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your-dietician · 3 years ago

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‘No one had any idea how bad this could be’: Local health care workers’ reflections on COVID-19

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‘No one had any idea how bad this could be’: Local health care workers’ reflections on COVID-19

Dr. Zack Mueller goes over rounds Thursday with Rachel Vendenhuevel, RN, at Central Maine Medical Center in Lewiston. Mueller is a hospitalist, who has spent much of the past year caring for COVID patients. Andree Kehn/Sun Journal Buy this Photo

LEWISTON — More than one year and three months ago, a Navy reservist in her 50s who recently returned from Italy was tested for COVID-19 at Central Maine Medical Center’s emergency department. Two days later, on March 12, 2020, state health officials confirmed the Auburn woman was Maine’s first presumptive case of COVID-19.

Since then, as of Friday, 68,924 Mainers tested positive for the viral disease and 858 died from complications.

Maine appears to be at a turning point in the pandemic: Maine’s civil state of emergency, which Gov. Janet Mills first declared on March 15, 2020, is set to expire at the end of this month; more than 57% of all Maine residents are fully vaccinated against COVID-19 and the seven-day rolling average of new daily cases is 27, the lowest it’s been since September 2020.

But when a second surge of new cases and hospitalizations erupted across the state in March and April, providers at Lewiston’s two hospitals found themselves caring for more COVID-19 patients than ever before, breaking records set by the previous surge in late winter and adding unusual stress to staff already exhausted from a year fighting COVID-19.

That period, and the overall pandemic, will not be soon forgotten by six of those providers the Sun Journal spoke to recently. Despite life slowly returning to normal for many people, the health care workers — critical care nurses Kate Dube, Suzi Morin and Suzanne Wilson, and hospitalist Dr. Zachary Mueller at CMMC, and emergency department directors Dr. Carl Ramsay and registered nurse Heather Nadeau at St. Mary’s Regional Medical Center — say the fight isn’t over.

‘NO ONE HAD ANY IDEA HOW BAD THIS COULD BE’

Morin, 29, a nurse leader in CMMC’s intensive care unit, can trace the development of the pandemic — from the first cases in Wuhan, China, to the disease’s arrival in the United States — through the weekly lectures of her graduate school epidemiology course.

First it was “Oh, it’s just something going on in China,” and then it was “This can’t last very long,” Morin said.

“No one had any idea how bad this could be,” she said.

Dube, 26, recalls walking out of CMMC following a job interview for the position she now holds as a nurse in the intensive care unit, and a notification popped up on her cellphone screen that said COVID-19 had arrived in Maine, to the very hospital she had just exited.

“I was like, ‘Oh, I signed up at the right time,’” said Dube, who previously worked in the orthopedic department.

Around the same time, Morin’s younger sister tested positive for COVID-19.

“It’s kind of very strange thinking about it from that perspective of she was one of the first cases of COVID in this country. And now here we are and it’s, you know, almost everyone that we know has been impacted in some way or another with COVID,” Morin said.

11:30 P.M., 28 DEGREES: ST. MARY’S DIAGNOSES ITS FIRST COVID-19 PATIENT

Dr. Carl Ramsay, Emergency Department medical director, and Heather Nadeau, Emergency Department nursing director, stand in a patient room at St. Mary’s Regional Medical Center in Lewiston. Andree Kehn/Sun Journal Buy this Photo

Ramsay, 68, joined St. Mary’s as the Emergency Department medical director in December 2020. Prior to that, he had a 30-plus-year career practicing emergency medicine in New York City. He cared for HIV/AIDS patients in the 1980s in Harlem and the Bronx, an experience Ramsay described as “devastating” for those on the front lines.

Ramsay said watching the initial COVID-19 outbreak in China in late 2020 and its eventual spread to other parts of the globe was for him like watching SARS and H1N1 make their way to the U.S. in the 2000s. He treated patients during both of those outbreaks in New York, too.

Soon after arriving, and before he even knew his way around the hospital, Ramsay — and soon Nadeau, who came to St. Mary’s a month after Ramsay as Emergency Department nurse director — began looking for additional space for a potential surge in patients.

“January’s when we really started to focus on what our steps would be as an emergency department,” Nadeau said.

Still, “I think as a nurse starting in a small community hospital, you never think it’s going to come to you,” she said.

Nadeau and Ramsay immediately recalled the time and date where things changed: March 15, 2020, a Sunday afternoon.

“You could feel it,” Nadeau said. They began directing less sick patients to stay outside of the emergency room, in their cars or in the ED parking lot where doctors and nurses would check on them. Ramsay said it must have been about 28 degrees out.

“Our first diagnosed COVID patient was actually a parking lot patient in a car at 11:30 at night. And then that next morning, we have a tent. And we saw 55 extra people the next few days, beyond who came into the ED,” he said.

Though they had prepared for this moment, Nadeau still said it was “nerve-racking,” especially being in a leadership position where she’s not only caring for the well-being of her patients, but of her staff.

“As a leader, you’re trying to lead a team through the unknown and they’re looking to you for answers to questions that they have. … And so you’re trying to help them navigate their own fears when you have your own, with no answers,” Nadeau said.

‘WHICH ONE ARE YOU?’

The arrival of COVID-19 and the deadly unknowns it brought with it, quickly changed life for the health care providers.

Morin told her husband to hold the dogs back when she walked in the front door because she didn’t want them to touch her until she showered. Wilson, 56, stripped at the door of her and her husband’s home out in the country and immediately got in the shower. Mueller, 37, and Dube threw their scrubs into the washing machine as soon as they got in their homes. Though they’re vaccinated now and feel a little more at ease, most of these habits have stuck.

Critical care nurse Kate Dube tidies up an empty room June 16 at Central Maine Medical Center in Lewiston. She transferred from orthopedics to the ICU at CMMC just as the pandemic was hitting Maine. “I was like, ‘Oh, I signed up at the right time,’” Dube said. Andree Kehn/Sun Journal Buy this Photo

“Cognitive load is kind of the word that comes to my mind,” said Mueller, a doctor of osteopathic medicine and assistant chief of adult hospital medicine at CMMC.

“It’s just an extra thing that you always have to be thinking about, an extra step in your life. It’s an extra, you know, 20, 30 minutes between getting home and actually being home and spending time with my kids,” he said.

Dube said she now knows it is unlikely the virus will spread from her clothes to other people, but getting out of them when she gets home is for “peace of mind.” At the beginning of the pandemic, she said, she didn’t even want to get into her car after a shift in the ICU she was so concerned about bringing something home.

Wilson has spent half of her career working in the ICU, but said this is the first time she’s ever been faced with a disease where it seems that no matter how hard everyone works, sometimes it’s not enough.

“In my mind, I’m thinking, ‘Which one are you? Which one are you going to be? Are you going to be the one who dies?’” Wilson said.

“We’ve had some really sick patients (before COVID-19), but many of them do survive. No, I assume they’re all going to live because we’re fighting like crazy to make them,” she said when asked if she ever had that experience pre-COVID.

“But with COVID, it’s like, you know, it didn’t – we did everything. And they would still die,” Wilson said. She doesn’t think she’ll ever shake that.

Morin agreed: “A lot of times it felt like it didn’t matter what we did.”

For all his experience treating patients during the AIDS epidemic and the SARS and H1N1 outbreaks, Ramsay said those diseases don’t compare to COVID-19 in a clinical setting.

“It’s not even close. It’s that much worse. (It’s) totally more unpredictable,” Ramsay said. “It’s ability to be unpredictable for so many populations and patient types and its ability to kill, or make people really sick, it’s a different ballgame.”

He and Nadeau agreed that rapid testing was a “game changer” for clinicians and their ability to quickly isolate the patients with COVID-19.

There was greater uncertainty at the beginning of the pandemic, when rapid testing was not readily available and it was taking days for labs to provide results.

“These tests were taking days to come back and I just remember going in that room for the first time,” Dube said of a positive COVID-19 patient’s room. “It felt like you were in this room with this big ominous black smoke that was gonna come at you and you didn’t know how bad it was going to be.”

“And I just didn’t want to go near my friends. I didn’t want to go near my family. And I didn’t want to walk near anybody,” she said.

Since then, the medicine and clinical protocols have vastly improved. The COVID-19 vaccines have been pivotal for the caregivers’ own sense of safety — and a sign that there’s a light at the end of the tunnel.

On Thursday, Maine Center for Disease Control and Prevention Director Dr. Nirav Shah said in a Tweet that of the 31 individuals hospitalized with COVID-19, 29 – 94% –were not fully vaccinated.

“People just feel different when they’re fully vaccinated,” Ramsay said. “They just do, (but) it doesn’t mean you let your guard down.”

