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00:00 Intro 00:29 A Quick Overview 01:26 Why I'm making this video and an apology 02:02 Testimonials 02:38 No pre-wash spot doesn't mean no pre-wash happens 03:09 A note about Express/Quick/Eco/Whatever settings 04:28 MY TERRIBLE MISTAKE (I'm sorry!) 06:27 Detergents and Hard Water 08:02 You can use way less detergent than the box says 09:29 When to use more 10:46 Tests! Experiments! 14:31 "No Pre-Wash!" on the box doesn't mean what you think it means 15:51 What about independent lab tests? 16:57 My varied dishwasher life experience 18:06 Co-marketing agreements of doom 20:16 Chemicals in detergent pacs vs powder 23:39 Cost comparison 26:02 A quick note on packaging waste 26:24 The Downside to Gels 29:08 But Gels aren't all bad 31:18 Do powder detergents have abrasives in them? 32:14 Rinse Aids (use them!) 33:38 Dishwasher cleaning and maintenance (do it!) 34:58 Dishwasher salt 36:16 Mostly snarky rants from here on out 46:34 Bloopers
I’m on vacation today. This was originally published in 2016.
A reader writes:
Last summer, I decided to re-enter the workforce after five years of raising my kids. I applied to a bunch of jobs that I thought I could do, and got an interview at this one very small company (~20 employees). The people I interviewed with — my future manager and her boss/the COO — were upfront with me that I didn’t possess the exact qualifications they were looking for, but I interviewed well and they decided to give me a few (paid) one-off assignments to see if I would be able to learn what I needed to do the job. I proved myself and they brought me on full-time.
I spent the first four months at that company doing a lot of learning on my own. My manager (let’s call her Betty) wasn’t very involved with my training at all, always claiming she had tons of work to do. Instead, she gave me lists of resources (training manuals, online certification classes, etc.) to go through, checked in with me maybe once a day, and assigned me a “starter project” so that I could “learn on the job.” So I basically taught myself everything I needed to learn, and the project I worked on was a huge success for the company. It launched about five months after I was hired. I got a raise out of it, and everyone in management seemed very happy with my work.
Once I had finished that project and the account I’d launched was doing well, I noticed some of the tactics/skills I’d used could be implemented on another account that wasn’t performing as well as the one I’d just launched. I told Betty about my plan, and she completely blew me off. Basically she told me that she “already had plans” for this account, that she didn’t need my help, and instead assigned me to another (less important) project. Needless to say, I was more than a little insulted by her attitude.
But I know that sometimes you have to push hard to get things done. I calmed myself down, and waited until the next day when Betty left for a vacation, and I went to Betty’s boss (Veronica). I walked her through the improvements I wanted to make on this other account. I was given the green light to go ahead and start that work. Clearly this was the right thing to do! Veronica wouldn’t have given me the go-ahead otherwise, right?
Well, Betty returned from her vacation on a Friday a few weeks later. I came in that Monday morning and found that she had sabotaged all of my work over the weekend! She went through everything I’d worked on that had already launched and made a bunch of changes, took down some stuff, and more. Essentially she did everything she could so that I wouldn’t be able to show the improvements that I’d made to the suffering account, and reverted it to how it was performing in the past. She also sent me a very passive-aggressive email along the lines of “let’s chat about this first thing Monday.”
In order to preempt another hissy fit from her, and once I assessed the gravity of what she’d done, I went into the meeting with Betty, but pulled Veronica into the conference room as well. I proceeded to explain to Betty that this project had been assigned to me by Veronica, and that she had no business interfering with my work. I was very clear that what she had done was unprofessional, extremely disrespectful, that the results I’d produced were speaking for themselves and that she shouldn’t meddle in things that don’t concern her. Of course I was very angry and maybe I was a little forceful during that meeting, but I feel like I had every right to be upset at what she did!
Betty was very quiet during this meeting. At the time I figured she just couldn’t think of how to defend her actions. Now I understand it’s because she’s even more conniving than I thought she was.
The next morning, I was called in to sit down with Veronica and the CEO. They told me that things weren’t working out, gave me a severance check, and told me I was laid off.
