” We talk about her experience on Obstetrics. “I sometimes think, screw I am going to have a baby even though I am vastly irresponsible and underprepared. Look at these moms. Then I remember that they are terrible people.” I recount my experience with the G9P8 having the ninth baby. When asked why she keeps having babies, she responds: “Well all my children are in foster care so I need to have another one to actually keep one.” Nervous Nancy laughs, and says, “I’ve seen those too. Maybe your children are in foster care because you are a crack addict.”
We head over to the school for confessions of a medical student. We were instructed to prepare by writing a two-paragraph anonymous confession from this year. We are divided into 10-person groups, each led by a physician who shuffles them and hands them out for presentation:
Dear patient, I know everything about you. I know your STD history, I know you have had more children than reported to your husband, and I know your mother died from colon cancer. But as I walk through the door I realized I forgot your name. Unnamed patient, I am sorry.
We were so rushed one day on rounding that we didn’t not explain to a patient why we were performing a digital rectal exam. I felt we violated his dignity. We were trying to rule out colon cancer.
I resent when doctors say “we have it so much easier than you did”. They don’t understand the stresses we are under from residency competitiveness and financial costs.
It is such a relief to see bad doctors practicing. The imperfection reminds me that I don’t have to be perfect to become a doctor. Being a doctor is human, and humans are imperfect. Some are even bad at their job.
I learn more from watching bad doctors make mistakes than from good doctors.
We had a patient whose biopsy was delayed because of another patient requiring a more urgent read. We joked how annoying he was. He started to yell that he was going to sue the hospital so the team disliked him even more for him being so difficult. He started to have delirium. When I went in alone to check on him in the morning he was clam and present. He confided in me: “I don’t care about myself, my wife is not strong enough to handle another day of not knowing.” The wife broke down in the room. He then got delirious and started asking philosophical questions, “Where are you going?”, “Are you content?”, “What happens next?” It gave me chills.
I can never do pediatrics. An anti-vaxxer mom and her three kids came to the pediatric clinic for a first visit after getting thrown out by their prior pediciatrian. The kids asked me why they can’t go to normal school instead of being homeschooled. It was terrifying seeing a crazy woman make decisions that will impact these kids’ lives with no one to stop her.
We don’t do much good in the hospital or in medicine. So much waste, discharging patients for them to come back in a week. We just use all this expensive technology that prolongs a miserable life. The best care I’ve seen so far was when a surgeon decided to not operate and recommended comfort care.
I kept telling my team that a patient had a certain diagnosis, albeit atypical presentation. They kept saying how it could never be that, and made fun of me. After a few days and it turned out I was right, but they never acknowledged what I had told them. In my evaluation they mentioned only trivial stuff: on time, attentive, knows patients.
I feel disillusioned. Despite all this training I feel worthless and unable to manage any real problems my friends and family ask me about. Barbara Freiderson helped me: “The negative screams at you, but the positive only whispers.”
Nervous Nancy: “I just feel like I am always in the way. That no one is grateful for us, and the people that actually care for the patient would have it easier without us present.” The physician leader asks, “Do any of you wish you were invisible?” Every student grinned, and nodded. Gigolo Giorgio, who sports a beer belly after gaining several pounds on psychiatry, comments: “I think you mean we all want to be flatter against the wall.”
Statistics for the week… Study: 10 hours. Sleep: 6 hours/night; Fun: 1 night. Halloween celebration. Gigolo Giorgio hosts a pregame before the class Halloween party downtown. We reminisce about our rotation experiences. Buff Brad and his girlfriend dress up as Gamora and Warlock from Guardians of the Galaxy, Adrenaline Andrew and his girlfriend win first prize with homemade jellyfish costumes out of Christmas lights and clear umbrellas. Classmates are downing shots and beer. Once we arrive at the rented out bar’s upstairs room, students dance Top 25 Pop hits while a line grows at the private bar for $5 mixed drinks. Gigolo Giorgio jokes: “[Put-Together Pete] is on his 24-hour night shift for surgery, we should all get blackout and visit him in the ED.”
