Northeast Island

 

There was a spike in COVID cases a week ago in Danbury, a city in western Connecticut near the New York border.  The state and city responded by urging residents to stay home and avoid large gatherings.  The city also canceled all youth sports for the fall to not leave their homes.  They also limit activities in public parks and close the boat launch at the local lake, as well as ask churches to limit in-person services.

In East Windsor, a small town in North Central Connecticut, there was an outbreak of COVID among migrant farm workers, who shared housing.

Over 50 returning students at the University of Connecticut test positive along with two staff and faculty members.  An entire dormitory is quarantined.  Football practice is postponed as members of the team test positive. Several students have already been kicked out of their dorms for partying without masks in close contact with other students.

Grade school kids will be returning next week and many are still uncertain how that will play out.  Each district is different, Many are using hybrid models of partial in school particla on-line.

The town I live in West Hartford has petitioned the state to limit outdoor gatherings to 20.

The indoor aquatics center where I used to swim everyday is supposed to finally open on September 14th, but I am nervous it will not happen.

My daughter is getting ready for her fall soccer season and a continuation of her AAU basketball, but as individual cities start to close down youth sports, I am nervous her seasons will get canceled before they begin.

While there are no COVID patients admitted to my hospital right now, when I worked in Hartford on Friday, I heard a number of calls go out for COVID positive patients.

Overall Connecticut has had a great summer, but our state has turned orange on the COVID-19 ACT now national map -- making us at risk island in Northeast. 

The numbers for the city of Hartford look even worse.

Who knows what the fall will hold?

 

Ventilation and Prolonged Exposure

 We are told to keep six feet of distance from each other, but how effective is this the distance in preventing the spread of COVID-19?

The answer may well be, yes, it helps, but it is not the full answer.

In a new article published in the British medical Journal provides a fuller view of our risk of exposure.

Two metres or one: what is the evidence for physical distancing in covid-19?

Six feet may be okay if you are wearing a mask and are outside, but if you are in a poorly ventilated room with a COVID positive person for an extended period of time, you may be exposed even if you are wearing a mask.

The chart below does a great job of estimating your risk based on a number of different factors including ventilation, location, duration of contact, facial coverings, and a person silent, speaking or shouting.

The chart seems to say, it is as much about ventilation and prolonged exposure as it is about distance.

 

The Lazarus Syndrome

 A 20 year old woman was declared dead by an EMS crew in Michigan, and was later found to be alive in the funeral home.

I don’t know the details:

Did they apply a monitor and confirm asystole in three leads?

Did they work the patient for twenty minutes?

Did they give the patient any epinephrine?

Did the patient have DNR orders?

I do know this. This is not the first time it has happened.

There may even be a medical explanation for it.

Google “Lazarus Syndrome:”

Here’s the Wikipedia article:

Lazarus Syndrome

It has links to many scholarly articles.

The bottom line is there have been cases where the person appeared not only dead to the EMS or medical workers, but to the people who carted them to the funeral home. That’s crazy stuff.

MI Firefighters on Leave as Chief Tries to Explain Woman Found Alive at Funeral Home

I always run a six second strip of asystole, but that is not always a guarantee.

Here’s a story I wrote in 2004 about “The Man Who Wouldn’t Die.”

***

We’re called for a person not feeling well in an elderly housing hi-rise not far from the hospital. The man is an emaciated AIDS patient, who is laying naked on the couch in his dark apartment. he has a colostomy bag. His girlfriend says they were at the emergency department for seven hours today, then left.

“What did the doctors say was wrong?”

“Nothing. We were in the waiting room.”

The fire fighter first responder says he can’t feel a pulse, but the man is talking and alert. Its not unusual to have a difficulty feeling a pulse on some AIDS patients who are often baseline hypotensive. Since it is so dark in the apartment, I just say put him on the stretcher, give him some 02 and we’ll work him in the ambulance.

