#without my family i would have been living in a bus stop enclosure by now

[jcbmcdrmtt]

Sorry if I am not as good about tagging stuff for the foreseeable future. I shattered the screen of my tablet (to the point where there are chunks missing and glass dust coming off under your fingers and you can see the electronics under the screen), and I normally use that + a keyboard case to browse tumblr. I’m using my phone now which means a.) no physical keyboard, and b.) I don’t have as much battery life so my time is more limited. I do not see a point where I can replace the tablet or get it fixed anytime soon either.

All that coupled with the fact that I normally use tumblr in a browser, not the mobile app, means it’s a lot harder to tag things now, especially if I can’t just tap to apply OP’s/the reblogger’s tags because they didn’t add any or i don’t like what they used etc.. Tumblr mobile is honestly tiny and kind of crap on my phone browser - the keyboard makes the screen elements squish together and some things like tag rearranging are broken.

TL;DR: You may possibly see more untagged posts from me in the coming weeks. I apologize, understand if you unfollow, and just. Yeah. I guess I just wanted to explain myself as I normally pride myself on my tagging etiquette.

[halothenthehorns]

All in the Family

Chapter 40: The Leaky Cauldron

Even before Peter's head had stopped spinning from their newest space he heard a door slam shut, and as his eyes focused on the surroundings he only saw four around him. Evans, Longbottom, and Smith had very likely gone into the first room they'd seen, away.

Blinking a few more times Peter found himself face to face with a crup, asleep at the moment curled up in the corner of its crate. Looking around more properly he recognized himself in the Magical Menagerie, he was leaning against the counter, and after hoisting himself to his feet found a pristine cage full of lively rats skipping happily about and a door beyond that, likely where the rest of their group had vanished to.

ames was already pacing in heated frustration, paying no attention to anyone around him with his continued mutterings. "Misunderstanding my arse, we just heard about Hagrid being taken to that place because of something he didn't do, but apparently it's the most mad thing on Earth for the same to have happened to Sirius. Thirteen people, thirteen years, this is a right load of-"

"I know that Prongs, we know that," Remus was still trying to soothe his temper, with good reason. They didn't have Snivellus here for him to vent on, and the niffler currently trying to escape its crate certainly didn't deserve his wrath any more than any other creature in here. "It just, shocked them I'm sure, caught all of us off-"

"Shocked! Yeah, that's a good one. Padfoot! Sirius, why the bloody hell didn't you-"

All three of them turned to find him right where he'd still landed, slumped against the back wall where apparently a billywig was usually displayed, though he wasn't spotting anything in there right now.

James finally vented some of his fury by clutching up the first thing his hand grabbed, a bag of rat feed off the counter, and chucking it at him. It collided just above his head and sprayed everywhere with still no reaction.

"The hell's the matter with you!" James stormed over to him still in a towering temper. "Why am I the only one-"

"What's shouting about it doing you? Any good? I don't think so!" Remus insisted, starting to look a little flustered himself as he looked desperately between the pair, and then finally to Peter as if actually thinking he'd have an answer for once. He just held his hands up in surrender, as lost for words as he had been during the last fight between his friends. He wasn't even sure if this was a fight, what did you call such a horrid accusation that Sirius wasn't protesting?

James began his pacing again as words echoed from outside the door about Harry spending his time in Diagon Alley of his own free will. He was grinding his teeth and muttering so furiously it was a wonder if he could even hear a word.

"Why weren't the names listed?" Sirius finally did speak up, when Harry would overhear passersby on the street talking of it so casually. "The, the ones who..."

Remus sat down beside him then, wrapping an arm around his shoulders while Sirius kept his knees tucked to his chest. James deflated slightly, but his need for action against this still wouldn't slow even as he answered a touch more calmly. "Ah, I'm sure they are at the bottom or something, probably that Shunpike guy just, you know, didn't read it."

"It, very well might have been us though," Peter grudgingly acknowledged what he thought Sirius might be thinking. "You got the blame for something happening, but the two of us were there, for some reason, and something happened."

"Said a Muggle was present, for all we know that could have been the target and things got out of hand. Merlin knows that sounds like something you'd get caught in," Regulus offered quietly, shuffling over by the front door as he looked uneasily from this room to the street. It was very clear he had no want to join the others upstairs now, but he still didn't feel secure in here with them.

Sirius didn't look particularly relieved, but he did marginally seem to come to grips with this idea now that there was some sort of explanation in the air. Even just Regulus speaking again, the first time he'd made any attempt to do so since the revelation of You-Know-Who had been announced, eased just some part of him. Of course the paper would take his name and slander the rest, come up with some cock-and-bull story about him being on the Dark Lord's side and blame him just like Hagrid had for being a half-giant so of course he'd been the cause of that Chamber mess no matter how little sense it made when you stepped back to look at it.

The majority of what they heard of the book wasn't particularly noteworthy, Ron and Hermione arriving, Ron's little pet rat apparently was sick and Hermione got her hands full with a new cat, literally. Glancing up at the shelves now he spotted it quickly enough, the squashed face wasn't hard to miss among the sleek breeds. Crookshanks was perched right on the edge of his enclosure, already out and free again, watching everything below with intelligent yellow eyes that frankly gave Sirius the creeps to stare at too long.

Then the fight with Molly and Arthur was overheard, and Sirius had to painfully remember how to swallow again. Remus tightened his arm around him and scooted just a bit closer with a scowl in place, while his other two friends began saying terse things of rebuttal to every horrible thing those Weasleys had to say about him. Sirius found himself as flush with gratitude for them as he had been with worry in the first place.

For the first time, he really thought about his life in this future without Prongs, what must be going through his head for all of this. It seemed he'd look past this heinous crime, possibly even seek Harry out and somehow reveal the truth to him. It's not like he had anyone else to turn to? It made some sort of sense, why Harry would have spotted a black dog around him, Harry seemed to be the only link he had left to the life around him.

Reaching up, he grasped Remus' hand on his shoulder and held it for a few moments longer than strictly necessary, just breathing again which he swore he hadn't done for the remainder of that bus ride. He grinned at Prongs and Wormtail, even Regulus for not running off the second they heard this. He didn't care what the rest of the magical world thought, he'd long since learned to ignore the student populace and this was no different. He had all the people he needed to care about right here.

[dvp95]

quiet on widow’s peak (13)

pairing: dan howell/phil lester, pj liguori/sophie newton/chris kendall rating: teen & up tags: paranormal investigator, mystery, online friendship, slow burn, strangers to lovers, nonbinary character, trans character, background poly, phil does some buzzfeed unsolved shit and dan is a fan word count: 4.3k (this chapter), 42.9k (total) summary: Phil’s got a list of paranormal experiences a mile long that he likes to share with the world. Abandoned buildings, cemeteries, and ghost stories have always called his name, and a particular fan of his has a really, really good ghost story.

read this chapter on ao3 or here!

Phil is herded out of the house before he can shower, style his hair, or put in his contacts. As soon as his clothes are finished drying, his parents are pushing him and all of his bags out the door.

“We’ve got someone coming to see the house,” his mum had explained in that half-frantic voice he associates with company arriving. “You’ve got somewhere to be, haven’t you?”

He doesn’t have the gumption to explain that he’s still got hours before he has to be anywhere. Instead, Phil just hoists his bags higher on his shoulders and sets off for the bus stop. The wind isn’t bad today, thank goodness for small mercies, but it still isn’t pleasant to be outside in November. He pushes his floppy, unwashed hair off his forehead and reluctantly sends Dan a message.

It’s still pretty early and Dan might be in class by now, so he doesn’t expect an immediate response. He’s halfway through a Buzzfeed article and leaning against the shaky bus window by the time his phone buzzes.

im omw from class now just meet me at my place

An address follows, close enough to the coffee shop and the Wilkins place for Phil to feel comfortable finding it. He’s not sure how comfortable he is with being in such a small, private place with Dan before spending most of the night with them. He wonders if his brewing feelings and abject confusion surrounding them will be obvious.

Phil bites his lip and taps away from the article. He’s not sure where to start, but he thinks it’s about time that he started looking into gender stuff. He’s lived with PJ for almost two years and been friends with him for longer, but this isn’t something they tend to talk about. Technically, he hadn’t even been told, he’d just picked up on it from conversations around the old Brighton house. PJ isn’t in the closet, but he seems to have the same attitude about his gender identity that Phil has about his sexual identity - it isn’t anyone’s business unless they’re actively pursuing him.

This isn’t about PJ, though. Phil can’t pretend like these bewildered Google searches are in any way an attempt to understand his friend better. This is about Dan.

--

“Dan?”

The girl looks confused enough that Phil thinks he’s gotten the wrong flat for a horrified moment, but then her brow uncreases and she laughs.

“Oh, duh. Sorry, she doesn’t have many people coming to visit.” She waves Phil inside and eyes his bags. “Especially not many that look like they’re moving in. You planning on staying long, mate?”

“Just the night,” Phil says, more or less honestly. His brain is still stuck on the new pronoun. He knows that Dan is fine with any pronouns, and that includes feminine ones, it just feels strange to have someone use the opposite of what most people might assume. “Er, my parents are selling their place and needed my junk out of the way.”

She nods and gestures deeper into the flat. It doesn’t have as many doors as the Brighton house that Phil shares with a rugby team’s worth of people, but it’s still enough to overwhelm him a bit. Seemingly in response to whatever panicked expression finds its way to Phil’s face, the girl laughs. “Winnie’s room is at the end of the hall,” she says. “Her name’s on the door, you can’t miss it.”

“Her name being Winnie,” Phil says slowly.

“That’s what she wants us to call her,” the girl says. There’s an edge to her voice now, a sort of protectiveness that Phil doesn’t know how to respond to.

Phil gives her an uncertain sort of smile and heads down the hallway. The common areas are surprisingly tidy for a student flat, but he still doesn’t feel comfortable there. He finds himself in front of a dark wooden door with a Winnie the Pooh poster stuck to it. It’s not exactly a nameplate, but Phil understands why their flatmate said that.

He knocks lightly, not wanting to disturb the other people who live here and might still be asleep. It’s barely past noon, after all, and Phil remembers what it was like to be a student. Hell, he doesn’t really have a proper sleep schedule now.

“Come in!”

Dan’s room is darker than the rest of the flat, and Phil has to let his eyes adjust for a moment as the door closes behind him. There are blackout curtains over the single window and fairy lights draped over every possible surface, giving the whole place a soft vibe. Phil doesn’t see Dan at first, but then he realises that they’re on the floor with -

“Is that a weasel?” Phil asks without bothering to say hello, dropping his bags carefully. The last thing he wants to do is scare the creature that’s scampering all over Dan’s shoulders and arms.

“Excuse me,” Dan laughs. They hold out the animal for inspection, and Phil joins them on the floor. “This is Tofu, he’s a ferret.”

“Hello, Tofu,” says Phil. He reaches out to gently take the ferret’s paw between his thumb and finger, and he pretends like they’re shaking hands. Dan laughs again, bright and happy, and Phil decides that he really likes seeing Dan in their comfort zone. “It’s very nice to meet you! I’m Phil.”

Tofu makes a squeaking sort of noise and wiggles out of Dan’s hands to roll around on the carpet.

“He’s kind of an idiot,” Dan says fondly. “Pixel is the smart one in this family, but she’s sleeping.”

Phil’s eyes follow Dan’s vague gesture to a surprisingly large, multi-level enclosure. There’s another ferret curled up in there, and Phil assumes that’s Pixel. “Exactly how many weasels do you have?”

“Just the two,” says Dan. They’re smiling so wide that Phil can’t bring himself to look away. Their lips are a dark shade of red, or maybe burgundy, but it’s hard to tell in the low lighting. The dark lines around their eyes are even more shadowed with it, though, and it’s an entrancing sort of effect. “Originally it was just the one, but she got so lonely. I should have gotten an introverted animal, I guess, if I didn’t want multiple, but I didn’t mind. Pixel wanted a buddy, so. Pixel got a buddy.”

“I think even introverts need buddies sometimes,” says Phil.

He’s suddenly so self-conscious about being here in his current state. He’s wearing his trusty denim on denim, which he knows suits him fine, but he’s also got his clunky glasses and can’t remember if he put deodorant on or not. Dan, on the other hand, looks as stunning as always.

That gets even more obvious as they lounge out a bit, uncrossing and stretching their long legs. Their leggings are tight and translucent enough that Phil might find them indecent if there weren’t a short, swishy skirt covering the important bits. When Dan stretches their arms out, too, their unbuttoned flannel falls further open and shows off the cropped band tee underneath.

Most of Dan’s body is covered, really. Only their hands and neck and navel are out, but that’s enough to make Phil’s brain short-circuit. Their hands are distractingly big, but still so gentle when they pick Tofu back up; their neck is long and ends in either a sharp clavicle or a soft, rounded jawline; their tummy is soft like the rest of them and there’s a simple barbell piercing through their belly button that Phil has to force himself to look away from.

“Have you talked to your friends about us going back?” Dan asks, seemingly oblivious to the way Phil is taking them in from head to toe.

“What?” Phil bleats, and then his brain catches up to the conversation before Dan can repeat themself. “Oh, yeah. I texted them about it, and they’re a bit worried, but they’re glad you’re coming along. They were pretty nervous about me doing this alone.”

“PJ said you tend to do stupid shit,” Dan says bluntly. Tofu is climbing up their arms and biting at their hair, but they don’t even react.

“When did PJ say that?”

Dan’s lips curve into a smile. “When he drove me home. We talked about you.”

Normally, a statement like that would make Phil anxious. He still feels it, a bit, that creeping sense of frustration and nervousness that he associates with mild anxiety, but it’s more dull than it would be if Dan wasn’t smiling at him so softly. Something about it makes Phil certain that he’d get an honest answer if he asked what they all said about him.

That certainty and budding trust are enough to keep his loud anxiety at bay, and Phil finds that he doesn’t feel the need to ask.

Instead, he looks around Dan’s room some more. Pixel is still napping soundly, and Phil doesn’t blame her - the room is so quiet and dim and full of pleasing scents from the candles on Dan’s nightstand, Phil can easily imagine curling up somewhere soft in here and nodding off.

The furniture itself is crappy in the way that most students have to deal with, but Dan seems to have an eye for design that Phil has never had. Sure, there’s no bed frame to hold Dan’s mattress, but their duvet matches the monochrome colour scheme of the posters and paintings on the walls, and their pillows look welcoming surrounded by a small collection of stuffed animals. Their desk is organized, but their closet is open and spilling clothes onto the floor a bit. Phil wonders if that’s something Dan had planned on fixing before he got here, or if Dan doesn’t mind having their dresses and jeans and boots on display.

There’s barely any colour at all, really, but it doesn’t feel depressing like Phil would have thought it might.

That’s not exactly true. There’s some colour.

Phil must be looking at the flag on the wall for too long, because Dan makes a humming sort of noise and breaks the comfortable quiet. “I know it’s a bit tacky,” they say, “and it doesn’t match, but… I dunno. I wasn’t able to be out until I got to uni, and I might have gone a bit nuts with it.”

“Yeah,” says Phil. His throat is a bit dry. “I can understand that.”

“It makes me feel safe,” says Dan. Phil turns to look at them again, but he regrets it as soon as he sees the genuine emotion in Dan’s wide eyes. He isn’t good with that. “Like. Knowing I can have it hung here, that I can be open with people without them being upset with me or something. I don’t think the flag itself makes me feel safe? But maybe that’s not true, either. Maybe embracing that part of myself helped me embrace the community as a whole. I haven’t done Pride yet or anything. Maybe next year. But - safety. Comfort. Y’know?”

“I do,” Phil says quietly. “I do know.”

Dan’s eyes go sharp. Phil hasn’t seen them do that before, and it’s unnerving how much it feels like his very soul is under scrutiny. He wants to squirm away from that feeling, doesn’t want any part of himself under a microscope, but he doesn’t want to run like he might normally.

There’s another moment of quiet, where Dan looks at Phil and Phil doesn’t look away, but of course Phil is the first to break.

“Which of those is your favourite?” he asks instead of saying the words he knows Dan is waiting for. He doesn’t want to run, but that doesn’t mean he needs to be more forthcoming. At Dan’s furrowed brow, Phil gestures to the bookshelf. Dan has a lot of books and movies and boxsets and textbooks, more than Phil can take in all at once. “The, uh, the anime. My favourite’s Fullmetal Alchemist. Er, Brotherhood, not the first one, but both are good.”

For a second, it doesn’t seem like Dan is going to allow him to change the subject so easily. But then Tofu bites at their ear and they’re both giggling, the intensity of the moment slinking off to make way for casual conversation.

--

Talking to Dan is easier than talking to some people that Phil has known for years. They put on a show that they’ve both seen and enjoy and they chat the whole time. Phil points out camera and editing choices that Dan hadn’t put much thought to before, and Dan rambles about theories they’d seen on Reddit for so long that Pixel has become Phil’s best friend by the end of it. Dan makes food at some point, their brief absence allowing Phil to look more carefully at the titles on their shelves. They have even more to talk about when Dan gets back, because Phil has a lot of opinions on some of the quote-unquote ‘classics’ that Dan reads and Dan has some opinions on Phil picking the cheese off his sandwich. Phil almost forgets that he’s here for a specific reason, that they aren’t just friends hanging out, until Dan brings out their Polaroid and starts asking questions about what to expect on the haunt.

Phil kind of wishes they could just stay here.

--

Before they left, PJ, Sophie, and Chris had all drawn several Sharpie sigils on a thin piece of scrap fabric and insisted that Phil tie it around his wrist or something. He takes it out of his pocket as he and Dan approach the house.

“Here,” he says, pulling them to a stop and rolling their sleeve up a bit. He ignores their big doe eyes and wraps it around their knobby wrist a couple of times. “Is that too tight?”

“No,” says Dan. They stay still while Phil ties it, and then they raise their hand to inspect it.

“It’s from the gang,” says Phil. “I know it seems like the sigils didn’t help last time, but - well, I dunno. Maybe they did help and it was going to be a lot worse without them. Or maybe they just rubbed off our skin too quickly. But, y’know, I know you don’t believe in this stuff, it just… it makes us feel better. I thought it would be a good placebo for you if nothing else.”

Dan touches the fabric and then smiles, looking for all the world like Phil has given them something precious.

