Over Easy posted:

this thread is doing pretty good, ~55 pages a day, nice

i am harry posted:

ugh, every night people in my neighborhood start howling at 8pm. I am not using any of those neighborhood community social things so I have absolutely no idea what the gently caress but I expect it’s some dumb American thing about keeping suburban spirits high as a way to participate in the “fight” against covid

Darude - Adam Sandstorm posted:

A post for every american covid death that day.

Darude - Adam Sandstorm posted:

A post for every american covid death that day.

etalian posted:

facetoucher cat posted:

Excellent

a few DRUNK BONERS posted:

how do i make hydrogen peroxide at home

a few DRUNK BONERS posted:

how do i make hydrogen peroxide at home

Charlz Guybon posted:

More than 20k avoidable death and 17m lost jobs sours the public on a president? Who could have predicted this?

https://mobile.twitter.com/NumbersMuncher/status/1249069704171282432

Google Butt posted:

cum + ammonia

Google Butt posted:

cum + ammonia

mycomancy posted:

Mix bleach and ammonia in a big vat in the center of your house.

A HORNY SWEARENGEN posted:

SardonicTyrant posted:

Please do not actually do this. In case you are unaware this produces a deadly gas.

EIDE Van Hagar posted:

Why???

facetoucher cat posted:

I don't know what I just stumbled upon. No idea on source or anything and don't want to be associated with sharing false information but felt compelled to share this

MadJackal posted:

Day 17 Quote

"Do me a favor?"

"I can tie you up."

"Patting me down for weapons?"

<She giggles>

"I might bring a shiv into the room for this guy."

"He's trying to run his own show. He's been here for weeks and weeks and he goes down in the eighties and it's failed, and he needs to go down on a nonrebreather and-"

"It's why I'm taking it not the interns. I know, I know, I know."

"And he's insisting on-"

"And he's pigheaded and wants to run the show and Rush loving Limbaugh told him we have some miracle drug and he already had five days of it."

"Doctor ___ spoke to him already and-"

"She came in and chewed me out in the room."

"She walked in there and-"

"Yeah, I'm going to go in there and say we've not having a conversation about the Plaquenil and already how we've tried this thing-"

"He's talked to Dr ___ and he screamed at her."

"Tell me I look pretty in yellow?"

<Crosstalk that all approved of my fashion statement>

"Some fancy heels and you're ready for a night out on the town."

"You want some booties or a hair net?"

"No, look, I don't plan on licking my shoes or my hair, I'm fine."

<Giggles, door closes.>

"Mr ___, what are you doing with your mask off? You're scaring me."

"I just got off the phone with my wife, she-"

"Let's get that back on your face."

"I got a problem."

"I got a problem too. Imma get a chair. OK, what's going on?"

"Yesterday, I got up to the bathroom, six liters and I passed out."

"I know you're focused on the days where you were on the nasal cannula, but you've been a nonrebreather since March. Let's be very, very clear about that. If you walk around, especially without the oxygen, you'll pass out and hit your head. And we don't need you to hit your head in addition to everything else."

"I feel that I'm failing. Do I have- do I have the virus in me yet?"

"You've had the virus in you for three weeks."

"It's still in me?"

"Yeah."

"How can I-"

"It's not just the virus. Your body is fighting it off but the issue with COVID is your own immune system is attacking your lung cells. It's what we're afraid of."

<The sound of his nonrebreather is almost overwhelming>.

…

"I have requested many times, I'd like to try the-"

"We're not doing it. You've had this conversation with multiple people. This is directly from our infectious disease doctor, ok? This is above both of us. I started it back up last night for stupid reasons. I was going by your wife and your's decisions. Against pretty much all reason. To be very honest, it was a stupid reason to restart it."

...

"Also, sitting up? This isn't helping your situation at all. I've been doing this for 3 weeks. People who lie flat on their bellies? Their numbers look great. People who lie on their backs have numbers that look lovely."

...

"You're sitting here with your mask off and its nuts."

"Married 50 years and I talked to her and she's scared to death-"

"Yeah, she should be. I'm scared to death."

"Twenty days ago, I'm walking five miles a day."

"Yeah. Then you got sick."