Downstairs in the ambulance, I try for a blood pressure and can’t hear anything. His nail beds are white. I put in an IV while my partner puts him on the monitor.

“Why are you grimacing?” my partner asks.

The man is suddenly writhing.

“My chest hurts,” he says.

I look at the monitor. He’s in V-tack.

I slam some lidocaine in the IV line and tell my partner to drive to the hospital. We are only a couple blocks away.

I put the pads on the man’s chest. “This is going to hurt,” I say.

Before I hit the shock button, I pull out my intubation kit and have it ready.

I shock him.

He screams.

Still v-tack.

“Sorry, I have to do it again.”

I shock him. He’s out.

I grab and tube and using a device called a bougie, slide the bougie between the vocal chords, then slide the tube over it. I’m in in like twenty seconds. I do some compressions, ventilate through the tube, grab some epi and slam it in the line, and just like that we are out at the hospital.

Another EMT comes around and helps us unload the patient. When we wheel him into the cardiac room, the doctor takes one look at his emaciated body and says, “He’s asystole, he’s dead.”

“But he just coded like two minutes ago,” I say.

“Look at him, he’s terminal.”

The doctor is right. He looks like a Biafrian.

“He was v-tack. I shocked him twice. He was here for seven hours today in the waiting room.”

The doctor ponders a moment, looks at the ECG, says, “11:34,” and leaves the room.

The nurse takes the rest of my report, then writes in the time, then goes over to prepare the body.

The man takes a breath, a deep gasp.

She jumps. “Oh, my god.”

He gasps again, and with each gasp, his breathing becomes more regular. She hooks him up to the monitor. He has a rhythm.

“I guess I better get the doctor.”

She comes back with the doctor just in time to see the man take his last gasp. The monitor goes back to straight line.

The doctor shakes his head. “He’s dead,” he says.

“You don’t want to give him some epi?”

“No.”

He turns to leave the room. The man takes another deep gasp.

The doctor turns and glares at him as if to command him to cut it out. He’s still breathing.

The doctor approaches, lays his hand on the man. He stops breathing.

“I’m giving him epi,” the nurse says.

“Fine,” the doctor says. He glares at me. “Thanks again,” he says.

I have been bringing him a number of codes lately. “My pleasure,” I say.

I leave to write my run form. When I come back fifteen minutes later there is a sheet over the man. The nurse stands across the room watching him.

“He’s really dead now?” I ask.

She gives me a sarcastic smile as she accepts my run form, then returns her gaze to the body on the ER table.

***

My guess why he kept coming back to life is when I gave the epi, I didn't shut off the line above where I gave the drug so some of the epi went back up the tube, effectively giving him a slow epi drip that likely retriggered some brief cardiac activity.

Trapped

In 2013, I wrote a post called Get Another Job.

Here's how it went:

We were dropping off a regular patient at one of the hospitals the other day. A chronic PCP user. The “crusty” old nurse in the psych ward threw a fit complaining that she had just dealt with him two nights before. The fit was not good-natured banter, but clearly a I’m being imposed upon and you are a piece of shit fit. I felt like saying to her you are either (despite your age) brand new or you have been here too long. Burn out is an occupational hazard, which I have found infects either the relatively new or those whose lives outside of work have grown unpleasant. I will give everyone a period to outlast their burnout, but then you need to find another job or take time off to fix your own life Repeat patients are the territory in emergency medicine. No one likes working with miserable people. I’ll accept burnout a little more in EMS than in nursing because it seems to me nurses have more options to seek employment than EMS. Tired of the urban ER, go work in a Dr.s office or a walk-in clinic in a suburb or take a 9-5 job in endoscopy. To newer EMS burnouts, whose burnout has lasted longer than 3 months, get out now and find something that makes you less miserable because you don’t get a pass forever.