SPRING SURGE WAS A ‘WEIRD TWILIGHT ZONE’ FOR CMMC NURSES

Most of Maine and its hospitals saw the worst surge in new daily COVID-19 cases and hospitalizations last fall, but Androscoggin County was hit hardest by the spike in cases this past spring. CMMC saw record numbers of COVID-19 patients, many or most of them requiring critical care.

“It felt so weird,” Dube said. “You come to work and things were the worst they had been ever in our career for COVID. But if you talk to somebody walking down the street or going to the grocery store or whatever,” and if they were not personally affected by the recent outbreaks “they’re like ‘Yeah, this is the best COVID has been.’”

At the height of the surge on April 20, Androscoggin County’s seven-day rolling average of new daily COVID-19 cases was 90.4. During the winter surge, the seven-day rolling average peaked on Jan. 15 at 73.7.

On that same day in April when cases peaked, providers at CMMC were caring for on average 18 confirmed COVID-19 patients over the past seven days, according to data provided by the hospital, a number that does not include patients with suspected cases that had yet to be confirmed via testing.

“At that point, everyone’s fed up and done with this pandemic, like it’s done. We’re all vaccinated, we’re fine,” Morin said. It was if everyone around her was saying, “I don’t know what you guys are moaning about.”

Morin said her family had a hard time understanding why she didn’t want to visit with them.

“All I’m thinking is like ‘You do not know how bad it is right now,’” she said.

Patients across the state were also trending younger and sicker. More patients needed higher amounts of supplemental oxygen, required a ventilator, required dialysis and other complications and many were in their 50s or younger, the three ICU nurses said.

TRAUMA AND JOY

“The PTSD is definitely real,” Morin said of the feelings of post-traumatic stress disorder that front line workers have experienced. It comes out in weird ways for her. Recently, she said she got “irrationally angry” at her husband because his friend’s wife did not want to get vaccinated against COVID-19.

“I knew it was irrational,” she said. “But there I am, like sitting on our basement floor, crying over it.”

Suzi Morin plays with her German shepherds June 18 at her home in Lewiston. Morin, who is an ICU nurse at Central Maine Medical Center in Lewiston, said she was grateful for the emotional support provided by her dogs during the worst of the pandemic. Andree Kehn/Sun Journal Buy this Photo

Dube and Mueller both said they haven’t really begun to unravel the impact that the past 15 months have had on them personally.

Dube said she’s constantly waiting for something bad to happen “and hoping that it’s not.” Morin was often preoccupied with the thought that if something happened to her family in Florida, she wouldn’t be able to get to them.

Wilson said she had “devastating family losses” and wasn’t able to be with her family in the South, where she’s from.

“It was a rough year (in) many, many, many ways,” she said.

Mueller suspects working through the effects of the pandemic will take a long time, while also “sort of living the ramifications of it for a long time.”

Ramsay called emergency physicians such as himself “pros” at distancing themselves from the situation at hand so they can focus on the medicine.

“I’m a pro at being a dissociative, put it in a box,” he said. “I haven’t personally caught up with those emotions yet.”

All six have found some silver linings amid an exhausting and traumatic year and a half.

“It’s weird considering everything, but I still feel hopeful,” Dube said.

The four nurses — the ICU nurses from CMMC and Nadeau from St. Mary’s — said the teamwork and bond they had with their co-workers was special.

Emergency Department nurses are “a lot like family, but that really shined through this,” Nadeau said.

Morin said without her fellow nurses, “I feel like I would not have made it through.”

Mueller said he was “excited” to practice medicine throughout the pandemic.

“Everyone was scared, but at least we could kind of channel that into doing our job at the hospital,” he said. “In a way that was actually relieving. … I felt like I had a chance to actually act on what everyone else, everybody was scared of.”

There were other moments of joy: Morin got married in October “in a mask.” Exercising with her husband and playing with her dogs have also been a huge help.

Wilson rediscovered the “Harry Potter” series. Dube got a puppy after her dog passed away earlier this year. Mueller said he’s especially thankful for his and his loved ones’ health.

Ramsay thinks the “biggest silver lining is yet to come.”

“I think there’s going to be this joy that just percolates,” he said.

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gethealthy18-blog · 5 years ago

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338: From Autoimmune Disease to Thriving Health With Ryan Lee

New Post has been published on http://healingawerness.com/news/338-from-autoimmune-disease-to-thriving-health-with-ryan-lee/

338: From Autoimmune Disease to Thriving Health With Ryan Lee

Child: Welcome to my Mommy’s podcast.

This podcast is brought to you by Four Sigmatic… a company I’ve loved for years for their superfood mushroom based products. They use mushrooms like lions mane, chaga, cordyceps and reishi in delicious products. Did you know that mushrooms are more genetically similar to humans than plants are? And that they breathe oxygen and exhale CO2 just like we do but mushrooms spores can survive the vacuum and radiation of space. These amazing fungi are always a part of my daily routine in some way, usually with Lion’s Mane Coffee or Matcha in the morning, I’ll turn to their plant protein and mushroom elixirs like chaga and cordyceps during the day and reishi at night to wind down. As a listener of this podcast, you can save on all Four Sigmatic products. Go to foursigmatic.com/wellnessmama and the code wellnessmama gives 15% off.

This episode is sponsored by Joovv, a natural red light therapy in your very own home. We may not think of light when we think of essential nutrients that our body needs, but it absolutely is! This is the reason I go outside as soon as possible after waking up each morning and the reason I spend time in front of Joovv. Light is energy and our bodies need light in certain forms to sustain healthy cellular function. Red light in particular, especially in certain wavelengths, has certain benefits for hair, skin, and cellular energy. I like Joovv because they are third-party tested for safety and performance and use a Patented modular design which allows you easily treat your whole body in under 20 mins. Joovv uses clinically proven wavelengths of light that provide energy to the body and help with things like skin elasticity or to help avoid wrinkles. You can get bundle pricing discounts which allow you to save more money when purchasing larger setups. Check it out at joovv.com/wellnessmama and use code WELLNESSMAMA for a free gift.

Katie: Hello and welcome to the “Wellness Mama” podcast. I’m Katie from wellnessmama.com and wellnesse.com. That’s wellness with an E on the end, which is my new personal care line that I would love for you to check out. And today in this episode, I talk to someone who has become a personal friend and who also has a really cool and somewhat similar story to mine of recovering from autoimmune disease, losing weight, and the process that made that possible. And we go deep on some tactics that we both used that led to that. And also, one of the things he does, which is create bars that meet all of the criteria of every dietary plan, but also that are highly nutritious and a repeatable habit. That was part of his story. And we also will have some fun references to the ’80s and some lifestyle, just in general, time management tips that we share in this episode as well. So, I know you’re going to enjoy this fun and lighthearted interview with Ryan Lee, who is the founder of REWIND. Without further ado, let’s join Ryan.

Ryan, welcome to the podcast.

Ryan: I’m excited to be here, Katie. I am ready to get this Wellness Mama thing rocking.

Katie: Well, there’s so much we can talk about today both in current events and also about your story, but that is where I would love to start. I always love to hear someone’s story and their origin. Think there’s so much power in that. So, to start off, will you walk us through your story and how you got to be where you currently are?

Ryan: Sure. I don’t know how far back. I’m not gonna go to when I was born. Let me go to my first job out of school. I graduated college and I spent the first six years of my career working in a children’s rehab hospital as a recreational therapist, and that’s what my degree was in, recreational therapy and play therapy and adapted aquatics, and I worked with kids who had every type of disability you could imagine, things from spinal bifida, cerebral palsy, spinal cord injuries, gunshot wounds, you name it. And we did play therapy and it was amazing. I’d loved working with kids. I’ve always loved working with kids. But on the side, I was a trainer. So, I would train young athletes. That was… I loved staying fit. I was captain of my track team all through, you know, in college and good career there and I wanted to keep staying athletic and I trained athletes. I trained hockey players, although it was ironic because I still can’t skate. Elite tennis players, gymnasts. And I wanted to build a website for my sports training company, my part-time business, and this was at the end of ’98, so it was really early on. And I just started writing articles about sports training and running faster and jumping higher and all that stuff and things just kind of started to take off. I mean, that was the genesis of me getting into this health world and trying to have more impact and reaching more people.

Fast forward a little bit, sold my site and then that kind of fell apart, then I became a gym teacher in the South Bronx, which is this really rough part of the area called Hunts Point. And so it was an alternative high school. Lot of kids, they’d all pretty much been arrested at one point or another. Lot of former gang members. And I started the whole health and phys ed program. So, this was 2000 and 2001. And I was still building my part-time business to the point where my part-time income was making more than my full-time. And that’s where I took the leap and I’ve been a full-time entrepreneur ever since. Most of my companies and business has been in the health space. And my wife and I have been married now. This year, it’ll be our 20-year anniversary. And we have four beautiful, happy, healthy kitties. And now I’m running Rewind. And I know we’re going to talk about that too. And there you go. There’s a little two-minute version of my journey and lots and lots of ups and downs during those 20 years.

