COVID 19 and such

I probably should have started this a few weeks ago to truly accurately convey the thought process and mental turmoil that comes along with a global pandemic. However its all recent enough I can still portray it all fairly accurately. These views are mine along and do not represent the healthcare system in which I work, my colleagues, friends or family. I'm still a stable person. Trying to do all the right things, sleep, exercise, eat, keep social connections, empathize with others and be strong through this whole things.

Rumors started popping up in January, but like many things in the news we just sort of brushed them aside, continuing on with life as normal. In February we hosted a 4 week elective for medical students all over the world. We briefly conemplated the corona virus - add some hand sanitizer to the tables, encouraged students to self quarantine if sick and let us know. The month was uneventful from the infectious disease perspective.
Quickly after elective was over a group of us headed to Sun Valley for the WMS meeting. The corona virus had picked up a bit in the news. Seattle was really the only place reporting many cases - a whole nursing home in fact. Some travelers had masks on. One family had masks and gloves - which the children used to tough every imaginable surface - and the father covertly would remove a finger to use his smartphone and place in back in the glove. I chuckled about this and shared my thoughts with friends via text message. Sun Valley was a nice oasis - great time to catch up with friends, learn the latest and greatest in WM and get a few ski runs in (at that time I didn't expect that to be my entire skis season :().
Several days after we returned home we hosted the 13th annual southeastern student wilderness medicine conference. I took pause before having the event as COVID 19 was now spreading. I preemptively sent out an email asking people with any symptoms or contact with anyone with concern for COVID to avoid the conference. A few people did.
The following week was when things started to get more "real". I worked on March 12 in the ED. That morning we went into Tier 2 due to concerns for COVID19 cases locally. That day was filled with chaos. Sometimes as ED docs I think we may thrive in that environment. Between shuffling calls to dealing with our normal patients and trying to re-invent patient flow when a subset of the patients now "screen positive" which means they require a new level of droplet isolation and testing in negative pressure. We went into disaster mode - which brought new workers to the ED. I stayed after my shift to help get some "regular" patients admitted.

You can tell a lot about my level of "panic" by my amazon orders. Safety glasses, safety goggles, CPAP cleaner, 3M P100 filers, Burpee seed starter kit, seed starter trays, bolle safety glasses, herb started kit, portable UV clearner, heirloom seeds, coffee, bolle safety google, scrub cap, 3M respirator,  scrub cap, squash seeds...
All of these were ordered delivered between March 7 and 27th. I've never truly feared for my safety at work or feared I would have the things I need to be safe at work. Once this fear became a reality I somehow found comfort in buying material items to try to ensure my safety. Plus changing habits such as striping to my underwear in the basement, crocs in clorox bath, a "clean" and "dirty" shelf, clothes in the washer on hot water, me in the shower immediately after work. I'm alternating 2 3M N95 masks, UVing them in between shifts. Some sort of plan or pattern atleast gives me the illusion I'm somehow in control and can control my own health.
Some articles seem to suggest this decreases efficiency but also kills the virus. So many unanswered questions-  what is the wavelength of my UV box? what does 5 minutes do? Did I even seen anyone with COVID 19? Am I needlessly degrading my protection? Is the box doing anything?

Daniel and I have been social distancing since March 12th now. This has changed our lives. We've started a subscription to misfit fruits/vegetable, bought a large basement freezer and minimized grocery store trip to only one of us a seldom as possible. We bought some chicks to have backyard chickens and eggs. We've taken up playing nineteno super mario brothers together which brings back memories. I've done a fair amount of solo riding with Copper and then some weekend and evening rides with Daniel.  I've splurged twice and gone on a ride with Lani and one with CJ and Lani - taking separate cars and maintaining 6ft of distancing.
My 37th birthday was March 20th. Daniel made me a cake and we had a nice home cooked meal. Several friends called and sang happy birthday. It was sort of surreal.

Day 2 and 3

Day 3: today we left the tornak hut and made our way to the coyote yurt. Definitely started to get a little better at all this powder skiing - still did manage to crash and get semi buried in snow. We did a couple of long skins. Starting to get better at kick turns. Got convinced to take an extra run with some peer pressure and ski some burned glades. Was glad I did - was fun - made it back thanks to an espresso double shot and some margarita clif blocks. 

