#because I literally have my respiratory exam next week

[goldenorder]

I know you all are likely sick of these kinds of posts, but my Neuro final is today 🙏

[ratralsis]

Brief update

I haven't written anything long in a while because I haven't had a ton of time.

My latest writing class ended a few weeks ago. The course report I filled out wound up hurting my tutor's feelings so much that, even after I wrote multiple emails apologizing, she didn't want to continue tutoring me in the next class. I didn't think anything I wrote in the report would surprise her, but I was wrong.

It's what I get for trying to be honest. I wound up saying at the end of my apology email that they should either ask me for my feedback more often than one time at the end of the course, to avoid being surprised like that again, or not ask for it at all. I'll do the work either way.

Writing classes are hard work. I don't view them as supposed to be fun. I can write for fun on my own time. And I do. You have no idea how much I cracked myself up writing last month that showing a non-gamer a photo of Squall from FF8 would literally kill them, and that the UN is actually an organization devoted to wiping FF8 from the Earth. That's fucking hilarious to me, man. Love that shit. Didn't get a single note. Most of what I write doesn't. Doesn't bother me. It did bother me when that Doctor Worm story didn't get any notes. I've said that before, but it does still bug me a little. That was a good fucking story, and I don't care who says it isn't.

My cat, Tina, nearly died of some kind of nasal blockage or respiratory infection. For $65, she got a quick exam from a vet and some amoxicillin, and now, nine days after starting that (and with a couple of days left of the stuff to go), she seems much better. But she hasn't jumped or run to play with the cat toy in over a month. I think that her new normal will never be as good as it was even three months ago. That's life. The vet she's "doing great for her age." Her age is 89 in cat years. "Alive" is great. "Typical for her age" would be dead. It's like if you went to the gym and saw an 89-year-old woman walking on a treadmill going 3 miles per hour. "Wow," you'd say. "A twenty-minute mile? That's great for her age." But that's because most people who were born 89 years ago can't walk at all, because they're fucking dead. So are most cats who were born 18 years and three months ago, so, yes, Tina is doing great for her age.

I discovered a small leak in the roof of my garage this afternoon. I called my home insurance company and will hopefully have someone able to give me an estimate on what it will take to fix it soon so that I can determine if I need to make a claim or not. There have been multiple bad storms where I live recently, just like there have been literally everywhere on the continental US recently. Where I live has been pretty mild, comparatively.

I'm hoping it won't cost more than a couple thousand dollars to fix. I can afford that much, though it will hurt, a lot. I've been saving like crazy all year, and that will undo much of that saving, but it won't even put me as low as I was last year when I was literally begging for money on the internet.

It's been over two months since I said on my Animal Crossing blog that I would post my photos from Leap Day and the few days before it. I haven't done that yet, and that really does upset me. I try hard to be a man of my word.

I'm not talented. I'm not charismatic. I have very few innate abilities. There's only one thing I know how to do, and that's put in the work. I updated that Animal Crossing blog every day for nearly a decade, so believe when I say that 1) I know a fucking thing or two about a work ethic, and 2) I'm sorry I haven't posted those photos yet. It's been difficult to do much writing lately that isn't for my novel.

I had to throw away everything I'd been working on on the latest draft about three months into my last class. I'm still working on catching up. I have sixty days before the next class starts. I have ten chapters left to write before I can call this draft done. Can I do it? Of course I can. Who the fuck do you think I am?

But it means I don't have a ton of time to write for fun, or watch TV for fun, or play video games for fun, or anything for fun. Every night, after dinner, it's an hour of writing, at least.

It's not supposed to be fun. Even chess grandmasters, the ones who love the game so much that they become the best in the world, don't get that good by playing casually. They work at it. The only way to get to that kind of level is to work at it.

There's no such thing as good enough. There's better than the last thing, which is always possible, and there's perfection, which never is. That's all there is.