“Thank you,” they say, their voice altogether too sincere for Phil to respond to without some major awkwardness. “What about you?”

“Oh, I’m already wearing my thing,” Phil lies. “C’mon, let’s get inside.”

The thing is, Phil figures Dan is the one who needs protecting from whatever is going on in the Wilkins place. They’re the one who got attacked last time, while Phil only dealt with flickering lights and the feeling of being watched. The last thing he needs is for Dan to insist on coming along again only to get themself hurt again.

He’s not sure if Dan believes him or not, but it doesn’t matter. Phil is already shouldering the back door open. He could climb through the window again with a boost from Dan, but he doesn’t think he has enough upper-body strength to pull Dan up after him.

The kitchen is as dark and dusty as ever, but that smothering, creeping feeling of eyes in the walls isn’t present. Phil stands still for a few seconds, waiting for it to wash over him again, but in the end he’s in the same place he figured he’d be from the beginning - listening to the creaking sounds of a house with absolutely nothing supernatural about it. He’s weirdly disappointed, but he imagines that Dan must be relieved.

He turns to Dan to see what they think, but their eyes are just as wide as they’d been the last time.

“Hey,” Phil says, quiet so as not to disturb the dust. “You feel something?”

“No,” Dan admits. They move closer to Phil, twisting their fingers into the cuff of his jacket and holding tight. It’s sort of sweet how they think he might leave them alone in this house, but it’s also somewhat of a nuisance to have a large person attached to him while he’s trying to move quietly.

“Then what’s wrong? Do you need to leave?”

Dan shakes their head. Their teeth dig into their dark bottom lip, and even though they reapplied their lip product before leaving the house, it still ends up on their teeth a little bit. Phil isn’t sure if he’s supposed to point it out or not. “I don’t need to leave or anything, it’s fine. I’m fine. Coming with you was the whole point. I just don’t… okay. Promise not to laugh at me?”

“I think I promise,” says Phil. He gives Dan a reassuring little smile. “But if you break into song and dance or something I reserve the right to change my mind.”

“Shut up,” Dan says, but they’re giggling. “No, I just… I just don’t like the dark, okay?”

It clearly takes something out of Dan to admit that. Phil shifts his hand so he can squeeze Dan’s. “Nobody really likes the dark,” Phil says. “I mean, it’s kind of my job, so I’m used to it, but I wouldn’t mind being somewhere brightly-lit and clean instead.”

“Thanks.” Dan’s cheeks look a bit darker, but that might just be the low lighting. “You can lead the way.”

--

Nothing happens.

There are spiders and dark corners and once or twice a loud noise from outside makes Dan jump and grab at his hand again, but Phil never feels like anything more is going to happen. The walls don’t have anything behind them except maybe rats, and even the attic simply makes Phil sneeze.

It’s frustrating. It’s almost worse than the night that he put his friends in danger, because at least then he knew that he could have a chance at a decent video. Now, there’s nothing to record.

Phil finds himself wishing for a flickering light or a quick shadow. He wants something, anything, to make him feel like he’s doing something productive with his life.

Instead, he just feels like he’s wading deeper into the confusion and shadows of his own future. He doesn’t know where he’s going to go if he can’t keep going back to the darkness of abandoned houses and old cemeteries. He went to uni, sure, but he hasn’t had a ‘real’ job in his life. Unless a month at the stationery store counts. He’s pretty sure it doesn’t. He wouldn’t even know where to begin with figuring out what he ought to be doing with his life if he isn’t chasing ghosts, but he’s not having fun with this anymore.

He’s twenty-six. It’s not old, he’s not old. He’s got plenty of time to figure his life out.

But if he’s spent the last decade wasting all his free time on something that isn’t enjoyable anymore, then he doesn’t know if he’s going to be able to forgive himself.

Dan is in his personal space again, pressing close to avoid the encroaching darkness, and they smell like… lavender. Phil remembers spice and mint from them, and he wonders if they’re wearing some kind of perfume today. It’s such a feminine scent that it’s hard for him to wrap his mind around the fact that he wants.

Further and further into the waters he goes. He doesn’t know what comes next for any of it, and it’s terrifying.

--

“We could stay all night again,” Phil is protesting, even as Dan frogmarches him down the back steps. “I know we didn’t find anything, but maybe it only works when you’re trying to sleep over? I could -”

“You’ll do nothing,” says Dan. “We are both going home, and I’m seeing you onto the bus so you don’t sneak back without me.”

Phil wants to object, but Dan tightens their grip on his arms like they know exactly what he’s going to say. Besides, it would probably be a lie. Phil is stressed and frustrated and in over his head, and if he could just get one clip or photo of this thing, then maybe everything will be okay. Maybe he can keep doing this after all.

He gently detangles himself from Dan and sighs, hoisting his backpack up. “Fucking… fine.”

“Fucking fine,” Dan repeats, their lips twitching.

“Maybe the sigils worked too well,” says Phil. He keeps his tone level so that Dan won’t be able to tell that he’s joking right away, but Dan shoves at his shoulder like they’re well aware of what he’s doing. “You know, I bet -”

“You’re annoying when you can’t do what you want, huh?” Dan interrupts. Their hands are shoved in their jacket pockets, but Phil wishes they weren’t. He wishes he could brush his hand against theirs as they walk and convince himself that it’s all an accident. “Bet that’s the baby brother in you.”

“No comment.”

The walk to the bus stop is quieter than the last time Dan walked him to it, but it's not uncomfortable. Phil can’t believe how much he cares about this person already. They’re friends, he’s pretty sure, and it’s impossible to deny how much this crush is starting to get to him. Still. It’s new, Dan is new, and Phil has to consider the possibility that the novelty is all he’s feeling.

It’s not. But he has to consider it, because Phil has to consider every possibility before he makes his mind up about anything.

“Hey,” Phil says, careful not to sound like he’s pushing.

“Hi,” says Dan. Phil isn’t looking at them, but he can hear a grin in their voice.

“I was just wondering,” says Phil. “I mean, you don’t have to tell me if it’s a sore spot or anything like that, but. Your flatmate said you were called Winnie. Obviously I know you go by Winnie online, but I didn’t know you did it, uh, outside of cyberspace.”

“Cyberspace,” Dan repeats like they can’t help themself. “Yeah, sometimes. I usually use it like a test.”

“A test?”

Dan hums. Phil wishes, again, that their hands weren’t trapped in the confines of their jacket. “For people I might get closer to. I ask my flatmates to call me something that’s clearly not masculine and see how they react and how often they slip up. Maybe it’s mean, I guess, since I don’t actually care one way or the other, but it’s a lot easier for me to open up to people who have already proven that they’re able to think of me outside of the Daniel box.”

“I can call you Winnie,” Phil offers. “If that’s what you want to be called. And I’m not a complete idiot, I’m sure I could remember to call you Dan when I’m bothering you at work.”

“Planning on bothering me at work some more?” Dan asks. They don’t wait for an answer. “No, I like Dan fine. They’re both fine. They just serve me different purposes, I guess, and I’m not bothered by either of them.”

“I don’t totally get it,” Phil admits. “But I’ll do whatever you want.”

“I know.”

Suddenly, Dan is tangling their long fingers with Phil's. It’s just for a second, long enough for the same sort of reassuring squeeze that Phil gave to them in the Wilkins place, but it makes Phil’s heart jump into his throat.

“You’re, like, overly considerate,” says Dan. They sound like they’re teasing - Phil hopes they’re teasing. He really, really doesn’t want to mess this up.

“I just think you should be able to, like, tell me if I do something wrong.”

Dan laughs. “You’re not getting it. That’s okay, you don’t have to get it. I will tell you if you do something wrong, I just have a really wide range of things I’m indifferent about before you get to the things that matter. Call me a boy or a girl or whatever, I don’t care. Try to imply that my favourite Pokémon is fucking Goldeen, on the other hand -”

They ramble all the way to the stop, and Phil finds himself feeling better despite the fruitless hours of wandering a dusty house.

“This is me,” Phil says as he sees headlights coming down the street towards them.

“Message me tomorrow,” Dan insists. For a moment, they’re both just standing there. Phil has no idea what he’s supposed to do in this situation. Surely a handshake would be weird, but would a hug be weirder? Should he just pat their shoulder, or is that absolutely the creepiest thing he could do? They had both waved, yesterday, so maybe that’s what he ought to do again. His eyes drift to Dan’s mouth. The product is still mostly there, but there are indents where their front teeth have been digging all night that show the natural colour of their lips.

That’s not an option, Phil reminds himself with a little shake. He’s about to keep overthinking it when Dan wraps their arms around him and says something that sounds like a goodnight. They smell good, and they feel good, and the only thing that gets Phil stepping back is the sound of a bus stopping next to them.

“Bye,” he says, quiet. Dan’s smile is almost enough to make him miss this bus and wait for the next one.

[unlessimwrongwhichyouknowimnot]

A Bit of Home

Written for @teamengineering‘s Fitz’s Birthday Wish List. I’m so sorry it’s so late! Based on the prompt: A visit with his Mum

Takes place pre-season two

Title changed from A Visit Home to A Bit of Home because I realized I had another fic titled A Visit Home

Read on AO3

Fitz sat on the couch in the common room. A single lamp was on, giving him just enough light to see. It was late. Everyone else was in bed. Fitz should be in bed too, but he wasn’t.

Everything was different. Everything had changed. Fitz didn’t like change. They’d turned his old lab on the Bus into a garage without even asking him. Now he had to work in a new lab. With people he didn’t know. Without Simmons. ‘Cause Simmons had left without even asking him.

She’d stayed through his birthday, and then she’d told him she was going away for awhile—to see her parents. Fitz understood why she wanted to see them; but he didn’t understand why she couldn’t—wouldn’t—take him along too. They’d begun visiting each other's families together while they were still going to the Academy. He liked visiting her parents. Nothing ever changed at the Simmons’ house. And Glasgow was a lot closer to Sheffield than it was to America.

Homesickness rushed over him like a tidal wave. Tears filled his eyes, blurring his vision, and he pressed his arm against his eyes as he began to cry quietly. He wanted to go to Glasgow. He wanted to go home. He wanted to see his bedroom that hadn’t changed since he left at 16 because his Mum knew better than to change anything without asking, and he wanted to see the park he’d played at as a child with the climbing frame where he’d spent so many hours pretending he was a monkey. Most of all, though, he wanted to see—

A mug was placed on the coffee table in front of him. Fitz swiped his arm across his eyes and looked up to see May standing next to the couch, holding her own mug.

“I want my mum,” he blurted out, and he didn’t care if he sounded like a child. “Simmons—Simmons went to see her parents; I want to go see my mum.”

“Okay,” was all that May said.

Fitz gaped at her. “Okay?” he echoed, cocking his head slightly in confusion.

“Okay,” May repeated. “I’ll make arrangements.”

Fitz picked up the mug, not quite believing that she actually would follow through. May typically meant what she said, but Fitz still didn’t want to get his hopes up only to be disappointed. He took a sip and found that it was tea, exactly as sweet as he preferred. “Thank you.”

Several days later, Fitz was on a plane to Scotland. May came too, which he thought would bother him, but it turned out he didn’t mind the company.

“Too bad we couldn’t use the—the Bus,” he commented not long after takeoff. “We’d get there faster and more—erm—more com—comfor—more—” he stopped, unable to get the word out.

“Yes, the Bus would be more comfortable,” May agreed, “but we can’t use it until we figure out the cloaking.”

Fitz tapped his fingers against the armrest as his insides twisted in a guilty reminder of his failures. “I’ve almost got it. I just—I just need more—more time.” He sighed and dug around in his backpack for his headphones.

~*~*~*~

It had been decided that Mum wouldn’t meet them at the airport for safety reasons. Fitz was rather glad for that because he knew there would be no way to stop from crying as soon as he saw her, and it was less embarrassing to cry in the privacy of his childhood home. Those walls had seen plenty of tears from both of them over the years.

They took a taxi from the airport. Fitz fidgeted in his seat the entire ride, legs bouncing, fingers tapping, eyes looking out all the windows as they passed by familiar and unfamiliar landmarks. There was a Starbucks that hadn’t been there the last time Fitz had visited, and the Chinese restaurant he’d eaten many meals at was closed. His house looked the same, though, so that was a relief. The bushes and trees and flowers had grown. Fitz took a picture to send to Jemma while May got their bags.

The front door opened and his Mum ran out, straight to Fitz. They wrapped their arms around each other, clinging tight, and that’s when the tears came. “Oh, my boy,” his Mum cried, “my beautiful boy!”

“Mum.”

May had them move inside after noticing nosy Mrs. Keller peeking through the curtains from across the street. They went to the kitchen where Fitz’s Mum had tea ready for them along with a plate of Fitz’s favorite chocolate digestives.

“You must be Agent May,” Fitz’s Mum said as she poured the tea. “I’m Ellie; it’s so nice to meet you.” May gave her a small smile as she accepted the cup handed to her.

Neither Fitz nor May were feeling very talkative after their long flight, so Ellie filled the silence, talking about the lives of various friends and neighbors while Fitz ate too many of the biscuits and May listened politely, instinctively filing away any bits of useful information Ellie shared.

“Oh, how I’ve been nattering on,” Ellie said as they finished their tea. “You two must be tired after that long flight. Leopold, you’re in your old bedroom, of course, and Agent May, you’ll be in the guest room. I’ll show you where it is.”

There were pictures lining the wall of the hallway leading to the bedrooms. Most were of Fitz as a child; some were of what May assumed were other relatives such as grandparents. May stopped to look more closely at a picture of a young Fitz, probably about 5-years-old, standing in front of a monkey enclosure at a zoo. He wore a somber expression and there was a blur around his chest.

“He was so excited to see the monkeys,” Ellie commented when she saw which picture May was looking at. “I couldn’t get him to stop flapping his hands long enough for me to take a picture.”

May gave her another small smile and they continued on to the guest room.

~*~*~*~

Fitz began taking the tea things to the sink to start washing up while Mum showed May to the guest room. One of the mugs fell from his hand and shattered on the floor. Fitz froze, staring down at the evidence of his damaged, broken body. He couldn’t even do something as simple as washing up, or get his body to move and go find the broom. He just stood there. Staring. How useless was he?

Ellie entered and took in the broken mug, and how Fitz was standing there, not moving. “Did you get stuck, love?” she asked. Fitz didn’t respond. “I’m going to bring you to your bedroom, where your weighted blanket is,” Ellie told him. She took his hand and led him out of the kitchen. Fitz laid down on his bed and she covered him with his weighted blanket. “Is that better?” Fitz still didn’t respond, so she went back to the kitchen to clean up the mug.

~*~*~*~

Fitz blinked, staring up at the ceiling. He was slowly becoming aware of what was happening around him. There was pressure on top of him. That was good. He could hear someone in the kitchen. Mum, probably. He hoped. He wasn’t sure what May would think if she saw him like this. She’d seen him have a meltdown before, but he hadn’t had a shutdown in front of her that he could remember.

He focused on his breathing. In. Out. In. Out. In. Out. He looked around his bedroom, eyes landing on the poster hanging on the wall across from him.  It was a picture of space. His mum had got it for his 15th birthday. I’m gonna take that back to the Playground he decided. Maybe having a bit of home there will make the change easier.

Mum entered with a glass of water, which she placed on the bedside table next to him. “I brought you water,” she said. Fitz brought his fingertips up to his chin to say thank you. Technically he was supposed to move his hand away from his chin too, but that wasn’t going to happen.

“Can I stay with you?” Mum asked.

Fitz managed a nod. She sat down on the bed next to him and began running her fingers through his hair.

“Agent Coulson came to see me,” she told him, “after your—” she paused, trying to figure out the right word, “—injury. I wanted to come see you, or have your transferred to one of the hospitals here, but he said it was too dangerous because of the Hydra threat.” She was quiet for a moment, and Fitz closed his eyes, soothed by the feeling of her hand on his head. “I’m thankful you were able to come to me.”

Me too Fitz thought to himself. At some point over the next couple days, Fitz would talk to his mum: tell her about Simmons, and how she’d gone, and how things kept changing around him, and how frustrated he felt all the time. But for the moment, they were quiet. They just existed together in a comfortable, familiar way. They were a mother and her son. He was home.

[florafaunaravenna]

Journal 1: My First Foray into Ravenna Creek

Having grown up in the Pacific Northwest, it’s hard for me to recall a one distinct childhood memory because a lot of my life’s experiences has been integrated with nature in some way. My family went camping to Lake Chelan or Olympia National Park in the summer seasons. Hiking up Mt. Si, or Tiger Mountain, or Rattlesnake Ridge was a weekly family activity on Saturdays that seemed to precede with the same regularity going to church every Sunday. I was enlisted every fall starting in 3rd grade in uprooting the invasive species of blackberry brambles encroaching upon the wetlands neighboring my elementary school. In high school I would wade into the same wetlands in the dead of night with my friends to smoke cannabis in secret. After high school, when I became obsessed with the psychedelic experience I would join my fellow disreputable friends, who jokingly called themselves “daytrippers”, at a waterfront cabin at Lake Kachess to eat handfuls of Psilocybe cubensis and swim laps in the cool dark waters of the oval shaped lake. 

However, I think the most impacting experience I had with nature as a child may have been when one of my elementary school teachers took our class out to the tide pools at Saltwater State Park. My young impressionable mind was mesmerized by the variety and sheer teeming vastness of living spectacle at the beach. There were limpets, crabs, sea stars, octopi, hermit crabs, gulls, sea urchins, that were electric blue, citrus orange, neon green, violently purple, and of every size and description beyond what I could have imagined after gazing at the pictures in my mail order “zoo encyclopedia”. 

I was mentally amorphous and easily distractible, then and now, but I remember looking down into the unsteady surface of the water in the rocky pool, hypnotized by its rhythmic yet unpredictable sway. After we got out of the bus and traversed the wooded path own to the beach itself, I was in awe at the sight of the ocean, which from that promontory seemed to be expanding the longer I stared out into it, and seemed to carry my across the light tipped waves into the grey horizon. The gulls flew overhead and I envied them for being unbound by gravity, free to go wherever they wished or they pleased without the impedance of buildings or streets or highways. 