I am sitting in my ambulance outside a McDonald’s right now (using their free wi-fi). I am watching one of their employees, quite possibly even their manager, walking around the outside of the building, picking up every stray scrap of paper on the ground he can find. He has a broom and dustpan. When he is done, he will get a hose and wash the sidewalks down. He does this every morning. You can’t find a cigarette butt in his parking lot. This man has a good work ethic. I am the only one watching him, but he is performing like he is before a sellout audience in Carnegie Hall.

Who you work with is important not only to your health but the health of your organization. I have been doing this over twenty years and can say that burnout is not an isolated problem. It is an infectious contagion. At times I have seen in EMS and in EDs burnout become almost a badge of honor, as if being burnout makes you an official member of the tribe. When I first started I thought the crusty old burned out triage nurse was a great character. Some I liked to think had hearts of gold, others clearly were just plain mean. One nurse would punch everyone having chest pain, if they groaned, she put them in the waiting room. You can’t have musculoskeletal pain and a real medical problem at the same time, she seemed to think.

Recently, I heard a triage nurse chastise a patient for wasting the system’s resources. The nurse was quite nasty and aggressive about it. It took me aback because it had been years since I had heard something like that where years ago it was much more common place. I almost said to the nurse, you could get fired for talking like that to someone. EMS used to talk like that all the time. I even talked like that a few times many years ago, but I don’t do it anymore, and it is rare in my organization. There is something positive to be said for manners and correctness.

I go into many hospitals and they all have their own vibe, the same I think is true of ambulance services. A paramedic from one service recently was fired from his part-time job at another service. The reason was attitude. Doing what was permissible and part of the culture at one service was clearly not at the other service. To which I say, bravo.

If you are miserable and hate our patients, I don’t want you working with me. My best partners have always been the most pleasant people. If I have a partner who bitches all day, i find myself bitching as well and go home feeling miserable.

I wonder what the guy here at McDonald’s thinks as he sweeps up the cigarette butts. Is he thinking “f-ing slobs. I hate these f-ing people.” Or is he is thinking, “My sidewalk is glistening, the sky is blue, today is going to be a good day.”

***

I received a number of comments on the post at the time, and then this comment came in just yesterday:

“tHiS is WhAT yOU sIgnED uP FOr”
That’s bullshit. I didn’t sign up for nurses and doctors treatment me like I’m a human taxi, or incompetent. I didn’t sign up for dispatcher stacking calls on me and running me into the dirt so company X can have a little more change in their pocket, and grandma Betty can get a ride home. I didn’t sign up for “open door policies,” that become “sorry don’t care not my problem, just deal with it”. And those of you saying “IF yOU dON’t LiKe YOur jOB fInd aNotHeR”, it’s not that simple. Especially when you don’t live in a large metropolitan area. No one wants to hire paramedics. You get trapped doing this because of the money you make with OT, and can’t possibly afford to leave the income behind for anything else. Not to mention, the burnout makes it difficult to deal with paper pusher “emergencies” after experimenting legitimate ones. Simply put, fuck you guys, and fuck ems for making us sacrifice our physical, mental, and emotional wellbeing for the sake of a job. No one else would do it for us if the shoe were on the other foot.

***

Last year, I wrote another post called Moral Injury.

Here's how that one went:

Check out this powerful You-tube video

https://www.youtube.com/watch?v=L_1PNZdHq6Q&feature=youtu.be

When I see another provider who is burned out, my reaction has always been:

"Get another job.  You have no business doing this kind of work."

Until I saw this video, I never really considered the concept of moral injury.

If a fellow paramedic hurts his back lifting or wrestling with a patient, I would never thing to say, "Get another job.  You don't belong in this work work anymore."

Companies take great precautions to make our work physically safe.  There have been great innovations in stretcher design (when I started we used a two man dead lift), stair chairs, safety nets, and driver safety systems.  And while most services have employee assistance programs, I can't think of any preventative measure routinely taken in EMS to prevent moral burnout.  Long shifts, holdovers, too few cars on the road, 911s holding, order-ins.

Meat in the seat.