Katie: Absolutely. Well, I’ve heard it said that, you know, sometimes people go into psychiatry to kind of be able to self-diagnose or to work through their own struggles. And I know for me that was very much the reason I got into health was, like, having health problems that doctors couldn’t figure out the answers to and wanting to find my own health answers. And I think we actually have some overlapping parts of our story here when it comes to like health declining and autoimmune disease from what I’m remembering. Is that part of your story as well?

Ryan: Yes, yes. So, that’s… So, I think about 10… So, during one of the downtimes, so 10 years ago, my wife and I we just had our fourth kid and right about that time, my mom passed away from cancer. Really it was like a two-month battle. She was only 63 at the time. One of my businesses fell apart. I tried to launch a print magazine, so I went to all this debt, so I had all this stress. And when you have so many kids, I know I think you have like 14, 15 kids, but I only have 4, but what happened was, you know, we started eating off their plate a little more, start gaining weight and combined with the stress, I started getting joint pain. And I would ignore it. I’m a guy. I try to toughen up and just play through it and run through it or do whatever to the point where, though, it kept getting worse and I woke up one day and I could barely walk. It was… I couldn’t step because it hurt that much and I couldn’t bend my fingers. And it took months and months of going to every kind of doctor and healthcare professional. I started with my general practitioner. I went to physical therapists. I went to chiropractors. I went to podiatrists because my feet hurt. I went to my good friend who’s an orthopedic surgeon. And no one could figure it out ’till finally I went to a rheumatologist. And he looked at me and then saw my fingers were swollen, my feet were swollen, I gave him all the history and in about 10 seconds, he looked at me he said, “Oh, you have an autoimmune disorder, it’s called psoriatic arthritis.” And I’m like, “Oh, that doesn’t sound good.”

So, that was the beginning of this journey back to health. I mean, I gained 40 pounds. Everything was just falling apart physically. And it took me a lot of starts and stops. I tried a complete inflammation free diet. I went all in. Went to a naturopath. They said, “Okay. No more sugar. No more dairy. No more gluten ever.” I’m like, “What?” And I tried that for two weeks. Couldn’t do it. It was just too hard, to be honest with you. I know people can do it. I just couldn’t. So, lots of ups and downs ’till about two years ago, I said, “You know what? That’s it. My symptoms are starting to come back. I don’t wanna go on methotrexate,” which is the drugs they recommended. “So, how do I figure this out?” And I said, “Let me just win the morning. Let me start off something in the morning that’s good for me on the go. I got the four kids. I’ve run businesses. I don’t have time to do a lot of stuff. Let me… Is there a good bar?” And I just had a bar every morning. And the problem was I couldn’t find a bar, though, that didn’t have dairy, gluten, added sugar, sugar alcohol and all that stuff. And that gave me the big, “Well, maybe I can create one for myself and maybe there’d be some other people that would like it.” And that became this journey back to health and really focusing on simplification and that’s become this business now called Rewind where it’s about rewinding the years and having things that make you feel good physically, emotionally, mentally, non-inflammatory. And now at the pinnacle, Katie, I’m talking with “The Wellness Mama.” Look at this. It’s amazing how far I’ve come.

Katie: Oh, I love that. And I think your story and my story, like I said, they overlap a little bit and they illustrate that we do have to become, like, partners in our own health and that there is such a personalized and individualized aspect to it, but at the same time there are some commonalities like those whole real foods and avoiding certain common inflammatory triggers in those spaces that can be kind of universally helpful across the board. How long did that process look for you? I know I also recovered from Hashimoto’s and I’m now in remission and all my numbers are great. But how long did that journey take for you?

Ryan: I think from the first time I was diagnosed it was about two years of me trying different things, you know, being good and saying, “Okay. I’m starting to get some symptoms. Let me go strict. No sugar, no dairy, no gluten.” And then I would last a couple weeks and then I’d kind of slowly fall off the wagon and then I’d go back. So, it was two years of that ’till the breaking point I’ll never forget. My wife and I took our kids on vacation, went down to Florida, and, you know, I wore a pair of jeans going down because the northeast, Connecticut. And I was putting the same jeans back on after the vacation coming home and they didn’t fit. And I asked my wife at the hotel, I said, “Did you dry clean my jeans? What’s going on? Why can’t they fi…” And she said, “I didn’t touch your jeans. What are you talking about?” And I gained weight. And I got home and I was so sick and I went I had a double ear infection and went to the doctor and then they said, “You have high blood pressure. You got some serious things starting to happen here.”

And that was, like, the scary point. So, it took two years of up and down, starts and stops ’till I said, “You know what? I need something that…” You’re right. “That has the universal principles of anti-inflammation that’s gonna make me feel good, but something that’s not so restrictive for me that I feel like I can never do it and I’m gonna fall off the wagon again.” So, I needed something that had a little built-in flexibility, which is how I came up with my kind of thing about the ’80s which we can go into in a few minutes, but that was… And I think it’s important for everyone to kind of know themselves and know their own body and see what makes them feel good and what doesn’t make them feel good. Right? What’s against it? So, it was two years of start and stop and then now I’ve been 100%…well, I won’t say 100%, 99% symptom-free for these past two years. So it’s been like four years since I’ve been diagnosed.

Katie: Got it. And do you maintain that same level of, like, dietary restriction now or… I found that once I was able to heal the underlying issues, I actually have a lot more leeway now.

Ryan: Yeah, yeah. And that’s exactly what happened. Now, I have this theory, live like the ’80s. And you know Rewind, we kind of have a fun retro thing, we talk about the ’80s because that was the best decade ever. But my idea was with the ’80s if I can do that Pareto’s principle of 80% of the time I’m gonna eat real good, clean whole foods, as many vegetables as I want, like, unlimited veggies, unlimited fruits and veggies, all good stuff and 80% really good stuff, but yet, you know what, give myself a little bit of leeway with that 20%. So, if there’s a salad and it has all this good stuff, so I love… Luckily, I like a lot of healthy foods now. I love sardines and olive oil. That’s one of my favorite things in the world. That in a bowl of greens. So, I’ll have maybe Swiss chard or arugula or kale. So, that’s, like, the 80% really good, but it’s missing a little something. So, maybe I’ll throw in some croutons, which I shouldn’t have, but that’s my little 20%. And because it has that little crunch and that little extra flavor, it makes me really look forward to the salad instead of just saying, “Oh, it’s good.” I really look forward to it. So, that is my way to kind of play with the 80/20 and give myself some of that flexibility. So, I’m definitely not 100% strict, but I try to eat really well 80% of the time. And if I’m not feeling good, what I find is I’ll kind of move up to the 90s and tighten it up even more and go 90%. And it’s worked. It’s worked well for me and for people that I’ve helped that feels like it gives them a little bit of that leeway.

Katie: Yeah. Well, I love the tie in with the ’80s. I’m a huge fan of the Pareto principle as well and I use that in a lot of areas of life both, like, dietary and fitness, but also just time and organization and house management. I feel like it’s kind of almost universally applicable. But I think it also speaks to another really important point which is… Because I did the exact same thing. I had that cycle for years of… All my symptoms would flare and I would feel bad and then I would tighten everything up to probably a neurotic level and be 100% compliant, which is not sustainable, and then eventually fall off the wagon. And I think that a big key of it, for many people, we all have ideas of what we probably should be doing or we know that we should be eating less sugar or we know we need to avoid certain inflammatory things, but it’s keeping that consistent motivation and focus on being able to do it and I think that’s where that 80/20 comes into play because it makes it sustainable.

Ryan: Yeah. And you know what? It just gives us a little bit of a break. And we put so much stress and pressure on ourselves. And I know obviously, a large majority of people listening to this are moms. There are some that don’t have kids, but we’re under so much pressure, anyway, you know, so much stress caring for not just ourselves, but our family that, you know, you see…and you see it all the time, Katie. You see the diet books. And what’s one of the first pages they have? It’s always within the first 10 pages. It’ll say something like, “Forbidden foods. Ten foods you can never eat again for the rest of your life.” And you look at it and you’re like, “Are you telling me I could never have a chocolate chip cookie forever?” We’re gonna have a problem. So, I think giving people a little bit of a break and saying, “It’s okay. You don’t have to be perfect. Let’s stop worrying about perfection and let’s get really good and dialed in. And I know everyone is different. Everyone is motivated by different things. But I think when you start to do this, knowing that you know what? I could have that cookie, but I choose not to. You don’t have to eat stuff that’s not the greatest for you 20% of time, but you can if you want. I’ll give an example, how this works. So, when I was at my height of just disgusting, like, falling off the wagon, my go-to junk food was plain M&Ms. That was a crack for me. What’s yours, Katie? What’s your “This is like the greatest thing in the world.”? Everyone has something.

Katie: Yeah. I mean, much less anymore. I don’t really crave anything, but it would be… For me, it’s salty stuff, not sweet stuff. So, it would be like chips or french fries probably.