On the bus ride back I was still spellbound by everything that I’d seen. While standing in the swirling waters amongst the sea stars huddling under the rocks, the urchins nesting all about and the limpets bunched up and seemingly dripping from each briny surface, I intuited that nature was a vast and self replenishing being whose home I was merely a guest to sleep on. There was an emerging feeling that beyond me and beyond what I knew in my simple day to day life there was a secret world, a world that had laid within it yet undiscovered wonder and mystery.

---------

For my site I chose to go to Ravenna Park, which was a ten minute walk from the house where I live, and I walked along the creek until I saw an uncovered area of ground, sloping down from the side of trail, where I saw a group of the same plants standing together, their bright leaves swaying gently in the wind. It was a cold wet day, and the sun by the time I had gotten out was beginning to set, dimming the already overcast sky. For this, I was surprised at how verdant and waxy these plants were. When I ran my fingers over the veined surface of a leaf, I could feel beads of moisture wick away and slide into my palms. 

I decided on this spot, and collecting myself. I spread my coattails behind me and sat down crosslegged in the dirt. A lot of people have made some commentary on the notion that our generation is uniquely and superlatively “plugged in” compared to other generations, that because we have immediate and persistent access to television (youtube), our relatives’ political opinions (facebook) and the dangling possibility of some outrageous tryst (tinder), we’re all practically out of our minds and don’t know how to take it easy. Well, I have to say that I agree for the most part. While I was sitting out listening to the creek water it was not like my experience at the tide pools when I was in elementary school, pre internet. I found myself reflexively reaching into my pocket for my phone and had to stop myself by slapping my hand with my other hand. My head was swirling indeed with everything that I’d seen and heard that week. All the fears, and desires and images that had as quickly blazed them across my mind before fading out seemed to persist even as I was sitting in that dim wooded enclosure. I closed my eyes. To calm myself I spread my fingers through the dirt and took a deep breath. It helped. I focused on what I was seeing around me, what I was hearing and what I was experiencing in the present moment, and then I focused on not trying to see or hear anything distinct at all, but to simply take it in. Gradually I became aware of the high chirping of the bushtit, and of the burbling slush of the creek waters flowing south. I could distinguish in the layers of scents emerging from the ground and the leaves the decaying trunks of fallen trees, something seeter in that, like sap, and the unctuous aroma of the soil itself, deep and dark. 

I opened my eyes and looked around again. The leaves of those verdant ground plants were still green and bright, and waving in the wind, and the trees I could see rose tall above in the sky, their trunks mottled by the small holes and spots were branches had been knocked off. 

A blurry picture because my camera arm was compromised. However, one can see here that the plants are of the same species and all living together. I don’t think that they 

I’m not quite sure what the species ID on this plant is but it seems to be a fern based on what little I can remember from a previous botany class I took in community college.

[brajeshupadhyay]

It's 8 pm. The streets of Chennai are dead. The checkpoints have multiplied for this 12-day lockdown, so have the cops on the street. Every vehicle is being stopped, scanned, questioned. Near the Rajiv Gandhi Government General Hospital (RGGGH), one of the four main facilitates which is treating COVID-19 patients in Chennai, this reporter saw an MTC bus leaving with a few healthcare workers. All of them looked like they were about to pass out. As we parked next to the canteen, this reporter spotted a doctor in blue scrubs and a green mask, walking with her head bowed down. In 2017, this reporter had interviewed a bunch of newly-christened ‘doctors’ at this very spot. Three of them had animatedly spoken about throwing themselves headlong into the profession, in spite of the various drawbacks. Opposite the parkin, a board read: new PG Hostel. Wonder how many of the 42 PG doctors from Madras Medical College, who had tested positive for COVID-19 almost two weeks ago, stayed there. Meanwhile, the reporter's friend’s cousin got out of the car and was waiting to catch a glimpse of her husband, who had tested positive a few days ago. He had almost recovered from fever when he experienced a bout of breathlessness and had to be rushed back to the facility. Since he has been at the COVID facility inside the RGGGH campus. She was bringing him a change of clothes, some medicines and was seeing him for the first time since he was admitted at the facility. They exchanged a few nervous words, as my friend and I tried to look away. The COVID Outpatient Block is two towers away from where we stood in Tower 1. These towers have a raised entrance, which makes the reception visible from the road, as well. As we started driving past the campus, I looked at the bright lights coming from the tower. Nothing poetic came to my mind but the dead silence, which is unusual to the hospital because usually it is bustling owing to Chennai Central Railway Station which is located right across the road. The jarring lights coming from the COVID Outpatient Blocks, only added to the general uneasiness that one had started to feel in Chennai. Rajiv Gandhi Government General Hospital in Chennai The COVID-19 Outpatients Block at the RGGG Hospital is built like a wedding hall. It has huge steps leading up to a hall-like reception. On either side are ramps. Ambulances stop at the right corner, from where patients can be wheeled in. Before you enter, there is an assistance kiosk outside labelled ‘May I Help You’. Those entering were made to sanitise their hands at the kiosk. The healthcare workers, manning the kiosk, also answer questions if you are confused. This kiosk though is not manned at all times. While we were there, a few people had to look around for help. Diagonally opposite the kiosk is a space to wash hands. Inside the hall, there are rows of chairs, all placed at a distance of 4-5 feet, facing a reception area. Patients have to wait their turn to make their entry at the reception, following which doctors on duty will assess the patients. Some have attendees helping them, while most of them are there by themselves. There are huge windows on either side of the entrance. This is where the family and friends of those who’ve gone inside are waiting. Pushpa, a resident of Thideer Nagar in Besant Nagar, was here with her husband K*, who was diagnosed with blood cancer in September 2019. He was just about to commence radiation therapy at Cancer Institute in Adyar when another patient at the institute was tested positive for COVID-19. Since April, as many as seven patients and three healthcare workers from the institute had tested positive. All the patients from that ward were told to test themselves for COVID 19 before seeking further therapy. K’s first test was negative but a second test confirmed their worst fears. After this, K was advised to seek help from RGGGH. "Now, they have said even though he is not showing any symptoms, he will be taken to an isolation ward for 14 days as he is a cancer patient," said his brother Suresh. Pushpa is worried that postponing radiation therapy will adversely impact K. "We already pushed it by three months. Now I am not sure when we can actually get to it," she said. As Pushpa continues to tell her story while waiting for the ambulance which would take K to the isolation facility, a doctor in a blue PPE darts out, a nurse in a green PPE at her heels, signalling for a stretcher. "Why isn’t it here yet, it's been half an hour," the doctor asked the nurse. “No ma’am, I’ll get it, just a moment," the nurse said before signalling furiously to a group of healthcare workers standing 100 meters away, next to a few stretchers. Two of them, with a face mask and no PPE, hauled it across the ramp, while the doctor looked around, clicking her feet. While waiting for the stretcher, the doctor glanced over to this reporter, and almost as if reading the reporter's mind she quickly looked away before there was a question. It was almost a telepathic no. Close to a month of tailing healthcare workers on COVID duty across the state will teach you to steer clear of them when they were working. Interrupting the nurses or the doctors on duty inside the OP was out of the question. "You need to understand that everybody is in a lot of tension. There is a lot of work. Just during my eight-hour shift, more than 600 people trickle in," said Palanisamy*, a contract worker from Korukpet, who was overseeing security arrangements outside the OP. "It wasn’t so much in the beginning, but now it is 24/7. This place doesn’t sleep anymore,” he added, explaining that asymptomatic patients from RGGGH were sent to facilities outside, whereas those with moderate to severe symptoms were housed within the hospital. "People are scared. Look at his face, can’t you see panic in it," he remarked, pointing at a middle-aged man who walked past us. “There is no reason to panic, we are very much in control. The uncertainty is going to be there because we don’t know how this pandemic will turn out but that doesn’t mean one should panic,” Dr K Narayansamy, Director of the Hepatology Department at MMC, said. He was recently appointed the Dean of MMC and Rajiv Gandhi Government General Hospital after the former Dean Dr R Jayanthi went on leave until further notice. MMC and RGGGH have been through choppy waters in the past few months, with many doctors, PGs, nurses and healthcare workers testing positive for COVID-19. It seemed a little ironic to be sitting inside a building with a possibly high viral load but being told that RGGGH is dealing with the pandemic head-on, minus the panic. Asking about F's experience, a COVID-19 positive patient who had told this reporter that he was turned away from RGGGH when he had shown up there with his results. F had said that he was denied admission due to lack of beds in the hospital. Dr Narayanswamy says that it must have been a misunderstanding. "We’ve close to 1,000 beds, half of them equipped with oxygen supply. We are constantly upping our capacity, there is no way anybody would have said there are no beds," Narayanswamy said, explaining that doctors make an assessment of patients in the OP block. If a person shows moderate to severe symptoms, they are admitted to the COVID care unit. If they don’t, they are sent to isolation wards outside RGGGH for observation. "This is how we ensure that facilities are available to those who are in actual need, without burning it all out," added Narayanswamy. Eventually, F was admitted to RGGGH and is at the moment, stable. F said he is happy with the facilities now and feels that he is well taken care of. Whether or not his problem was a wrong assessment of the patient’s symptoms or if the patient had misunderstood the doctor, what was told to him doesn’t seem easy to figure out. This problem though has been mentioned by many doctors on duty. Some of them, across several districts in Tamil Nadu, said that they assess ILI (Influenza-Like Illness) symptoms in patients and to ensure that the system isn’t overburdened, admit those who absolutely need hospital care. If not, they are told to rest and recover at home. A few patients are also not very forthcoming which hinders the process further. But since the decision largely rests on discretion, as there are no guidelines set in stone, there is room for error. *** Kilpauk Medical College Hospital, Chennai The waiting area outside the COVID OP Block in Kilpauk Medical College Hospital (KMCH) was an open space, like a sit out in a park. It had an enclosure on top but was open otherwise. Ambulances were lining up right in front of the waiting area, from where patients were being taken into the OP. The ones waiting their turn had worry written all over their faces. Approaching a young woman seated alone, the reporter asked her in Tamil, "Neenga positive patient ah (Have you been tested positive)?" She first shook her head and then nodded. She introduced herself as C* from Nepal. The reporter switched to Hindi and asked her if she wanted to speak to her. She said yes, and pulled out a piece of paper from her bag. She pointed to the section which said ‘POSITIVE’. "I don’t know where they are going to take me," she said. C has been living with her son in Chennai for more than a year now. The lockdown had been a drag as she was out of work. But she had managed until she developed a fever a few days prior. Though her fever subsided, she tested positive for COVID-19. So, she packed up, told her son to stay home and set out for Kilpauk Medical Hospital. “What will they do now, how long will I have to wait here?” she asked. She had two young teens to keep her company. Their uncle, who was on dialysis, had tested positive for COVID-19. "He is in there, getting it done. They usually do it on the arm, but this time they are going through his neck,” one of them said explaining the process of dialysis. Two rows away, an individual who was waiting his turn, spat onto his side. Everybody looked, a few hissed. Twenty-four hours later, C had been allotted a room at a COVID isolation facility in Pulianthope. She was first lodged at a facility within KMCH, and then the next day transferred. It has been three days and she seems okay. The problem that patients seem to face at government facilities is only at the beginning. Stricken by panic in the beginning, most patients are confused and need reassuring. Healthcare workers, however, seem overworked and not in a position to do so. *** Government Order 174 issued by the former health secretary Beela Rajesh, dated April 3 of 2020 reads: “1. In the G.O. read above, the Government has notified the list of designated Government Hospitals for treatment of COVID-19 patients. Further, treatment for COVID-19 is being offered in all Government Medical College Hospitals, District Head Quarters Hospitals and Key Sub-District Hospitals completely free of cost. 2. It has been brought to the notice of the Government that certain patients/public desire to have treatment for COVID-19 in Private Hospitals also. 3. Considering the spread of CoronaVirus Disease (COVID-19) in the State, the Government have decided to include the Private Hospitals in the State for treatment to COVID-19 patients to prevent the spread of this communicable disease. 4. Accordingly, the willing patients are hereby informed that they may approach the Private Hospitals listed in the Annexure to this order to receive treatment for COVID-19, at their own cost. The hospitals are directed to follow the treatment protocol prescribed by the Government of India from time to time.” Of the 22 hospitals listed on this Government Order, the number of private players catering to COVID-19 patients in and around Chennai has increased to 45 in a period of two months. Yet, there is uncertainty regarding the functioning of these hospitals. First, a few videos emerged saying that these hospitals are charging exorbitant and unaffordable rates. This was followed by another government order, which capped the price for private hospitals. For non-critical cases, the cost was to be capped at Rs 5,000 per day. For critical cases, the cost was fixed at Rs 10,000 to Rs 15,000 depending on whether the patient required ICU and ventilator facility. Another video by a news anchor and television actor S Varadharajen went viral, where he claimed that a friend of his, who had severe breathing problems and fever, was unable to secure a bed for himself at either a government or a private hospital. Health Minister Vijay Bhasker immediately got into a damage control mode and announced his team was making all efforts to ensure that facilities are adequate. "There are 75,000 beds in Tamil Nadu and 5,000 in Chennai alone," he announced a day after the video went viral. Provisions of IPC, the Epidemic Diseases Act and the Disaster Management Act were invoked against Varadharajen for the offence of ‘falsifying information to create panic.’ Two weeks since and all the damage control later, the feeling of panic in Chennai is far from gone. A flurry of transfers, including that of the health secretary hasn’t helped matters. '‘Mismanagement' is the word on the street and the rumour mills have become difficult to track. It's mostly hearsay as very few "go on record" to say anything. The fear among doctors and bureaucrats keeps them from speaking out aloud. But statements by those leading the state are hard to miss. For instance, chief minister E Palaniswami’s transition from "our positive cases will be zero in a few days" to "God alone knows when this will end." "Strong leadership and a clear line of command is crucial to managing any public health emergency. When people are clueless as to who to turn to for a decision, you know there is a problem," said Dr Aiswarya Rao, public health consultant and former joint director of Tamil Nadu State Aids Control Society (TANSACS). In April, there were multiple teams comprising bureaucrats who were put in charge of managing the situation. Then came the appointment of another committee. There was also the health secretary who was issuing directions on one side, while the ministers did their own thing. This is pretty much how April and May went by for Chennai. Even after the appointment of Dr J Radhakrishnan, who has managed to control multiple crises in Tamil Nadu, this crisis seemed all over the place. His reinstatement as health secretary seems to have given many within the department hope. What about frontline workers in Chennai? The basic fear, reiterated both private and government healthcare workers, doctors, nurses and technicians, is the fear of exposure. April witnessed many protests by government doctors and nurses in Chennai, demanding basic preventive protective equipment and post-duty quarantine facilities, after a bunch of them tested positive at RGGGH. In a few weeks, healthcare workers at Government Stanley Medical Hospital tested positive. While government doctors have to work irrespective of fear of exposure, the same isn’t the case with private practitioners. Many private establishments have sought help from the government stating that they are not able to take on the costs required to operate a COVID-19 facility. Sanitary workers organised a strike this week after one of them died following exposure to COVID-19 positive patients. While the government has been saying that it is meeting these demands, how the government hopes to sustain meeting these demands remain unknown. So does the expenditure over COVID-19 so far. During his interaction with Prime Minister Narendra Modi, Palaniswami sought a grant of Rs 9,000 crore and a sanction of Rs 3,000 crore for medical equipment during a pandemic. An official statement by the chief minister also said that 2.75 crore triple-layer face masks, 38.85 lakh N-95 masks, 21 lakh PPE kits and 15.45 lakh RT-PCR testing kits have been ordered by the Tamil Nadu government. There is no official figure on how much the government has spent on personal protective equipment. The biggest challenge for the government continues to be how it will bring about some level of accountability from private hospitals in the middle of this pandemic, which doesn’t seem like will abate any time soon. Many non-COVID patients have spoken out about how cumbersome it has become to get private hospitals to cater to them, even under serious circumstances like deliveries. The norm at every private hospital since April has been that almost all procedures only after a COVID 19 clearance. Two months since the lockdown, yet private hospitals have not figured their way out, and that's worrisome. Many seem to be treading the safer path by staying away. But senior doctors say that media trying to put the entire blame on private hospitals is unfair. "The costs are high, the usual patient load less. We are doing what we can to keep the hospitals running with the bare minimum," said a private practitioner, "When will the government step in and help out?" Real situation at private hospitals listed as COVID-19 designated centres Firstpost looked at the Tamil Nadu live dashboard and spoke to all the 45 hospitals (four from Chengalpattu and Kanchipuram districts) listed under Chennai district. Of these 45, many of the hospitals are already operating at full capacity. Doctors at some of these hospitals said "that isn’t the case but don’t want to say anything further." In the case of some hospitals, authorities said there were no beds available anymore. Even though in some cases the live dashboard says the opposite. Some of them tailor their answers after asking a routine set of questions, which are common to all: How old is the patient? Are they obese? Do they have any existing conditions or co-morbidities? Do they’ve breathlessness? A positive answer to the fourth question brings forth this answer: “We are out of ventilators” or “Where are you at the moment? Okay, then go to the closest government facility, that would be the safest for you.” Here is a brief of what Firstpost found The Live Dashboard says these hospitals are running at full capacity: Apollo Hospital, Be Well Hospital, Bharathiraja Hospital, CSI Kalyani General Hospital, Dr Kamakshi Memorial Hospital, Dr Mehta’s Hospital, Fortis Malar Hospital, Kauvery Hospital, Lifeline Hospitals, Maya Nursing Home, Venkateshwara Hospital, Noble Hospital, Panimalar Hospital, Prashanth Hospital, MIOT Hospital, Medway Hospital. For other hospitals, the dashboard, as on 22 June (some updated on 21 June) say has 1,865 beds, 89 ICU beds and 71 ventilators. Here are the responses of the hospitals, when contacted regarding beds: Apollo Hospitals: No beds Sri Ramachandra Medical College Hospital, Porur: Dashboard says 184 beds are available, hospital authorities said there are no beds. Bharath Medical College: Dashboard shows as having 60 + 2 ICU beds. Authorities said that they aren’t admitting any patients as they don’t have the staff or the resources to handle the situation. Be Well Kilpauk: Asked if the patient has insurance. Then said beds are available, will quote fees only after consultation with the doctor. Chettinad Hospital: Dashboard says 161 empty beds at the hospital whereas the hospital authorities say that there are no beds available. Kanchi Kamakoti Child Trust Hospital: Facility available for children. Aysha Hospital: Will assess the patients and admit according to need. If oxygen is stable, patients can home quarantine and recover. Gleneagles Global Health City: Authorities said patient can come for a check up, cannot confirm if there is a bed. Mint Hospital: Said beds available at the cost of Rs 35,000 per day. Vijaya Hospital: No beds, if there is a discharge and a slot opens, can contact. Cost Rs 30,000 to 40,000 a day. With ventilator will cost Rs 70,000 a day. Tagore Medical College: Beds are available, costs are Rs 12000/day for asymptomatic patients, Rs 14000 with oxygen support, Rs 21000 if ventilator is used. Sundaram Medical College: Full, there are patients waiting in the ER. St Thomas Hospital: There are beds but they will decide after it's communicated how serious the patient is. SRM Medical College: Dashboard says 103 beds + 3 ICU beds is incorrect, they are running at full capacity. Sathya Sai Medical College: Not a super speciality, can only admit mild cases as they don’t have resources to take care of severe cases. Will cost Rs 15,000 to 20,000 a day. Balaji Hospital: Can only admit mild cases as ICU beds are full. SIMS hospital: Full, can’t admit. National Hospital: Overflowing, government hasn’t updated dashboard. Muthu Hospital: Beds are available, cost will be communicated after assessing the patient. Meenakshi Medical College: Not admitting private patients at the moment, only admitting patients from government hospitals. Karpaga Vinayaga Medical Science & Research Facility: Beds available; Rs 5,000/ day is the base amount, exclusive of oxygen support or investigation/scan charges. Melmaruvathur Aadhiparasakthi Medical College: Is a Trust Hospital, all charges will come up to Rs 10,000/day GLB Hospital: Beds available, will cost Rs 35,000/day Appasamy Hospital: 1 bed available, will cost Rs 23,000/day. *** J Radhakrishnan IAS, the newly reinstated health secretary says that the health department is pushing its limits to ensure that facilities are coping with the increase in numbers. “We are increasing beds in government hospitals for people who depend on us. Many non-COVID beds are lying vacant, as most aren’t coming for routine procedures, so we are constantly in the process of switching that dormant lot to our COVID bed strength. We’ve added 25 percent of those beds into COVID care,” he told Firstpost. The health department is also trying to create a call centre for access to private facilities, in addition to 104 services, so that they can cross monitor, Radhakrishnan explains. “We held an open meeting with private hospitals, and the estimate of beds with them is 5000. We are attempting to provide dynamic data of these beds, in order to facilitate a smoother process for COVID patients”, he adds. When I inform him that many of the hospitals aren’t admitting patients even if they have beds, he says, “Close to 170 hospitals are registered with us for treating patients. If they are not admitting COVID patients or even non-COVID cases, we will take action against them under the Clinical Establishments (Registration and Regulation) Act of 2010.” *Names withheld to protect the identities of COVID-19 patients

