Good Timin’

Back in 1960, the song Good Timing’ by Jimmy Jones was a big hit. I found myself humming it and looked it up as I thought about the important decision as to the timing of impending strategy adjustments near in the future. There will have to be a transition in strategy to deal with Covid-19. This is due to two inescapable facts: 1. There will be some more deaths, regardless and 2. The economy cannot survive many more weeks of the present strategy (and that, itself, will result in long term increases in morbidity and mortality).

Unfortunately, the MSM is not interested in informing. Rather, it is inflaming and attacking President Trump regardless of what he says or does. They are truly disgusting, beneath contempt. Should violence ensue, and I sincerely hope that will not be the case, they will be held largely responsible.... [Read More]


What Are You Doing?

I am (I hope only) temporarily unemployed. My anesthesiology job stopped as of last Monday with cancellation of all elective surgery. My job depends upon the need for after call coverage – mostly Mondays so the doc in the hospital over the weekend can have the day off. Now that they are doing emergencies only, less than half our physicians are needed every day. No need for after call coverage.

My detox job – every Saturday day shift – is also gone, as I am the second person who covers those days and the census is down by 50%, so I am not needed. Part of me is grateful to not be needed, since given the growing shortages of “personal protective equipment,” the likelihood that doctors and nurses will be infected is rising. If somebody there gets sick, I may well have to work. It’s ironic that I have been talking about what it might be like if I retired or became ill and couldn’t work. Now I know,... [Read More]


Report from a Rear Echelon of the First Covid-19 War: Anxiety Is Also Contagious, Resulting in Rumination, Brooding

Awareness of this other phenomenon of psychic contagion forced itself upon me early in the practice of anesthesiology. I found it to be  quite easy to ‘catch’ a patient’s anxiety and allowing that to happen, I quickly realized, was a disservice to my patient; when I become anxious, my performance definitely degrades. This is an essential and hard-learned part of the art of medicine and it is often poorly practiced – as exemplified by physicians who, in an attempt to maintain emotional boundaries, simply distance themselves and come off as uncaring. Who hasn’t had that experience? Sometimes, I try to defuse the situation explicitly with digression. I will say to the patient, “I understand you are feeling anxious. I recognize your anxiety but I cannot not allow your fears to affect me”. Sometimes anxiety is poorly or dysfunctionally expressed by bizarre or controlling behavior. The varieties are sufficiently extensive that I will refrain from further description, only to say that, by default, I consider any unusual talk or behavior by the patient as a form of anxiety and do my best to relieve it with whatever means I have at my disposal. Sometimes it is an early IV administration of a benzodiazepine – a miracle drug in this setting (sometimes I do wish I could share!).

Aside from the anxiety naturally incident to this great disruption of all aspects of daily life, the isolation has already undone my previously functioning, carefully constructed psychic economy. Thus, because it has stopped me from doing one of my jobs, isolation is already becoming difficult for me; I count on the “social nutrition” they allow me to hold at bay my tendency to ruminate on my own mortality – surely heightened by the knowledge that my age and medical problems put me in the high-risk category when it comes to Covid-19. My pre-morbid status – working two part-time jobs at age 75 – had been completely unanticipated for most of my life when I contemplated retirement in the way everyone else did. Once upon a time, back then, I imagined I would retire and be free to travel and “take it easy”. Little did I imagine that travel would completely lose its allure (given the discomfort/hassle/TSA/uncertainties/possible cancellation due to illness etc.) or that the absence of structure provided by work would prove all but intolerable to me.... [Read More]


Here is an Epidemiologist

In a comment I can’t find quickly, a few days ago I posed the question “Where are the epidemiologists” and asked why there has been no epidemiologically-sound random sampling to get a handle on the number of asymptomatic carriers. Only then can the draconian measures in place be rationalized.

Here is an excellent overview by a Stanford epidemiologist, which is the single most cogent thing I have read. Please consider reading it. It points out that, without that information, we have no idea if the effective shut-down of the country is rational and it indirectly suggests to us that we ought to ask a pertinent question: what is the economic cost to society in the long run of a statistical live saved. There are various methods used by epidemiologists for this estimation, including something called QUALY -quality adjusted life year and other methods which attempt to get a handle on health care costs and costs of regulation aimed at health and safety, generally. I am not conversant with these methods.... [Read More]


Covid-19 ‘Stealth’ Spread. Some Implications

“Stealth”spread is one of today’s headlines. It means that most who become ill are contaminated by carriers of the virus who manifest minimal or no symptoms. This is hardly an unknown medical circumstance. It has been long known about tuberculosis. As to TB, the carrier state is fairly easily recognized using routine chest X-ray and/or Tine test; not so easy for coronavirus, so far.  This state of affairs is thus hardly surprising and it is important to know. It ought to inform some particular behaviors going forward. Several epidemiologists are saying what I have been suggesting to my family for some time now – that for every confirmed case, there are at least six others. I have been saying there are ten carriers for every confirmed case of illness. I still suspect my guess is closer to reality.

Be that as it may, I will share with you what I am doing to protect my family in light of these facts. Today, Amazon announced it was prioritizing deliveries. It will, prudently, first deliver medical products and staples. As with mail, it is important to remember that coronavirus, it is believed, persists on fomites for anywhere from minutes to hours to days. Now, mail and packages are not sterile – far from it. Thus if any individual who handles the product is a carrier, your deliveries may be contaminated with virus and you may become infected by merely handling them!... [Read More]


Will Pandemic Result in a Tidal Wave of Socialism?

… or some other rendition of redistributionist authoritarianism?

