Posted in Uncategorized

Don’t Stop Thinking About Tomorrow

It’s the second week of April, and it has snowed nearly every day this week. The heavy, wet flakes cling together in the shadows, blanketing the barely-awake grass in patches so the snow looked crocheted. It will melt as the sun encroaches, seeping into the cold ground. The brook has finally receded back to its springtime levels after rising a few feet during a day of torrential downpour. By the time we walk in it, it will be impossible to tell which storm or melt moved new boulders into our path. 

The air is no clearer, there are no changes in the traffic on our road. Stay-at-home looks almost no different than when the world is bustling and busy. We still hear a plane maybe once a week; logging trucks still thunder by. 

Our governor declared that Vermont has passed the peak of coronavirus infection. Watching the first signs of a plateau in cases, I am almost ready to be maybe cautiously optimistic. To paraphrase the meme I’ve seen regarding the northern New England states, staying six feet apart seems awfully close. Vermonters have been pretty good about staying, in local terms, one cow apart

We have not seen the influx of illness and death that had been projected just 4 weeks ago. Social distancing, “stay home, stay safe” orders, and the Vermont attitudes toward independence and resilience are working to reduce and prevent transmission of Covid-19. 

Working for the hospital as a non-clinical member of the infection prevention team and scrolling through my echo chamber on Facebook have validated this first tingle of hope that we have avoided catastrophe. 

Of course, one only has to blink to see outside that bubble.

I have decided that arguing with men on the internet is a form of self-care I am indulging in during this pandemic. I have not been one to wade in to internet arguments much before; I don’t enjoy feeding trolls. When I did engage, it was not necessarily to argue (ha!) but to correct something blatantly false that wasn’t also a conspiracy theory – I have my limits. But right now, there is a deadly pandemic; a gorgon at the door, its hot breath blowing in from New York and Massachusetts. 

When I worked in EMS, we had to prepare for blizzards and hurricanes, and in 2014, for the possibility of Ebola finding its way to us. My counterparts made the necessary arrangements and backup plans but teased my high level of concern in both situations. I was a newer member of management, relatively young in the field, and one of extremely few women at the table; I was not as jaded when it came to preparing for disasters that never seemed to materialize. I was better at keeping quiet then, too. I did not fool around during PPE training, but I wasn’t as vocal as I am now. 

Seeing the carelessness with which some people are conducting themselves during this pandemic enrages me on every level – personally, professionally, and academically. The misplaced bravado, the utter disdain for guidelines, the willful ignorance of science pumps up my blood pressure. I feel it build like some sort of apocalyptic katamari in my chest, jagged and off-kilter, heating and churning to boiling point when I can’t stop reading for incredulity. I need to release the valve, blow off some of that steam; scalding men on the internet who call me a sheep has been a fun little release (I am specifying men here because when I argue with women, they don’t often respond; and when they do, it lacks the utter condescension and vitriol).

Why is this affecting me so? Why can’t I just scroll past? I don’t like how much time I spend on social media anyway, why can’t I just put my phone down? I have asked myself this several times lately, and the answer comes from my idol, Leslie Knope:

I care too much because I understand the stakes, and I have seen enough suffering.

I have seen the panic in the eyes of the vented patient when the perfectly spaced breaths aren’t enough, when the air sacs in the lungs fail to inflate. I have locked eyes and delivered breaths through long, drawn-out minutes of a power outage, waiting for a generator to click on, and a machine to take over the squeezing of my hands. I have seen the terrified disbelief in the eyes of someone drowning by inches in a dry bed.

I am no stranger to Death. I have seen her come for the unfamiliar and family alike. I have felt the brush of her hair as she has reached past me to spirit away the hand that I hold. I have ignored her gentle admonishment to stop when pushing, pushing, pushing on old and broken ribs. I have seen her leave the memories, a trail of blood-red rose petals to the afterworld; and I have seen her snatch away breath with greedy hands. I have seen her wait patiently for my father, and smooth my mother’s hair away from her soft face. I have seen her cradling my son, tears in her eyes, an unspoken promise to care for him. No, Death and I are not strangers. 

Death has already come for tens of thousands around the world, invited to this grim party by the coronavirus in addition to her normal rounds. Already the numbers have reached those a degree or two away from me. Right now, thankfully, they seem to be plateauing. Our vigilance is working; alternate care sites and negative pressure rooms stand empty, boxes of supplies on the shelf. Staff is still ready, all hands on deck; the hallways echo without visitors. Work pushed aside so quickly in March is starting to pop up on to-do lists for some; furloughs and lay-offs have emptied the common areas. 