http://sansaartimes.blogspot.com/2020/06/scared-patients-overflowing-hospitals_23.html

[ecotone99]

[RF] Los Angeles - The city of angels

I saw through the window a moltitude of lights: it was now evening and the plane on which I traveled was about to land in Los Angeles. It was love at first sight. I rushed, without really knowing where I was going, to take the luggage then went out immediately to finally breathe a bit 'of fresh air. I had made a stopover in New York and I was not able to leave the airport. I also want to smoke a cigarette. I lit two in a row. I looked a bit 'around bewildered. I had come halfway around the world. I proceeded to objectives. My destination was the hostel where I stayed for my two-week stay. I relied a direct shuttle services from the airport. Within a few minutes I was on the road again. While I was on the bus a stranger offered me a piece of candy. I accepted it. I am a bit 'naive and I tend to have good faith in others. It was good. The impact with the wide, endless highways took my breath away. A sense of freedom comes over me from the inside. It was the first trip that I faced alone. I was fascinated. We reached our destination. I paid the TAXI. Twenty-one dollars had already left. The hostel resembled in all respects to one of those typical American houses in a rustic style. When I entered I saw a melting-pot of people who watched TV. They didn't look at me. I soon realized that it was something quite normal considering the bustle of people who frequented the place. But someone stepped forward to me: a young innocuous-looking black guy and rather serious. He wore glasses and his hair cut short. He introduced himself, "Hello my name is Pedro, Welcome to Free Housing, I'll show you the house." He was a crew member who ran the "cabin". My english, school, had yet to turn up and during the home tour I nodded my head. I carried the luggage in the room that I was given and that I had to share with three other people. I paid in advance the bill for the night. I spent one hundred and fifty US dollars. From then on I had to live with ten dollars a day. I tried to ask my first question. "Where can I buy cigarettes and a lighter?" I'm a heavy smoker. The answer thankfully was simple and painless. "Down down the road." I followed that one indication and in fact I was faced with one of the classic American open day and night supermarkets. I took a pack of Marlboros and a lighter with ergonomic enclosure which I keep still. It 's strange to me because lighters have always been short-lived. I returned to the hostel without looking around much. It was dark. My priority was fall into bed to write to my family and to my girlfriend that I was fine. So I did. I was ready to fall asleep when I realized that it was impossible. There was a guy who snored worse than anyone else. It made a loud noise and by the way he sobbed. This went on for hours although eventually stopped and I managed to get to sleep with the ardent hope for him to go on his way as soon as possible. The next morning I woke up early and I was more lively than ever. Among other things I noticed, looking in the mirror, that my tongue was once again become pink. My body had already disposed of the accumulated stress before the trip. I put it in my suit and went downstairs where I uttered a timid "Hello" to me and I arranged to have breakfast. From what I understood each roommate was free to take the supplies they wished, place them in the appropriate shelves or in refrigerators and cooking. So I headed back to the Rite Market to buy some drink and some snacks. It was early November, the sun was already shining and did not at all cold. I noticed that the path along which I was was dotted with palm trees. I bought a "tank" milk, an orange juice and cereals. So, to begin with. So I went home and put something in my teeth. I already knew what would be my next move. I had, as agreed, to make an important phone call. I had to call Sam Lane, executive producer of cannabis for free, to arrange a meeting in order to present the project that I realized hoping that acquire the rights. I had read that he spent fifteen thousand US dollars a week to produce an episode of his show so I was hoping to make a good shot. No sooner said than done. I locked myself in the bathroom and dialed the number. He answered almost immediately. I was not ready to have a conversation in English and even more so "business" but God though I did not pray more for some time helped me anyway. "Hello Sam, I'm Michael." I paused. "I'm in Los Angeles." "When we can meet?". I was already out of breath as my future at that time depended for much from him. He responded with some enthusiasm, "Michael! Send me a message saying your address this afternoon I send you to take a car. " "Okay, great," I said. "See you later". My heart was pounding. I was thinking what I would have done if he had not replied. I was playing around. I had right away, however, a strange feeling. Too good to be true. I did not lay down and after lunch I was ready to start exploring the city. Before going out I checked the e-mail account. My best friend wrote me: "Hello Michael, How was your trip? I know what you felt just before we left. Enjoy this adventure and believe it all the way. California is one of the most beautiful places in the world. Take care. Andrew "I put the signed blacks pants, a T-shirt printed with a picture of James Dean and a three-button jacket between the elegant and casual. Since I had your hair cut almost to zero also I put my funny gray cap with the visor. Instead of going to South as I had done up to that point, once out in the street, I proceeded northward along Crenshaw Boulevard until I reached the intersection with Wilshire. I was carrying a briefcase with inside the project that I had to present to anyone who could also be only minimally affected and in hand clutching a list of possible contacts divided among talent agencies and television production companies. I chose Los Angeles because of it. I decided to start with the talent agency. The problem was to find them. Wilshire Boulevard is one long highway dotted with skyscrapers and buildings on both right and left and numbered in a specific order. I had to get to the number 10250. Where I was at that moment I was more or less at number 700. Once I discovered which way the numbers were going in up I reached the goal and rang the bell. I was very nervous because of the research that I had conducted found that in almost all cases the answer was "We do not accept unsolicited material." I showed up with a weak voice, "Hello, I'm an Italian guy and I want to introduce you to the pitch for a new animated series". The answer was clearly the one I anticipated. First door in his face. First of a long series. No problem. I looked through the list of contacts an address close to where I was at that time and I noticed that for better or worse many were located along the Wilshire although to a variety of civic. I made another attempt, but the answer was the same. It seemed to me a completely absurd policy. At about half past four p.m. I sent a text message to my primary contact. I asked him if it was confirmed the meeting and took the opportunity to invite him to eat a pizza. Meanwhile I sat a moment. I had already ground several kilometers and I was pretty torn down because it does not like being told no so openly. I began to get really afraid of not succeeding. Mr. Lane replied apologetically that he had an important business meeting and then we would not have been able to see that day. He could stay. Then I resumed walking towards one of the most famous of the city agencies. I arrived at the base of the skyscraper which housed intending to pretend a university student who wanted the opinion of one of the trade concerning his dissertation. I talked to the porter who advised me, since it was quite late, to come back the next day and discuss with a young lady named Alice. I came out more than satisfied because at least he gave me an answer that was not entirely negative and that gave me some hope. I stopped at a fast-food, ate a sandwich along at least twenty centimeters so I went back to the hostel. It was not yet very clear in my head the projects in which I had ventured. That evening I met the rest of the team who ran the house. AJ was high, egocentric and gym-lover. Mike seemed rather reserved and had the air of being always tired. The youngest, Chris, had already taken part in several commercials while Dan, the General Supervisor, took the part of thirty libertine. Also I made a first friendship with a French girl named Valentine who wished to become a make-up artist and which briefly told her my story. He advised me saying any more upside to be the best. That night I slept like a log because the snoring man was gone. The next day I went back to the building where I had "appointment". I was even more agitated than usual. After a short wait in came a young girl who asked me politely what she could do for me. I stammered my unusual request. I was all sweaty hands. My English was still quite sparse. He brought up the top floor of the building where there was the agency's focus. Before joining I had to ask permission from the Director reception. It was a private company. He asked me some general information such as first and last name and what kind of university course I attended. Then politely he said "At the moment there is no one, in case you recall." I accepted gladly the answer and walked away. I already knew that I would not receive any phone call and that in fact there had to be someone. Stay within those offices was like being one step from heaven. Were companies that were earning hundreds of millions of dollars a year and who ran the biggest talents on the planet. In the afternoon I wrote to Sam to find out what had happened. He replied that he was at the Westin Bonaventure Hotel in downtown Los Angeles. I rushed there. It was evening now, and walking through the streets of Downtown I realized where we were really arrived. Skyscrapers. Exclusively tall and majestic skyscrapers. It was an impressive sight, amazing and breathtaking. I tried to take some pictures but I lost myself in admiring such beauty. Certainly there are many who argue that there are no feelings in a heart of steel. I personally find it endearing. I see it as a boost to want to rise to the top. The hotel where we were to meet was one of the most luxurious of downtown. I sat in the lobby and I wrote to him that I had arrived. Meanwhile I talked with some of the demonstrators who were participating in a movement called "Stop the war on drugs!" And to which he also attended my contact. He replied apologizing again. He told me he was already gone, and he had forgotten our meeting. He asked to see us the next afternoon. I naively believed him. I returned to housing. Valentine introduced me to that point a man in his fifties. He told me he was very intelligent and who had just met. His name was Gabriel. From the looks of a poor man. The sound of his voice, however, was very special. Sweet, to be that of a man. I showed no fear my project and he said: "It 'spectacular!". It excited me a lot. Then he asked me if I had protected with copyright and I said: "Of course!". He made a good impression right away because he told me to be a former French billionaire who had lost everything because of the crisis and who was in Los Angeles to meet his daughter, fashion designer. Before falling asleep, I sent this message Sam: "It is said that America offers everyone a chance to become great. You are mine. See you tomorrow. Michael ". He replied with a smiley. The next morning arrived in no time at all. I returned early in the Westin Bonaventure and sat, waiting, doing up and down the elevators as they faced the outside of the main building giving directly on the city. I had lunch in a small restaurant inside the hotel and took a quick tour in the conference room where they held a debate on the huge number of arrests because of drugs. Mr. Lane does not was felt. So I took with the situation, and I wrote him that I was there waiting for him. He told me to make me find the blue elevator base. "Here we are!" I thought. I rushed to the place indicated and after few minutes of waiting came. He was a man in his forties, dressed in a simple way, with a little 'of beard and long hair down to his shoulders, but collected with a pigtail. He greeted me and invited me to go to her room. I could not wait to talk to him. I was charged more than ever. He let me in and introduced me to some of his collaborators. I noticed, to my surprise, that on the sofa there were bags full of marijuana. I was hoping to get to join the club. Finally I opened the bag pulling out the silhouettes of the characters and the file with its description. "That's Sam, this is an American doctor, good-looking and with the medical card for Marijuana, who runs his beautiful home as a rehabilitation center. He looked interested and sometimes closed his eyes. I went to explain its main features: "It 'a bit' crazy, hyper-active, often giggly and head in the clouds". "It feels like Peter Pan." With the same determination I introduced also the remaining components of the pseudo family: the adopted adolescents, the natural children, the fat housekeeper, the hippie visionary and the priest Rastafarian. He did not give them time to finish that stood up and motioned for me to follow him to the door. I could not understand. We went out. He asked, "Are you here on vacation?". I replied "No Sam, have come specially from Italy to introduce this project." Then he asked, "Are you from a good family?". I in all honesty told my mother was not well and that the money was gone. "Well," he told me at that point. "I appreciate your enthusiasm, but I am an activist! I have no money to develop your project. " while we were moved to the hotel and when we were out in front of his car did not have time to say anything but he left. He told me to give my phone number to a certain Paul. "I will invite you to my house to surf!" He exclaimed. Three days of waiting for five minutes went very badly. In those moments I thought that if it had happened a miracle would come home defeated, empty-handed and with more debts than before. I returned to the hotel I spoke with Gabriel. I told him how the meeting had gone, and put, for the first time since I was there, a joint in my mouth. He said clearly: "He's trying to fuck you." I immediately plugged in everything that had happened: the three days of waiting, the questions about my family status and that concerning the purpose of my trip. I was surprised. My brain was pervaded by continuous electrical shocks that are transformed into images just as happened to me before we left when I was smoking marijuana with my friends. The reality was beginning to distort assuming the guise of a picture already painted. Gabriel added, "Never trust of businessmen." The world of Hollywood show business opened before my eyes: a cruel reality and most armored of a maximum security prison where those who hold the reins of the game are producers, high finance sharks, always looking for new ideas for which, however, are not willing to shell out a penny. I took his words as a dogma. The conversation became interesting. We were sitting on the couch under the gazebo in the small courtyard of the residence. I wanted to know more. Something magical was happening. He added, "Why are you here?". I replied saying that limiting beliefs, sex online poker and had reduced me to poverty. She made a face that earned him a thousand words. I had fallen into death traps. He kept saying "You look like a nice guy." He had already understood everything. Then he asked me "What do you want?". I immediately replied, "I want the money." "So you want success?" He said. "The money is with the success". I confirmed faster and with more conviction than I had ever done up to that point, "Yes, I want success." Already I hung on his every word. The lesson was not over yet. Gabriel spoke again: "If you want to succeed you will have to sacrifice everything." I listened. I would also have accepted a deal with the devil. "You'll have to rely on yourself and look like a millionaire." "Remember that the snake do not comes from the castle but from ruin","It 's so for all successful men". I had just met, I knew little about him and already his words sounded like the commandments in my ears. The goal was became clear: when I presented my project I had to look a prominent businessman, a wealthy entrepreneur, or even better a Hollywood secret star. To get to the big boys, get their attention and take home the pot I had to bluff. It was created a 'particular understanding that it would be further strengthened with the passage of time. Then I spoke and said, "When you smoke marijuana I see the world differently". He replied "Marijuana cures your depression." I breathed a sigh of relief. I thought I was schizophrenic. I began to see better the design. I had managed to reverse my perdition tunnel. He said, "Let's go back to the person you met, tomorrow write them a message and tell him you're going to go back to Italy because you have people involved there too." "Okay," I replied. Finally he said, "Tomorrow is another day." I went to bed happy as ever because hope had fed again. The next morning I wrote what Gabriel had suggested and more added that I had already registered the subject and to actually be a businessman. He answered almost immediately and I did not believe what I was reading. "Michael, come to my house this afternoon at Sunset Beach. I want you to discover another side of California. I told Paul to leave. " I replied that there was no need. I wrote "Mr. Lane knows that I like to move relying only on myself. " Gabriel advised me to go with nothing. So I did. I studied the path on the Internet and undertaken. I took a piece and then walk a stretch on the subway. It was an opportunity to see outside the Staples Center. In a moment the memories resurface. It had been at least ten years since I dreamed of becoming an NBA star. I arrived in Long Beach. I thought to have come to Paradise: palm trees everywhere, open spaces, fresh air, blue sky and bright sun. For the first time I saw the ocean. He immediately transmitted a feeling of omnipotence. I took a bus that would take me almost to the finish line and I remember having no loose change to pay for the ticket came forward a smiling woman who paid him in my place. Dropped in Seal Beach and proceeded on foot on the Pacific Coast Highway: a wide road that was developed parallel to the ocean. The sun was already setting. It was a unique spectacle. It was like living in an impressionist painting. I wrote a message to my mom, one of the few that I sent since I was there and I told her that I was realizing my dream. I was unaware that he had another kidney crisis due to his medical condition and voltage. They were taking her to the emergency room. I arrived at their destination: the house was situated in front of the beach. Sam was outside waiting for me. We watched the sun disappear behind the horizon in a few seconds improbable. He asked me if I wanted to smoke pot. I agreed, and we entered. He went down there malice. I faked myself in the part that had to represent. The trip took me to say I was in fact a seller of ideas, that every time I have to propose a project fixed a budget for the trip, beyond which I can not go, and then I was back in Italy because I had run out of cash. I also said that my sister's boyfriend was a very wealthy guy and then I made him intuit that they are well covered. "I am like a snake" I said almost hissing. I expressed calmly, I held my legs crossed, I moved my hands and had a relaxed attitude precisely because I knew I had the trump cards in hand. He made his move. He offered me ten thousand US dollars. I had crushed. My heart started beating me in the chest for a few moments. Ten thousand dollars for something that I had done in twenty days. "No" rest. "How much?" He asked. I looked him straight in the eyes and made my counteroffer. Slow motion said "A hundred thousand." She told him not to resent. They had too much money to put on a project at the embryonic stage. I had raised dramatically. Then he asked me to be his partner. Among the show's creators in addition to his name figured would also my and I would receive a share of the future profits of the series. I refused even that proposal. He got angry. He was about to lash out at me when I asked him to calm down. There I had in hand. I told him I had to think about it. I did not close the deal because its transformation had annoyed me. I had left twenty US dollars in the wallet. He gave to me another twenty. "That's my friend keep them", "If you want I can help you sell the project to the big majors" he said. Already I imagined the characters I had created come to life magically within the animation studios. Foretaste of the idea of arousing the interest of the major television networks in the nation and to sign a multi million dollar contract. I left convinced potermelo hold good in case the following week I was not able to get much better. Going back to the hostel I noticed a large dog outside a hotel. I went down to cuddle. He also had hair before her eyes. I asked the owner of a photo scattarci. I wanted to send it to my girlfriend. I knew that she would like. Then he invited me to a party of artists that was held in his hotel. He introduced me to his companion and made me compliments for eyeglasses that I carried. Gabriel had suggested me to continue to wear them because they gave me even more the air of being an intellectual. I did know a journalist who left me her contact details. Exhausted, I sit down in a closet full of paintings. A couple entered. He was a business man. She was drunk and was convinced that I was homosexual. The man left his business card on a table. I picked it up. It said the film producer. I took it and put it in my pocket. From that day I turned around the cards on the table. First I wrote an e-mail to that contact asking him on a date. Gabriel pointed out to me that I had forgotten to prefix the name of the recipient with the correct name. He did not answer. I put aside the reality, as they do with a dress out of fashion and began to smoke more marijuana. I found myself catapulted into an experience of transcendental life, metaphysics and mysticism. I reach the headquarters of a major television network. I tried to go in and say to the secretary, "I have an appointment", and pulling straight for the offices. I stopped by an employee and waved in the face characters. "Have you ever heard of an American doctor well-to-do and middle-aged ...?" I shouted against. He got excited and sent me upstairs. There, I stopped at the front desk. "It 's showtime!" I exclaimed. They called security. I began to understand how companies were structured. Before you talk to a potential decision makers you had to pass at least two levels: receptionist and assistant. People were paid on purpose to keep away guys like me and represented the last two steps of the stairs that would lead me to success. I had to step on them. In the evening, I polishing a technique and began to write notes on my phone to remind me of what I should have said. I organized amazing presentations as I began to immerse myself completely in the part of the arrogant young yuppie, bold and confident. I saw the results. I was able to get the email of a major film producer. I convinced the secretary to call the assistant then I KO him by telling that I wanted to propose to his boss to play himself in a film about the pitching. Unconsciously, I used a mix of sales techniques and persuasion. I sent details of the project. He said, "Hello Michael, Thanks for introducing me your idea. I appreciate your enthusiasm and your hard work, but unfortunately it is not a matter on which I will focus. You are right in believing that it is an easily marketable and eligible project but the story has to be something that interests me and that's not the case. It considers that it is very difficult to develop this type of projects even when I myself firmly believe in the idea. So, ultimately, I can not spend my time working on projects for which they are not certain. Of course this is just my opinion and you should certainly continue to show your project to people who could answer you better than I did. Sorry can not help you but I wish you luck. Best wishes. Bob". I did not demoralizing. I made business cards and began to introduce myself as a film producer. I began to live a dream. To really become one. I showed also the American Film Market. It was a film event that was held at a hotel in Santa Monica, and where there were hundreds of manufacturers and distributors. To enter you had to buy a pass for two hundred dollars. Potendomelo not allow smoked a little 'Marijuana and positioned myself in the lobby waving the characters as a street vendor. A girl, fresh of his first short film, gave me the attendant number of a famous producer telling me to try to contact her. I walked all day, every day. At one point I bought an ointment because I had an inflamed foot tendon. Every day new contacts. People telling me where to go and people encouraged me not to give up. I had begun to see the origin of a new project: a TV series set in the hostel where I was staying. Those guys who ran were so simple and common in their diversity that could well become the protagonists of a new and interactive TV show set right there. I spoke with people from all over the world and they all had their own stories to tell. Moral of the story: one hundred episodes and ten seasons. Gabriel, however, also suggested to me an idea for a movie. He whispered, "A boy from Senegal flying to Los Angeles with nothing but his ideas and become a Hollywood producer." "Americans love fairy tales with a happy ending," he concluded. The young man could be me, or better yet, I could use my adventure as an integral part of what would become a screenplay. Strong of these three ideas my rat race was esplanade. I spent a weekend to scream. That Saturday night I went to a famous Hollywood nightclub with a Milan boy named Cristian, a Mexican and a French. We arrived with a sporting car. We entered after an hour. To jump the queue you had to tip the bouncer. I was not in the mood to spend money. Cristian, said piciu, had just lent me one hundred and fifty euro and had to be enough. There were incredibly sexy girls who smoked marijuana and occasionally, from above, showered dollars. I spent the night in the car. Sunday we strolled along the Venice Beach. It was full of street vendors who proposed the most diverse gadgets and street artists who performed in exceptional performance. I could hang out with most of the girls who attended the hostel. Even the seductive girlfriend of Dan told me she liked me. I had the eyes of a tiger, and I had turned into a predator of dreams. However, I was always in a hurry and I preferred to spend his evenings confront Gabriel. The latter gave me other valuable information. "Never look back", "Never talk about money", "Never give up," he said. Then he added, "You do not like money, it's money that like you". Music for my ears. "Go after lunch appointments, we talk better with a full stomach." He concluded . I asked him "How many lives you saved?". "Three maybe four," he said. I did not notice the time passing so much that I decided voluntarily to lose the return flight to stop there a little '. I knew I was on the right track and I wanted to prove to myself and to the world that I could do it. Meanwhile my girlfriend decided to leave. The relations were strained for several days due to the fact that I was completely gone. I had been sucked into the City of Angels. My mom bought me another ticket. It remained a few days left. Gabriel and I went to Universal Studios. My goal was the production company Munchies 2 that according to what my contact said could be interested in my project. I smoked grass Ak47 from the pipette that Mike had lent me. The high caught me prepared. I was more than ever determined to go all the way and soon after I walked in the direction of the offices set out in the background the refrain of a popular song that said "It 's all written in the stars". At that moment I realized I could be destined to do something great and I really felt the protagonist of a film. Everything made me think it would be the final scene. I spoke to the security guard, and I convinced him, almost threatening him, to call someone from the inside. Came a girl. I was exuberant as ever. I began to talk of the project with an uncontrollable enthusiasm, without stopping and with a toothy grin on my face. I felt exalted and almost possessed. Nonetheless I paid attention to how I asked myself, and what I said. I KO'd in the third round even the most skilled of Wall Street brokers. My English had become American pure. I had turned from neophyte to showrunner. Miss told me to wait there. I felt good vibes. When she came back out she told me that the leaders were out and that she would give me the forms to fill out in order to present my idea. Haughty and almost offended I said "Not interested." I went back to Gabriel telling him that I would certainly have tried again and I reached the finish line at all costs. already felt the smell of money. I could not wait to return to my mom and my sister everything I had taken away. I would have stayed in LA. I bought a loft and invited my best friends. The nights by lions we dreamed of spending by teenagers were there waiting for us. We returned to dinner time. I made friends with Joseph, a gentle Scottish alcoholic and Anthony, a homeless man who tattooed me the word "California" on the right leg. All I've got was another free day. Then I would have broken down. Gabriel, meanwhile, had gone. He had disappeared that morning suddenly. He had left his email and his cell phone number. I prepared for a new all-in. I searched the headquarters of a home production of cartoons called Cartoon Machine. I showed up at the reception saying with conviction, "I am the best young Italian-American producer who you'll meet", "I want to speak directly with the manager because I'm running and I have to submit a project that I am convinced will be a success." The receptionist told me to wait there. I followed him without delay and found myself face to face with Corey Wright, CEO and financial partner. I asked him five minutes of his time. I told him "I love America" and showed him the tattoo. Then I threw myself in what was the most spontaneous and spirited conversation I had ever sustained. I took advantage of my whole repertoire of sound bites. I tried to run the show and take it by the throat. I put before his eyes the image of pseudo-family I had created and asked him to carefully observe it. Do not let him time to respond. I had to convince him that I possessed a gold mine. "I see the most original animated series and subversive that could ever be devised" I exclaimed. "The characters are innovative, fun and sarcastic." "They represent America nowadays. "We can create hundreds of episodes and point to a growing market." "Americans love the crazy things!" He concluded. I was convinced that he would accept my proposal. I asked him to work for him. "I like Michael," he said. However, he replied that he could not make a decision just like that. He would leave his e-mail address to which I would have to send the project in detail. I played my last card. "Life in a hostel" I said. When I did her eyes lit up with bright light so much that he left the race exclaiming "This is a nice idea!". I had in mind to make one more effort then I headed for Hollywood Hills in search of the American base of the company which cooperated with a famous Italian director. I found myself facing a simply home. The matched address. I wrote the idea of the film on a business card and tucked it in the mailbox. A damsel, passionate yoga and country music, offered me a ride up to number 448 of Crenshaw Boulevard. It was time to go home. I gave the best of me and already I was planning my next move. Bollywood was the future. That evening I chose to go out with a New York girl who did not even know to be in the world. We toasted to life and health in the last five dollars that I had left. I packed my bags, and Anthony, who also had to go to the airport to welcome one of his three girlfriends, offered to accompany me. After smoking I soon began to fear that something would happen because it was night and we had to pass the most dangerous areas of the city. "Are you with me friend" told me to calm down. We took a bus. They climbed two mothers made of cocaine that brought with them the visibly sick children. "Welcome to California" told me the driver. Arrived at 'LAX, Anthony prepared me dinner with what he had in the suitcase. He did first, second and managed to even offer me coffee warming water and pouring an instant solution. We watched a football game and then fell asleep on a sofa in a small restaurant. The next morning he said to me before I left "Are you crazy man, just like me, that's why we get along." I cried bitterly when the plane took off again and I saw the city from above.