I'll be better later. Probably. I don't like to complain, so I try very hard to do it very rarely, but sometimes I go so long without saying anything at all that I think even complaining might be better than nothing.

Let me know if I'm wrong.

Let me know if I'm right.

Let me know anything at all. I don't like screaming into the void like this, but I sure have been doing it for over twenty years, haven't I.

[doodlebuggity]

Testimony of a surgeon working in Bergamo, in the heart of Italy's coronavirus outbreak.

“There are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.”

Daniele Macchini works in Humanitas Gavazzeni Hospital, Bergamo in Italy. This is a directly translated account of his experience there. It was written on March 7th, 2020. Italy has since gone into lockdown.

“In one of the non-stop e-mails that I receive from my hospital administration on a more than daily basis, there was a paragraph on "how to be responsible on social media", with some recommendations that we all can agree on. After thinking for a long time if and what to write about what's happening here, I felt that silence was not responsible. I will therefore try to convey to lay-people, those who are more distant from our reality, what we are experiencing in Bergamo during these Covid-19 pandemic days. I understand the need not to panic, but when the message of the danger of what is happening is not out, and I still see people ignoring the recommendations and people who gather together complaining that they cannot go to the gym or play soccer tournaments, I shiver. I also understand the economic damage and I am also worried about that. After this epidemic, it will be hard to start over.

Still, beside the fact that we are also devastating our national health system from an economic point of view, I want to point out that the public health damage that is going to invest the country is more important and I find it nothing short of "chilling" that new quarantine areas requested by the Region has not yet been established for the municipalities of Alzano Lombardo and Nembro (I would like to clarify that this is purely personal opinion). I myself looked with some amazement at the reorganization of the entire hospital in the previous week, when our current enemy was still in the shadows: the wards slowly "emptied", elective activities interrupted, intensive care unit freed to create as many beds as possible. Containers arriving in front of the emergency room to create diversified routes and avoid infections. All this rapid transformation brought in the hallways of the hospital an atmosphere of surreal silence and emptiness that we did not understand, waiting for a war that had yet to begin and that many (including me) were not so sure would never come with such ferocity (I open a parenthesis: all this was done in the shadows, and without publicity, while several newspapers had the courage to say that private health care was not doing anything).

I still remember my night shift a week ago spent without any rest, waiting for a call from the microbiology department. I was waiting for the results of a swab taken from the first suspect case in our hospital, thinking about what consequences it would have for us and the hospital. If I think about it, my agitation for one possible case seems almost ridiculous and unjustified, now that I have seen what is happening. Well, the situation is now nothing short of dramatic. No other words come to mind. The war has literally exploded and battles are uninterrupted day and night. One after the other, these unfortunate people come to the emergency room. They have far from the complications of a flu.

Let's stop saying it's a bad flu. In my two years working in Bergamo, I have learned that the people here do not come to the emergency room for no reason. They did well this time too. They followed all the recommendations given: a week or ten days at home with a fever without going out to prevent contagion, but now they can't take it anymore. They don't breathe enough, they need oxygen. Drug therapies for this virus are few.

The course mainly depends on our organism. We can only support it when it can't take it anymore. It is mainly hoped that our body will eradicate the virus on its own, let's face it. Antiviral therapies are experimental on this virus and we learn its behavior day after day. Staying at home until the symptoms worsen does not change the prognosis of the disease. Now, however, that need for beds in all its drama has arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the sicks, of different colors depending on the department they belong to, are now all red and instead of the surgical procedure, there is the diagnosis, which is always the same: bilateral interstitial pneumonia.

Now, tell me which flu virus causes such a rapid tragedy?