I am trying to be extremely deliberate when I say the measures are working – present tense, a current and ongoing action. It will be a long time until we can say it worked. As the internet says, ending quarantine now because it’s working is like stopping medication because you feel better. We just aren’t there yet. Projections show that the curve has been flattened absolutely, some places much more than others; but we have to keep looking down the line. This virus doesn’t magically disappear when we hit a certain date or temperature or season. There is much more work to do. We are not out of the woods yet. 

I understand the gravity of the economic situation. I know hundreds of thousands of people are scared of what the next days will bring, even if the lockdowns were to end immediately. I can see the havoc wreaked by the virus on sectors other than healthcare. I worry about the success of our small businesses, and the education of our students. I miss concerts and baseball and my family. I see the effect quarantines and lockdowns are having on people, and I sympathize – but without people, there won’t be an economy to fix. If we were to lift all the restrictions, the only things different would be that some places would be ready for a second wave of infections and fatalities, and some would continue to be devastated. 

There is no going back to life as we knew it. That is a switch that cannot be flipped, as most in the US were able to do after the Ebola outbreak in 2014. This time, we are heavily involved, whether people want to admit that or not. Going forward, life will be irreversibly changed. No one will be unscathed. If we continue to handle with caution and test tomorrow’s ground with every step, we can maintain this plateau. If we don’t, if we start going out and gathering together in the streets as we did before, we will rewind this tired clock and have to start again. 

And if you want to fight about it, get ready to step. I can keep up this argument as long as the willfully ignorant can.

Keep staying the fuck home, friends.

Posted in Uncategorized

How Am I Going To Be An Optimist About This

In the middle of a massive forest, surrounding by rolling mountains, sat a village. It wasn’t perfect, but it was picturesque; a white steeple rose from the middle of the valley, and the whole scene became vividly painted in autumn. It had your general assortment of people; some folks weren’t as nice or law-abiding as they could be, some went out of their way to be contrary. Mostly, people there kept to themselves, living and letting live. In times of crisis or need, however, so many of them were ready to help in a moment’s notice. 

Like most places that sound idyllic when encapsulated by an outsider, the village had its share of problems and concerns. Most folks went about their day-to-day lives with an ease of accessing all they wanted, often unaware of their own privilege. Others struggled to get where they needed to be, or find ways to meet their essential needs. For long stretches of time, everyone forgot that they lived on the slopes of a volcano. 

There had been occasional talk in the lofty treetops of being ready when the volcano awoke. Such plans were often brought up when money needed to be spent or leaders wanted to be elected, only to be waved off like smoke once the price was paid or the election over. Everyone murmured agreement with the vague statements of preparation and planning, but there was always something else to pay attention to. Anyway, they said, the volcano had lay dormant for a hundred years. There were a few rumbles, now and again, sure; but nothing that hadn’t been weathered with some extra grit and good old Yankee know-how.

The volcanologists who happened to live in the village even forgot about the sleeping giant for periods of time. 

But lately, when snow still blanketed the forest floor and the tops of the pines brushed against the winter blue sky, the birds had been twittering. The woodland creatures scampered with a more frantic step; in the way of things, they were tuned into something much bigger than the villagers, mere mortals, could feel. The wind blew with the barest whisper of what was to come; no one noticed.

The rumbles started from far away, far enough that the village had an almost imperceptible shimmer. The scientists and scholars  glanced at each other, unsure of how to acknowledge the tiny trembles, not wanting to believe what they could mean. Messages came from far-off places; earthquakes, eruptions. Those who worked the land began to take heed, and helped the scientists amplify their voices. As the ground started to shake closer and closer to home, the village began to prepare. 

Businesses were shuttered, schools were closed. Windows were boarded with plywood, and people lay in odd supplies. Bottles of water and rolls of toilet paper were hoarded; antiseptic cream and clean bandages were stockpiled. Surely, these would be what they needed to survive the coming torrents.  Some went through the motions, not believing it would be as bad as others said. They called it an overreaction, even as they added cans of food to their shopping carts. 

