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Nothing like seeing multiple suspect cases in a single shift to help strengthen weak resolves.
And no beds. And the hospital rule to not say no beds. And the ER rule to not keep patients beyond 2 hours because audit. And the lack of a short stay ward.
And the number of calls, missed calls, and the waiting and being forced to wait, and the impatience - within and of others dependent on your call, and the executive decisions you take hoping they don't backfire, and the weaseling around and the begging just to get something done.
And the hours of sitting in front of the computer battling the shitty EMR UI, because documentation and notes seem to be more important than being next to the patient. And the damned inability to breath or speak with the perfect seal of an N95 mask with another mask over it.
Not going through the loo-gistics of wearing PPE for close to 12 hours/day.
So anyone sharing that link of that crock of shit so called documentary called Plandemic featuring a well known antivaxxer claiming data data data, let people go out etc, mind you, she's made peace with the fact that people will die; as long as it isn't her.
https://www.reddit.com/r/Moronavirus/comments/geokm9/where_can_i_find_a_good_rebuttal_to_plandemic/ People doing God's work while I block anyone and everyone sending me the Plandemic video asking, "iS tHiS tRuE?!"
Tired to the bone, and appalled at human expectation of human efficiency. Might as well become half cyborg.
Am currently doing an IF routine but I couldn't go eat after 2PM as I finally got a breather only around 6PM, only for another suspect case to walk in. So basically a full day fast without planning for it.
Higher-ups don't like to be corrected, told that they missed something or that they're wrong.
Shoutout to the consultants who're a godsend. Being available, sweet, and flexible is such a relief in this minefield of an ER in a pandemic.
Perhaps time to get back to the Class II antiarrhythmics.
Oh, and I got a N95 mask + safety goggle pressure mark on face selfie finally.
Well, word on the street and 108 is that their ambulances are running around with suspect/Covid patients awaiting in them being unable to admit because no beds in GH. Your move, TN govt.
Our hospital and 4 other hospitals I tried last night - say that they have no beds. And we haven't hit our peak yet.
Maybe we don't have the money or the resources or the idea that hindsight sometimes is a tight slap on the face, but at this rate - we might as well accept a *lot* more deaths as inevitable. Perhaps just a flesh wound for us as a population.
This has us wishing for Dengue season. Last years'. Covid + Dengue will just break the system - whatever the sham this is.
Good diagnosis day. Day 8 of the CT machine being broken. Maybe we just need Chest X-rays after all. What is a ground-glass appearance even?
Lifted a *finally* empty ER's spirit with a rousing (a.k.a partially catatonic) dance in place to Bella Ciao and spewing wiki factoids about the antifascist movement to the already sleepy and now bewildered staff. Not my proudest Professor moment.
Plus showed off my improved self haircut with ponytail held by disco rubberband. They had no words for this midlife crisis.
Quarantined colleague is back from tomorrow and we have jugaaded the roster to come in only once in 2 days.
I have major doubts regarding the accuracy of these infrared thermometer guns. They've just suddenly gotten adopted, so I'm confused whether it was a supply issue, hospital being thrifty issue or just the usual of lack research - let's adopt it for "safety" issue.
I finally understand the dab.
Me at the moment saying This is Fine - while the world burns around me.
My midlife crisis has peaked or is almost there. When will it end is another question. In this graph I will explain the...
Another day in hell. Wow.
The CT machine finally works and out of the 10 CT Chest Screenings we've taken - atleast 6 have respiratory changes. Out of those, atleast 3 have groundglass appearances and are asymptomatic.
Not going to expound on this, but we're well and truly fucked at this rate of spread. Some hospitals shut down ERs and fumigate them or turn away patients at the door; and we've got this open door policy in the name of service, regardless of suspect or positive situations.
Maybe it's money. I don't know.
Had two surgery cases which later were found to be Covid positive. Asymptomatic, of course.
Grateful to fellow EPs/doctors who have the courtesy to call ahead before sending cases, no love for those who don't - none AT ALL.
On the other hand, a very exhausted me (last night) wolfed down a couple of dosas dipped in exquisite fish curry. My heart is full - my tummy was too.
Just a realisation that maybe all the talk about flattening the curve was always about the population pyramid. 
This intellectual joke probably actually needed a graph.
Cyclone in Kolkata, and a replica of the situation here in the ER. How is it that people wait till it's past 12AM (and just very late in general) to maybe do something about a long standing health issue?
No isolation beds as it has become the norm; requested definitely suspect patient to go get tested in the GH. Godspeed.