Because that's the difference (now I get a little technical): in classical flu, besides that it infects much less population over several months, cases are complicated less frequently: only when the virus has destroyed the protective barriers of our airways and as such it allows bacteria (which normally resident in the upper airways) to invade the bronchi and lungs, causing a more serious disease. Covid 19 causes a banal flu in many young people, but in many elderly people (and not only) a real SARS because it invades the alveoli of the lungs directly, and it infects them making them unable to perform their function. The resulting respiratory failure is often serious and after a few days of hospitalization, the simple oxygen that can be administered in a ward may not be enough. Sorry, but to me, as a doctor, it's not reassuring that the most serious are mainly elderly people with other pathologies. The elderly population is the most represented in our country and it is difficult to find someone who, above 65 years of age, does not take at least a pill for high blood pressure or diabetes.

I can also assure you that when you see young people who end up intubated in the ICU, pronated or worse, in ECMO (a machine for the worst cases, which extracts the blood, re-oxygenates it and returns it to the body, waiting for the lungs to hopefully heal), all this confidence for your young age goes away.

And while there are still people on social media who boast of not being afraid by ignoring the recommendations, protesting that their normal lifestyle habits have "temporarily" halted, an epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.

The cases multiply, up to a rate of 15-20 hospitalizations a day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the emergency room is collapsing. Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how the to use to emergency room EHR and a few minutes later I'm already downstairs, next to the warriors on the war front. The screen of the PC with the chief complaint is always the same: fever and respiratory difficulty, fever and cough, respiratory insufficiency etc ... Exams, radiology always with the same sentence: bilateral interstitial pneumonia. All need to be hospitalized. Some already need to be intubated, and go to the ICU. For others, however, it is too late. ICU is full.

And when ICUs are full, more are created. Each ventilator is like gold: those in the operating rooms that have now suspended their non-urgent activity are used and the OR become a an ICU that did not exist before. I found it amazing, or at least I can speak for Humanitas Gavazzeni (where I work), how it was possible to put in place in such a short time a deployment and a reorganization of resources so finely designed to prepare for a disaster of this magnitude. And every reorganization of beds, wards, staff, work shifts and tasks is constantly reviewed day after day to try to give everything and even more. Those wards that previously looked like ghosts are now saturated, ready to try to give their best for the sick, but exhausted. The staff is exhausted. I saw fatigue on faces that didn't know what it was despite the already grueling workloads they had. I have seen people still stop beyond the times they used to stop already, for overtime that was now habitual. I saw solidarity from all of us, who never failed to go to our internist colleagues to ask "what can I do for you now?" or "leave that admission to me, i will take care of it." Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we are unable to save everyone and the vital signs of several patients at the same time reveal an already marked destiny.

There are no more shifts, no more schedules.

Social life is suspended for us. I have been separated for a few months, and I assure you that I have always done my best to constantly see my son even on the day after a night shift, without sleeping and postponing sleep until when I am without him, but for almost 2 weeks I have voluntarily not seen neither my son nor my family members for fear of infecting them and in turn infecting an elderly grandmother or relatives with other health problems. I'm happy with some photos of my son that I look at between tears and a few video calls. So you should be patient too, you can't go to the theater, museums or gym. Try to have mercy on that myriad of older people you could exterminate. It is not your fault, I know, but of those who put it in your head that you are exaggerating and even this testimony may seem just an exaggeration for those who are far from the epidemic, but please, listen to us, try to leave the house only to indispensable things. Do not go en masse to make stocks in supermarkets: it is the worst thing because you concentrate and the risk of contacts with infected people who do not know they are infected. You can go there without a rush. Maybe if you have a normal mask (even those that are used to do certain manual work), put it on. Don't look for ffp2 or ffp3. Those should serve us and we are beginning to struggle to find them. By now we have had to optimize their use only in certain circumstances, as the WHO recently recommended in view of their almost ubiquitous running low. Oh yes, thanks to the shortage of certain protection devices, many colleagues and I are certainly exposed despite all the other means of protection we have. Some of us have already become infected despite the protocols. Some infected colleagues also have infected relatives and some of their family members are already struggling between life and death. We are where your fears could make you stay away. Try to make sure you stay away.