"I can't even- I can't even stand up. I'm sick, I'm real sick.. I can feel, I can actually feel…"

I don't owe you anything. Finish the story however you want.

.

.

.

Day 18 “You’re trying to save the world and I’m trying to save you.”

Premeditated. That's the word I'm worried about.

75M w/PMH of CVA, nonverbal, bed bound, resident of a NH. Presented w/ fever of 103F, found to be COVID positive. He was doing well this morning, only on 2L via NC.

While responding to a different patient's Rapid, my intern is called off to assess this guy. By 14:00 he was satting in the 80s. Started on NRB. She orders a CXR and a ABG. I return from the Rapid (60F w/ alcoholic pancreatitis, COVID negative, hypoxic, watched her get tubed) and take a look at the patient. Junky lungs on auscultation. Agonal breathing. Clearly. Despite the NRB and sats in the upper 90s, the guy looks scary. Scary enough that I think he's going to crash in the next 10 minutes or so.

He's Full Code, of course. Before he had been transferred to our service, Palliative had already been consulted. After a few days of unsuccessfully trying to contact the patient's only living relative (his daughter), she signed off on the case. No Goals of Care meeting for this man.

I don't want to Code him. I don't want my nurses or I needlessly exposed to a droplet bomb of a resuscitation that I know for certain the ICU would never accept. He won't get tubed, and if he's not getting tubed he's dead. He's dead regardless of whatever we try.

"Full Code, COVID positive. Probably going to have to do chest compressions." "Yeah. Limit the people in the room. Five minutes on the clock." "Then we'll call it."

I didn't hesitate when I said that.

It wasn't a spur of the moment decision. I have thought over the previous Code and my decision then to limit it. And I'm repeating it.

God help me.

It doesn't sit right with me so I go to the medical director of the hospital (the very nice gentleman who got me a breakfast burrito, as you remember). I present the case.

"This is a big ethical dilemma." He exhales with the same exacerbation I feel. He offers the choices of treatment as usual (CPR / maybe intubation) or possibly two attending doctors attesting could sign off that CPR/intubation would be pointless. He tells me to see the CMO.

I go to the Chief Medical Officer. I repeat the story. He's a good man, a pediatrician by trade. Used to do our 8AM peds didactics. He's on the ethics board. He chews over the ethics of the case for a while.

As much as the conversation about end of life was enlightening, I'll spare you the filibustering.

The CMO meets up with my team (gently caress, I never meant for this to escalate like this). He again filibusters the ethics of the case. Ultimately, he chooses to write a note as an Ethics Consultation advising that if two physicians are in agreement, a DNI/DNR order can independently be made.

After he leaves, my attending: "Once you make someone DNR yourself it's a civil case, but it can be a criminal case against you."

We all agree that he has no chance of surviving the Code, and even if he magically made it to a vent he'd die from respiratory failure. Or the kidney failure. Or maybe heart failure.

The other attending, my program's inpatient director for the hospital and "Physician of the Year" also balks at signing the form. Because he's not involved in the case, you see.

My attending says he'll talk to the ICU attending to maybe get a signature.

"Don't call it a soft code. Never say the words 'soft code.' But…"

I won't write the rest of what he said because I respect the man too much.

I am fighting uphill to do the right thing. Or what I think is the right thing. I don't know anymore.

...

Before I leave for the night, I text my attending asking if he signed the DNI/DNR. He replies "No. It’s a tough decision."

As I'm walking out I tell the nurse handing off this patient to the night shift that he is still full Code. She's incredulous. She had put out that bright pink MOLST form right in front of the attending to make sure it was signed two hours ago.

"Why didn't he sign it?"

"Because he's a moral coward."

…

I come home, watch Westworld, call up my best friend and weep.

Not the pretty tears of a Hollywood doctor overcome with their episode's brush with mortality who goes on to eloquently explain their sorrow.

No. It was ugly, wordless, choking crying.

Not for anything in particular. I couldn't say why today was the day I broke a little. Maybe a lot.

The only words I remember saying are "They all keep dying."

.

.

.

Day 19 The Story of Me

The absolute arrogance of you.

You thought you knew this thing. This loving monster. And yeah, you caught and exposed one case. You could probably catch every case from 100 yards out at this point from just basic labs and an O2 sat even without a COVID test.