I feel that I was treated extremely unfairly by this company. I had a clearly incompetent manager, I never received proper training, and when I tried to help by taking on important projects, my work was sabotaged and I was punished for my initiative. I think Betty may even have spread harsh rumors about me in the industry because despite applying to a bunch of jobs since then, I’ve had very few interviews, and the ones I’ve had never went past the references stage.
Some of my friends are telling me I should let this go and count my blessings that I’m out of that environment, while my husband wants me to get a lawyer involved. Money’s tight right now, and I really need income, even if it’s returning to work for that company (under a different manager). What should I do?
You weren’t fired for taking initiative. You were fired for undermining your manager by going around her to her own boss after she already told you no, and for not being clear with Veronica that Betty had already told you no, and for having a bizarrely aggressive attitude about it when called out on it.
Here’s how this looks from a manager’s perspective:
* You offered to take on a particular project, but your manager told you she had it covered. You found this insulting, even though it’s your manager’s prerogative to decide who will work on what projects, to have her own plans for accounts, and to decline your help.
* As soon as your manager left for vacation, you went over her head to her own boss to ask the same question that you’d already been told no about. You didn’t tell Veronica that Betty had already told you no, which means that she didn’t have the full context to make a decision.
* You interpreted Veronica’s “yes” as meaning that Betty had been wrong, when all it really means is that Veronica didn’t have full information. When you write, “Veronica wouldn’t have given me the go-ahead otherwise, right?” the answer to that is no. Betty probably knows the work she oversees more intimately than Veronica, and could have all sorts of good reasons for saying no that Veronica didn’t know about (for instance, that your ideas had been tried in the past but didn’t work for particular reasons, or that a stronger plan was already in progress, or that the client specifically rejected those ideas in the past, or all sorts of other things). But even leaving that aside, there’s no way that Veronica wouldn’t want to know that Betty had already weighed in on this, and it seems like you intentionally didn’t tell her that.
* Then, when called out on it once Betty returned, you disingenuously claimed that Veronica had assigned you the work — when in fact you’d asked Veronica to let you do it without telling her Betty had already said no.
* Most incredibly, you had the audacity to say that Betty had no business “interfering” with your work — when she is your manager. Your manager’s business is to intervene in your work, if that’s what she judges is needed. She has complete standing to interfere in your work. You even said she shouldn’t meddle “in things that don’t concern her,” when your entire job is her concern.
* To make matters worse, you describe yourself as being angry and forceful in the meeting where you asserted all this.
* Throughout this, you interpreted all of Betty’s behavior in the worst possible light: You say she wasn’t involved with your training when she was meeting with you daily, gave you what sounds like significant resources to learn from, and assigned you work designed to help you learn on the job — all of which sounds pretty good, not something worthy of contempt. When she undid the work that you did after she specifically told you not to, you called that sabotage (!). You described her as “passive-aggressive” when she said you’d need to meet to discuss all this, when that’s just straightforward and direct. You describe her as having “hissy fits” and being “conniving.” This is just a bizarrely adversarial approach toward Betty, and it’s rooted in a really fundamental misunderstanding of what your manager’s role is and the authority that she has over your work.
I’ll be blunt here: I would have fired you too. Most managers would. This isn’t a matter of making a mistake. This is a situation where you deliberately went around your boss, deceived your boss’s boss, and attacked when called out on it, and you still don’t think you did anything wrong. Firing was a logical response.
As for getting a lawyer involved, I’m not sure what grounds your husband thinks you’d have for legal action, but nothing you’ve described here is illegal. Companies are allowed to fire people for any reason they want, as long as it’s not based on race, sex, religion, disability, or other protected characteristics and as long as it’s not as retaliation for exercising a legally protected right like reporting discrimination. Even if Betty was wrong in her assessment — and it doesn’t sound like she was — it would be perfectly legal to fire you for any of this.
The best thing you can do now is to use this as a flag that you need to do some serious re-thinking about how offices work and what it means to have a manager. If you find another job without doing that, you’re going to see this repeat itself.