There is always a new hiring class to pick up the fallen stethoscopes and take their places on the front lines. 

It is hard to change things overnight.

I am glad there seems to be an awakening ahead.

***

Back to the comments I received yesterday.  Unfortunately, there is some truth to what the commenter says.  While it easy for some people to "get another job" when they burn out or suffer "moral injury," the nature of EMS, particularly commercial EMS, is such that people get trapped in the job.

You get trapped doing this because of the money you make with OT, and can’t possibly afford to leave the income behind for anything else

Many who don't have a college degree, get into EMS and because of near unlimited overtime, they got locked into a situation where they can't make a comparable amount in any other line of work.  I have seen young EMTs and paramedics, buy new 4x 4 trucks, get married, have kids, buy houses all while long shifts working 6 days a week, and then they suddenly find they hate their jobs (and in many cases their lives), but they can't quit because they are overwhelmed with debt.  While I have had the ability to get a second job as an EMS coordinator, due to my education, if I hadn't, I would find myself now in my sixties unable to physically keep up with the hours I used to work when I was out there six days a week.  As a commercial paramedic, I made over $100,000 a year easily (with overtime) and did so year after year, and this was 10-20 years ago.

While I sympathize with the commenter, I still don't want him out on the street anymore.  Whether unable to lift due to a broken back or unable to care due to moral injury, you can't due this job anymore.  As a profession, we need to have healthy responders.  We also need to have a system in place to help those who can no longer work at the standard, physical or mental, that is required, and a system in place to try to try to help people before its too late.

I know one local service used to give its employees financial planning sessions to help them understand things like debt, life insurance and planning for your kid's college.

Good luck to all out there.  Stay safe and take care of yourselves and your families so you can take care of your patients in the same manner you would want your loved ones to be cared for.

  

Temperature Checks

 

I have had my temperature taken hundreds of times since COVID hit and I have yet to reach 98 degrees.  I routinely ask the temperature takers if they have ever found anyone with a fever and the answer has routinely been no. Add to that that the latest knowledge is that much of the COVID transmission takes place when people are asymptomatic, and you think what is the point?

Even Dr. Fauci has admitted that temperature are “pointless.”

Dr. Fauci explains why temperature checks to fight COVID-19 are pointless

He suggests that people merely be asked if they have any symptoms.

Still, I feel a bit comforted when a facility does temperature checks.  They are at least following a protocol and it tells me that they are taking COVID seriously and are likely to be actively cleaning and following other safe practices.

With all the sports events my daughter has been playing, the one place that she played at where they did not take temperatures at the door, turned out to be crowded with poor ventilation and people disregarding the masking rules.

I am okay with getting rid of the temperature checks, but please people, take the protocols seriously.  We can have a safe society, but it depends on the community caring for others, and not individuals doing whatever the F they want.

EMS Napping on the Job

 

Commentary in the August 2020 issue of the  American Journal of Industrial Medicine asks: Should public safety shift workers be allowed to nap while on duty?

After weighing pros and cons, they conclude: 

"Where feasible, administrators of EMS agencies and others with influence over policy and safety should consider novel (yet safe) applications of an intra‐shift napping strategy and be attentive to assessing impact."

While many EMS organizations prohibit sleeping on the job and others allow it only in designated areas, a 2018 safety panel empowered by the National Association of State EMS Officials also issued recommendations that included encouraging napping as a way to mitigate the adverse effects of fatigue.

Recommendation 4: Recommend that EMS personnel have the opportunity to nap while on duty to mitigate fatigue.

The panel determined that current evidence supports the use of naps while on duty as an effective strategy to positively impact fatigue-related outcomes. Naps improve alertness, reduce sleepiness, and improve personnel performance (e.g., reaction time).

A couple years ago, I posted about a picture put up on our employees only Facebook site where a crew was blasted for being photographed while sitting in their ambulance, the driver with eyes closed, and the passenger slouching in his seat.