Ryan: Okay. So, for me, it was M&Ms, plain M&Ms. Every night, I would have like a bowl of plain M&Ms, just watching TV and trying to eat away like my stress. And I still… I rarely have M&Ms, but I will have them once in a while, maybe, like, when I go to the movies, like, once a month or something. But the other night I got my kids a little treat and I bought myself a little bag of plain M&Ms, like, a little tiny bag. And it’s been sitting in my house for five days. I just didn’t want it. I don’t want it. I don’t know if I’m ever gonna eat it. But the fact that it’s not like I have this pressure and I feel like, “Oh my God, I’m resisting because I could never have it again,” knowing that if I want to I could, but I just choose not to. Giving yourself that power is… Sounds redundant. Giving yourself that power is powerful. And you’re right. You’re to the point now where you don’t even crave it. And I’m kind of getting there too. Again, I just don’t feel like having it anymore. But I think if it was a diet or “diet,” a restrictive thing where it says, “You can never have sugar. You can never have an M&M. You can never have a cookie. You can never have this. You can never have a slice of pizza the rest of your life,” then I feel that pressure and resistance. Again, this is me personally, and everyone is different. But you do that enough over time and you start feeling good, you don’t want to feel bad again, like, you don’t want to have the M&Ms or the pizza because you know how it makes you feel.

Katie: Exactly. And I think that’s the mindset shift that was pivotal for me and I think everybody’s tipping point of getting here is a little bit different, but it was that shifting focus from foods being good or bad and needing to deprive myself and being angry at my body for what it wasn’t to switching to a point of view of “I want to nourish my body with things that are good because I love my body and I’m trying…and I wanna support it and nourish it,” versus deprive and just taking away that deprivation mindset made all the difference because I think we do have that thing as humans too, like, or at least I maybe I’m projecting, I have that thing where if I’m told I can’t do something, even if I didn’t wanna do it in the first place, now I’m like, “Well, now I do.” It’s kind of like right now we’re all stuck at home. I don’t usually wanna go anywhere anyway, but now that I can’t go anywhere, of course I want to go somewhere.

Ryan: You’re like, “I wanna walk into Target and just hug strangers.” That’s all you wanna do now.

Katie: Exactly.

Ryan: Yeah, yeah. With no gloves, just feeling everyone’s faces. Look, everyone… I think most people feel that. When you’re told you can’t do something, you want it even more. It’s like the restaurant. You can walk by and there could be an empty restaurant and then the restaurant next door has a line at the door, but you want that because you can’t get in. So, yeah, it is pretty powerful that when you just say…you make that shift to, “I just wanna feed myself, my body with really, really good stuff.” But knowing that if I wanna have a little bit of flex time, if I wanna have something that I know isn’t the greatest for me, but maybe it’s a celebratory thing and maybe you don’t like drinking alcohol, like, I think I maybe have one beer every like three or four months. That’s my alcohol. You could maybe say, “Okay. I’m gonna have a glass of alcohol, I’m gonna have a glass of wine,” and not beat yourself up over it or feel guilty or not go out with your friends or your family or go to any holidays anymore because they’re gonna have wine and you feel bad and you’re sitting there the whole night staring at it and just miserable. That’s not fun either.

So, it’s kind of this, this flexibility of giving yourself a little bit of a break and just filling up with the good stuff. When I discovered…when I really, really started to discover, like, how good vegetables are a couple of years ago because I didn’t…I ate a little bit but not a lot, man, it’s life-changing. And you look now and it’s really sad, Katie. You look at the typical American diet and what they eat and there’s just, like, no vegetables. Everything is brown and fried and sandwiches and fried food and pizza. It’s just… It has no nutritional value. Their idea of vegetables is, “Oh, well, I had some lettuce on a hamburger,” or, “I ate ketchup with my fries.” And that’s it. It’s really sad. And people have this misconception that vegetables are just…they taste bad. It couldn’t be further from the truth. My oldest daughter who’s 16 she loves making vegetables. Every day she’s experimenting. She’s like, “Oh, I’m gonna do some Brussel sprouts and I’m gonna try to add this and add these little spices and…” My kids all love eating vegetables, and I think it’s pretty cool.

Katie: Yeah, I love it. Mine too. And me too. And that was something I had to learn as an adult as well because I didn’t grow up loving vegetables and now I can’t imagine not eating as many as I do because I love them. But I think another part of this that was a key for me and I’m guessing for you as well is to simplify and automate as much as possible the things that need to be repeatable to make something a habit versus I feel like the more decisions are built into something, the less likely it is to succeed over time because you hit decision fatigue. And so for me, I eat many of the same meals, like, at least lunches, I’ll eat the same thing over and over the same three meals because it’s simple, I don’t have to think about it. One of them has definitely sardines, but it takes away the decision fatigue and it takes away the choice of it and then I can just stick with it because it’s there, it’s easy and I know what I’m doing. And the same thing with, like, I eat usually a six to eight-hour window every day which is just an easy change that I made that works for me, it won’t work for everyone. But that was a huge key for me. And so I think that’s where things like the bars come into play as well because it’s a simple, repeatable habit that is always there, there’s no decision involved and that tastes great. So, talk about the bars and the formulation. What went into that and why did you decide on bars?

Ryan: And you’re 100% right. The less decisions you have to make, the less willpower and fatigue you start getting. And I’m the exact same way. Every morning it’s a bar with supplements and every lunch it’s either sardines with greens or rice cauliflower with sardines or a piece of salmon or something like that. And that’s 99% of time. That’s my breakfast and lunch. The reason with bars is just for me, it’s really about convenience and something that I’m gonna stick with. And I’ve always loved bars. I love the convenience of them. But I said, “Well, if I’m going to create a bar, if I wanna…” If in a perfect world, because all the bars I always having, the protein bars, and I’m sure you’ve seen this a lot, most protein bars, the protein source is whey protein, which is dairy, which is not great for inflammation. I don’t react well to dairy. And a lot of them, all of the, you know, cookie-flavored ones or anything like that they all had gluten as well. And now the big trend was everyone is like, “Oh, we’re keto this. We’re keto that.” So, what they do is they say we only have one gram of sugar, but they’ll jam it with all this sugar alcohol, which tends not to be the greatest.

So, I’m like, why can’t there be a really good, clean, healthy bar that even has some greens, so we snuck in some spinach and kale, but tastes really, really good? That was the thing because you can have a bar… And there were some bars that are healthier, but they just didn’t taste good and I didn’t wanna have it every morning. I still want something that tastes good. And that was the original idea behind it. Can I create a bar? Can I have one that tastes really, really good that doesn’t have the added sugar, the gluten or the dairy? And it’s only made with good stuff. So, it’s non-GMO, no artificial flavors, no artificial sweeteners, no corn, no rice, no nothing like that. And that’s what we set out to do. And it took probably seven months of, like, playing and back and forth and tasting and then, you know, people don’t realize when you make a bar you can have the best ingredients in the world, the best nutritional facts, and maybe even you get the flavor profile, but then there’s the texture. And maybe you have too many of one thing and it’s way too chewy and sticky or it’s too crumbly, or it’s too wet, or it’s too dry. So, nailing all those, the flavor and the texture and the nutritional profile, and then the actual ingredients, it’s a lot easier said than done. And it drives me a little crazy when, you know, we put all this effort into the bar and someone on Facebook will be like, “Oh, why don’t you…how come you didn’t just make it with blah, blah, blah?” I’m like, “You have no idea how hard it is to make a bar like this.” I wish I could just say, “Oh, yeah, we’ll just add that. Cool. No problem.”

So, it took a while. But that was the idea, just something convenient. My wife calls it grab and go. And as a really, really nice side benefit, which I didn’t know originally, my kids and kids in general love it. All my kids have the bars every day. My daughter who’s on the tennis team in high school, her tennis team they always have the bars. My little three-year-old nephew, Luke, loves the bars everyday. Rewind bar. So, it’s pretty cool to see families now enjoying it and having something that’s good. And because we have nine grams of fiber, they fill you up. So, I have the bar in the morning and that’s it. I’m good. I have the bar in the morning. I work out a couple of hours later, and then I have lunch. So, it holds me over for a few hours.

I did try like you…I know you do…if you eat in that six to eight-hour window, a lot of people call intermittent fasting. I tried that. I couldn’t do it. All I did was think about food. I was nasty, Katie. I was not a good person. So, for me, the bar worked for me. It took the edge off and it gave me a little bit of fuel for those first few hours in the morning.

Katie: Yeah. I think fasting is very much an individualized thing. And like I said, it works for some people. I’m definitely not recommending it for everyone. And certainly, a lot of women actually should not intermittent fast if there’s any kind of hormone issue and so it’s not something I would recommend everyone do. I think it just speaks to, we all have to find kind of our thing that works. And I know in your case from what I remember of your story, you lost a pretty substantial amount of weight and you have now reversed your autoimmune disease. That had to be an amazing journey. What do you do? What is your routine and your day look like now both nutritionally, exercise and just lifestyle to maintain that?