Remember the letter-writer who quit on her second day because her coworker was horrible (and who, among other problems, gave her 45 minutes of training how to switch on a standard light switch) and kept getting approached by board members who wanted to know the real reason she left? Here’s the update.
After I read your response, I promised myself I’d say something if I saw one of the board members. Didn’t have to wait long because I seem to be bumping into them everywhere (two of their spouses work with me). After talking with two separate board members, I have a huge amount of gratitude for the bullet I dodged.
First, I bumped into the woman who conducted my interview, we’ll call her Board Member 1. Board Member 1 is in her 60s. We spoke briefly and I think I know why Amy gets away with stuff. (For reference since I didn’t offer it at first, I’m in my late 20s, Amy is in her late 50s.)
I walked Board Member 1 through Amy’s greatest hits, including sharing negative stories about the board and instructors, the light switch thing, and her godawful customer service. I told her about Amy’s oversharing without relaying details, but that the content was inappropriate and made me feel unsafe and uncomfortable. She immediately sang Amy’s praises and said that Amy had told the board I refused to pay attention and was on my phone the whole time. Board Member 1 then went into a tangent about my generation being lazy and not wanting to work hard and always needing safe spaces. I was speechless.
After I picked my jaw up off the floor, I thanked my lucky stars that I had enough self-preservation skills to get the hell out of there.
I also ran into the younger board member who asked me about Amy’s behavior. We’ll call him Board Member 2, who is much closer to my age. I spilled all the tea and left nothing out, including my panic attack and the conversation with Board Member 1. Nothing I said shocked him but he was obviously upset. He said I lasted longer than the previous employee, who walked out after an hour. I don’t think I have a big enough yikes for that, and I’m also not thrilled that they all had an inkling Amy was like this and just let me go into the apeshit ball pit with no support. He asked me to write up my experience with Amy, including my conversation with Board Member 1 and whatever I was comfortable sharing regarding my reasons for leaving, and send it to him for next month’s board meeting. At least I don’t feel like diving under a rock when I see the other board members.
Mystery solved. Good riddance. I have a better new job that doesn’t give me panic attacks. I do have half a mind to send the board my therapy copays for reimbursement though.
How to get the man of your dreams using the Internet
Chance
2005
Ladies! Here is your chance to find the man of your dreams using the Internet. We have had a lot of dating books on our website over the years. By the time this book was published, many online dating sites were still in their early days. Very little is offered about finding the right type of service, although the author said that a good quality in a service is a chat room.
There is also an excessive amount of information for importing the man of your dreams or you going out of the country to find him. I am sure the immigration information and other travel information is out of date. I started thinking this was something like a green card scam.
Other helpful advice:
Don’t send money to people you don’t know.
Don’t trust a profile without a picture.
Make a spreadsheet of your “finds” with the basic facts.
No mention of safety protocols or what to do about creeps. Sorry friends, this one was a weeder from the get go.
Another craptastic craft book for your consideration. The copy I happened to see was pretty beat up. That said, all I had to do was note the quasi “harvest gold” palette of colors to determine that this book was straight out of the 1970s. Looking at the crafts, you can see this is related to the macrame books of the same era. Everyone knew about macrame, but I never heard the term finger weaving used.
Of course we have some perennial 1970s looks: ponchos, vests, and a decorative collar. I believe I have seen a similar example of an afghan on every couch when I was a kid.
This is a weeder. The dirt on the book and a somewhat broken binding qualifies it for the recycle pile. Retro crafts can be something fun, but how about a book from this century?
I think I am ready for some Brady Bunch re-runs after looking at this gem.
A few years ago Dan Reilly, the warning coordination meteorologist at the local National Weather Service, and I were discussing fall cool fronts. The first day it truly felt like fall in Houston should be a holiday, we agreed. Every year since, Space City Weather has designated the first day it will truly feel like “fall” in Houston as Fall Day. This year, that day comes on Wednesday, after a front moves through overnight and brings much cooler and drier air to the region. It may not be an official holiday, but it sure should be one after we survive summer.