Had medical talks on on traumatic arrests in the field. Was surprised how much resuscitation some of my colleagues would do for a blunt traumatic arrest in the field. 

Also had some talks about carbon monoxide. Scott brought a detector. Interestingly the sauna and dining tent (while cooking) had pretty high levels. Leaned alcohol is the cleanest fuel for cooking and diesel is the worst. Plus the bigger the pot the more co is released. 

Every evening someone gets the Hawaiian lay - and tonight I got it as the lay of fame for my efforts on the next to last run. Hoping the ibuprofen kicks in so I can ski some more tomorrow. Despite being the youngest on the trip I think I might one of the sorest. Trying to dig yourself out of snow after crashing is not easy. Reminds me of how hard it was to get up as a kid when I'd crash. Probably crashed more here than I have in the past 10 year, well maybe 5 years of skiing. 

Day 2 we toured from tornak. Crazy how the weather shifts from snow and wind to sun over just a few minutes. We did some education on Avalanche deaths.in short if you don't die of trauma, asphyxia is the next thing that will kill you. We did a practice burial scenario on our way back to the hut. Thought we did pretty well. Easy to assess a patient in the field as a team of er docs. 

Sun Valley DiMM - Day 0

The WMS has decided to do continuing education for the diploma in mountain medicine I completed in fellowship. Luckily I was able to swing enough time off after the student elective last year to participate. 

Arrived in Sun Valley yesterday - long trip from Roa to atl to slc and finally sun valley. Temps were nice on arrival 40s - however appeared most of the snow was melting. I walked around town and explored a bit. 

This morning after catching up on sleep I met one of the other participants, Billy Martin, who'd I spent time with on Rainier. Despite the rain, we went up to sun valley resort - and after buying an absurdly expensive lift ticket $115- headed up the gondola. After our first few runs the clouds broke and it turned into a blue bird day. Snow is a bit wet and heavy after the rain and warmer temps but still great terrain. I'll have legs of steel after this week :)

Next spent some time organizing my stuff. Packing for a ski trip is a little different when you have to carry everything on your back for the week. (Except food). 

The avy conditions should provide some good learning given the warm snow and rain - with a cold front approaching and about 1ft of snow on the way. 

Hoping to improve my avy skills and backcountry skiing on this trip. It's a great opportunity to learn and get some cme at the same time! Will try to keep this updated throughout the week...

End of the trip-Belize

Our last day was a fun day. We went to blue creek and went cave swimming. Highly reccomended. The day culminated with a group dinner at Coleman's cafe and then some card playing with the mcg  folks. 4am bus ride to the airport came a bit too early. Rode about 1/2 way with randy and sort of decompressed about the trip. Although I didn't meet my expectations on the trip - I'd hoped to do more teaching of health workers, of our students and form some meaningful relationships with the people of Belize I did learn numerous lessons. 

I navigated the challenges of traveling with 8 other women of various background and experiences. I experienced atleast 7 different villages in the Toledo district. I listened to two new language and understood none of it. I saw a brand new country via very bumpy roads. I slept in a hammock in the jungle, in huts, health buildings and even a church kitchen. I ate tortillas cooked in front of me on wood stoves while chickens, dogs and cats roamed the house -and inquisitive children watched. I tried new foods such as Caldo, cahoun cabbage, and jippy jappa. I bathed in and river and washed my clothes there. I saw scorpions, tarantulas and heard howler monkeys. I made paper airplanes for kids and showed them photos of snow. I tried to educate women about health issues and performed more Pap smears than I've probably done in my entire career. I leaned how much I appreciate some of the consciences in my world. 

Just like the parable where the man walks on the beach throwing back starfish and someone asks why bother since there are so many I hope something I did affects someone's life, even if just for person. 

Day 6 - Santa Ana to San Marco.

Last night was a bit clammy in my hammock. There were several howler monkeys that seemed to have messed up sleep wake cycles / they howled all night. Sorta sounds like a bad horror film. 