Ryan: Yeah. And it was a really, really nice byproduct because just by doing this, I automatically ate less calories because the bar is about 160 calories. So, rather than having crappy food or a doughnut or whatever, just that alone was saving me calories and losing all the weight. Yeah. So, I’m down the 40 something pounds. I’m the exact same weight and pant size I was in high school, which is still mind-blowing considering I’m gonna be 48. So, I’ve never felt so good and my symptoms are gone and I never needed to get on the drugs. So, in terms of my routine. So, nutritionally, my routine is pretty much always the same just like you, very structured, bar in the morning, lunch is usually some kind of salad with a protein, usually sardines. And often I’ll have a bar in between lunch and dinner too because I eat lunch really early. I’ll have lunch at, like, 11:00, 11:30 in the morning because I’m up so early, and then we’ll eat dinner as a family at like 5:00, 5:30. So, I’ll usually have another bar around 3:00, 2:30. And dinner, it’s just different things. Whatever my wife makes, we bring in, and… There’s oftentimes, because I love it so much, I’ll have another salad with a different protein. And I’m not… I guess I’m probably more pescetarian-ish, but I don’t subscribe to any specific diet. I just tend not to eat a lot of meat, especially red meat. It just doesn’t make me feel good, but for some people, they love it and they eat all red meat. Again, I don’t judge. So, that’s nutritionally and it’s that 80/20 rule, 80% really, really good, clean, healthy veggies and greens and 20% go crazy.

Exercise wise, this was interesting because I was a trainer and even my master’s degree is exercise physiology, I always believed exercise and fitness was 90% of your results. And that’s what we were told as a trainer. Ninety percent is fitness and exercise and you got to know your progressions and your upper body, lower body, your splits, your… And I was obsessed with that. And then I started getting older, I’m like, “You know what? Let me just feel good. And what can I do that more importantly than the workout, what am I gonna do consistently that I enjoy and I know is not gonna take up a lot of time?” That’s the thing with me. It’s gotta be efficient. It’s gotta be simple. Like you, you said with your lunch, you eat pretty much the same thing every day so you know what to do, it’s one less decision you have to make. My workouts are almost identical every single day, but I add a little bit of progression. So, I’ll take you through it. You ready for it, Katie? You’re ready for the workout?

Katie: Let’s go.

Ryan: Here we go. It’s in my bedroom. I have a treadmill and a couple little free weights and kettlebells there and a pull-up bar over the door. So, I go on the treadmill, I go at the highest incline. Our treadmill I think is about 10%. And I walk at about 4.1 miles an hour, so it’s like a fast walk. And I’ll do that for about two and a half minutes. So, it’s 200 meters on the thing. I ran track, so I always think in terms of meters. So, the equivalent is two, two and a half minutes, so it’s about half a lap on a track. I jump off. Obviously, stop the treadmill first. I’m not a lunatic. Stop the treadmill, jump off, and I’ll usually do like pull-ups, like 8 to 10 pull-ups, 15 to 20 push-ups and 15 to 20 abdominal core exercises. Then I go back on the treadmill, I do another two, two and a half minutes, stop the treadmill, get off and do another exercise, sometimes like kettlebell swings. And that’s it. So, each of those little two minutes, so the two minutes on the treadmill, and then the strength exercise, that’s one, like, little mini circuit and I do eight of those. So, with the exercise and the treadmill, it takes maybe 20, 25 minutes tops, and I’m done. And I’ve got some good cardiovascular benefit, I’ve got the strength in, which I think is really important. Cardio is great, but especially as we start getting older, we need strength exercise. It doesn’t have to be hardcore weights, but we need at least resistance training, could be bodyweight training, old school push-ups and bodyweight squats. That stuff still works. And it’s all done at my house. I don’t have to go to the gym. I don’t have to spend time driving back and forth and showering there. And it’s easy. I just did the workout right before we started this call.

So, that’s my nutrition. That’s my fitness. I do that five to six times a week. Pretty much the same workout except I might switch up the strength exercise and maybe I’ll have one day it’s all kettlebell swings or something else in there instead. And just simplifying. I’ll tell you that the biggest thing I did when I was going through this, I knew that autoimmune is definitely worsened with stress. And I was traveling a lot. I was speaking at all these marketing events and selling and doing all this stuff, just wasn’t making me feel good. And I was missing stuff in my kid’s life. And about six years ago, one of the biggest decisions I made was…well, actually, this was eight years ago now that we’re looking back. For six years, I’m not traveling at all. I said no to every single speaking gig, every one. And I turned away hundreds and hundreds of thousands of dollars, maybe a million over the course of those years by not speaking. But I just wanted to focus on my wife, my kids, my family, and I made them the center of my universe and I said, “I’m gonna build everything. I’m gonna build my business, my life, everything around my family.”

So, every decision is run through that filter of, “Is this bringing me closer to my goals of spending more time with them and building a business of soul or is this taking me further apart?” And if it was taking me further away from it, I said no. And just that simplification, it made my relationship with my wife stronger with my kids. I don’t miss any…I don’t miss a play or a sporting event and I still coach all their sports. I’m done with my day by 3:30, 4:00. So, I carpool all night, which isn’t always the best, but I get to spend time with them. I’ve coached every sport from football, to baseball, to soccer, to lacrosse. You name it, I’ve coached it. And it just… And I’m…look, I know I’m blessed to be able to do it. I don’t have a typical 9:00 to 5:00 job, but the simplifying of the nutrition, the simplifying of my workouts and the simplifying of just my life, it just changed everything and I just feel so much happier and more content with the way things have gone and I feel better.

Katie: And I love that you brought that up about exercise because I think that’s also a source of guilt for a lot of people is the idea that we should be doing more harder exercise. And you’re right, especially with certain conditions like autoimmune disease, very often we need to give the body a break and rest becomes more important or at least restorative, regenerative movement, not just high intensity as hard as possible which is…or like extended cardio which is what society kind of, at least a lot of times, presents as the option. And I know in my own journey, I’ve now lost over 60 pounds as well in the last couple of years. And I didn’t exercise at all during the really intense part of that weight loss because I’m a data nerd and a math person and in general, if you’re doing hard workouts, you’re going to make yourself more hungry. And if you’re trying to heal, you need to let those calories and that energy go to healing. And I’m not saying not move, but I didn’t focus at all on exercise during that time and I found the things that were the most important like that rest and the calm and being with the family, the things that really do help you rebuild. And I think that point can’t be stated enough is, you know, it’s easy to try to focus on all of these silver bullets and exercising more, “I need to take more supplements,” or whatever it is, but you’ve got to find those core things, and sometimes that means doing less, not doing more.

Ryan: Hundred percent. I can’t agree with you more on that one. And believe me, I was drinking the Kool-Aid 25 years ago. I was all about the high intensity. Actually, I taught high-intensity exercise classes, then I remember when CrossFit came out and everyone’s thinking like, “You got to work harder and play hard, work hard.” And they’re showning, you know, 60-year-olds flipping tires. And I was totally into that stuff, but I’m like, “You know what? It’s not necessarily best for everyone.” You should… And I tried. And again, I’m not putting down CrossFit. There are people that love it. If it works for you, great. I tried it at two different places. I’m like… I try everything. And both times I ended up getting hurt. And it didn’t make me feel good. It actually broke my body down too much and I was not getting enough rest. Sleep is just as important as the exercise. And you know, where I used to believe it was 80% exercise or 90% exercise, 10%, 20% nutrition, it’s flipped. If you’re eating well and filling yourself with the good stuff and getting the rest and recovery, great.

And I’m all about now, like, the lower impact stuff. Again, I was in…so, I ran track competitively all through college and I was a sprinter, so as hard and as fast as you can. But now I enjoy the walking part. I like that part. And another thing I do is I try every day to just walk 20 minutes outside, usually with my wife. If she’s not around, just by myself just thinking and just taking that time. That’s almost like my spiritual meditative time, just getting out. There’s about 60 acres of nature preserve in our backyard, so I just walk the trails and it’s like one of the greatest things that we can do. And it’s more important to find stuff that you like and it makes you feel good verse it’s the hottest trend or get this, you know, stupid ab wheel thing and all your fat’s gonna melt off, which is the most ridiculous thing in the world because it doesn’t work like that. The weight loss and the abs it’s made in the kitchen, not in the gym. So, I’m glad you’re bringing that stuff up, Katie, and showing people and showing them it doesn’t have to be high crazy intensity exercise.

Katie: Yeah. It’s amazing to me how many…how much our stories overlap and I love that you’re spreading this message and giving people a practical, repeatable habit that they can implement to help get there faster.