submitted by /u/luigipierobon [link] [comments] via Blogger https://ift.tt/2XGLSSV

[garrisontownhall]

01.02: Clara

Things hadn’t been right for quite some time with my family. We all watched my mother slowly sink into her ancient sitting chair, where she would blankly gaze at hazy daytime television shows until her eyes rolled back into her head, and we would come and shut her lids, and lay down grandma’s quilt across her. Father worked long hours at the mill, and would always come home coughing, then he’d start a pack of coffin nails, and walk out to his work shed without a word, his face and clothes always darker with dirt than the day before. Nobody was allowed to bother father. The doors to the shed stayed locked, and he wouldn’t leave until the whole house was sleeping. It was just me and my younger brother Jason, day after day, struggling to keep each other sane.

My father was respected enough within the town, as he continued working and showing up to church, but the people harbored hatred for my mother ever since the day she stopped leaving the house. Other kids wouldn’t speak to us in the schoolhouse, or on the street. They called our family a curse, and made up nasty ugly rumors, which they whispered just loud enough for us to hear. When I cried, my brother told me not to listen to the lies, but as he said so, I would wonder whether they were lies at all.

Gradually, mother became less and less. Her skin and muscle seemed to separate from the bone like slow cooked meat, sitting loose inside a bag of wrinkled tissue. All of her bodily fat seemed to slump off to her sides and melt into the gaps between cushion and chair. Terrified by my new reality, I allowed myself to be overcome with cowardice, and inaction became the tool by which I would deal with my circumstances. I stopped showing up to school, and though the office called home every day, nobody ever answered. Instead, I would wander the fields and woods between our house and Maine Street. I would write down a name for every critter I encountered, and draw pictures of them in my journal, until Jason got off the bus, and then he’d meet me in the clearing.

One afternoon, we were out in the woods together, playing games. Neither of us could stand to be inside our home, and we would often hide out for hours, in a silent sanctum detached from the nauseating fear, and burning anger that had swallowed up our normal lives. We went running over roots and leaves, and laughed among the trees, until that creature came to light out of the corner of my sight and brought my brother to his knees. Buried under sticks, which had mostly all been knocked away by weather and passing pests, festered the dismembered torso of a massive buck. It’s hind legs were attached, but mangled badly, held together with a yard of barbed wire, and both of it’s front legs were missing, blackened scabs marking the loss. The head was also gone, and in it’s place a broken, gnarled antler, stuck inside the open throat. It’s insides had been cleared out so it’s husk was all that rest beneath the shroud of overarching trees that wept like children for it’s death. And so did Jason, for he’d never seen such a horrible display of decay and destruction. It tugged at his stomach and left him curled up on the fallen foliage, spurting up his lunch and closing his eyes tight while I watched anxiously, unsure of how to help. When he finally regained clarity, all Jason could do was hold his knees to his chin with his back against a sturdy tree and rock himself. The sense of dread that had overwhelmed my spirit came not from the crass perversion of nature that lay before us, but at the thought of what kind of hell driven beast would be capable of such a thing, and the knowledge that this monster resided within the limits of my home town.

Hours passed before Jason could get back on his feet, and we emerged from the enclosure of forest into a night flooded with the watery glow of a moon covered in fog, unsettled and defeated, no longer safe in our only sanctuary. As we marched along the roadside, Jason running up ahead of me kicking a discarded can like a soccer ball, the owner of Garrison’s only fill station and convenience store, Billie G. Dennison eased up beside us in his ghastly green pick-up. Bill always made me feel a bit uneasy, even as a little girl, but he was known around town for being a helpful, handy sort. He rolled down his passenger window and leaned over the center console.

“What’re you two doin’ walkin’ ‘round here so late?” He lifted a cup from it’s holder and spit a wad of brown tinted sludge from between his lips.

“Just heading home Mr. Dennison,” I stuck my hands in my pocket and nervously dragged my shoe against the ground as my brother turned around to join me at my side, “Spent a long day playing outside and now we’ve gotta get home and have some supper.”

“Supper at 8:30?” Billie snickered to himself and pinched the end of his goatee, twirling it around a bit before he redirected his focus to us, “Your mother still make that shepards pie she always used to? Been a long while since we had some of that good home cookin’ down at town hall.”

“Mama hasn’t been cooking much of anything lately,” I stared down at the rocks and the leaves.

“Say, she up on her feet again yet? Heard that surgery they done on that knee put her out of comission for a while.”

“I really should be getting home Mr. Dennison. My dad’s gonna wonder where we are if we’re not back soon.”

“Well then why don’t I give you two a lift back home, little Miss Lamont?”

“I’m all set, but thank you Mr. Dennison. We were just enjoying the fresh Fall air, and besides, the exercise would do us well.”

He slid into the passenger’s seat and stretched his arm out the window to rest an oily black hand on my shoulder. I shrugged it off and stepped away. He stunk fantastically of bottom shelf gin and his piggish eyes were rolling round in the sockets like catseye marbles on a wobbly table.

“You look an awful lot like your mama when she was a tight little pretty young thing,” A globulous trail of dirty brown drool running down from his chin to the window, “Why don’t you get in the truck Clara?”

He started sliding the strap of my dress off with his long hairy fingers and I froze in panic. Overtaken by a sense of distress and alarm, coupled with disgust at the thought of what might come, I closed my eyes and began to cry and as he reached for my face, Jason wound up and hurled a golf ball sized rock straight at his repulsive wrinkled face. It cut through the air and landed with an echoing crack right above his lazy left eye, splitting the skin of his brow, and Billie recoiled with a yelp that put Wilhelm to shame, holding his head as blood poured forcefully between his hairy knuckles.

“Fucking inbreds!” He shouted, scurrying back into the driver’s seat, spilling AC/DC and Motorhead tapes from the cluttered seat onto the much more cluttered floor, “You wait til’ the town hears about this you stupid little cunts!” Billie’s truck roared with the thunder of zeus, as it hastily swerved back onto the street and proceeded messily out of sight.

“Thanks Jay,” I re-adjusted my dress and tried to wipe the invisible residue of Billie’s awful touch from my shoulder, “You know I’ve always got your back too, right?”

“I know Clara.” He stared ahead with a demeanor of vengeance, fixated on the shadowy tunnel into which Bill’s truck had disappeared. Jason still didn’t look like himself, and I could tell that his thoughts were caught in the dissonance that had developed between what now existed, and the world we’d always known. His easy way and gentle nature appeared to have changed in the passing of a moment, as if he had grown ages in hours, rapidly becoming achingly aware of mankind’s depraved nature, and all the more resistant to it’s influence.

From that point, our moonlit walk had become overcast by clouds of unease and an fog of mistrust. For once, I felt eager to return home, just so I might hide for a while from the chilling cold and foreign fog that filled the streets which wound and twisted like the entrails of some great beast who’s been reluctantly provoked from out of sleeping. A sickening hum of burning telephone wires overhead rang out in a discordant chorus with the penetrating whistle of a distant railway train, plowing across some barren meadow, sounding out the wail of a harbinger of oncoming trauma.  

(continued.)

[brajeshupadhyay]

Scared patients, overflowing hospitals and overworked doctors​: It's time Tamil Nadu govt got its act together in Chennai

It's 8 pm. The streets of Chennai are dead. The checkpoints have multiplied for this 12-day lockdown, so have the cops on the street. Every vehicle is being stopped, scanned, questioned.

Near the Rajiv Gandhi Government General Hospital (RGGGH), one of the four main facilitates which is treating COVID-19 patients in Chennai, this reporter saw an MTC bus leaving with a few healthcare workers. All of them looked like they were about to pass out. As we parked next to the canteen, this reporter spotted a doctor in blue scrubs and a green mask, walking with her head bowed down. In 2017, this reporter had interviewed a bunch of newly-christened ‘doctors’ at this very spot. Three of them had animatedly spoken about throwing themselves headlong into the profession, in spite of the various drawbacks.

Opposite the parkin, a board read: new PG Hostel. Wonder how many of the 42 PG doctors from Madras Medical College, who had tested positive for COVID-19 almost two weeks ago, stayed there.

Meanwhile, the reporter's friend’s cousin got out of the car and was waiting to catch a glimpse of her husband, who had tested positive a few days ago. He had almost recovered from fever when he experienced a bout of breathlessness and had to be rushed back to the facility. Since he has been at the COVID facility inside the RGGGH campus. She was bringing him a change of clothes, some medicines and was seeing him for the first time since he was admitted at the facility. They exchanged a few nervous words, as my friend and I tried to look away.