Tell your family members who are elderly or with other illnesses to stay indoors. Bring him the groceries please. We have no alternative. It's our job. Indeed what I do these days is not really the job I'm used to, but I do it anyway and I will like it as long as it responds to the same principles: try to make some sick people feel better and heal, or even just alleviate the suffering and the pain to those who unfortunately cannot heal. I don't spend a lot of words about the people who define us heroes these days and who until yesterday were ready to insult and report us. Both will return to insult and report as soon as everything is over. People forget everything quickly. And we're not even heroes these days. It's our job. We risked something bad every day before: when we put our hands in a belly full of someone's blood we don't even know if they have HIV or hepatitis C; when we do it even though we know they have HIV or hepatitis C; when we stick ourselves during an operation on a patient with HIV and take the drugs that make us vomit all day long for a month. When we read with anguish the results of the blood tests after an accidental needlestick, hoping not to be infected. We simply earn our living with something that gives us emotions. It doesn't matter if they are beautiful or ugly, we just take them home. In the end we only try to make ourselves useful for everyone. Now try to do it too, though: with our actions we influence the life and death of a few dozen people. You with yours, many more. Please share and share the message. We need to spread the word to prevent what is happening here from happening all over Italy.”

His original Facebook post.

Italian newspaper (Corriere della Sera, edizione di Bergamo) transcript.

[bookwormbambi]

Mega Update!

05/05/2019

Hello my friends! Sunday is here and that means that it is time for some big updates and I’m so excited that I’m practically jumping out of my chair (although all of the coffee may have contributed to that one).

So on the list of more recent things I just celebrated my 22nd birthday on Monday and I am so so grateful for all of the love and kindness that had been sent my way and I just really love everyone :-)

I’m also now about four months into my new job in restaurant management and it’s a bit crazy still but we do feel a lot more settled in and I feel a lot more knowledgable about my job. My schedule has been fairly hectic but I told them when they hired me that I would be going back to school in June which they are fully prepared for. Everyone’s been great, and I’ve been very grateful for the new experience and the learning experience that comes with first time management. I still have so much to learn but honestly I feel right at home with all of the work I do with people, and I feel like the skills I’m learning are great stepping stones when it comes to patient care, because the main thing I’m learning is how to work with people, to be more empathetic, and to motivate. Obviously restaurant life is a bit different than medicine, but it is a good stepping stone, at least in my opinion.

So that’s a little bit about my personal life, but I know that what y’all are really here for is the school updates. I’ve been teasing this new school program for months now and I’ve been waiting for so long to give you all some real updates. For a long time I was just waiting, and the plan was to make a sort of mini-series about the process of applying and (hopefully) getting in, but then everything went down in the course of a few days and I’m actually already at the end of the application process when I literally just turned the app in five days ago.

So, let’s talk about it.

If I haven’t already stated it, the program that I’m applying for is Respiratory Therapy. It’s a two-year program that ends with my receiving an Associate’s Degree in Science, as well as eligibility for board certification to become a licensed Respiratory Therapist and be in the field by the time I turn 24.

I first learned about this program about a year ago through a friend. Her boyfriend at the time was actually in the previous class and it actually came up in passing just from her telling me about how busy he was all the time. I was looking into other programs one day and saw RT pop up and I remembered her mentioning it, and I decided to look into it a bit more because, honestly, I had no idea what RT really even was, or what they did. The more I researched, the more intrigued and excited I got, and the more I could picture myself actually doing this sort of thing.

At the time the course was already in session, and the website said that the next application window would not be open until February 2019, so I waited. When February came along I checked the website every day waiting for the app to be posted and it actually wasn’t up until the 1st of March. I checked the website on a whim because I was in bed with the flu and bored and miserable and needed ANYTHING to get my mind off of how sick I was (and brother I was SICK). I printed out the application and filled it out without really reading the information packet because I was sick and reading was for losers who were healthy I guess. So I sat on the application for a little while because I knew that, at the very least, there was a $100 application fee which was not readily available to me because I had just started my new job, the restaurant had only just opened, and I was still doing a lot of transitioning with bills and insurance and all of that boring stuff.