Low temperature forecast for Wednesday night and Thursday morning. (Weather Bell)
Monday
Before we get to the front, however, Houston will experience a little bit more heat. Highs today should reach at least the low 90s, with sunny skies. Rain chances are essentially zero north of Interstate 10, and perhaps 10 to 20 percent closer to the coast. Winds will be light, out of the southwest, at 5 mph. Conditions overnight will be warm and muggy.
Tuesday
This will be another hot, humid, and sunny day in Houston, but it will be the last one for awhile. That’s because a bona fide front will push through Houston. The timing is a bit uncertain yet, but expect a broken line of showers and thunderstorms to reach central Houston perhaps around sunset, and push off the coast during the late evening hours. After this, drier air will move into the region during the overnight hours. Most of the region should wake up Wednesday morning to dewpoints in the 50s.
NAM model forecast for the radar at 7pm CT Tuesday. This is only a very rough estimate. (Weather Bell)
Fall Day
This will be a fine day, with sunny skies, moderate northerly winds of 10 to 15 mph, and highs in the low 80s. As the sun drops toward the horizon, so too will temperatures. Inland lows likely will reach the upper 50s, with areas closer to the coast staying in the low 60s.
Thursday and Friday
These should be sunny, pleasant days with highs in the low 80s, and overnight lows down around 60 degrees.
Saturday and Sunday
We should see some warming over the weekend, but even with mostly sunny skies I don’t think highs will get above the mid- to upper-80s. Dewpoints will remain lower than summertime levels, so while it won’t be cold, it won’t be unpleasantly steamy, either.
Call it the Charlie Hustle tropics forecast, with Peter and Rose active in the Atlantic Ocean. Fortunately, neither storm presents a significant threat to any landmasses. Beyond this, the red X off the coast of Africa could very well develop as it moves west across the Atlantic Ocean. This system seems unlikely to be bound for the Gulf of Mexico, however. Overall, in fact threats to the Gulf over the next 10 days are fairly low. I’m not complaining.
We continue to enjoy fairly quiet weather across the region in the wake of Hurricane Nicholas. Today will be no exception, though things get a bit more unsettled this weekend. But the drumbeat regarding our first legitimate autumn cold front is growing louder today. For now at least, it would seem that some very nice weather is on the horizon for the back half of next week. More on that below.
Today
Friday will probably be similar to Thursday in a lot of ways with clouds and sunshine sharing the sky. Yesterday saw upper-70s at Bush Airport compared to mid-80s at Hobby. Today should probably see 90 or better in a lot of locations, provided the sun is out a good bit. Otherwise, look for mid to upper-80s, still warmer than Thursday.
A warm but fairly pleasant Friday should be in store for most of the area, with little rain chance. (NOAA)
Rain chances are quite slim to none today.
Saturday & Sunday
We sort of settle back into more of a typical late summer pattern this weekend, as Eric’s been noting the last couple days. The coverage of showers and storms expected has wobbled a bit lately, but it looks like we’ll have decent coverage of showers tomorrow and maybe a bit less coverage on Sunday. We’ll have a good bit of humidity and highs in the upper-80s to low-90s depending on cloud cover. Morning lows should be in the 70s.
Early next week
Monday looks pretty good right now with just a chance of a shower or storm but otherwise partly to mostly sunny. Look for morning 70s and afternoon 90s. Tuesday looks similar, though with perhaps a slight nudge up in rain chances.
Cold front update!
On to what should be the good news. Both the GFS & European models are in agreement on a cold front coming into the area on Wednesday. They differ on exact timing and how strong it will be, but they both show it distinctly in their forecasts and ensembles for the most part. Here are the low temperature charts from the 51 Euro ensemble members and the 31 GFS ensemble members. I’ve boxed in the period for next week.