The COVID Outpatient Block is two towers away from where we stood in Tower 1. These towers have a raised entrance, which makes the reception visible from the road, as well. As we started driving past the campus, I looked at the bright lights coming from the tower. Nothing poetic came to my mind but the dead silence, which is unusual to the hospital because usually it is bustling owing to Chennai Central Railway Station which is located right across the road. The jarring lights coming from the COVID Outpatient Blocks, only added to the general uneasiness that one had started to feel in Chennai.

Rajiv Gandhi Government General Hospital in Chennai

The COVID-19 Outpatients Block at the RGGG Hospital is built like a wedding hall. It has huge steps leading up to a hall-like reception. On either side are ramps. Ambulances stop at the right corner, from where patients can be wheeled in. Before you enter, there is an assistance kiosk outside labelled ‘May I Help You’.

Those entering were made to sanitise their hands at the kiosk. The healthcare workers, manning the kiosk, also answer questions if you are confused. This kiosk though is not manned at all times. While we were there, a few people had to look around for help. Diagonally opposite the kiosk is a space to wash hands. Inside the hall, there are rows of chairs, all placed at a distance of 4-5 feet, facing a reception area. Patients have to wait their turn to make their entry at the reception, following which doctors on duty will assess the patients. Some have attendees helping them, while most of them are there by themselves.

There are huge windows on either side of the entrance. This is where the family and friends of those who’ve gone inside are waiting.

Pushpa, a resident of Thideer Nagar in Besant Nagar, was here with her husband K*, who was diagnosed with blood cancer in September 2019. He was just about to commence radiation therapy at Cancer Institute in Adyar when another patient at the institute was tested positive for COVID-19. Since April, as many as seven patients and three healthcare workers from the institute had tested positive.

All the patients from that ward were told to test themselves for COVID 19 before seeking further therapy. K’s first test was negative but a second test confirmed their worst fears. After this, K was advised to seek help from RGGGH.

"Now, they have said even though he is not showing any symptoms, he will be taken to an isolation ward for 14 days as he is a cancer patient," said his brother Suresh. Pushpa is worried that postponing radiation therapy will adversely impact K. "We already pushed it by three months. Now I am not sure when we can actually get to it," she said. As Pushpa continues to tell her story while waiting for the ambulance which would take K to the isolation facility, a doctor in a blue PPE darts out, a nurse in a green PPE at her heels, signalling for a stretcher.

"Why isn’t it here yet, it's been half an hour," the doctor asked the nurse. “No ma’am, I’ll get it, just a moment," the nurse said before signalling furiously to a group of healthcare workers standing 100 meters away, next to a few stretchers. Two of them, with a face mask and no PPE, hauled it across the ramp, while the doctor looked around, clicking her feet. While waiting for the stretcher, the doctor glanced over to this reporter, and almost as if reading the reporter's mind she quickly looked away before there was a question. It was almost a telepathic no.

Close to a month of tailing healthcare workers on COVID duty across the state will teach you to steer clear of them when they were working. Interrupting the nurses or the doctors on duty inside the OP was out of the question.

"You need to understand that everybody is in a lot of tension. There is a lot of work. Just during my eight-hour shift, more than 600 people trickle in," said Palanisamy*, a contract worker from Korukpet, who was overseeing security arrangements outside the OP. "It wasn’t so much in the beginning, but now it is 24/7. This place doesn’t sleep anymore,” he added, explaining that asymptomatic patients from RGGGH were sent to facilities outside, whereas those with moderate to severe symptoms were housed within the hospital. "People are scared. Look at his face, can’t you see panic in it," he remarked, pointing at a middle-aged man who walked past us.

“There is no reason to panic, we are very much in control. The uncertainty is going to be there because we don’t know how this pandemic will turn out but that doesn’t mean one should panic,” Dr K Narayansamy, Director of the Hepatology Department at MMC, said. He was recently appointed the Dean of MMC and Rajiv Gandhi Government General Hospital after the former Dean Dr R Jayanthi went on leave until further notice.

MMC and RGGGH have been through choppy waters in the past few months, with many doctors, PGs, nurses and healthcare workers testing positive for COVID-19. It seemed a little ironic to be sitting inside a building with a possibly high viral load but being told that RGGGH is dealing with the pandemic head-on, minus the panic.

Asking about F's experience, a COVID-19 positive patient who had told this reporter that he was turned away from RGGGH when he had shown up there with his results. F had said that he was denied admission due to lack of beds in the hospital. Dr Narayanswamy says that it must have been a misunderstanding. "We’ve close to 1,000 beds, half of them equipped with oxygen supply. We are constantly upping our capacity, there is no way anybody would have said there are no beds," Narayanswamy said, explaining that doctors make an assessment of patients in the OP block. If a person shows moderate to severe symptoms, they are admitted to the COVID care unit. If they don’t, they are sent to isolation wards outside RGGGH for observation. "This is how we ensure that facilities are available to those who are in actual need, without burning it all out," added Narayanswamy.

Eventually, F was admitted to RGGGH and is at the moment, stable. F said he is happy with the facilities now and feels that he is well taken care of.

Whether or not his problem was a wrong assessment of the patient’s symptoms or if the patient had misunderstood the doctor, what was told to him doesn’t seem easy to figure out. This problem though has been mentioned by many doctors on duty. Some of them, across several districts in Tamil Nadu, said that they assess ILI (Influenza-Like Illness) symptoms in patients and to ensure that the system isn’t overburdened, admit those who absolutely need hospital care. If not, they are told to rest and recover at home. A few patients are also not very forthcoming which hinders the process further. But since the decision largely rests on discretion, as there are no guidelines set in stone, there is room for error.

***

Kilpauk Medical College Hospital, Chennai

The waiting area outside the COVID OP Block in Kilpauk Medical College Hospital (KMCH) was an open space, like a sit out in a park. It had an enclosure on top but was open otherwise. Ambulances were lining up right in front of the waiting area, from where patients were being taken into the OP.

The ones waiting their turn had worry written all over their faces. Approaching a young woman seated alone, the reporter asked her in Tamil, "Neenga positive patient ah (Have you been tested positive)?" She first shook her head and then nodded. She introduced herself as C* from Nepal. The reporter switched to Hindi and asked her if she wanted to speak to her. She said yes, and pulled out a piece of paper from her bag. She pointed to the section which said ‘POSITIVE’. "I don’t know where they are going to take me," she said.

C has been living with her son in Chennai for more than a year now. The lockdown had been a drag as she was out of work. But she had managed until she developed a fever a few days prior. Though her fever subsided, she tested positive for COVID-19. So, she packed up, told her son to stay home and set out for Kilpauk Medical Hospital.

“What will they do now, how long will I have to wait here?” she asked. She had two young teens to keep her company. Their uncle, who was on dialysis, had tested positive for COVID-19. "He is in there, getting it done. They usually do it on the arm, but this time they are going through his neck,” one of them said explaining the process of dialysis. Two rows away, an individual who was waiting his turn, spat onto his side. Everybody looked, a few hissed.

Twenty-four hours later, C had been allotted a room at a COVID isolation facility in Pulianthope. She was first lodged at a facility within KMCH, and then the next day transferred. It has been three days and she seems okay.

The problem that patients seem to face at government facilities is only at the beginning. Stricken by panic in the beginning, most patients are confused and need reassuring. Healthcare workers, however, seem overworked and not in a position to do so.

***

Government Order 174 issued by the former health secretary Beela Rajesh, dated April 3 of 2020 reads:

“1. In the G.O. read above, the Government has notified the list of designated Government Hospitals for treatment of COVID-19 patients. Further, treatment for COVID-19 is being offered in all Government Medical College Hospitals, District Head Quarters Hospitals and Key Sub-District Hospitals completely free of cost.

2. It has been brought to the notice of the Government that certain patients/public desire to have treatment for COVID-19 in Private Hospitals also.

3. Considering the spread of CoronaVirus Disease (COVID-19) in the State, the Government have decided to include the Private Hospitals in the State for treatment to COVID-19 patients to prevent the spread of this communicable disease.

4. Accordingly, the willing patients are hereby informed that they may approach the Private Hospitals listed in the Annexure to this order to receive treatment for COVID-19, at their own cost. The hospitals are directed to follow the treatment protocol prescribed by the Government of India from time to time.”

Of the 22 hospitals listed on this Government Order, the number of private players catering to COVID-19 patients in and around Chennai has increased to 45 in a period of two months. Yet, there is uncertainty regarding the functioning of these hospitals.

First, a few videos emerged saying that these hospitals are charging exorbitant and unaffordable rates. This was followed by another government order, which capped the price for private hospitals. For non-critical cases, the cost was to be capped at Rs 5,000 per day. For critical cases, the cost was fixed at Rs 10,000 to Rs 15,000 depending on whether the patient required ICU and ventilator facility.

Another video by a news anchor and television actor S Varadharajen went viral, where he claimed that a friend of his, who had severe breathing problems and fever, was unable to secure a bed for himself at either a government or a private hospital. Health Minister Vijay Bhasker immediately got into a damage control mode and announced his team was making all efforts to ensure that facilities are adequate. "There are 75,000 beds in Tamil Nadu and 5,000 in Chennai alone," he announced a day after the video went viral. Provisions of IPC, the Epidemic Diseases Act and the Disaster Management Act were invoked against Varadharajen for the offence of ‘falsifying information to create panic.’

Two weeks since and all the damage control later, the feeling of panic in Chennai is far from gone. A flurry of transfers, including that of the health secretary hasn’t helped matters. '‘Mismanagement' is the word on the street and the rumour mills have become difficult to track. It's mostly hearsay as very few "go on record" to say anything. The fear among doctors and bureaucrats keeps them from speaking out aloud. But statements by those leading the state are hard to miss. For instance, chief minister E Palaniswami’s transition from "our positive cases will be zero in a few days" to "God alone knows when this will end."

"Strong leadership and a clear line of command is crucial to managing any public health emergency. When people are clueless as to who to turn to for a decision, you know there is a problem," said Dr Aiswarya Rao, public health consultant and former joint director of Tamil Nadu State Aids Control Society (TANSACS).

In April, there were multiple teams comprising bureaucrats who were put in charge of managing the situation. Then came the appointment of another committee. There was also the health secretary who was issuing directions on one side, while the ministers did their own thing. This is pretty much how April and May went by for Chennai. Even after the appointment of Dr J Radhakrishnan, who has managed to control multiple crises in Tamil Nadu, this crisis seemed all over the place. His reinstatement as health secretary seems to have given many within the department hope.

What about frontline workers in Chennai?

The basic fear, reiterated both private and government healthcare workers, doctors, nurses and technicians, is the fear of exposure. April witnessed many protests by government doctors and nurses in Chennai, demanding basic preventive protective equipment and post-duty quarantine facilities, after a bunch of them tested positive at RGGGH.

In a few weeks, healthcare workers at Government Stanley Medical Hospital tested positive. While government doctors have to work irrespective of fear of exposure, the same isn’t the case with private practitioners. Many private establishments have sought help from the government stating that they are not able to take on the costs required to operate a COVID-19 facility. Sanitary workers organised a strike this week after one of them died following exposure to COVID-19 positive patients.

While the government has been saying that it is meeting these demands, how the government hopes to sustain meeting these demands remain unknown. So does the expenditure over COVID-19 so far.

During his interaction with Prime Minister Narendra Modi, Palaniswami sought a grant of Rs 9,000 crore and a sanction of Rs 3,000 crore for medical equipment during a pandemic. An official statement by the chief minister also said that 2.75 crore triple-layer face masks, 38.85 lakh N-95 masks, 21 lakh PPE kits and 15.45 lakh RT-PCR testing kits have been ordered by the Tamil Nadu government. There is no official figure on how much the government has spent on personal protective equipment.

The biggest challenge for the government continues to be how it will bring about some level of accountability from private hospitals in the middle of this pandemic, which doesn’t seem like will abate any time soon.

Many non-COVID patients have spoken out about how cumbersome it has become to get private hospitals to cater to them, even under serious circumstances like deliveries. The norm at every private hospital since April has been that almost all procedures only after a COVID 19 clearance. Two months since the lockdown, yet private hospitals have not figured their way out, and that's worrisome.

Many seem to be treading the safer path by staying away. But senior doctors say that media trying to put the entire blame on private hospitals is unfair. "The costs are high, the usual patient load less. We are doing what we can to keep the hospitals running with the bare minimum," said a private practitioner, "When will the government step in and help out?"

Real situation at private hospitals listed as COVID-19 designated centres

Firstpost looked at the Tamil Nadu live dashboard and spoke to all the 45 hospitals (four from Chengalpattu and Kanchipuram districts) listed under Chennai district.

Of these 45, many of the hospitals are already operating at full capacity. Doctors at some of these hospitals said "that isn’t the case but don’t want to say anything further." In the case of some hospitals, authorities said there were no beds available anymore. Even though in some cases the live dashboard says the opposite. Some of them tailor their answers after asking a routine set of questions, which are common to all:

How old is the patient? Are they obese? Do they have any existing conditions or co-morbidities? Do they’ve breathlessness?

A positive answer to the fourth question brings forth this answer: “We are out of ventilators” or “Where are you at the moment? Okay, then go to the closest government facility, that would be the safest for you.”

Here is a brief of what Firstpost found

The Live Dashboard says these hospitals are running at full capacity: Apollo Hospital, Be Well Hospital, Bharathiraja Hospital, CSI Kalyani General Hospital, Dr Kamakshi Memorial Hospital, Dr Mehta’s Hospital, Fortis Malar Hospital, Kauvery Hospital, Lifeline Hospitals, Maya Nursing Home, Venkateshwara Hospital, Noble Hospital, Panimalar Hospital, Prashanth Hospital, MIOT Hospital, Medway Hospital.

For other hospitals, the dashboard, as on 22 June (some updated on 21 June) say has 1,865 beds, 89 ICU beds and 71 ventilators. Here are the responses of the hospitals, when contacted regarding beds:

Apollo Hospitals: No beds

Sri Ramachandra Medical College Hospital, Porur: Dashboard says 184 beds are available, hospital authorities said there are no beds.

Bharath Medical College: Dashboard shows as having 60 + 2 ICU beds. Authorities said that they aren’t admitting any patients as they don’t have the staff or the resources to handle the situation.

Be Well Kilpauk: Asked if the patient has insurance. Then said beds are available, will quote fees only after consultation with the doctor.

Chettinad Hospital: Dashboard says 161 empty beds at the hospital whereas the hospital authorities say that there are no beds available.

Kanchi Kamakoti Child Trust Hospital: Facility available for children.

Aysha Hospital: Will assess the patients and admit according to need. If oxygen is stable, patients can home quarantine and recover.

Gleneagles Global Health City: Authorities said patient can come for a check up, cannot confirm if there is a bed.

Mint Hospital: Said beds available at the cost of Rs 35,000 per day.

Vijaya Hospital: No beds, if there is a discharge and a slot opens, can contact. Cost Rs 30,000 to 40,000 a day. With ventilator will cost Rs 70,000 a day.

Tagore Medical College: Beds are available, costs are Rs 12000/day for asymptomatic patients, Rs 14000 with oxygen support, Rs 21000 if ventilator is used.

Sundaram Medical College: Full, there are patients waiting in the ER.

St Thomas Hospital: There are beds but they will decide after it's communicated how serious the patient is.

SRM Medical College: Dashboard says 103 beds + 3 ICU beds is incorrect, they are running at full capacity.

Sathya Sai Medical College: Not a super speciality, can only admit mild cases as they don’t have resources to take care of severe cases. Will cost Rs 15,000 to 20,000 a day.

Balaji Hospital: Can only admit mild cases as ICU beds are full.

SIMS hospital: Full, can’t admit.

National Hospital: Overflowing, government hasn’t updated dashboard.

Muthu Hospital: Beds are available, cost will be communicated after assessing the patient.

Meenakshi Medical College: Not admitting private patients at the moment, only admitting patients from government hospitals.

Karpaga Vinayaga Medical Science & Research Facility: Beds available; Rs 5,000/ day is the base amount, exclusive of oxygen support or investigation/scan charges.

Melmaruvathur Aadhiparasakthi Medical College: Is a Trust Hospital, all charges will come up to Rs 10,000/day

GLB Hospital: Beds available, will cost Rs 35,000/day

Appasamy Hospital: 1 bed available, will cost Rs 23,000/day.

***

J Radhakrishnan IAS, the newly reinstated health secretary says that the health department is pushing its limits to ensure that facilities are coping with the increase in numbers. “We are increasing beds in government hospitals for people who depend on us. Many non-COVID beds are lying vacant, as most aren’t coming for routine procedures, so we are constantly in the process of switching that dormant lot to our COVID bed strength. We’ve added 25 percent of those beds into COVID care,” he told Firstpost.

The health department is also trying to create a call centre for access to private facilities, in addition to 104 services, so that they can cross monitor, Radhakrishnan explains.

“We held an open meeting with private hospitals, and the estimate of beds with them is 5000. We are attempting to provide dynamic data of these beds, in order to facilitate a smoother process for COVID patients”, he adds. When I inform him that many of the hospitals aren’t admitting patients even if they have beds, he says, “Close to 170 hospitals are registered with us for treating patients. If they are not admitting COVID patients or even non-COVID cases, we will take action against them under the Clinical Establishments (Registration and Regulation) Act of 2010.”

*Names withheld to protect the identities of COVID-19 patients

via Blogger https://ift.tt/3dlGnMp

[brajeshupadhyay]

Scared patients, overflowing hospitals and overworked doctors​: Time Tamil Nadu govt got its act together in Chennai

It's 8 pm. The streets of Chennai are dead. The checkpoints have multiplied for this 12-day lockdown, so have the cops on the street. Every vehicle is being stopped, scanned, questioned.

Near the Rajiv Gandhi Government General Hospital (RGGGH), one of the four main facilitates which is treating COVID-19 patients in Chennai, this reporter saw an MTC bus leaving with a few healthcare workers. All of them looked like they were about to pass out. As we parked next to the canteen, this reporter spotted a doctor in blue scrubs and a green mask, walking with her head bowed down. In 2017, this reporter had interviewed a bunch of newly-christened ‘doctors’ at this very spot. Three of them had animatedly spoken about throwing themselves headlong into the profession, in spite of the various drawbacks.