When I finally mended I was ready to go to the school to turn the application in, and went through the information packet to figure out who I was actually turning it in to, when I found out I actually needed copies of my high school and college transcripts, and I had no idea how to get them. So I sat on the app for a few more weeks while I figured it out, ordered them, waited for them to get to me, etc. Then I got my transcripts and once again did not have an extra $100 lying around to go turn the app in. Or, when I did, I didn’t have the time to go to the school because my work schedule kept getting in the way.

So on my birthday (Monday) I asked my sister to take me to the school before we went on our outing so I could turn it in, because the application was due by 2 May (which was Thursday) and I was officially running out of time. So we decided we could be a little late to our lunch plans to turn it in.

The application alone is just the first part of everything. Once you turn it in, you have to take the TABE test (which is the Test of Adult Basic Education), along with five additional comprehensive math questions, and then you receive a date and time for your interview with the head of the department, some program alumni, and representatives from the hospital. My assumption was that once I turned in the application I would get an email telling me when the test was and that it would be like two or three weeks away, and that we’d go from there.

NOPE.

I went to the registration office, paid my application fee, then went to the counseling office to deliver the application, my receipt, and my transcripts. For starters, she was very pleased that I already had the fee and the transcripts taken care of. Then she told me the test was on Thursday (three days away) at 3pm.

So here I am, panicking a little bit because of how fast everything was moving, and I told her that I would be there, no problem, thanked her for her time, and went on my way back to our car. I had no idea what to expect from this test and having only literal days to prepare was not helping the anxiety.

So Thursday came along, I was able to get out of work a little bit early to have extra time to get to the school (which is only a little ways down the road) and get to the test. There was an optional information meeting beforehand which I was only able to make the last twenty minutes or so of, but I got the gist of everything, and it only made me more excited about the program. I met the head of the program, he seemed very kind. Then it was test time.

So the TABE is a 1 hour exam that tests basic reading, math, and grammar skills. Kind of like the standardized testing I had to take when I was in school. I took a semester off so I was a little rusty with quick test taking (each portion was roughly thirty questions with roughly fifteen minutes each) but I got through it, and I’m actually pretty sure I nailed it. The additional comprehensive math questions were a little bit tougher, but I feel pretty good about those too. These were five questions crafted by the department head which, according to him, were designed more to test out problem-solving abilities, and even if the answer itself wasn’t right, you’d still get points for how you got to your conclusion. Really only the last problem threw me, and I was feeling a bit rushed, but I got through it.

So I finished up, handed in my exam, and was given a slip of paper with my interview date and time - Tuesday at 2pm. Tuesday is, as I write this, the day after tomorrow. I’m stressing about the interview but he did tell us that the majority of the questions have nothing to do with Respiratory Therapy, but I will be asked about how well I understand what the program is, and, obviously, why I want to do this. I’ll also be asked basic things about who I am as a person to see if I would be a good fit. After that, I wait for the email telling me if I have been accepted, or if I am an alternate. If I’m accepted, I pay the tuition fee (which is not cheap and will require a loan), and classes start on 10 June.

So, what determines acceptance? Every year the program accepts a maximum of thirty students. The application process is all point-based. The thirty students with the most points will be accepted. Everyone else will be placed as an alternate, meaning that if someone who is accepted withdraws for whatever reason, an alternate can take their place, and will be asked in the order of their rank. 

So now I’m going to spend the next two days prepping for this interview, which is going to be my very first interview that has anything to do with my career. Medicine has been my passion for as long as I can remember, and Respiratory Therapy feels like my true calling. I’m nervous, but I’m so excited. xx