Both the Euro (left) and GFS (right) have good agreement among the majority of their ensemble members for a cold front through Houston next week, though they differ on exact timing and amplitude. Click to enlarge. (Weather Bell)
The Euro is at nearly 100 percent agreement on a pretty potent cold front reaching the area, closer to Wednesday morning. The GFS, however looks to be at more like 50 to 55 percent agreement, with most ensemble members not quite as cool as the Euro. But, when you look closer at the GFS, it does bring a strong front south; it just manages to whiff to our east, bringing most cool air into Louisiana, rather than Texas. That same chart above and to the right shows more like 90 percent agreement in a front when you look at it for Lake Charles, which seems a bit odd to me.
I would say there’s a bit of uncertainty right now on the finer details, like whether it’s 60 to 65 or 65 to 70 in the mornings late next week (though I will say that it’s quite tantalizing to see several European ensemble members in the 50s). In terms of getting the front through Houston, that’s looking like an increasingly likely proposition. Assuming that’s the case, expect a period of showers or thunderstorms Tuesday night or Wednesday, followed by mostly sunny conditions for the end of the week. Highs would be in the 80s with low humidity. And again, we’ll see about how cool morning lows go.
Tropics
The Atlantic remains active with two areas still holding at a 70 percent chance of development over the next 5 days. Both are expected to head out to sea.
While the tropics remain busy, as is typical for September, none is a realistic threat to the Gulf. (NOAA)
Some folks will continue to point to Invest 95L (the red area in the central Atlantic) as being concerning, but in order for it to come more west, it would have to remain a disheveled mess and would likely get ripped apart before it got far enough west to be concerning. Oh, and with a cold front likely to get well offshore next week, the western Gulf is protected through at least next weekend. In other words, you can rest easy. No concerns for us.
On Monday as Hurricane Nicholas was approaching Texas, police were called to a Galveston beach where a gentleman was creeping around dressed as Halloween's Michael Myers, complete with mask and bloody knife. The fellow's name is Mark Metzger, an attorney in the area. — Read the rest
by kpodd@uxbridgeshimoda.com (Dan Kennedy and Benjamin Harrison)
It's 1-29-98 and the DJs of the KPODD morning show are taking your calls, reading FM Listener Review Cards, and to getting in trouble with the fuzz. Plus! Workshopping new slogans for the Raddest Morning Team in the Southland! Machine Bolt had an in-person interaction with Art Alexakis! And El Farto delivers a heartfelt apology. Epic! The Double D!
Hello, Mr. Chips! Computer Jokes and Riddles
By Ann Bishop
Published 1982
Submitter: Turns out computer joke books age about as well as any other kind of computer book. The content starts before the title page, with a picture of a computer carved from a literal apple, though I’d be hard pressed to identify it as a carving of a computer if it wasn’t captioned. There’s a nice Red Scare Era joke on page one, and later on a joke about computers driving cars that reads a little differently now that computers are driving cars. Also a joke about humans turning computers on—is that supposed to be literal, or did we put innuendo jokes in books for children 40 years ago? Shockingly, this book circulated as recently as 2016, which is also about when I became responsible for this collection. Honestly, I’m a little embarrassed it took that long for this book to come to my attention.
Holly: These were cute in 1982, but jokes have to keep up with technology! Like these:
Don’t use “beef stew” as a computer password. It’s not stroganoff.
Why did the PowerPoint Presentation cross the road? To get to the other slide.
PATIENT: Doctor, I need your help. I’m addicted to checking my Twitter! DOCTOR: I’m so sorry, I don’t follow.
A hospital system in Arkansas is making it a bit more difficult for staff to receive a religious exemption from its COVID-19 vaccine mandate. The hospital is now requiring staff to also swear off extremely common medicines, such as Tylenol, Tums, and even Preparation H, to get the exemption.
The move was prompted when Conway Regional Health System noted an unusual uptick in vaccine exemption requests that cited the use of fetal cell lines in the development and testing of the vaccines.
"This was significantly disproportionate to what we've seen with the influenza vaccine," Matt Troup, president and CEO of Conway Regional Health System, told Becker's Hospital Review in an interview Wednesday.
Good morning. After a week of all-Nicholas, all-the time, we’re returning to a period of more normal late-summertime weather in the Houston region. As for the hurricane, it’s now a tropical depression nearing southwestern Louisiana, and should soon dissipate. After more clouds today our weather will turn more sunny, and highs around 90 degrees likely return for the weekend.