A local 18-year-old, raised on a steady diet of social justice messages delivered by unionized employees at the public school he has attended, asked his mom for help in choosing a primary care physician now that he has aged out of pediatrics.
Perhaps he didn’t absorb what the school was trying to teach. He told his mother that he didn’t want a female physician or a doctor of color because “they get into medical school easier.”
A law passed by Denmark’s Parliament on Thursday allows asylum seekers to be sent outside Europe to await the review of their applications.
In Greece, high-tech “sound cannons” are being used to deter migrants from crossing into the European Union from Turkey.
The sound cannons are part of a larger strategy to create a high-tech barrier that will prevent migrants from entering Greece in hopes of seeking asylum. Artificial intelligence will be used to analyze potentially suspicious movement captured by long-range cameras, and the country is also experimenting with using the technology to conduct lie detector tests during interviews with asylum seekers, according to the AP.
In Denmark, attempts to discourage migration have taken on a different form: A law that passed Thursday means asylum seekers can be sent to another country outside Europe while they wait for their cases to be reviewed.
“If you apply for asylum in Denmark, you know that you will be sent back to a country outside Europe, and therefore we hope that people will stop seeking asylum in Denmark,” Rasmus Stoklund, a spokesman for the Danish government, told broadcaster DR, according to Reuters.
Although it’s not yet clear what countries will take in refugees under such an arrangement, Denmark and Rwanda recently signed a memorandum of understanding that has led to speculation that migrants will probably be relocated to Africa.
Denmark, one of the wealthiest countries in Europe, has increasingly taken a hard-line stance on migration in recent years. The Danish Refugee Council said in a statement that sending refugees to a third country was analogous to Australia’s much-criticized policy of housing asylum seekers in offshore camps, and warned that the model has meant that migrants face “physical assault, slow asylum proceedings, lack of access to health care and lack of access to legal assistance.”
Immigration is essential to who we are as a nation, our core values, and our aspirations for our future. … Trump’s policies are also bad for our economy. For generations, immigrants have fortified our most valuable competitive advantage–our spirit of innovation and entrepreneurship. Research suggests that “the total annual contribution of foreign-born workers is roughly $2 trillion.” Key sectors of the U.S. economy, from agriculture to technology, rely on immigration. Working-age immigrants keep our economy growing, our communities thriving, and country moving forward.
Coming the above two… Greeks and Danes don’t want to be rich. From Denmark, 2019 (“send them back”):
As vice president, Joseph R. Biden Jr. led an enormous push to deter people from crossing into the United States by devoting hundreds of millions of dollars to Central America, hoping to make the region more tolerable for the poor — so that fewer would abandon it. Now, as President Biden, he is doubling down on that strategy once again and assigning his own vice president, Kamala Harris, the prickly challenge of carrying out his plan to commit $4 billion in a remarkably similar approach as she travels to the region Sunday. “When I was vice president, I focused on providing the help needed to address these root causes of migration,” Mr. Biden said in a recent speech to Congress. “It helped keep people in their own countries instead of being forced to leave. Our plan worked.” But the numbers tell a different story. After years of the United States flooding Central America with aid, migration from the region soared in 2019 and is on the upswing once more.
Here in Guatemala, which has received more than $1.6 billion in American aid over the last decade, poverty rates have risen, malnutrition has become a national crisis, corruption is unbridled and the country is sending more unaccompanied children to the United States than anywhere else in the world.
One, called the Rural Value Chains Project, spent part of its $20 million in American aid building outhouses for potato farmers — many of which were quickly abandoned or torn apart for scrap metal.
Uncle Joe wouldn’t lie to us (unlike you know who!). Thus, since every person from Guatemala who arrives in the U.S. makes us richer, happier (“our core values”), and more hopeful (“our aspirations for the future”), it is odd that we would want to spend $1.6 billion of our hard-earned wages to discourage Guatemalans from coming here.
U.S. sales returned to pre-pandemic levels, Chief Executive Officer Kevin Johnson said during a call with analysts.