Opposite the parkin, a board read: new PG Hostel. Wonder how many of the 42 PG doctors from Madras Medical College, who had tested positive for COVID-19 almost two weeks ago, stayed there.

Meanwhile, the reporter's friend’s cousin got out of the car and was waiting to catch a glimpse of her husband, who had tested positive a few days ago. He had almost recovered from fever when he experienced a bout of breathlessness and had to be rushed back to the facility. Since he has been at the COVID facility inside the RGGGH campus. She was bringing him a change of clothes, some medicines and was seeing him for the first time since he was admitted at the facility. They exchanged a few nervous words, as my friend and I tried to look away.

The COVID Outpatient Block is two towers away from where we stood in Tower 1. These towers have a raised entrance, which makes the reception visible from the road, as well. As we started driving past the campus, I looked at the bright lights coming from the tower. Nothing poetic came to my mind but the dead silence, which is unusual to the hospital because usually it is bustling owing to Chennai Central Railway Station which is located right across the road. The jarring lights coming from the COVID Outpatient Blocks, only added to the general uneasiness that one had started to feel in Chennai.

Rajiv Gandhi Government General Hospital in Chennai

The COVID-19 Outpatients Block at the RGGG Hospital is built like a wedding hall. It has huge steps leading up to a hall-like reception. On either side are ramps. Ambulances stop at the right corner, from where patients can be wheeled in. Before you enter, there is an assistance kiosk outside labelled ‘May I Help You’.

Those entering were made to sanitise their hands at the kiosk. The healthcare workers, manning the kiosk, also answer questions if you are confused. This kiosk though is not manned at all times. While we were there, a few people had to look around for help. Diagonally opposite the kiosk is a space to wash hands. Inside the hall, there are rows of chairs, all placed at a distance of 4-5 feet, facing a reception area. Patients have to wait their turn to make their entry at the reception, following which doctors on duty will assess the patients. Some have attendees helping them, while most of them are there by themselves.

There are huge windows on either side of the entrance. This is where the family and friends of those who’ve gone inside are waiting.

Pushpa, a resident of Thideer Nagar in Besant Nagar, was here with her husband K*, who was diagnosed with blood cancer in September 2019. He was just about to commence radiation therapy at Cancer Institute in Adyar when another patient at the institute was tested positive for COVID-19. Since April, as many as seven patients and three healthcare workers from the institute had tested positive.

All the patients from that ward were told to test themselves for COVID 19 before seeking further therapy. K’s first test was negative but a second test confirmed their worst fears. After this, K was advised to seek help from RGGGH.

"Now, they have said even though he is not showing any symptoms, he will be taken to an isolation ward for 14 days as he is a cancer patient," said his brother Suresh. Pushpa is worried that postponing radiation therapy will adversely impact K. "We already pushed it by three months. Now I am not sure when we can actually get to it," she said. As Pushpa continues to tell her story while waiting for the ambulance which would take K to the isolation facility, a doctor in a blue PPE darts out, a nurse in a green PPE at her heels, signalling for a stretcher.

"Why isn’t it here yet, it's been half an hour," the doctor asked the nurse. “No ma’am, I’ll get it, just a moment," the nurse said before signalling furiously to a group of healthcare workers standing 100 meters away, next to a few stretchers. Two of them, with a face mask and no PPE, hauled it across the ramp, while the doctor looked around, clicking her feet. While waiting for the stretcher, the doctor glanced over to this reporter, and almost as if reading the reporter's mind she quickly looked away before there was a question. It was almost a telepathic no.

Close to a month of tailing healthcare workers on COVID duty across the state will teach you to steer clear of them when they were working. Interrupting the nurses or the doctors on duty inside the OP was out of the question.

"You need to understand that everybody is in a lot of tension. There is a lot of work. Just during my eight-hour shift, more than 600 people trickle in," said Palanisamy*, a contract worker from Korukpet, who was overseeing security arrangements outside the OP. "It wasn’t so much in the beginning, but now it is 24/7. This place doesn’t sleep anymore,” he added, explaining that asymptomatic patients from RGGGH were sent to facilities outside, whereas those with moderate to severe symptoms were housed within the hospital. "People are scared. Look at his face, can’t you see panic in it," he remarked, pointing at a middle-aged man who walked past us.

“There is no reason to panic, we are very much in control. The uncertainty is going to be there because we don’t know how this pandemic will turn out but that doesn’t mean one should panic,” Dr K Narayansamy, Director of the Hepatology Department at MMC, said. He was recently appointed the Dean of MMC and Rajiv Gandhi Government General Hospital after the former Dean Dr R Jayanthi went on leave until further notice.

MMC and RGGGH have been through choppy waters in the past few months, with many doctors, PGs, nurses and healthcare workers testing positive for COVID-19. It seemed a little ironic to be sitting inside a building with a possibly high viral load but being told that RGGGH is dealing with the pandemic head-on, minus the panic.

Asking about F's experience, a COVID-19 positive patient who had told this reporter that he was turned away from RGGGH when he had shown up there with his results. F had said that he was denied admission due to lack of beds in the hospital. Dr Narayanswamy says that it must have been a misunderstanding. "We’ve close to 1,000 beds, half of them equipped with oxygen supply. We are constantly upping our capacity, there is no way anybody would have said there are no beds," Narayanswamy said, explaining that doctors make an assessment of patients in the OP block. If a person shows moderate to severe symptoms, they are admitted to the COVID care unit. If they don’t, they are sent to isolation wards outside RGGGH for observation. "This is how we ensure that facilities are available to those who are in actual need, without burning it all out," added Narayanswamy.

Eventually, F was admitted to RGGGH and is at the moment, stable. F said he is happy with the facilities now and feels that he is well taken care of.

Whether or not his problem was a wrong assessment of the patient’s symptoms or if the patient had misunderstood the doctor, what was told to him doesn’t seem easy to figure out. This problem though has been mentioned by many doctors on duty. Some of them, across several districts in Tamil Nadu, said that they assess ILI (Influenza-Like Illness) symptoms in patients and to ensure that the system isn’t overburdened, admit those who absolutely need hospital care. If not, they are told to rest and recover at home. A few patients are also not very forthcoming which hinders the process further. But since the decision largely rests on discretion, as there are no guidelines set in stone, there is room for error.

***

Kilpauk Medical College Hospital, Chennai

The waiting area outside the COVID OP Block in Kilpauk Medical College Hospital (KMCH) was an open space, like a sit out in a park. It had an enclosure on top but was open otherwise. Ambulances were lining up right in front of the waiting area, from where patients were being taken into the OP.

The ones waiting their turn had worry written all over their faces. Approaching a young woman seated alone, the reporter asked her in Tamil, "Neenga positive patient ah (Have you been tested positive)?" She first shook her head and then nodded. She introduced herself as C* from Nepal. The reporter switched to Hindi and asked her if she wanted to speak to her. She said yes, and pulled out a piece of paper from her bag. She pointed to the section which said ‘POSITIVE’. "I don’t know where they are going to take me," she said.

C has been living with her son in Chennai for more than a year now. The lockdown had been a drag as she was out of work. But she had managed until she developed a fever a few days prior. Though her fever subsided, she tested positive for COVID-19. So, she packed up, told her son to stay home and set out for Kilpauk Medical Hospital.

“What will they do now, how long will I have to wait here?” she asked. She had two young teens to keep her company. Their uncle, who was on dialysis, had tested positive for COVID-19. "He is in there, getting it done. They usually do it on the arm, but this time they are going through his neck,” one of them said explaining the process of dialysis. Two rows away, an individual who was waiting his turn, spat onto his side. Everybody looked, a few hissed.

Twenty-four hours later, C had been allotted a room at a COVID isolation facility in Pulianthope. She was first lodged at a facility within KMCH, and then the next day transferred. It has been three days and she seems okay.

The problem that patients seem to face at government facilities is only at the beginning. Stricken by panic in the beginning, most patients are confused and need reassuring. Healthcare workers, however, seem overworked and not in a position to do so.

***

Government Order 174 issued by the former health secretary Beela Rajesh, dated April 3 of 2020 reads:

“1. In the G.O. read above, the Government has notified the list of designated Government Hospitals for treatment of COVID-19 patients. Further, treatment for COVID-19 is being offered in all Government Medical College Hospitals, District Head Quarters Hospitals and Key Sub-District Hospitals completely free of cost.

2. It has been brought to the notice of the Government that certain patients/public desire to have treatment for COVID-19 in Private Hospitals also.

3. Considering the spread of CoronaVirus Disease (COVID-19) in the State, the Government have decided to include the Private Hospitals in the State for treatment to COVID-19 patients to prevent the spread of this communicable disease.

4. Accordingly, the willing patients are hereby informed that they may approach the Private Hospitals listed in the Annexure to this order to receive treatment for COVID-19, at their own cost. The hospitals are directed to follow the treatment protocol prescribed by the Government of India from time to time.”

Of the 22 hospitals listed on this Government Order, the number of private players catering to COVID-19 patients in and around Chennai has increased to 45 in a period of two months. Yet, there is uncertainty regarding the functioning of these hospitals.

First, a few videos emerged saying that these hospitals are charging exorbitant and unaffordable rates. This was followed by another government order, which capped the price for private hospitals. For non-critical cases, the cost was to be capped at Rs 5,000 per day. For critical cases, the cost was fixed at Rs 10,000 to Rs 15,000 depending on whether the patient required ICU and ventilator facility.

Another video by a news anchor and television actor S Varadharajen went viral, where he claimed that a friend of his, who had severe breathing problems and fever, was unable to secure a bed for himself at either a government or a private hospital. Health Minister Vijay Bhasker immediately got into a damage control mode and announced his team was making all efforts to ensure that facilities are adequate. "There are 75,000 beds in Tamil Nadu and 5,000 in Chennai alone," he announced a day after the video went viral. Provisions of IPC, the Epidemic Diseases Act and the Disaster Management Act were invoked against Varadharajen for the offence of ‘falsifying information to create panic.’

Two weeks since and all the damage control later, the feeling of panic in Chennai is far from gone. A flurry of transfers, including that of the health secretary hasn’t helped matters. '‘Mismanagement' is the word on the street and the rumour mills have become difficult to track. It's mostly hearsay as very few "go on record" to say anything. The fear among doctors and bureaucrats keeps them from speaking out aloud. But statements by those leading the state are hard to miss. For instance, chief minister E Palaniswami’s transition from "our positive cases will be zero in a few days" to "God alone knows when this will end."

"Strong leadership and a clear line of command is crucial to managing any public health emergency. When people are clueless as to who to turn to for a decision, you know there is a problem," said Dr Aiswarya Rao, public health consultant and former joint director of Tamil Nadu State Aids Control Society (TANSACS).

In April, there were multiple teams comprising bureaucrats who were put in charge of managing the situation. Then came the appointment of another committee. There was also the health secretary who was issuing directions on one side, while the ministers did their own thing. This is pretty much how April and May went by for Chennai. Even after the appointment of Dr J Radhakrishnan, who has managed to control multiple crises in Tamil Nadu, this crisis seemed all over the place. His reinstatement as health secretary seems to have given many within the department hope.

What about frontline workers in Chennai?

The basic fear, reiterated both private and government healthcare workers, doctors, nurses and technicians, is the fear of exposure. April witnessed many protests by government doctors and nurses in Chennai, demanding basic preventive protective equipment and post-duty quarantine facilities, after a bunch of them tested positive at RGGGH.

In a few weeks, healthcare workers at Government Stanley Medical Hospital tested positive. While government doctors have to work irrespective of fear of exposure, the same isn’t the case with private practitioners. Many private establishments have sought help from the government stating that they are not able to take on the costs required to operate a COVID-19 facility. Sanitary workers organised a strike this week after one of them died following exposure to COVID-19 positive patients.

While the government has been saying that it is meeting these demands, how the government hopes to sustain meeting these demands remain unknown. So does the expenditure over COVID-19 so far.

During his interaction with Prime Minister Narendra Modi, Palaniswami sought a grant of Rs 9,000 crore and a sanction of Rs 3,000 crore for medical equipment during a pandemic. An official statement by the chief minister also said that 2.75 crore triple-layer face masks, 38.85 lakh N-95 masks, 21 lakh PPE kits and 15.45 lakh RT-PCR testing kits have been ordered by the Tamil Nadu government. There is no official figure on how much the government has spent on personal protective equipment.

The biggest challenge for the government continues to be how it will bring about some level of accountability from private hospitals in the middle of this pandemic, which doesn’t seem like will abate any time soon.

Many non-COVID patients have spoken out about how cumbersome it has become to get private hospitals to cater to them, even under serious circumstances like deliveries. The norm at every private hospital since April has been that almost all procedures only after a COVID 19 clearance. Two months since the lockdown, yet private hospitals have not figured their way out, and that's worrisome.

Many seem to be treading the safer path by staying away. But senior doctors say that media trying to put the entire blame on private hospitals is unfair. "The costs are high, the usual patient load less. We are doing what we can to keep the hospitals running with the bare minimum," said a private practitioner, "When will the government step in and help out?"

Real situation at private hospitals listed as COVID-19 designated centres

Firstpost looked at the Tamil Nadu live dashboard and spoke to all the 45 hospitals (four from Chengalpattu and Kanchipuram districts) listed under Chennai district.

Of these 45, many of the hospitals are already operating at full capacity. Doctors at some of these hospitals said "that isn’t the case but don’t want to say anything further." In the case of some hospitals, authorities said there were no beds available anymore. Even though in some cases the live dashboard says the opposite. Some of them tailor their answers after asking a routine set of questions, which are common to all:

How old is the patient? Are they obese? Do they have any existing conditions or co-morbidities? Do they’ve breathlessness?

A positive answer to the fourth question brings forth this answer: “We are out of ventilators” or “Where are you at the moment? Okay, then go to the closest government facility, that would be the safest for you.”

Here is a brief of what Firstpost found

The Live Dashboard says these hospitals are running at full capacity: Apollo Hospital, Be Well Hospital, Bharathiraja Hospital, CSI Kalyani General Hospital, Dr Kamakshi Memorial Hospital, Dr Mehta’s Hospital, Fortis Malar Hospital, Kauvery Hospital, Lifeline Hospitals, Maya Nursing Home, Venkateshwara Hospital, Noble Hospital, Panimalar Hospital, Prashanth Hospital, MIOT Hospital, Medway Hospital.

For other hospitals, the dashboard, as on 22 June (some updated on 21 June) say has 1,865 beds, 89 ICU beds and 71 ventilators. Here are the responses of the hospitals, when contacted regarding beds:

Apollo Hospitals: No beds

Sri Ramachandra Medical College Hospital, Porur: Dashboard says 184 beds are available, hospital authorities said there are no beds.

Bharath Medical College: Dashboard shows as having 60 + 2 ICU beds. Authorities said that they aren’t admitting any patients as they don’t have the staff or the resources to handle the situation.

Be Well Kilpauk: Asked if the patient has insurance. Then said beds are available, will quote fees only after consultation with the doctor.

Chettinad Hospital: Dashboard says 161 empty beds at the hospital whereas the hospital authorities say that there are no beds available.

Kanchi Kamakoti Child Trust Hospital: Facility available for children.

Aysha Hospital: Will assess the patients and admit according to need. If oxygen is stable, patients can home quarantine and recover.

Gleneagles Global Health City: Authorities said patient can come for a check up, cannot confirm if there is a bed.

Mint Hospital: Said beds available at the cost of Rs 35,000 per day.

Vijaya Hospital: No beds, if there is a discharge and a slot opens, can contact. Cost Rs 30,000 to 40,000 a day. With ventilator will cost Rs 70,000 a day.

Tagore Medical College: Beds are available, costs are Rs 12000/day for asymptomatic patients, Rs 14000 with oxygen support, Rs 21000 if ventilator is used.

Sundaram Medical College: Full, there are patients waiting in the ER.

St Thomas Hospital: There are beds but they will decide after it's communicated how serious the patient is.

SRM Medical College: Dashboard says 103 beds + 3 ICU beds is incorrect, they are running at full capacity.

Sathya Sai Medical College: Not a super speciality, can only admit mild cases as they don’t have resources to take care of severe cases. Will cost Rs 15,000 to 20,000 a day.

Balaji Hospital: Can only admit mild cases as ICU beds are full.

SIMS hospital: Full, can’t admit.

National Hospital: Overflowing, government hasn’t updated dashboard.

Muthu Hospital: Beds are available, cost will be communicated after assessing the patient.

Meenakshi Medical College: Not admitting private patients at the moment, only admitting patients from government hospitals.

Karpaga Vinayaga Medical Science & Research Facility: Beds available; Rs 5,000/ day is the base amount, exclusive of oxygen support or investigation/scan charges.

Melmaruvathur Aadhiparasakthi Medical College: Is a Trust Hospital, all charges will come up to Rs 10,000/day

GLB Hospital: Beds available, will cost Rs 35,000/day

Appasamy Hospital: 1 bed available, will cost Rs 23,000/day.

***

J Radhakrishnan IAS, the newly reinstated health secretary says that the health department is pushing its limits to ensure that facilities are coping with the increase in numbers. “We are increasing beds in government hospitals for people who depend on us. Many non-COVID beds are lying vacant, as most aren’t coming for routine procedures, so we are constantly in the process of switching that dormant lot to our COVID bed strength. We’ve added 25 percent of those beds into COVID care,” he told Firstpost.

The health department is also trying to create a call centre for access to private facilities, in addition to 104 services, so that they can cross monitor, Radhakrishnan explains.

“We held an open meeting with private hospitals, and the estimate of beds with them is 5000. We are attempting to provide dynamic data of these beds, in order to facilitate a smoother process for COVID patients”, he adds. When I inform him that many of the hospitals aren’t admitting patients even if they have beds, he says, “Close to 170 hospitals are registered with us for treating patients. If they are not admitting COVID patients or even non-COVID cases, we will take action against them under the Clinical Establishments (Registration and Regulation) Act of 2010.”