But you had no clue early on that this was EVERYWHERE. That this would spread so quickly and would overwhelm the census this thoroughly. The ED was right to start testing everyone who entered the doors and it wound up protecting you and your team.

And you denigrated them for ordering those tests. Day 4, it's there in black and white. And now your census is 100% COVID even if they came in for a fall. You wrote that on the same day as you proclaimed your mastery of this plague. Idiot.

You can manage the cases on the floor and order all the meds that whatever today's recommended shotgun approach to management has advised. You can know each and every single COVID patient's SpO2 and if they're NC or NRB by heart and it doesn't matter.

The monster causes DVTs even in patients on blood thinners. How many people did you admit that were placed on SCDs instead of heparin or Lovenox because their clotting score was essentially nil? How many people on Lovenox still threw clots? How many did you discharge home two weeks ago without a 30 day prescription for Lovenox? How many of them are going to die?

And the sudden deaths. You didn't notice a pattern in all those Code Blues? How pretty much all of them were PEAs? You coded a guy on the loving floor because he dropped dead walking to the bathroom. How many did you send home are going to drop dead from that?

You advocated for a man to not receive CPR or be tubed like everyone else. What do you possibly think gives you the right? All you did was piss off your attending. Nothing changed. The patient will still end up getting Coded.

Every other doctor in the hospital is ok with pointless interventions, so why aren't you?

You're not doing well. And you want to forego one or two weeks of scheduled vacation to go volunteer for more of this suffering?

Your mentor got sick, and you could be sick. You already suspect you're an asymptomatic carrier like every other Resident.

Why stick with this?

The absolute arrogance of you.

…

But don't forget the good parts.

Don't forget going to an impromptu party you just had next door with your fellow residents.

Don't forget drinking Coronas and laughing with your friends.

Don't forget commiserating with them over this catastrophe.

Don't forget being open and honest with your interns and knowing they don't think you're an rear end in a top hat.

Maybe you're doing a good job.

You can't get that Starfleet Medical tattoo on your left deltoid in Brooklyn right now like you wanted, but you will eventually. And getting a permanent reminder of those three red lines of split skin on your left 5th digit knuckle from washing your hands constantly would be a nice memento of this shitshow.

The eyebrow gash you got from that botched piggyback ride last night is pretty funny though.

Hugs and kisses,

You

etalian posted:

yup it produces chlorine gas

SardonicTyrant posted:

Please do not actually do this. In case you are unaware this produces a deadly gas.

Mrs. Dash posted:

I live in Knoxville TN and I once overheard two old white dudes at the gym referring to Asheville as a "socialist hellhole." Can you confirm??

Jymmybob posted:

It's a hippie city surrounded by hillfolk. It makes for a weird dynamic especially when you factor in the upstate SC bunch which are much more typical southerners.

Gripweed posted:

You stumbled on some propaganda twitter account that posted a video of a fight. Unless they're yelling "I want that piece of bread!" in Turkish I see no reason to believe they're actually fighting over a piece of bread

Pittsburgh Fentanyl Cloud posted:

much like your posts!

MadJackal posted:

Day 17 Quote

"Do me a favor?"

"I can tie you up."

"Patting me down for weapons?"

<She giggles>

"I might bring a shiv into the room for this guy."

"He's trying to run his own show. He's been here for weeks and weeks and he goes down in the eighties and it's failed, and he needs to go down on a nonrebreather and-"

"It's why I'm taking it not the interns. I know, I know, I know."

"And he's insisting on-"

"And he's pigheaded and wants to run the show and Rush loving Limbaugh told him we have some miracle drug and he already had five days of it."

"Doctor ___ spoke to him already and-"

"She came in and chewed me out in the room."

"She walked in there and-"

"Yeah, I'm going to go in there and say we've not having a conversation about the Plaquenil and already how we've tried this thing-"

"He's talked to Dr ___ and he screamed at her."

"Tell me I look pretty in yellow?"

<Crosstalk that all approved of my fashion statement>

"Some fancy heels and you're ready for a night out on the town."

"You want some booties or a hair net?"

"No, look, I don't plan on licking my shoes or my hair, I'm fine."

<Giggles, door closes.>

"Mr ___, what are you doing with your mask off? You're scaring me."