Over the years in which we have enjoyed the dubious privilege of inundation in mass media, the political implications of crisis have been amply and repeatedly rehearsed for us – usually by grasping politicos intent on expanding their power (Rahm Emmanuel’s  past pronouncements come to mind). The present crisis is, even if not unprecedented in fact, unprecedented in terms of the disease itself combined with the sheer volume and immediacy (much of it fully contradictory) of “information” broadcast about it.... [Read More]


Alien-Nation or Alienation: My Inescapable Ethos

“In the absence of values, society begins to decay. … Conservatism is that which does not get in the way of moving forward and upward, but does prevent from sliding backwards and downwards.” – Vladimir Putin

Born in 1944, I think such a statement as Putin’s would have been unremarkable for about the first half of my life. Since, according to America’s self-proclaimed elite mouthpieces, conservatives are haters of all peoples and things hallowed by progressives, his statement today would almost certainly be classified as “hate speech” by our media betters; even worse, the speaker is Russian, demanding louder condemnation.... [Read More]


Migration from Mac to Chromebook. How to?

Being parsimonious, I can’t see spending $1000 every 4 or 5 years (if I’m lucky) for new MacBook Airs for both my wife and for me. We use them for simple things. She: email, crossword puzzles, sudoku, jigsaw puzzles. Me: email, Ratburger, vast right-wing conspiracy perusal, word processing, household management via more websites than I can count (banks, utilities, memberships, Amazon, education, etc.) each with unknowable login credentials (which are now all different for obvious security reasons).

To help manage this, beyond Safari Keychain, I recently bought 1Password. Bottom line: I want to migrate all my user-created materials and login credentials to a new platform(s), either a new Chromebook and/or a soon-to-be shipped Raspberry Pi 4 (I am excited by the prospect of finally learning some programming and one of the Linux-based operating systems. Thanks to John, I am particularly curious about Ubuntu. As well, since I have a new iPhone Xr with face recognition, I am feeling more comfortable doing more of the above online tasks on this device. Until now, I have been loathe to put my credentials on a mobile phone.... [Read More]


Russia Radioactive Again?

According to our news media, Russia has been radioactive since at least the Trump inauguration, if not Chernobyl. Today, a scintillating story has broken, telling of released radiation following explosion of an experimental engine using “radioisotopes and liquid propellant.” The engine is speculated to be related to Russia’s development of a hypersonic missile.

The “radioisotopes” got my attention. Radioisotope thermoelectric generators (RTG‘s) have been around for quite some time and used to power  niche items like isolated lighthouses and spacecraft. They use heat resulting from the known and predictable decay of various radioactive heavy elements to produce electricity.... [Read More]


“The Nurse Will See You Now” (but you won’t know it’s a nurse!) – Internecine Warfare in Anesthesia


Introductory note on language: In the US, an anesthesiologist is a physician, an M.D. with 4 or more years specialty training in the field after completion of medical school; with rare exceptions, all are board certified by rigorous examination by the American Board of Anesthesiology. An anesthetist is a nurse, a C.R.N.A. (certified registered nurse anesthetist). New graduates have a BSN (bachelor of science nursing and a MSN (master of science nursing); a total of six years of schooling plus one year working in ICU,  for a total of 7 years. A significant number still practicing have neither degree, but are ‘grandfathered’ under the less rigorous former standard. Not so in the United Kingdom, where ‘anaesthetist’ generically  describes whoever is administering ‘anaesthesia.’ Until recently, as far as I know, anesthesia was administered only by physicians in the UK, but the “anesthesia care team” (more below, and likely the best) model has been introduced and is growing in prevalence in order to extend physician manpower.... [Read More]


Mortal Lessons Taught by a Baby Bunny

Tuesday, 5 long days ago, our grandson found a baby bunny in the front yard. One of its tiny bunny ears had been torn and bloodied. Since their lives are very busy, our grandson’s mom (our daughter) & dad brought the baby to us to nurse. It was about 3 days old (and weighed about 60 grams), as best we could learn from frantic internet searches on how we might keep it alive. As the poor, adorable creature breathed its last (having spent most of this afternoon cupped in my hands for warmth), amid the hottest tears I have shed in many years, I am simultaneously grateful for this mortal lesson and wishing my grandson had never found it. We have alternated in referring to it as him and her; he and she. All that mattered was its life.

My wife had been feeding it heavy cream through an eye dropper. We have kept it swaddled in hand towels in a shoe box kept warm with a microwaved bag of rice in the bottom. For the first three days, it seemed to eat well and move around actively. Since yesterday, though, it became listless, fed poorly, and became very jumpy when touched. My wife sensed it would not survive and today has been a steady downhill course; I could almost see the life draining out of this lovable, fragile and oh-so-vulnerable tentatively- living thing, whose desire to live was so apparent as to demand our full attention for 5 days on end. This experience may cure my terminal cynicism. I am more acutely and explicitly aware of the preciousness of life than maybe I have ever been.... [Read More]


Privacy and Chromebook: an Oxymoron?

My wife  uses my hand-me-down Macbook Air (mid 2013), which she received when I bought my new(er) Macbook Air in early 2015 (wow, that went fast!). Hers is getting a bit quirky running updated OS, and the trackpad has been erratic responding to clicks since forever. So, we are near the point that a new laptop will be needed. She uses it exclusively for web browsing – no word processing or spreadsheet or anything. Maybe stores some photos downloaded from her cell phone. Hasn’t used even half the 120GB flash storage.

Being my frugal self, I can’t see spending $1000 (plus the 7% Commonwealth of PA extortion for the privilege of purchasing it online from another state/country) for a new one – 90% of the use is for online solitaire or jigsaw puzzles, with the occasional email or web search. So, I investigated Chromebooks, and found a reconditioned Acer Chromebook 14 with 32GMB flash storage, 4GB RAM, and a 14 inch full HD 1080 IPS screen for $155 shipping included! It arrived and I have been exploring it now for about a week.... [Read More]