How is this possible? If Mx. Johnson was talking about sales in the first quarter of 2021, that’s a time period when all Starbucks had closed down indoor dining, when the weather in most of the U.S. was uncomfortably cold for sitting outside, and when many American downtown offices were still vacant. How can his/her/zir/their company be selling just as much coffee as when people had the option to come in, share the bathroom with the local homeless, and sit down with the SUV-driving single moms?
If indoor dining turns out to be worthless, from a business point of view, how could Starbucks not have figured that out years ago and thereby saved itself a ton of cost? They would never have gotten into the bathroom dispute that forced “Starbucks Closes More Than 8,000 Stores Today For Racial Bias Training” (NPR) because they wouldn’t have had public restrooms.
I guess one answer is that the U.S. has changed. Customers used to demand and pay for the indoor dining space, but now they don’t want it nor are they willing to pay for it.
I’m kind of amazed that Starbucks is popular in its take-out-only configuration. So many Americans are sitting at home all day. Why do 15 minutes of driving to get coffee that takes 5 minutes to brew at home? If you’re on a long car trip, wouldn’t it make more sense to stop at McDonald’s where the dining room is open so that you can go in and use the bathroom?
Also, I wonder if this kind of business transformation will result in further fragmentation of American society. Due to its outrageous prices relative to quality, Starbucks had a somewhat upscale clientele. Nonetheless, it was a place where one might see a wider variety of people than one would see by driving in a private car from point to point. If Americans don’t see each other in common spaces, how will we know what our fellow residents of this stolen land are like?
Bug lives with her mother in rural Vermont. She’s 11, that terrible cusp of an age, right when everything is about to change. It’s the summer before middle school starts, and Bug’s best friend, Moira, has become a lot more interested in makeup, hoping to fit in. Bug has other concerns, especially the recent death of her beloved Uncle Roderick. A former drag queen in New York, Roderick was such a force of life that he may, in fact, be literally haunting Bug after his death. This is a very clever metaphor indeed, because Bug is haunted. When Moira talks winsomely of becoming a new person in middle school — “You don’t have to change, but don’t you want to?” — Bug remains troubled that what she sees in the mirror never matches how she sees herself. “A lot of books have a moral,” she tells us, “some lesson about how you have to stay true to who you are. … But those books never tell you how to figure out what your self is.”
I am being particular about pronoun use here because Bug uses “she” throughout the story until the moment of self-discovery — and then he doesn’t. “Too Bright to See” is the story of what it’s like to realize the gender you were assigned at birth is not the one you actually are. Lukoff — a transgender man himself — tells the story with such truth, such purity, such remarkable emotional clarity that you may be moved to tears by Bug’s triumph in the end.
This book is a gentle, glowing wonder, full of love and understanding, full of everything any of us would wish for our children. It will almost certainly be banned in many places, but your child almost certainly needs to read it.
The book review includes an education on current American politics:
Now here is a beautiful little book that carries a great, great weight on its shoulders. … Around the country, legislatures are suddenly busy enacting a variety of laws against transgender boys and girls, including one denying them medical treatment to transition before they’re 18. … When I say lives will be saved because of this book, I only wish it were hyperbole.
Based on the sample available at Amazon, Bug lives with a “single mom”:
Uncle Roderick’s room is at the top of the stairs. Mom’s is at the end of the hall.
Biology 101 interferes with procreation plans:
One of Uncle Roderick’s ex-boyfriends is across the room, down from Portland. … He was nice, but had wanted kids, and my uncle decided that I was enough kid for him, so they broke up but stayed friends.
(The book is set in Vermont, so if the ex-boyfriend were a biological female and had access to Clomid, he could have produced the kids that he wanted and harvested child support from Uncle Roderick under Vermont family law.)
I have no doubt that this will be a read-aloud hit with our kindergartener (this person, whose gender ID we will not assume, has already asked for an explanation of what the rainbow flags mean).
Separately, here’s what’s at the top of the HBO Max for my viewing pleasure:
How about Amazon Prime?
You might say “Of course these companies are putting LGBTQIA+ stories at the top of your feed because of your viewing history.” Yet, in fact, nearly all of the content that we stream is G-rated kids’ stuff. On the rare occasions when I’m able to watch a movie for grown-ups, it will be one without romance or sex of any kind.