*Names withheld to protect the identities of COVID-19 patients

via Blogger https://ift.tt/2Z0mqpl

[brajeshupadhyay]

It's 8 pm. The streets of Chennai are dead. The checkpoints have multiplied for this 12-day lockdown, so have the cops on the street. Every vehicle is being stopped, scanned, questioned. Near the Rajiv Gandhi Government General Hospital (RGGGH), one of the four main facilitates which is treating COVID-19 patients in Chennai, this reporter saw an MTC bus leaving with a few healthcare workers. All of them looked like they were about to pass out. As we parked next to the canteen, this reporter spotted a doctor in blue scrubs and a green mask, walking with her head bowed down. In 2017, this reporter had interviewed a bunch of newly-christened ‘doctors’ at this very spot. Three of them had animatedly spoken about throwing themselves headlong into the profession, in spite of the various drawbacks. Opposite the parkin, a board read: new PG Hostel. Wonder how many of the 42 PG doctors from Madras Medical College, who had tested positive for COVID-19 almost two weeks ago, stayed there. Meanwhile, the reporter's friend’s cousin got out of the car and was waiting to catch a glimpse of her husband, who had tested positive a few days ago. He had almost recovered from fever when he experienced a bout of breathlessness and had to be rushed back to the facility. Since he has been at the COVID facility inside the RGGGH campus. She was bringing him a change of clothes, some medicines and was seeing him for the first time since he was admitted at the facility. They exchanged a few nervous words, as my friend and I tried to look away. The COVID Outpatient Block is two towers away from where we stood in Tower 1. These towers have a raised entrance, which makes the reception visible from the road, as well. As we started driving past the campus, I looked at the bright lights coming from the tower. Nothing poetic came to my mind but the dead silence, which is unusual to the hospital because usually it is bustling owing to Chennai Central Railway Station which is located right across the road. The jarring lights coming from the COVID Outpatient Blocks, only added to the general uneasiness that one had started to feel in Chennai. Rajiv Gandhi Government General Hospital in Chennai The COVID-19 Outpatients Block at the RGGG Hospital is built like a wedding hall. It has huge steps leading up to a hall-like reception. On either side are ramps. Ambulances stop at the right corner, from where patients can be wheeled in. Before you enter, there is an assistance kiosk outside labelled ‘May I Help You’. Those entering were made to sanitise their hands at the kiosk. The healthcare workers, manning the kiosk, also answer questions if you are confused. This kiosk though is not manned at all times. While we were there, a few people had to look around for help. Diagonally opposite the kiosk is a space to wash hands. Inside the hall, there are rows of chairs, all placed at a distance of 4-5 feet, facing a reception area. Patients have to wait their turn to make their entry at the reception, following which doctors on duty will assess the patients. Some have attendees helping them, while most of them are there by themselves. There are huge windows on either side of the entrance. This is where the family and friends of those who’ve gone inside are waiting. Pushpa, a resident of Thideer Nagar in Besant Nagar, was here with her husband K*, who was diagnosed with blood cancer in September 2019. He was just about to commence radiation therapy at Cancer Institute in Adyar when another patient at the institute was tested positive for COVID-19. Since April, as many as seven patients and three healthcare workers from the institute had tested positive. All the patients from that ward were told to test themselves for COVID 19 before seeking further therapy. K’s first test was negative but a second test confirmed their worst fears. After this, K was advised to seek help from RGGGH. "Now, they have said even though he is not showing any symptoms, he will be taken to an isolation ward for 14 days as he is a cancer patient," said his brother Suresh. Pushpa is worried that postponing radiation therapy will adversely impact K. "We already pushed it by three months. Now I am not sure when we can actually get to it," she said. As Pushpa continues to tell her story while waiting for the ambulance which would take K to the isolation facility, a doctor in a blue PPE darts out, a nurse in a green PPE at her heels, signalling for a stretcher. "Why isn’t it here yet, it's been half an hour," the doctor asked the nurse. “No ma’am, I’ll get it, just a moment," the nurse said before signalling furiously to a group of healthcare workers standing 100 meters away, next to a few stretchers. Two of them, with a face mask and no PPE, hauled it across the ramp, while the doctor looked around, clicking her feet. While waiting for the stretcher, the doctor glanced over to this reporter, and almost as if reading the reporter's mind she quickly looked away before there was a question. It was almost a telepathic no. Close to a month of tailing healthcare workers on COVID duty across the state will teach you to steer clear of them when they were working. Interrupting the nurses or the doctors on duty inside the OP was out of the question. "You need to understand that everybody is in a lot of tension. There is a lot of work. Just during my eight-hour shift, more than 600 people trickle in," said Palanisamy*, a contract worker from Korukpet, who was overseeing security arrangements outside the OP. "It wasn’t so much in the beginning, but now it is 24/7. This place doesn’t sleep anymore,” he added, explaining that asymptomatic patients from RGGGH were sent to facilities outside, whereas those with moderate to severe symptoms were housed within the hospital. "People are scared. Look at his face, can’t you see panic in it," he remarked, pointing at a middle-aged man who walked past us. “There is no reason to panic, we are very much in control. The uncertainty is going to be there because we don’t know how this pandemic will turn out but that doesn’t mean one should panic,” Dr K Narayansamy, Director of the Hepatology Department at MMC, said. He was recently appointed the Dean of MMC and Rajiv Gandhi Government General Hospital after the former Dean Dr R Jayanthi went on leave until further notice. MMC and RGGGH have been through choppy waters in the past few months, with many doctors, PGs, nurses and healthcare workers testing positive for COVID-19. It seemed a little ironic to be sitting inside a building with a possibly high viral load but being told that RGGGH is dealing with the pandemic head-on, minus the panic. Asking about F's experience, a COVID-19 positive patient who had told this reporter that he was turned away from RGGGH when he had shown up there with his results. F had said that he was denied admission due to lack of beds in the hospital. Dr Narayanswamy says that it must have been a misunderstanding. "We’ve close to 1,000 beds, half of them equipped with oxygen supply. We are constantly upping our capacity, there is no way anybody would have said there are no beds," Narayanswamy said, explaining that doctors make an assessment of patients in the OP block. If a person shows moderate to severe symptoms, they are admitted to the COVID care unit. If they don’t, they are sent to isolation wards outside RGGGH for observation. "This is how we ensure that facilities are available to those who are in actual need, without burning it all out," added Narayanswamy. Eventually, F was admitted to RGGGH and is at the moment, stable. F said he is happy with the facilities now and feels that he is well taken care of. Whether or not his problem was a wrong assessment of the patient’s symptoms or if the patient had misunderstood the doctor, what was told to him doesn’t seem easy to figure out. This problem though has been mentioned by many doctors on duty. Some of them, across several districts in Tamil Nadu, said that they assess ILI (Influenza-Like Illness) symptoms in patients and to ensure that the system isn’t overburdened, admit those who absolutely need hospital care. If not, they are told to rest and recover at home. A few patients are also not very forthcoming which hinders the process further. But since the decision largely rests on discretion, as there are no guidelines set in stone, there is room for error. *** Kilpauk Medical College Hospital, Chennai The waiting area outside the COVID OP Block in Kilpauk Medical College Hospital (KMCH) was an open space, like a sit out in a park. It had an enclosure on top but was open otherwise. Ambulances were lining up right in front of the waiting area, from where patients were being taken into the OP. The ones waiting their turn had worry written all over their faces. Approaching a young woman seated alone, the reporter asked her in Tamil, "Neenga positive patient ah (Have you been tested positive)?" She first shook her head and then nodded. She introduced herself as C* from Nepal. The reporter switched to Hindi and asked her if she wanted to speak to her. She said yes, and pulled out a piece of paper from her bag. She pointed to the section which said ‘POSITIVE’. "I don’t know where they are going to take me," she said. C has been living with her son in Chennai for more than a year now. The lockdown had been a drag as she was out of work. But she had managed until she developed a fever a few days prior. Though her fever subsided, she tested positive for COVID-19. So, she packed up, told her son to stay home and set out for Kilpauk Medical Hospital. “What will they do now, how long will I have to wait here?” she asked. She had two young teens to keep her company. Their uncle, who was on dialysis, had tested positive for COVID-19. "He is in there, getting it done. They usually do it on the arm, but this time they are going through his neck,” one of them said explaining the process of dialysis. Two rows away, an individual who was waiting his turn, spat onto his side. Everybody looked, a few hissed. Twenty-four hours later, C had been allotted a room at a COVID isolation facility in Pulianthope. She was first lodged at a facility within KMCH, and then the next day transferred. It has been three days and she seems okay. The problem that patients seem to face at government facilities is only at the beginning. Stricken by panic in the beginning, most patients are confused and need reassuring. Healthcare workers, however, seem overworked and not in a position to do so. *** Government Order 174 issued by the former health secretary Beela Rajesh, dated April 3 of 2020 reads: “1. In the G.O. read above, the Government has notified the list of designated Government Hospitals for treatment of COVID-19 patients. Further, treatment for COVID-19 is being offered in all Government Medical College Hospitals, District Head Quarters Hospitals and Key Sub-District Hospitals completely free of cost. 2. It has been brought to the notice of the Government that certain patients/public desire to have treatment for COVID-19 in Private Hospitals also. 3. Considering the spread of CoronaVirus Disease (COVID-19) in the State, the Government have decided to include the Private Hospitals in the State for treatment to COVID-19 patients to prevent the spread of this communicable disease. 4. Accordingly, the willing patients are hereby informed that they may approach the Private Hospitals listed in the Annexure to this order to receive treatment for COVID-19, at their own cost. The hospitals are directed to follow the treatment protocol prescribed by the Government of India from time to time.” Of the 22 hospitals listed on this Government Order, the number of private players catering to COVID-19 patients in and around Chennai has increased to 45 in a period of two months. Yet, there is uncertainty regarding the functioning of these hospitals. First, a few videos emerged saying that these hospitals are charging exorbitant and unaffordable rates. This was followed by another government order, which capped the price for private hospitals. For non-critical cases, the cost was to be capped at Rs 5,000 per day. For critical cases, the cost was fixed at Rs 10,000 to Rs 15,000 depending on whether the patient required ICU and ventilator facility. Another video by a news anchor and television actor S Varadharajen went viral, where he claimed that a friend of his, who had severe breathing problems and fever, was unable to secure a bed for himself at either a government or a private hospital. Health Minister Vijay Bhasker immediately got into a damage control mode and announced his team was making all efforts to ensure that facilities are adequate. "There are 75,000 beds in Tamil Nadu and 5,000 in Chennai alone," he announced a day after the video went viral. Provisions of IPC, the Epidemic Diseases Act and the Disaster Management Act were invoked against Varadharajen for the offence of ‘falsifying information to create panic.’ Two weeks since and all the damage control later, the feeling of panic in Chennai is far from gone. A flurry of transfers, including that of the health secretary hasn’t helped matters. '‘Mismanagement' is the word on the street and the rumour mills have become difficult to track. It's mostly hearsay as very few "go on record" to say anything. The fear among doctors and bureaucrats keeps them from speaking out aloud. But statements by those leading the state are hard to miss. For instance, chief minister E Palaniswami’s transition from "our positive cases will be zero in a few days" to "God alone knows when this will end." "Strong leadership and a clear line of command is crucial to managing any public health emergency. When people are clueless as to who to turn to for a decision, you know there is a problem," said Dr Aiswarya Rao, public health consultant and former joint director of Tamil Nadu State Aids Control Society (TANSACS). In April, there were multiple teams comprising bureaucrats who were put in charge of managing the situation. Then came the appointment of another committee. There was also the health secretary who was issuing directions on one side, while the ministers did their own thing. This is pretty much how April and May went by for Chennai. Even after the appointment of Dr J Radhakrishnan, who has managed to control multiple crises in Tamil Nadu, this crisis seemed all over the place. His reinstatement as health secretary seems to have given many within the department hope. What about frontline workers in Chennai? The basic fear, reiterated both private and government healthcare workers, doctors, nurses and technicians, is the fear of exposure. April witnessed many protests by government doctors and nurses in Chennai, demanding basic preventive protective equipment and post-duty quarantine facilities, after a bunch of them tested positive at RGGGH. In a few weeks, healthcare workers at Government Stanley Medical Hospital tested positive. While government doctors have to work irrespective of fear of exposure, the same isn’t the case with private practitioners. Many private establishments have sought help from the government stating that they are not able to take on the costs required to operate a COVID-19 facility. Sanitary workers organised a strike this week after one of them died following exposure to COVID-19 positive patients. While the government has been saying that it is meeting these demands, how the government hopes to sustain meeting these demands remain unknown. So does the expenditure over COVID-19 so far. During his interaction with Prime Minister Narendra Modi, Palaniswami sought a grant of Rs 9,000 crore and a sanction of Rs 3,000 crore for medical equipment during a pandemic. An official statement by the chief minister also said that 2.75 crore triple-layer face masks, 38.85 lakh N-95 masks, 21 lakh PPE kits and 15.45 lakh RT-PCR testing kits have been ordered by the Tamil Nadu government. There is no official figure on how much the government has spent on personal protective equipment. The biggest challenge for the government continues to be how it will bring about some level of accountability from private hospitals in the middle of this pandemic, which doesn’t seem like will abate any time soon. Many non-COVID patients have spoken out about how cumbersome it has become to get private hospitals to cater to them, even under serious circumstances like deliveries. The norm at every private hospital since April has been that almost all procedures only after a COVID 19 clearance. Two months since the lockdown, yet private hospitals have not figured their way out, and that's worrisome. Many seem to be treading the safer path by staying away. But senior doctors say that media trying to put the entire blame on private hospitals is unfair. "The costs are high, the usual patient load less. We are doing what we can to keep the hospitals running with the bare minimum," said a private practitioner, "When will the government step in and help out?" Real situation at private hospitals listed as COVID-19 designated centres Firstpost looked at the Tamil Nadu live dashboard and spoke to all the 45 hospitals (four from Chengalpattu and Kanchipuram districts) listed under Chennai district. Of these 45, many of the hospitals are already operating at full capacity. Doctors at some of these hospitals said "that isn’t the case but don’t want to say anything further." In the case of some hospitals, authorities said there were no beds available anymore. Even though in some cases the live dashboard says the opposite. Some of them tailor their answers after asking a routine set of questions, which are common to all: How old is the patient? Are they obese? Do they have any existing conditions or co-morbidities? Do they’ve breathlessness? A positive answer to the fourth question brings forth this answer: “We are out of ventilators” or “Where are you at the moment? Okay, then go to the closest government facility, that would be the safest for you.” Here is a brief of what Firstpost found The Live Dashboard says these hospitals are running at full capacity: Apollo Hospital, Be Well Hospital, Bharathiraja Hospital, CSI Kalyani General Hospital, Dr Kamakshi Memorial Hospital, Dr Mehta’s Hospital, Fortis Malar Hospital, Kauvery Hospital, Lifeline Hospitals, Maya Nursing Home, Venkateshwara Hospital, Noble Hospital, Panimalar Hospital, Prashanth Hospital, MIOT Hospital, Medway Hospital. For other hospitals, the dashboard, as on 22 June (some updated on 21 June) say has 1,865 beds, 89 ICU beds and 71 ventilators. Here are the responses of the hospitals, when contacted regarding beds: Apollo Hospitals: No beds Sri Ramachandra Medical College Hospital, Porur: Dashboard says 184 beds are available, hospital authorities said there are no beds. Bharath Medical College: Dashboard shows as having 60 + 2 ICU beds. Authorities said that they aren’t admitting any patients as they don’t have the staff or the resources to handle the situation. Be Well Kilpauk: Asked if the patient has insurance. Then said beds are available, will quote fees only after consultation with the doctor. Chettinad Hospital: Dashboard says 161 empty beds at the hospital whereas the hospital authorities say that there are no beds available. Kanchi Kamakoti Child Trust Hospital: Facility available for children. Aysha Hospital: Will assess the patients and admit according to need. If oxygen is stable, patients can home quarantine and recover. Gleneagles Global Health City: Authorities said patient can come for a check up, cannot confirm if there is a bed. Mint Hospital: Said beds available at the cost of Rs 35,000 per day. Vijaya Hospital: No beds, if there is a discharge and a slot opens, can contact. Cost Rs 30,000 to 40,000 a day. With ventilator will cost Rs 70,000 a day. Tagore Medical College: Beds are available, costs are Rs 12000/day for asymptomatic patients, Rs 14000 with oxygen support, Rs 21000 if ventilator is used. Sundaram Medical College: Full, there are patients waiting in the ER. St Thomas Hospital: There are beds but they will decide after it's communicated how serious the patient is. SRM Medical College: Dashboard says 103 beds + 3 ICU beds is incorrect, they are running at full capacity. Sathya Sai Medical College: Not a super speciality, can only admit mild cases as they don’t have resources to take care of severe cases. Will cost Rs 15,000 to 20,000 a day. Balaji Hospital: Can only admit mild cases as ICU beds are full. SIMS hospital: Full, can’t admit. National Hospital: Overflowing, government hasn’t updated dashboard. Muthu Hospital: Beds are available, cost will be communicated after assessing the patient. Meenakshi Medical College: Not admitting private patients at the moment, only admitting patients from government hospitals. Karpaga Vinayaga Medical Science & Research Facility: Beds available; Rs 5,000/ day is the base amount, exclusive of oxygen support or investigation/scan charges. Melmaruvathur Aadhiparasakthi Medical College: Is a Trust Hospital, all charges will come up to Rs 10,000/day GLB Hospital: Beds available, will cost Rs 35,000/day Appasamy Hospital: 1 bed available, will cost Rs 23,000/day. *** J Radhakrishnan IAS, the newly reinstated health secretary says that the health department is pushing its limits to ensure that facilities are coping with the increase in numbers. “We are increasing beds in government hospitals for people who depend on us. Many non-COVID beds are lying vacant, as most aren’t coming for routine procedures, so we are constantly in the process of switching that dormant lot to our COVID bed strength. We’ve added 25 percent of those beds into COVID care,” he told Firstpost. The health department is also trying to create a call centre for access to private facilities, in addition to 104 services, so that they can cross monitor, Radhakrishnan explains. “We held an open meeting with private hospitals, and the estimate of beds with them is 5000. We are attempting to provide dynamic data of these beds, in order to facilitate a smoother process for COVID patients”, he adds. When I inform him that many of the hospitals aren’t admitting patients even if they have beds, he says, “Close to 170 hospitals are registered with us for treating patients. If they are not admitting COVID patients or even non-COVID cases, we will take action against them under the Clinical Establishments (Registration and Regulation) Act of 2010.” *Names withheld to protect the identities of COVID-19 patients

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