Down Time

 I found some links to fatigue on the job, but did not get around to reading them in their entirety until later. I was surprised and pleased to find the pro-napping recommendations. In the document they directly address the issue of public misunderstanding of sleeping EMTs.

The general public may perceive EMS personnel napping on duty as unacceptable. The panel concluded that the benefits of improved alertness on duty, and ultimately improved patient and personnel safety, are a commonsense justification to this anticipated undesirable effect. Additionally, it is common knowledge that many EMS personnel and other first responders work long duration shifts requiring nighttime sleep when not on a response. Policies and protocols that clearly describe the appropriate use, structure, and benefits of naps on duty may be useful toward educating the public and reducing potential negative opinion.

I have been working EMS for almost 30 years, and have worked all types of shifts, overnights, 24s, 16s, 12s, and have never had a shift, where I did not occasionally on some days catch some rest with my eyes shut.  It could be in a designated bed with my cheek on a pillow and the blanket pulled up to my neck, in a comfy armchair with my feet up, on the stretcher or bench seat with my legs stretched out, or simply in the front seat with my head against the window and my mouth, hopefully closed.

I have always found the power nap restorative.  The only issue I have ever had with sleeping on the job was when I did overnights in places where you could sleep in a bed, and I would get a call in between the hours of 3:00 AM and 4:30 when I would wake and find myself driving down the road having no idea where I was or where I was going.

The Industrial Medicine Journal recommends caffeine either before a short nap or immediately after awaking to counter effects of sleep inertia.

EMS conditions most responders to listen for their number and hear it even in a sound sleep.  I have never failed to respond to a call for my number when I was dozing on the job. I have had partners however who have fallen asleep so deeply that they needed a shake.

Many, many years ago when I was on overnights (and EMS was still the wild west), I did a call for a patient on a street corner who wanted to go to detox.  While my partner slept soundly in the back (he was logging 100 hour plus weeks), I had the man sit in the front seat and we drove the half mile down the road to the detox facility.  My partner was still asleep when I came back out.

It has been years since I have done an overnight.  Today I work 12 hour day city shifts and my only napping is of the head against the window power variety (or the head nodding forward and jerking me awake as just happened while writing).

The safety panel recommends for those services that use dynamic deployment that napping should only be done in the front passenger seat or the patient compartment, that the sleeper be seat belted, and the driver never engage to prevent him from waking up with sleep inertia, leading to impaired driving.

Makes sense to me.  It’s nice to know napping has the sanction of the experts.

Read the full report here.

Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services

 

Promising News

 Promising news on COVID-19!

The New York Times reports we may be closer to herd immunity than thought.

What if ‘Herd Immunity’ Is Closer Than Scientists Thought?

"In interviews with The New York Times, more than a dozen scientists said that the threshold is likely to be much lower: just 50 percent, perhaps even less. If that’s true, then it may be possible to turn back the coronavirus more quickly than once thought."

In another article in the Times, researchers now believe the human body is storing strong memory of COVID-19 which may prevent reinfection.

Scientists See Signs of Lasting Immunity to Covid-19, Even After Mild Infections

"Scientists who have been monitoring immune responses to the virus are now starting to see encouraging signs of strong, lasting immunity, even in people who developed only mild symptoms of Covid-19, a flurry of new studies suggests."

And in one of the most fascinating articles I have read about the epidemic, a vision of a normal society even without a vaccine emerges through alternative testing. Instead of doing the expensive nasal swab testing, a much cheaper, easier to produce test that relies on saliva is mass produced. Testing becomes a part of our daily lives.

The Plan That Could Give Us Our Lives Back

"...it is in our power to have an abundance of tests within months—and to return life to normal, or something close to it, even before a vaccine is found. There is a way out of the pandemic."

Imagine this, you go to a community event -- restaurant, theater or sports game, spit into a cup, wait ten minutes for the test to come back, you are negative, you can enter with no need for a mask. 

Let's hope these visions come true.

Meanwhile, in Connecticut, things are still looking good.