Felt a little blah this morning. Randy and Jono stopes by and grabbed our vehicles in exchange for 15 passenger van. 

We had flap jacks for breakfast breakfast. Think sorta like funnel cakes. I added some sugar for good measure. 

Couldn't quite stomach the beans and chicken. 

Next we headed to the health clinic. This clinic was a bit more well stocked with a pharmacy and several different rooms. There were many protocols for disease treatment that seemed similar to what we see in the states. 

Very few people (4) turned up for Pap smears. We headed out a bit earlier and stopped at a cacao farm - delicious chocolate. We then headed to San Marco eating out to go burritos in the car. 

At San Marco we stayed with our interpreter - yucinias - family. We bathed, swam and washed clothes by the creek. There were tons of minnows they seemed to be attracted to the soap and kept nipping at us. 

We did a health presentation which was chaotic at best. All the school children kept trying to peer in the windows and were very disrespectful. They propositioned one of our group members and made crude comments. Despite multiple attempts to ask them nicely to leave they wouldn't. Afterwards a bit more time by the creeks improved our moods a bit. 

We had tortillas, Cajune cabbage, potatoes, egg/hotdog mixture for dinner. 

Afterward yucinia and her dad sang several songs with guitar music. It was nice. 

The bathroom was interesting. You had to walk through the bull pasture, dodging manure to get there. It was a pit Latrine with a wooden seat. 

Before bed - like 7pm- we went to visit her grandparents. One of her cousins was there and was very pregnant - with contractions every 20 min or so. I advised she should probably go to the hospital :)

Safely in my hammock here. Time for bed. We'll see what tomorrow holds. Plan is for clinic with hillside at 830. Followed by traveling to corazon for a presentation. 

Day 6.75

We were awoken around midnight by someone saying "miss". The pregnant lady was having more regular contractions and thought that it was "time". Shana and I loaded her, her husband and mother in the 15 passenger van to take her to the hospital in PG. We made it to the hospital without any trouble. 

On the way back badness started brewing in my stomach. Despite my extreme care to what I was eating clearly I've failed somewhere. When we got back I ducked under the barbed wire fence, wove my way around the cow dung, hoping to avoid the grazing (or maybe sleeping??) bull and cows on my quest to the pit Latrine. Picture a rickety wooden platform with a diamond cut out shape - a bit too far back so you are committed to sit rather than squat. The door is half covered by an old potato sack. I assumed my half sit and hoped for some relief. About half way in I noticed the hole in front of the latrine contained a large tarantula. I had no choice but to continue my business and hope that it would stay in the hole. I trudged back past the pigs, chickens, cows and dogs to my hammock. By laying very still I was able to withstand the cramping and get a bit of sleep before the next round of rooster calls. 

The saga continued this morning. At one point the cow, bull and calf surrounded the pit latrine...

Day 7 San Marco to corazon

Today was rough. GI bug, sick of non American food, hot and humid...

Between episodes of abdominal cramps and trips to the flush toilet - dirty - but a beautiful sight nonetheless I managed to do 4 or 5 of our 21 Pap smears.

It was a bumpy ride in the 15 passenger bus. I'd made it through about 200cc of pedialyte all day and started to feel a bit hungry so I slowly supplemented with mini Oreos. Did ok with those. 

Rant - if I see another child kick or throw rocks at a dog I'm going to kick them. I can't believe the neglect and abuse of animals here. So sad. 

We had a large turnout today for the presentation. I got task with answering questions afterwards. Sorta reminds me why I don't do primary care. These women repeatedly ask me why their periods are irregular or why they don't bleed with the "injection". One lady who looked to be in her 40s told me she had lower abdominal cramping each month before her period. These topics are pretty taboo in society here but just can't imagine never discussing these things. 

Lots of people came up complaining of years of lower abdominal pain. With no lab capabilities and very jumbled histories due to cultural differences and translation trouble it was pretty frustrating. 

Tonight was Caldo again for dinner. I managed to eat a tortilla. We stopped by the "store" on our way back and I had a sprite. 

Bedtime now. Looks like tomorrow will be a busy day... Hoping I feel better then.