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A few questions I’d love to ask toward the end of interviews and I look forward to hearing your answer is, what are some things that are less known or not well understood about your area of expertise that you like to talk about?

Ryan: Well, we definitely covered a few of them today. I think number one is that ’80s rule. I think a lot of people are all about strict diets and what you can and can never eat again. So, I think giving yourself that flexibility is definitely my nutritional philosophy. And the workout stuff too. I mean, that’s the second thing. It’s the more about the consistent, repeatable, lower impact, but also getting bang for your buck and adding in strength exercise.

And I’ll give you a third thing. With Rewind, we definitely have fun with some of the retro ’70s, ’80s, ’90s pop culture. And I love it. It’s fun. But there actually have been scientific studies showing the mental, the psychological, physiological benefits of nostalgia. And I’m not talking about sitting around and thinking about when you were a kid and just crying and getting depressed and living in the past. I’m not talking about that at all. But it does feel good to kind of go back a little bit and watch a movie from your childhood or listen to an album. You should see. If you saw my space here it’s filled with hundreds and hundreds of records, cassette tapes, VHS tapes, arcade machines, movie posters here. I’m looking at “Back to the Future” and “The Goonies” and “Breakfast Club” and “Ferris Bueller’s Day Off,” stuff from my youth. And it does feel good. It really does. And obviously, whatever decade you guys were born in, if you were more ’60s or ’70s or ’90s person, but just going back and having a little bit that nostalgia is good for you. And I’m trying to spread that too. Just go back and feel good. Live in the present, but it’s good for you to go back a little bit sometimes.

Katie: I agree. And that’s one thing we’ve been doing lately to pass the time is we have a playlist my kids have made for cleaning or just for, like, dance parties around the house and it’s a lot of ’80s music and it’s fun and it does take you back.

And I love having those kind of touchpoints. I think that’s awesome. Also, I know we’ve mentioned the bars multiple times and, of course, there’ll be a link in the show notes at wellnessmama.fm. But also for any of you listening, the website is rewindbars.com if I make sure I got that right, Ryan. And then there is a discount code MAMA, M-A-M-A. That’s for 30% off, which is awesome. That’s a huge discount. So I just wanna make sure we said that out loud. And, of course, it’ll also be in the show notes as well. What kind of flavors do you guys have?

Ryan: Right now with the bars… Well, when people are listening to this, we’re gonna have a new flavor come out. We have a new mint brownie coming out, which is…and that was, by the way, my 14-year-old daughter came up with that one because she’s obsessed with mint and I’m like, “All right, let’s try it,” and it’s incredible. So, we have mint brownie. We have cinnamon coffee cake, which is my personal favorite. We have chocolate coconut. And then we have almond butter and jelly. And they’re all gluten-free, vegan, no artificial flavors, no GMOs, no inflammatory ingredients, not added sugar. So, those are the flavors. And then we have new green drinks that just came out. We have orange, we have berry, and we have pineapple. And they are, by far, the best-tasting green drinks ever created. I could say that because I’ve tried every green drink and every one of our customers say the exact same thing. So, they’re the best tasting anti-inflammatory green drinks in the world. I don’t talk about them as much because they’re brand new, but I’m really excited about those. And we’re creating lots of new smoothie flavors and fun stuff with that.

Katie: Awesome. And of course, those will be linked in the show notes, you guys can find them. Just head over to rewindbars.com. And then another question I love to wrap up with is, is there a book or a number of books that have had a really dramatic impact on your life? And if so, what are they and why?

Ryan: I think the initial book that changed the way I thought about things and really got me kind of into the personal development world, read a long time ago, it was “The 7 Habits of Highly Effective People” by Stephen Covey. I read that in, I think, like, early ’90s and mid-’90s and it was just life-changing. I was like, “This is…” It was amazing to see and to start learning about personal development from this thing that I never even realized. I remember my dad had tapes when I was younger and he had tapes by like Denis Waitley and I listened to those. I thought those were kind of cool and interesting, but “The 7 Habits” was the one where I was old enough to really get it and understand and got me into this whole different mindset of priorities and that he had the whole chart and all this kind of stuff. And I just thought that was really cool. That was definitely, like, a life-changing impactful book. I haven’t read it in a long time. I should reread it because that was the one I remember as kind of started me off on this journey.

Katie: Awesome. Well, Ryan, this has been such a fun conversation as it always is when talking to you. And I really appreciate you being here and sharing your story today.

Ryan: Well, I appreciate you having me on. And you’re right, we’re so similar. I think I’m gonna start a new site called Wellness Daddy because I am ready to rock this. No. But I appreciate you and I always love talking to you and to Seth and so I am always here to help anytime, any way you need me, Katie. Thanks for having me.

Katie: Oh, thank you for the time. And thanks to all of you as always for listening and for sharing one of your most valuable assets, your time, with both of us today. We’re so grateful that you did and I hope that you will join me again on the next episode of the “Wellness Mama” podcast.

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.

Source: https://wellnessmama.com/podcast/ryan-lee/

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These California doctors flew to New York to fight Covid-19. Here's what they learned.

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After two weeks at Coney Island Hospital, Lin came back to his colleagues with first-hand knowledge of how to handle a Covid-19 outbreak — and, perhaps most importantly, he returned as a living testament to the effectiveness of personal protective equipment.

“What we brought back, which is super helpful, is a degree of reassurance,” he said.

“There’s a tremendous amount of relief that (colleagues) know that what we’re doing at our site locally is at least (as good), if not better, than what we were doing in New York in terms of personal protection, and everyone was fine in New York.”

Now the situations have flipped. Cases have consistently declined in New York over the past few months even as they have increased in California, despite the state being the first to initiate stay-at-home orders. In late May, the seven-day moving average of new coronavirus cases in California passed that of New York and has only increased since, pushing toward a seven-day average of nearly 8,000 cases a day.

Covid-19 hospitalizations in California are up 44% and people in intensive care have climbed by 34% over the past two weeks, Gov. Gavin Newsom said Wednesday.

As these cases increase across the country’s South and West, volunteers like Lin find themselves the foremost coronavirus experts in their home hospitals.

They’re also still healthy and, as such, a symbol of comfort for anxious colleagues.

“I think that in general has let a lot of people relax,” said Dr. Stephanie Loe, 39, who spent two weeks in late April to May in the ICU at Elmhurst Hospital in Queens and another two weeks in May in the ICU at North Central Bronx Hospital.

“The fact that I went and didn’t get deathly ill, and I went back a second time and still didn’t get deathly ill, I think people are reassured by that.”

Aside from those psychological benefits, Lin and Loe said they learned practical lessons that can be broadly broken up into two categories: clinical and structural. How do you treat patients with Covid-19? And how should the hospital be set up to provide the best care?

Clinical lessons from New York

On the clinical side, Loe said one of the biggest things she learned was the drawbacks of putting patients on ventilators. In the early days of the pandemic, the thought was to put patients on mechanical ventilators sooner rather than later, but the treatment was not as effective as originally hoped.

“Since that experience, I am very reluctant to put a patient on a ventilator unless it’s absolutely necessary,” she said.

Instead, she prefers to treat patients with supplemental oxygen or a less invasive machine like a high-flow nasal cannula, which gives a boost of oxygen into a patient’s nose.

Other clinical tips have shown some small positive signs, such as “proning” patients by placing them on their stomachs, drugs such as remdesivir, or convalescent plasma treatments.

But those are not cure-alls, and there is still so much unknown about how to treat Covid-19 patients.

“None of those to me, even now, have shown any real promise right before my eyes that I could say ‘oh this is the answer,'” Loe said. “Just the fact that we don’t have the answer right now, it still feels a little bit helpless.”

Lin said the lack of a treatment left him feeling similarly helpless at times in New York.

“Any disease process where there’s not a definitive intervention that we can do, whether it’s cancer or Covid-19, there’s a degree of helplessness that all providers feel,” he said.

How to prepare a hospital for a Covid-19 surge

The other major lessons learned were centered on how to set up a hospital with surge capacity to avoid becoming overwhelmed.

During Dr. Loe’s time in New York, the surge of so many patients at once meant that they were not able to provide the best possible care to everyone who needed it.

“There was such a high, high volume of people that got it and got so sick from it all at one time, I think that the care that they could have received if the volume was reasonable would have been better,” she said. “It was just a complete disaster situation, and when you’re in a complete disaster situation where you’re doing everything you can and nothing is helping, it feels helpless.”

Both Dr. Lin and Dr. Loe are emergency medicine physicians who were thrust into working in the Intensive Care Units, or ICUs, while in New York. It was an unfamiliar position for them; Lin said he hadn’t worked in an ICU in 22 years.

But there were not enough ICU specialists, known as intensivists, or critical care physicians to go around, so they had to make do.

“Their biggest issue was they had to find ways to scale that expertise and bring in other physicians that were not necessarily board certified in critical care, but could help and assist, with oversight by critical care (doctors),” Lin said.