COVID ACT NOW Connecticut

2.0 news cases daily per 100,000 people.

Infection rate 0.96 (less than 1 is desirable).

0.8% positive test rate.

***

Here's an article about Los Angeles considering the rapid inexpensive tests.

LA mayor embraces shift in COVID-19 testing strategy: simplicity and speed

AC Fireworks

 

Every year on the 4th of July we have a big party at my house. My brother and his family come up from New Jersey. I grill steaks, ribs, burgers, fries, chicken, and also cook fish, scallops, shrimp and sometimes lobster, as well as corn, zucchini, and mashed potatoes. “The tribe,” as my wife calls her Jamaican family, comes over, bringing friends with them, as well as curry goat and oxtails, with rice and peas. I fill up coolers with bottles of water, beer, hard seltzers and sodas from a local place that makes kid centric drinks like Zombie Juice, Toxic Slime, Monster Mucus, Dog Barf, and Kiddy Piddle. Dessert is ice cream and pie (apple and pumpkin) along with grapes and fresh berries, (blueberry, raspberry and strawberry). And then after dark, there are fireworks that I set on a step ladder and fire into the night sky, ending always with a spectacular finale.

Well, because of COVID we cancelled 4th of July, and instead at the last minute decided to have just a small get together, limiting the food to hot dogs and hamburgers and chicken, and inviting only my wife’s sisters and their kids. The plan was for everyone to bring a chair and we would all sit out back. Things were going pretty well, then I noticed it was just me in the back. It was awfully hot and humid and it seemed the rest had all gravitated to the living room where the large window AC was cranking on high. There were fifteen people in the room, sitting on the couch, one love seat and one arm chair, many in each other’s laps, talking loudly, close together, with no masks on. Why masks, when this is all family?

Here is just some of who were in the room (counting me when I walked in on the scene), a paramedic, an ER nurse, a nursing home health aide, a corrections worker, a supermarket worker, and an ice cream shop worker, as well as someone who recently left a job as a group home worker. Talk about touching all the hot spots. Now, while Connecticut is doing great (for the most part) as far as COVID goes, (and way better than most of the country), all it takes is one person to have been infected a couple of days before and not know it, to get every one in that room infected with COVID, thanks to proximity, loud talking and laughter, producing more respiratory droplets, no masks, and with a giant assist from the air conditioner, which as the window type, pulls air in, cools it and then recirculates it (along with its possible COVID droplet storm) shooting back into the room.

British experts say turn OFF air conditioning to reduce risk of spreading coronavirus as WHO admits pathogen can spread through tiny floating droplets

Open windows while using air conditioning, experts say as WHO shifts stance on airborne coronavirus

This is how super-spreader events work.

My wife, who makes me strip when I come home after every city shirt, throw my COVID clothes in the hot wash, and take an immediate shower, was very apologetic for letting her guard down. With family something you don’t think. 

All it takes is one person to get infected, and be at their most infectious a few days after infection, to be in extended contact with a group of people in a confined space.   Fortunately, they weren't all in there for that long

While all the people in attendance were relatively healthy and fit (and two had recent Negative COVID tests), they all have contact with older family members who did not attend.

We are going to be more careful. We will still have family gatherings, but keep them outside and better spaced, and if anyone goes inside, instead of using the window AC, we are going to open windows and fans.

 

Part-Time

For over twenty-five years I was a full time street medic.  I have been part-time now for only a few months.  I have tried to work at least 20 hours a week, but there have been a couple of weeks when I have only worked once, and one week where I did not work at all.

I sit at my desk at the hospital and watch the crews come in and listen to their stories, and i feel like a desk-jockey fan boy wishing i was still out there.  Tell me again about that call...

When I was full time I always worked at least three twelve hour shifts in a row so my weeks balanced between being a paramedic and then living a regular life.

Now that the regular life is a much larger portion of my time, I am finding two things.  I don’t look forward to going to work as much as i did and when I do, I am nervous.

