Things a rural doctor has in his iPhone during Alberta’s COVID-19 pandemic

Doctors were early adopters of Palm Pilots. My in-laws gave me one as a graduation president from medical school more than twenty years ago.

The ability to carry large texts around in your pocket was revolutionary–it saved many medical students from carrying the telegraphic handbooks with which my lab coats were always too stuffed. (Hard on the shoulders! Plus they tend to spill everything out of your stupid little short medical student coat, which makes you look even dumber than you actually feel, which is saying something.)

We’ve come a long way since then. Like most people, I now carry a supercomputer everywhere in my pocket. Sometimes I use it to watch funny videos.

But, I also use it as an “auxiliary brain” for medicine. It’s particularly useful for stuff that I will rarely use, but if I need it, I need it right now.

One of those things wasn’t in my iPhone until the COVID-19 pandemic. But it is now.

It’s an article that appeared in the Canadian Medical Association Journal. It begins like this: “All physicians should be prepared to manage dyspnea, especially during the coronavirus pandemic.”

What’s dyspnea?

It’s feeling short of breath–of being starved for oxygen, like you’re smothering or drowning. It is a terrible way to die. Even with all the oxygen we can blow at you, it isn’t enough. Each breath is torture.

Usually, my patients with dyspnea get quickly transferred to Lethbridge for an ICU. I might intubate them (sedate them and put a tube into their breathing passage) to help.

Right now, that’s what my patients with COVID get. (All of them that I have had to transfer to Lethbridge thus far have been unvaccinated.)

If the health care system becomes overwhelmed, and if we have to triage care (as described here), then that won’t happen. I even wonder if I might be sent patients from Lethbridge for whom there is no space in the ICU. The Lethbridge docs might decide that I can at least “palliate,” and so unclog their hospital slightly.

They help me so often with my patients, it would be nice in a way to return the favour.

What’s palliate?

To “palliate” means to treat symptoms for comfort until the patient dies. It is “keeping you comfortable.”

We can treat dyspnea.

We’ll give you things like morphine or fentanyl, and maybe drugs like Valium or Ativan if needed. Don’t worry, I don’t even need to look up the doses in my iPhone.

If things get bad enough, we’d put you into a medical coma. Not to save you–it won’t–but to spare you suffering. You’ll be unconscious as you drown to death.

Medical coma doses–those I would have to look up. But I’ve got my supercomputer to help. Won’t take long.

We won’t let you suffer. Your family might suffer–it’s hard to watch someone die of dyspnea. But, if you’re dying of COVID and the health care system is in the kind of crisis where a rural family doc is your top care provider, your family probably won’t be allowed at the bedside anyway. So they won’t have to hear you suffer, except as you say good-bye via Facetime before we sedate you.

I’m not trying to be dramatic. I hope it doesn’t come to this.

But this is the outcome we in health care have feared all along, and what we’ve tried so hard to prevent. And right now it is hard to see how this won’t happen to someone in Alberta in the next few weeks, maybe many someones.

Last thoughts

If it does come to this, the last thing you see will probably be the nurses’ and my gowned and masked faces (plus goggles or face shield and sweaty gloves). We drilled how to get in and out of all the gear safely at the beginning of the pandemic, since we knew we’d have to look after people while being vulnerable ourselves.

A nurse’s gloved hand will probably hold yours as we administer the meds. You won’t have to ask, and I won’t have to order it–it’s just what they do.

When I’ve done my part and moved on to the next patient, the nurses will watch you closely to make sure you don’t come out of sedation and suffer some more. I won’t have to order that either.

But, after you’re asleep and comfortable, we’ll probably think of all the people who told us COVID was a hoax, that vaccines don’t work, and masking was too inconvenient.

I might even think about all the people who’ve screamed at my clinic staff or the nurses I work with when asked screening questions. I hope not. Such people don’t bear thinking about.

We’ll be wearing masks. And yeah, they aren’t as comfortable as we’d like.

But we’ll be far more uncomfortable about everything else that’s going on. So we probably won’t notice the masks much.

You, at least, will be comfortable. We promise.

Hydroxychloroquine and conspiracy

Social media is one again a-twitter (pun intended) over hydroxychloroquine as a supposed COVID-19 therapy that is (for some reason) being suppressed by a variety of evil actors: physicians, Big Pharma, Anthony Fauci, etc.

This is a modest effort to explain why these arguments don’t make sense, or are misleading.

Continue reading

A slightly less wacky pro-hydroxychloroquine article

Newsweek published an article by a doctor who doesn’t (so far as I know) believe that reptilians run the US government and alien DNA is being used in scientific experiments.

He does, however, claim hydroxychloroquine helps COVID-19.

As far as we know, this is false. My brief note on this is here.

And his article is terrible. If you want a point by point analysis, see here. A quote:

The rest of Prof. Risch’s AJE article is a veritable Gish gallop of cherry-picked studies. Hilariously, he relies heavily on uncontrolled “studies” and case series from two grifters, Didier Raoult and Vladimir Zelenko….

I had a hard time believing that an actual professor of epidemiology at a school as reputable as Yale could write such drivel. The study he is referring to is Gautret et al., a study so awful, so full of flaws (and maybe even fraudulent), that it was quite properly dragged on science and medical Twitter for days and weeks afterward. That Prof. Risch would cite such an abomination of science tells you all you need to know about him.

ER docs from California and their press conference

Many people have shared two ER docs’ claims about coronavirus.

Despite their claims, they are not experts. They misrepresent the data, and their professional college has condemned their actions. (They also lie about what their local public health department believes, see here.)

ER docs (and family docs) are not the experts in this. Epidemiologists are. You don’t ask epidemiologists to read your chest x-ray or put in your chest tube.

A point-by-point rebuttal:

Again, there is a good policy case for easing the lockdown. But don’t use bad science as an argument.