He said that model was successful in New York and that he was working to implement a similar crash course in case of a surge at his hospital, John Muir Health in Concord, California.

“How do we bring in the orthopedic doctors, the ER docs, the internal medicine doctors, the pediatricians?” he said. “How do we bring them in, knowing they have some fundamental medical training and background, and that with the right oversight they can provide management of critical care patients when we have a surge?”

California’s caseload compared to New York

Despite the rise in cases in California, both Lin and Loe said hospitals are not nearly as overwhelmed as they were in New York during the spring.

“From what I understand talking to the providers that were there during the peak, I don’t think we are anywhere near what they were at,” Lin said. “They weren’t full; they were three (times) full is really what they were at, and they ran out of all sorts of resources. I don’t think we’re there yet, thank goodness.”

Loe said on Wednesday the volume of coronavirus cases has grown immensely in her hospital, Riverside University Health System Medical Center in Moreno Valley, and that the hospital’s ICU is at capacity. But they have not yet expanded into their surge plan, such as canceling elective procedures or transforming other hospital units into ICUs.

Even though there is no clear, effective treatment, Loe felt confident that as long as they are not overwhelmed they can provide the best possible support.

“I still feel like the patients are getting the care they deserve,” Loe said. “It gives you a little bit more of a feeling of control that you have control over this disease the best you can.”

Their hope is that people continue to wear masks and socially distance, thereby keeping new cases and hospitalizations to a manageable level — and calming the stresses within the medical system.

“There’s a ton of anxiety in the health care industry about this,” Lin said. “And I’m glad to see that as things start to settle down, (we can) approach this in a very rational way, and people feel like they can provide care to patients in a safe way.”

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lpdwillwrite4coffee · 5 years ago

Text

CHILDREN OF LILITH CHAPTER TWENTY

“Excuse me, sorry, comin’ through, whoa sorry!” Boz weaved between slower going pedestrians and bolted up the stairs from the subway platform.

Making a wide turn, his boots scraped on the concrete as he immediately pulled up short, blocked by two moms with double strollers. Seriously? Hadn’t they heard of population control?

Boz ducked right, only to be cut off, so he moved left. Nope, not that way either.

“Okay really?” He blurted, waving his arms out. “We get it, your kids have that cute Double Mint Twin thing going for them. Now please get out of the way.”

Ignoring the vulgar shouting from the two women- who by the way shouldn’t be using those words around children old enough to repeat them- he jogged past them and took off at a dead run.

Regret twisted his stomach into a double Windsor. He should have never gone to the Bronx or to Queens. He should have stayed with Griffin and Nikki. And he definitely shouldn’t have eaten a Ruben with extra sauerkraut right before sprinting.

Slamming into the front door, he palmed the knob and skidded into the main room.

“I’m here, I’m here,” he gasped. “How are they? What happened? Is everyone okay?” He groaned and leaned over, supporting himself on his thighs. “Oh God… running… full stomach… I think I’m gonna hurl.”

“Chill, Boz,” Lisa commanded. “Everyone’s alive.”

She was standing behind Griffin, who was hunched over with his right forearm pressed onto the edge of the kitchen table. He looked like hell.

Forcing air down his throat, he stared at Griffin. “What happened?”

“Dislocated shoulder,” Griffin answered, voice turned to gravel.

“Another one? At this rate buddy, you’re gonna need orthopedic surgery before you’re thirty.”

The smirk Griffin flashed was inked in bitterness. “Looking forward to it.”

Lisa steadied herself behind Griffin and only offered Nikki a cautionary glance before she said, “Okay Griff, on three…” She placed her hands on him. “One-”

The loud crunchy pop of Griffin’s shoulder when she manipulated it back into the socket made Boz’s nausea multiply. “Oh, shit, that’s gross,” he mumbled against his fist.

Griffin cursed and slumped against the table. Tucking his chin, he squeezed his eyes closed and inhaled ragged breaths.

“Forget how to count?” he finally said through gritted teeth.

“It would have been much worse if you’d tensed up when I did that.” Lisa gave him a gentle pat on the bicep before going to the counter and grabbing a pack of gauze and a bottle of rubbing alcohol. “Hey Boz, you mind giving me a hand?”

Boz blinked owlishly. “Ah… What else, exactly, needs to be done?”

“Help Nikki while I finish up here,” Lisa said, gesturing to the first aid kit on the table.

Relieved there weren’t any more joints needing to be returned to their natural positions, Boz nodded and strode over to the seat next to Nikki. Blood, guts, and nasty smells he could handle. It was the sounds that made him sick.

“What happened?” He asked, unraveling the cloth from her palm.

“I cut myself,” Nikki responded, expression as flat as her voice.

Removing the taped gauze from her palm, he whispered, “Yikes. That’s a deep one.”

“A box cutter will do that to you,” Griffin muttered sharply.

Boz glanced at his friend. He’s seen that look, heard that tone, too many times to count, but even this time felt different. The ice in his glare permeated.

Turning to Nikki, Boz asked, “Someone came at you with a box cutter?”

“I did.”

He frowned. “What?”

She lifted her gaze, gold staining the natural sapphire in the shape of a starburst, and Boz’s mouth went slack.

“I did it to myself,” Nikki explained.

He was about to ask why, when Griffin shot to his feet, waving Lisa off of him as she tried to clean a gash near his hairline.

Keeping his stare on the ground, he grunted, “I need a shower,” and strode past them.

“Be careful with your shoulder,” Lisa told him, tossing gauze onto the table.

The silence left in his wake was less than comforting. Boz couldn’t handle it.

“So… didn’t anyone tell you to be careful with sharp objects?”

Not even a smile.

Clearing his throat, he said, “Right. I’ll just…” and nodded at Nikki’s hand.

A hand that was scarily cold and trembling. Making sure each touch was as gentle as possible, Boz redressed Nikki’s wound and didn’t say another word.

* * *

There were two things Griffin had thought about himself for so long he learned to accept them as fact: That the sum of his broken parts still didn’t add up to much, and that whether or not he was capable of it, he wasn’t in a position to love.

He was fine with the first statement, but the second… The second was causing him a lot of trouble.

Griffin had heard what Doctor Oliver said, heard what he called Nikki. She wasn’t just a civilian, she was important to the Hunter race as a whole. So important, in fact, that Vampire Alphas were trying to make a public spectacle out of her death. She needed to be guarded, kept out of harm’s way, at all costs. And Griffin had been all too willing to fall in the line of fire if it meant keeping Nikki safe.

But seeing blood drip from her nose, feeling the energy drain from her as they ran; it wasn’t a sense of duty that had him forcing his keys into her palm and shoving her away, ordering her to run.

He had done it… to save the woman he loved.

It was selfish, really. He’d needed to keep her alive because he loved her.

His own fate be damned, as long as she was still breathing, then whatever happened to him didn’t matter.

And then Nikki came back.

She’d sliced her hand open and bled for him. The fierce determination in her eyes as she’d stared down four Newborns haunted him.

She had been ready to sacrifice herself for him… Just as he had been ready to do the same for her.

The implications of that were too much for him to handle.

Flattening his right hand on the tiled wall, he supported himself as he hung his head beneath the shower head and let the water run over him. Heat and steady rhythm eased the soreness in his muscles, but it did nothing to comfort the ache in the center of his chest.

Nikki had completely disregarded her own well-being, had risked her life… for him.

Griffin growled, baring his teeth to the wall in front of him. He shut his eyes as a new ache ripped through him. Nikki’s screams still pierced his eardrums, clawing their way through his skull. The color of her blood painted the inside of his eyelids.

Didn’t she know how stupid it was to come storming back into a fight with only a box cutter and a horrible sense of self-preservation?

What if she had died? Didn’t she realize how important she was? How could she be so careless with her own life when…

When I love her so much.

The idea of her willingly doing it again made him queasy.

My broken parts aren’t worth that cost, he thought, watching rust stained water circle the drain. I love her, and I don’t deserve her.

* * *

Nicholas drummed the tip of his pen on his legal pad and hummed a noise of acknowledgment. “Yes, I’m already aware of her Henson,” he said, adding another line to his doodle. He wasn’t much for note taking, but that didn’t mean he couldn’t look like he cared.

“Oh,” Henson mumbled, papers shaking in his hand. “Ah, well, Caroline was spotted in the building-”

“Yes, by me,” Nicholas intoned. “I’ve already spoken with her.” Sighing, he dropped his pen. “Is this really all you have? A couple Familiar sightings and news of Doctor Oliver’s suicide?”

“I… I’m sorry sir.” Henson began folding his notes. “Not much else has happened this morning.”

Nicholas curved his eyebrow at the man. “Oh really? Nothing else has happened? Nothing else has become evident in the last few hours? Nothing?”