"I just got off the phone with my wife, she-"

"Let's get that back on your face."

"I got a problem."

"I got a problem too. Imma get a chair. OK, what's going on?"

"Yesterday, I got up to the bathroom, six liters and I passed out."

"I know you're focused on the days where you were on the nasal cannula, but you've been a nonrebreather since March. Let's be very, very clear about that. If you walk around, especially without the oxygen, you'll pass out and hit your head. And we don't need you to hit your head in addition to everything else."

"I feel that I'm failing. Do I have- do I have the virus in me yet?"

"You've had the virus in you for three weeks."

"It's still in me?"

"Yeah."

"How can I-"

"It's not just the virus. Your body is fighting it off but the issue with COVID is your own immune system is attacking your lung cells. It's what we're afraid of."

<The sound of his nonrebreather is almost overwhelming>.

…

"I have requested many times, I'd like to try the-"

"We're not doing it. You've had this conversation with multiple people. This is directly from our infectious disease doctor, ok? This is above both of us. I started it back up last night for stupid reasons. I was going by your wife and your's decisions. Against pretty much all reason. To be very honest, it was a stupid reason to restart it."

...

"Also, sitting up? This isn't helping your situation at all. I've been doing this for 3 weeks. People who lie flat on their bellies? Their numbers look great. People who lie on their backs have numbers that look lovely."

...

"You're sitting here with your mask off and its nuts."

"Married 50 years and I talked to her and she's scared to death-"

"Yeah, she should be. I'm scared to death."

"Twenty days ago, I'm walking five miles a day."

"Yeah. Then you got sick."

"I can't even- I can't even stand up. I'm sick, I'm real sick.. I can feel, I can actually feel…"

I don't owe you anything. Finish the story however you want.

.

.

.

Day 18 “You’re trying to save the world and I’m trying to save you.”

Premeditated. That's the word I'm worried about.

75M w/PMH of CVA, nonverbal, bed bound, resident of a NH. Presented w/ fever of 103F, found to be COVID positive. He was doing well this morning, only on 2L via NC.

While responding to a different patient's Rapid, my intern is called off to assess this guy. By 14:00 he was satting in the 80s. Started on NRB. She orders a CXR and a ABG. I return from the Rapid (60F w/ alcoholic pancreatitis, COVID negative, hypoxic, watched her get tubed) and take a look at the patient. Junky lungs on auscultation. Agonal breathing. Clearly. Despite the NRB and sats in the upper 90s, the guy looks scary. Scary enough that I think he's going to crash in the next 10 minutes or so.

He's Full Code, of course. Before he had been transferred to our service, Palliative had already been consulted. After a few days of unsuccessfully trying to contact the patient's only living relative (his daughter), she signed off on the case. No Goals of Care meeting for this man.

I don't want to Code him. I don't want my nurses or I needlessly exposed to a droplet bomb of a resuscitation that I know for certain the ICU would never accept. He won't get tubed, and if he's not getting tubed he's dead. He's dead regardless of whatever we try.

"Full Code, COVID positive. Probably going to have to do chest compressions." "Yeah. Limit the people in the room. Five minutes on the clock." "Then we'll call it."

I didn't hesitate when I said that.

It wasn't a spur of the moment decision. I have thought over the previous Code and my decision then to limit it. And I'm repeating it.

God help me.

It doesn't sit right with me so I go to the medical director of the hospital (the very nice gentleman who got me a breakfast burrito, as you remember). I present the case.

"This is a big ethical dilemma." He exhales with the same exacerbation I feel. He offers the choices of treatment as usual (CPR / maybe intubation) or possibly two attending doctors attesting could sign off that CPR/intubation would be pointless. He tells me to see the CMO.

I go to the Chief Medical Officer. I repeat the story. He's a good man, a pediatrician by trade. Used to do our 8AM peds didactics. He's on the ethics board. He chews over the ethics of the case for a while.

As much as the conversation about end of life was enlightening, I'll spare you the filibustering.

The CMO meets up with my team (gently caress, I never meant for this to escalate like this). He again filibusters the ethics of the case. Ultimately, he chooses to write a note as an Ethics Consultation advising that if two physicians are in agreement, a DNI/DNR order can independently be made.