This isn’t to say that I still don’t enjoy the work, and don’t for most part, still feel comfortable in the position.  It is just that I feel unbalanced.

Not having to get up at 4;30 in the morning is great.  Being always free to take my daughter to her sports practices and games is very special.  Getting more time to exercise is life-saving..

But when I am back on the street, I feel like a second string guard being put in to play for a few minutes while the starters get a rest, then I am back on the bench, never having really gotten into the flow.  Maybe I scored a bucket or two or had an assist, but I am not the starter.  I think back to when ten years ago, I worked six days a week, and working as a paramedic was as smooth for me as breathing. It was my world.

Now sometimes after a long busy shift, I start to feel back in the groove but then I am punching out, and several days later when I punch back in, I feel like a newbie again.  

I do good calls and I want to work more.  Schedulers who are always trying to grab people for extra shifts (The COVID slowdown has ended) would do well to post themselves in hospital EMS rooms after big trauma calls or STEMIs.  You want to work an extra shift?  Hell yeah!  Sign me up!

Sometimes, even after the end of the busy shift when I have done calls that I felt mattered, I will take a look at the open shifts.  I’m a paramedic.  This is where I belong.  This is what I do.

I look at my schedule now and say, yes, I’ll take that, no, wait a minute, I have a meeting at the hospital that day or yes, I can, no, wait, my daughter has basketball practice, sorry, not available.

I do feel more rounded in my life and healthier, but I don’t think I’ll ever be fully comfortable as a part-time medic.

The firefighters are always asking when am I going to retire.  I tell them I will when my daughter graduates college.  Looking at 2030,  I’ll be 71.  I hope I can make it that long.  Not sure I’ll be able to.

I worry that as hard as going part-time has been, retiring completely will likely be even worse.  I’ll sit in my rocking chair and when I hear the sirens in the distance, I will have to turn my hearing aide down to keep the pangs of loss from being too great.  If I am ever in a nursing home (please put a bullet in my head), how will I feel watching the crews wheel past my open door?  Will I wheel myself out into the hall and race after them?  Or will I take a pillow and try to suffocate myself to spare myself any further torture of the sad knowledge that life that has passed me by?  When the paramedics come through the door for me, I hope I am long gone.

Followers of the legendary guitarist Jimi Hendrix and Duane Allman leave joints and guitar picks on their graves.  Anyone looking to track my final resting place down, please don’t put a toy ambulance on my site.  The joint will probably be okay, because I imagine that later in life after my children have grown and moved away, I will have a medical marijuana card by then to ease my  chronic pain and depression.  Wait!  Actually I do not wish to be buried in the cold cold ground.  Cremate me instead.  Spread my ashes in the places I have loved.  Fenway Park, the Atlantic Ocean, and yes, the city streets of Hartford.   

Riggs

 

Riggs is a therapy dog.  Our ambulance service moves him about between various divisions to boost responder morale.  I met him for the first time on Friday.  They brought him out to one of the hospitals, and he came over where I sat in my fly car, and he let me take his picture.

When I was a boy I was scared to death of dogs.  I grew up in Turkey where packs of wild gypsy dogs roamed the streets.  The first word I ever spoke was “enginar," which means artichoke in Turkish.  Gypsy women carried baskets of them on their backs, and shouted “Enginar!” hoping to entice people to buy.  I had an unusual childhood.  One of my first memories was of a dancing bear in the streets and holding a small cup of coins.  I remember fires and dancing to music, and the ever present growling dogs.