Just a repeat shouting from the rooftops, (we're so fucked).
Panic attacks and ice cubes was it?
We're on our way to a humanitarian crisis at the moment.
Had two definitely suspect cases I had to refer to the Govt Hospital because we have no isolation beds - fully knowing that the government setup has no beds.
Called 15 hospitals to request them to take in patients - either they don't have beds, have shut down their ERs, or don't take in Covid suspect/+ve patients. 108 requested me to call after 9AM to see if any beds could be freed by the on duty RMO by then.
I know that corporate hospitals hold their own interests first, so do we, but wow, this is a failure if we're this woefully unprepared for the number of positive/suspect cases way before the lockdown is relaxed. And we haven't reached the peak yet.
The patient's relative going - this is a FAILURE - broke my heart. But she and the transferring hospital did kind of try to not mention the suspect status and most definitely did not mention the CT Chest images - asshole move, guys, asshole move.
You don't try to fix a broken system by breaking it further.
Perhaps a private hospital Covid Alliance of sorts. You guys share the riches, just give us physicians - beds to admit patients.
Here's a challenge for you private hospitals taking care of Covid patients - link up - be reasonably priced - share available bed data - and make inter-hospital transfers easier and transparent. Doesn't take much if the big shots and owners get their heads together.
I hear isolation room rates go from 25k-50k/day depending on the hospital. Definitely more for ICU and ventilation. Let's leave that for the Rs. 6L/month incomed privileged patient to decide where to go, the poor will be shunted to the overburdened GHs anyway, right?
https://twitter.com/sanjaynagral/status/1262927826405253120?s=19 So... Cheaper than Chennai? 
Oh, oh. Patient who came yesterday with fever for a week, breathlessness, dropping saturations and literally had infiltrates all over her lungs tested negative for Covid-19... just 5 days ago. Where's your God now? Her only sin, you ask? Staying in a hotspot.
Lots of small clinics/local doctors seeing suspect cases as OP or initial admissions then referring them to bigger hospitals or the GH for further treatment. Be safe.
https://www.deccanchronicle.com/nation/current-affairs/210520/covid-19-pandemic-corporate-hospitals-in-hyderabad-testing-doctors-v.html Just in case you needed more proof that we're fudging numbers.
So just had a brainwave and realized that... we as a hospital aren't really keeping track of possibly Covid suspect patients we send home/discharge advicing self isolation or refer to other hospitals/GH as we have no beds.
If anyone can guide me as to the legal way to go about this, (other than telling the patient to download the AS app) - because if we're like this, I don't know what other hospitals are doing. Who do we inform?
Because we're seeing increasing numbers of cases per day - some stable/some unstable - but who's keeping count of these - I'm sure labs have been instructed to fudge numbers.
If anyone can guide us, please let me know. We're inadvertently contributing to the spread if the patient doesn't follow written+spoken advice to test/self isolate.
Kerala of course, thinking ahead, working on something and implementing it. TN-Chennai on the other hand - anyone?
Toldja Boi, Soulja Boy. https://twitter.com/Priyadoc22/status/1264178739304226816
If only you guys could see the CT images we see. Smh.
https://twitter.com/TheHatmanTweets/status/1264351122409402369?s=19 Just a reminder. Plus colleague had to intubate a definitely positive 45 year old patient today. We're definitely peaking sooner than later.
Had to intervene because the patient crashed due to hypoxia in spite of high flow oxygen; The risk of aerosolization non-withstanding. Wear masks please, wash your hands and *stay home*.
If you're happy and you know it, wash your hands,
If you're asymptomatic and you doubt it, get a CT.
If you're asymptomatic and you doubt it, get a CT.
A fair number of people coming in with prolonged breathlessness, horrible CTs and... negative Covid tests (sometimes multiple).
Another case with a prior fever history - now afebrile, saturation fine, no breathing difficulty, came with h/o fatigue and minimal-est lung creps on examination - Chest XRay and CT show signs. This is the other end of the spectrum.
2 others, same history. Now we're having a discussion to skip the CTs in almost asymptomatic cases and assume they're Covid and force self isolation and home quarantine, unless proven otherwise.
Still asking about this - as we send more suspect cases home or refer them out to other hospitals - and they just decide to go home anyway. https://twitter.com/adbsideload/status/1263820860026089472?s=19
It's getting progressively worse, some of these are people who haven't stepped out of their houses for months. Protect your vulnerable.
Separate the young from the old. This is the new norm. Something's out to kill the latter, and take a few younger people along as well.
Another 4 cases post duty. Who will watch the watchmen?!