After he leaves, my attending: "Once you make someone DNR yourself it's a civil case, but it can be a criminal case against you."

We all agree that he has no chance of surviving the Code, and even if he magically made it to a vent he'd die from respiratory failure. Or the kidney failure. Or maybe heart failure.

The other attending, my program's inpatient director for the hospital and "Physician of the Year" also balks at signing the form. Because he's not involved in the case, you see.

My attending says he'll talk to the ICU attending to maybe get a signature.

"Don't call it a soft code. Never say the words 'soft code.' But…"

I won't write the rest of what he said because I respect the man too much.

I am fighting uphill to do the right thing. Or what I think is the right thing. I don't know anymore.

...

Before I leave for the night, I text my attending asking if he signed the DNI/DNR. He replies "No. It’s a tough decision."

As I'm walking out I tell the nurse handing off this patient to the night shift that he is still full Code. She's incredulous. She had put out that bright pink MOLST form right in front of the attending to make sure it was signed two hours ago.

"Why didn't he sign it?"

"Because he's a moral coward."

…

I come home, watch Westworld, call up my best friend and weep.

Not the pretty tears of a Hollywood doctor overcome with their episode's brush with mortality who goes on to eloquently explain their sorrow.

No. It was ugly, wordless, choking crying.

Not for anything in particular. I couldn't say why today was the day I broke a little. Maybe a lot.

The only words I remember saying are "They all keep dying."

.

.

.

Day 19 The Story of Me

The absolute arrogance of you.

You thought you knew this thing. This loving monster. And yeah, you caught and exposed one case. You could probably catch every case from 100 yards out at this point from just basic labs and an O2 sat even without a COVID test.

But you had no clue early on that this was EVERYWHERE. That this would spread so quickly and would overwhelm the census this thoroughly. The ED was right to start testing everyone who entered the doors and it wound up protecting you and your team.

And you denigrated them for ordering those tests. Day 4, it's there in black and white. And now your census is 100% COVID even if they came in for a fall. You wrote that on the same day as you proclaimed your mastery of this plague. Idiot.

You can manage the cases on the floor and order all the meds that whatever today's recommended shotgun approach to management has advised. You can know each and every single COVID patient's SpO2 and if they're NC or NRB by heart and it doesn't matter.

The monster causes DVTs even in patients on blood thinners. How many people did you admit that were placed on SCDs instead of heparin or Lovenox because their clotting score was essentially nil? How many people on Lovenox still threw clots? How many did you discharge home two weeks ago without a 30 day prescription for Lovenox? How many of them are going to die?

And the sudden deaths. You didn't notice a pattern in all those Code Blues? How pretty much all of them were PEAs? You coded a guy on the loving floor because he dropped dead walking to the bathroom. How many did you send home are going to drop dead from that?

You advocated for a man to not receive CPR or be tubed like everyone else. What do you possibly think gives you the right? All you did was piss off your attending. Nothing changed. The patient will still end up getting Coded.

Every other doctor in the hospital is ok with pointless interventions, so why aren't you?

You're not doing well. And you want to forego one or two weeks of scheduled vacation to go volunteer for more of this suffering?

Your mentor got sick, and you could be sick. You already suspect you're an asymptomatic carrier like every other Resident.

Why stick with this?

The absolute arrogance of you.

…

But don't forget the good parts.

Don't forget going to an impromptu party you just had next door with your fellow residents.

Don't forget drinking Coronas and laughing with your friends.

Don't forget commiserating with them over this catastrophe.

Don't forget being open and honest with your interns and knowing they don't think you're an rear end in a top hat.

Maybe you're doing a good job.

You can't get that Starfleet Medical tattoo on your left deltoid in Brooklyn right now like you wanted, but you will eventually. And getting a permanent reminder of those three red lines of split skin on your left 5th digit knuckle from washing your hands constantly would be a nice memento of this shitshow.

The eyebrow gash you got from that botched piggyback ride last night is pretty funny though.

Hugs and kisses,

You

MadJackal posted:

CPA Hell posted:

it’s definitley more left leaning than most of the south east. but a lot of it feels performative if that makes sense. I haven’t lived there, just visited a lot. so maybe just ignore everything I’m saying here. upstate SC is being overrun by suburbanite transplants from the rest of the country