I came to America in the early 1960s when John Kennedy was still alive. I was in the Indian Guides, which was an alternative to cub scouts/boy scouts.  The theme of the Indian guides was “Like father like son, Pals forever.”  My father’s Indian name was Big-Elk-that -Walks the High-Places,  Mine was little frog that hops on lily pad.  We were on a bike outing when I was attacked by a German Shepard.  The German Shepherd raced across a farmer’s field, and picked me out of the Indian Guide peloton like I was the smallest wildebeest in the great herd.  He leapt up and tore a hunk out of my pants and left teeth marks in my hide.  Later, a neighbor had a German Shepard named Stormy, who lived in a big cage in their garage.  The neighbor let him out in the evenings to run the neighborhood (and hunt small boys like me).  Stormy would come at me, and then jump up on his hind legs and bark, showing his teeth as I would break out in tears.  My sister would have to come out and chase him away.  At night I dreamed of poisoning his meat.

It was only when I was in my middle twenties and a girlfriend of mine had a dog, a small runt Shepard, who was the only animal that the SPCA in her Iowa town had to put a picture in the paper twice warning that she would be killed if no one claimed her, that I learned to love dogs.  I would walk Elizabeth of “Bibs” early in the morning and feed her biscuits.  She got old and started having seizures after which she would have ten minutes of energy like she was puppy and I could hold a biscuit up and she would jump in the air like Flipper for them.  My girlfriend took her twice to the vet to have her put down, but came back the first time because she could not bear the sorrow of losing Bibs.

All of this is to say that I learned in time to hold my hand out and let a dog lick it.  I learned how to pat them and feel some sort of bond.  I learned how to love a dog and let the dog love me back. 

I don’t know Riggs that well yet, but he seems like a good dog, and I think having him around could lift some spirits on sad days.

Uptick

 One the COVID ACT map, Connecticut is still yellow.  It had turned orange briefly, but that was due to a statistical abnormality where old cases that had been recorded on paper back in May were added to the state totals.  

COVID ACT NOW Connecticut

The hospital where I work this week had its first COVID Free Day where no one in the hospital had COVID.  Additionally in a recent study over 600 asymptomatic employees were tested and not a single one tested positive for COVID.  

But trouble is working nearby.  To the North in Springfield, Massachusetts, at Baystate hospital, 20 staff members and 13 patients tested positive for COVID after reportedly being infected by an employee who had traveled to a hot spot and returned to work without guaranteeing or telling anyone.

Another COVID-19 cluster identified: 13 patients, 23 employees at Baystate Medical Center

  To the south in Greenwich, Connecticut on the New york border, there were 41 new cases in a week with half between 10 and 19.  And just yesterday after the state had dropped to its lowest number of hospitalized patients, Fairfield country, which includes Greenwich, added 8 new cases.

House parties in Greenwich may have spread COVID-19 among teenagers; official says individuals not cooperating with contact tracing

To the East, our neighboring Rhode Island , which reopened a few weeks earlier than Connecticut has been experiencing a spike that is putting it on the edge of being added to Connecticut’s no travel list.  Since the covid shutdowns began, the only time I have left Connecticut was on hot overcast day when I took my daughters to the Rhode Island beaches where we body surfed and boogie-boarded for a few hours, then left straight home.

Rhode Island is seeing a coronavirus spike. What does that mean for Connecticut?

Today, on the ambulance I had my first COVID confirmed patient in over a month.  A gentleman who felt unwell a few days ago, got tested and was positive.  Today, he had a fever and rigors, and felt short of breath.

I've switched from the surgical mask to the N95 as my in house mask.  I can't breathe as well after climbing four flights of stairs with all my gear, but I don’t want to walk into a room full of COVID microdroplet soup.

In an “Are You Kidding Me?” article I read yesterday, there is a new study out speculating that tall people are at higher risk of getting COVID due to airborne transmission.  By tall they are talking about those over 6 feet who they claim have double the risk of contracting COVID .  I wonder what my risk is at 6 foot 8?  I walk into a room, and my head is in the COVID miasma cloud of suspended microdroplets that have been lingering for hours in the poorly ventilated apartment above the head of those below -- all except me.  Just great.

New research suggests COVID-19 can spread via aerosol transmission -- and might affect tall people more

I hope this uptick is temporary and not the whole deal again.

But I am fearful.