Others rallied to action, making supplies by hand to handle the fallout. Their movements brought the community together and helped to ease the anxieties of so many. This was how they would save the village. Those who needed the supplies accepted them with gratitude and grace, but with a heavy heart as well. 

The volcanologists worked tirelessly, preparing for a future no one wanted to acknowledge, that everyone wanted to believe could be avoided. They screamed the truth, but no sound came out. 

This is Rutland, Vermont. This is the town I work in, the hospital I have dedicated the past 5 years of my career to, the community I have come to embrace as my own. There is no fault to be had in this village. The leadership has been excellent, from our CEO to our governor. The preparations have been running at full speed. The community has come together, donating time and supplies, helping each other. The streets are nearly empty; most everyone is staying home, staying safe. My drive to work has no traffic now. I pass storefronts with fluorescent paper signs in the window – Closed, Stay Safe. The hospital feels like a ghost town, employees working from home or not working at all. The air is heavy with foreboding, and people are taking the threat of coronavirus seriously. 

I’m screaming, and no sound is coming out. 

This is what I have studied for years. This is what I went to school for, giving up hours upon precious hours with my wife. Hawthorne knows what the back of my head looks like in every mode and mood. They hear my silent cries, and I’m grateful, but it doesn’t stop the screaming.

People cannot fathom what is about to hit. They have weathered storms and natural disasters and fought on; they have taken up the shield before. They think we’re ready; and truly, I think we’re as ready as we can be. But you can’t board up your windows with plywood and expect to make it out when the floor becomes lava. 

We are flattening the curve. The rise of corona cases in Vermont follows the same trajectory as in other places, true to the epidemiologic curve, but at much smaller numbers. As of 8 AM Saturday morning, March 28, 2020, we have less than 200 cases, and ten deaths. That number will rise today, tomorrow, and the days after that. We are practicing social distancing, and bleach is the new ambience. The measures are working. 

I don’t know if it is the human condition or us in particular as Americans that lead us to believe we are special. Ask a group of people if they think they think they would be in the 70% of the population who is going to contract the virus, or the 30% who is not; nearly everyone believes they are in that 30%. We don’t want to think about losing loved ones, about what it actually means to get the virus, and to be in the high risk groups. It’s always somebody else who is going to get it; someone else’s grandmother, someone else’s spouse. 

I am not special. I have more chance of catching this virus than I do of staying clear. I work for a hospital; not in clinical care, not even in the main building, but with people who do. There is an acceptance in our office, a knowledge that sits within each of us that we will most likely be infected. People in healthcare, grocery stores, supply chains, and cleaning professions around the world are familiar. We are not so special that we can avoid the virus. 

Putting aside factors like age and general health, if I have one hundred people in my life, 70 of them will contract the coronavirus. Out of them, 14 people will become life-threateningly ill. 3 of them will die.

The town I live in has 650 people. 455 will get the virus, with 91 needing critical care, and 21 will die.

My hospital has over 1700 employees. We need to expect 1190 to get the virus, with 238 needing critical care, and still, 51 will die.  

Flattening the curve doesn’t necessarily mean less people will need critical care or less people will die. We don’t yet know enough about the virus to know that. What it means is this. 

Hospitals, like ours, will still be overwhelmed. It almost doesn’t matter in some respects if you are short 30 ICU beds or 3000. Those working the front lines are still overrun and still doing their job as best they can for as many people as they can. Flattening the curve means that we are giving our healthcare workers who WILL get sick time to get better, and hopefully return to help. It means that instead of the loss of hundreds of lives within days, when everyone gets sick and all the critical patients arrive at once, we at least have the chance to save more by spreading thin resources out. We don’t want what happened with toilet paper to happen with ventilators. 

I am scared. I know I am likely to get the virus, to pass it on. I am so likely to lose people, and I don’t want to acknowledge that, let alone make my peace with it. I am no politician. I’m not trying to get elected for anything. I’m not a motivational speaker, not a preacher or priest. I cannot offer hope, a silver lining, or promises of bright future if we just fight hard enough. I can’t even fake it.

But along with memes and messages of hope I cannot smile at, there are also those of support, and I’m here for that all day. Knowing the grim statistics will not make me fight less. It just makes me hyper aware of what devastation our village will endure. The world is going to look very different in a couple months. We will be changed; no one will be unaffected. And it will be up to the survivors to make sure those silent screams are captured by the history books.

Stay the fuck home, friends.