Henson shook his head and Nicholas could hear his stomach churning. Jesus, if he threw up again…

“Perhaps I haven’t given you enough time to acclimate yourself to your new widower status,” Nicholas said, lacing his fingers together over his belly and leaning back in his chair. “Why don’t you take a couple hours? Go for a walk, have some lunch, hire a prostitute, and allow yourself to grieve.”

Henson’s eyes went comically wide and he paled. “Um…” He swallowed thickly. “I… Yes, sir. Thank you, sir.”

“Of course.” Nicholas beamed. “Enjoy your afternoon. Come back when you’re finished.”

“Finished,” Henson repeated, his tone flat. “Yes… Finished.”

Nicholas watched as the man got up from his seat and shuffled to the door. Maybe he’d broken him in too hard…

“And drink some tea,” he added. “Nothing that can’t be cured with a good cup of tea.”

Henson stared, unblinking, at him for a long moment before he nodded again. “Yes, sir.”

When Henson was down the hall, Nicholas pulled a travel sized squirt bottle of mild air freshener from his drawer and spritzed it around his desk and the opposite chair. Distraught humans always smelled a bit like a port-a-potty.

He’d only been reading the revised contracts from Tokyo for ten minutes when he heard the cadence of footfalls in the hallway.

“Come in, Alexander,” he called without looking up. “Please, make yourself at-”

His words were cut off by a vice-like grip around his throat, hoisting him out of his chair and leaving his feet to dangle several inches above the floor.

“How dare you?” Alexander shouted, fangs bared.

“’Sgood to see you too,” Nicholas wheezed.

“You have the audacity to interrogate my Caroline, alone, behind my back?” Alexander shook him. “Do you have a death wish? Because I’d certainly be willing to help you make it a reality.”

Grappling with his Sire’s hold on him, Nicholas inhaled raggedly. “In retrospect, my family did seem to have a history of depression and coinciding farming accidents but I don’t think that’s what you mean.”

Alexander’s fingernails dug into Nicholas’ flesh, drawing blood. “You arrogant piece of shit,” he hissed.

“To clarify, are you upset that I talked with Caroline, or that you didn’t know about it?”

“You don’t know your boundaries,” Alexander said with a growl. “Obviously I should have instructed you better when you were a Newborn.”

Fighting the hand clamped around his neck, Nicholas said, “Consider me the practice progeny. I’m sure you’ll get it right with Caroline.”

Alexander stilled. “What are you talking about?”

“Now, now Alexander,” Nicholas tsked. “Don’t try to play that game with me. You’ve never been very good at feigning ignorance.” He narrowed his cunning gaze, despite the growing discomfort of being held up by his throat, and noted the flash of anxiety in the other man’s eyes.

Releasing his hold, Alexander dropped him and Nicholas stumbled back into his chair. He coughed and rubbed the healing marks on his skin.

“Did you really think I wouldn’t find out about her?” Nicholas asked.

“There’s nothing to ‘find out’,” Alexander countered.

“If that’s the case, then why haven’t you mentioned her before? If she’s to be our new pack mate-”

“She hasn’t made the decision yet,” Alexander cut him off. “And until she does, you will stay away from her.”

“You’re giving me orders now?” Nicholas shot back angrily. “And here I thought we were a team. A joint force to reign over this ‘New Empire’.” He stood up, locking eyes with his Sire. “That was the arrangement, wasn’t it? Duel leadership with equal power and quadruple the profits?”

Alexander’s features hardened, schooled into an expression of mild irritation. “Of course.”

Smiling with too much teeth, Nicholas said, “Good. Because I’d hate to think you’ve changed your mind.” He stepped around him, heading for his drink cart.

“It’s a little late for that now,” Alexander muttered.

Nicholas hummed in ascent. “I’d say. Killing the other four Alphas in the city, taking over their aligned, drafting a new codex… Those are all very big steps into the land of no return.”

“You aren’t having second thoughts, are you?”

Nicholas scoffed over the rim of his glass. “And give all this up?” He waved his hand out at the surrounding office. “I’ve grown too attached to the view.”

Alexander nodded firmly. “Then we’re in agreement,” he said, turning towards the door.

“But Alexander,” Nicholas called, stopping him just before he made it into the corridor. “Next time I find out you’ve been keeping something from me, I won’t be so kind as to invite it to tea. So choose your secrets wisely.” His lips twisted into an acrid grin.

Eyes darkening, Alexander stared at him, searching his face. “And I would offer the same advice to you,” he said. Just before he crossed the threshold glanced over his shoulder and added, “By the way, you might want to invest in different air freshener. The one you use isn’t very strong.”

Nicholas waited until his Sire was out of range before crushing the glass tumbler in his hand and chucking the shards across the room.

* * *

Kaelin would know what to do.

That was the only thought Nikki had as she finished washing her face. Kaelin would know exactly how to handle the situation, know the perfect sentence that would sting but not wreck, and she’d do it with flare.

If she was there, she’d tell Nikki to get right in Hunter boy’s face and say what gives? Who do you think you are, ignoring me after everything that just happened? You think you’re big and bad, well honey have I got news for you. You’re not even close to being half as scary as me when I’m pissed, so if you wanna save what little bit of your manhood you have, you’d better spill right now. And make it speedy ‘cause neither one of us is getting any younger.

Nikki chuckled into the hand towel she was using to dry her face. Kaelin would have Griffin on his knees begging in two minutes flat.

If she was there…

I miss her, Nikki thought, staring at her blurry reflection. I want my friend.

Clearing her throat, she folded the towel, placed it on the counter and went to shut off the bathroom light. She could hear bits of the conversation downstairs, mostly between Boz and Lisa, but she decidedly didn’t care. She would care in a few minutes. But right then her only concern was changing clothes and keeping the tears at bay.

Closing her door, she headed for her duffle bag and began riffling through it.

His door. It was his door, to his room. And it was filled with his things.

Suddenly she was furious, standing in the middle of Griffin’s room, surrounded by everything… him. She didn’t want to be anywhere near it- near him. Not after he’d shut her out, leaving her dazed and cold. She hated the thought of going back to the kitchen, sitting there with everyone and having to pretend she didn’t want to throttle Griffin until he went blue.

She had gone back for him.

She’d watched a man shoot himself in the face- the horror of it still twisting behind her eyelids.

She had gone back to help, to give Griffin a chance, and after all of that- after everything she’d been through- he couldn’t even look her in the eye.

Maybe she was wrong. Kaelin wouldn’t have Griffin begging in two minutes, she would have skinned him in thirty seconds.

Yanking on a fresh pair of jeans and a clean tee shirt, Nikki kicked her bag back into the corner it had been in and stomped her feet back into her sneakers. Griffin was going to explain himself. Now.

She jogged down the stairs and rounded the banister, catching the tail end of Boz’s statement.

“… I guess I can try remote access but that’ll take longer.”

“Boz, you’ve cracked bigger systems in your sleep,” Lisa commented over the lip of her mug.

“Yeah, but with everything going on-”

“Just try it,” she said. She acknowledged Nikki with a nod. “Hey.”

“Where’s Griffin?” Nikki asked, knowing she sounded angry.

Lisa glanced over to the adjacent hallway. “He’s-”

“Thanks,” she said, moving into the dimly lit corridor just as Griffin stepped out of Boz’s office, staring down at his phone. When he saw her he slowed his gait but he didn’t say anything.

She steeled herself, blocking his path. “We need to talk.”

His expression was hard but his stare wavered momentarily. Good, he was worried.

Griffin hesitated before asking, “Can it wait?” Slipping his phone back into his pocket.

Nikki wanted to scream, No, this can’t wait, you asshole.

She started to do exactly that when Griffin cut her off.

“Amsterdam just called. He wants us over there in fifteen minutes.”

Oh for God’s sake… Folding her arms, Nikki bit out the word, “Fine.”

“Okay.” Griffin dropped the word like a stone in a bucket. He waited several beats before lifting his eyebrows in question. “So, if we’re leaving, then we should…” He trailed off, jerking his chin towards the main room.

Nikki spoke through clenched teeth. “Yeah. Sure.”

Griffin brushed passed, refusing to look at her. It stung worse than any insult.

Eventually trailing behind him, Nikki found herself in the kitchen, ignoring Lisa and Boz’s probing stares.

Lisa lowered her coffee mug, eyeing the two as they hovered awkwardly near the table. “Is everything-?”

Griffin wouldn’t let her finished the question. “John wants us at his place ASAP.”

“Cool,” Boz said, hopping up. “I’ll bring my laptop and work from there.”

“Boz-”

“No. Nope. We’re not doing this again,” he said, holding up his hand. “Lisa, me, Beulah-” he gave the laptop a gentle pat “-We’re all coming.”

Pulling his coat and holster off the back of his chair, Griffin started towards the door. “Fine. You’re driving.”

#Children of Lilith #free fiction #free novels for pandemic times #my writing #my work

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