Wednesday
Some very light rain has fallen across parts of the area overnight, and additional spotty showers will be possible later today. But for the most part, this should simply be a cloudy day with moderate high temperatures of about 80 degrees. As we’re on the backside of Nicholas, winds will be out of the north or northwest for much of the day at 10 to 15 mph. Tonight should be mostly cloudy and pleasant, with lows dropping to around 70 degrees in the city.
High temperatures today will be near 80 degrees for most of Houston. (Weather Bell)
Thursday and Friday
Skies should start to become at least partly sunny on Thursday, and this will help to push highs into the mid- to upper 80s tomorrow, and possibly as high as 90 degrees on Friday. Rain chances for both days are low, perhaps 20 percent, but not non-existent.
Saturday and Sunday
After a few days of a drier overall flow, we’ll start to a see a more pronounced return of moisture from the Gulf of Mexico this weekend. This will result in rising rain chances, but I think there’s still a shot for mostly sunny skies on Saturday. Highs are likely in the low 90s. Even if most of us get through Saturday without too much rain, showers probably become more widespread on Sunday, with perhaps two-thirds of the area seeing some rain. Accumulations shouldn’t be huge, perhaps one-quarter to one-half inch for most.
Next week
Daily shower chances remain in the forecast through the middle of next week, with highs likely settling out in the upper 80s to low 90s. At that point we’re going to be looking for our first “fall” front of the season, which knocks temperatures below 65 degrees in Houston. It’s possible that is coming around next Thursday or so, but at this point we have no guarantees. But I’m ready. I suspect you’re ready as well.
Tropical outlook for Wednesday morning. (National Hurricane Center)
Tropics
The tropics remain very active, which is usual for this time of year. But we’re getting closer to the end game for the Texas coast, in terms of hurricanes. And while there is the potential for a few tropical systems to develop this week, none appear likely to trouble the Gulf of Mexico (even that ominous looking red blob in the eastern Atlantic). I suspect you’re OK with that as well.
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What first struck Nathaniel Osborn when he and his wife took their son, Seth, to the emergency room this summer was how packed the waiting room was for a Wednesday at 1 p.m.
The Florida hospital’s emergency room was so crowded there weren’t enough chairs for the family to all sit as they waited. And waited.
Hours passed and 12-year-old Seth’s condition worsened, his body quivering from the pain shooting across his lower belly. Osborn said his wife asked why it was taking so long to be seen. A nurse rolled her eyes and muttered, “COVID.”
Seth was finally diagnosed with appendicitis more than six hours after arriving at Cleveland Clinic Martin Health North Hospital in late July. Around midnight, he was taken by ambulance to a sister hospital about a half-hour away that was better equipped to perform pediatric emergency surgery, his father said.
But by the time the doctor operated in the early morning hours, Seth’s appendix had burst — a potentially fatal complication.
As the nation’s hospitals fill and emergency rooms overflow with critically ill COVID-19 patients, it is the non-COVID-19 patients, like Seth, who have become collateral damage. They, too, need emergency care, but the sheer number of COVID-19 cases is crowding them out. Treatment has often been delayed as ERs scramble to find a bed that may be hundreds of miles away.
Some health officials now worry about looming ethical decisions. Last week, Idaho activated a “crisis standard of care,” which one official described as a “last resort.” It allows overwhelmed hospitals to ration care, including “in rare cases, ventilator (breathing machines) or intensive care unit (ICU) beds may need to be used for those who are most likely to survive, while patients who are not likely to survive may not be able to receive one,” the state’s website said.
The federal government’s latest data shows Alabama is at 100% of its intensive care unit capacity, with Texas, Georgia, Mississippi and Arkansas at more than 90% ICU capacity. Florida is just under 90%.
It’s the COVID-19 cases that are dominating. In Georgia, 62% of the ICU beds are now filled with just COVID-19 patients. In Texas, the percentage is nearly half.
To have so many ICU beds pressed into service for a single diagnosis is “unheard of,” said Dr. Hasan Kakli, an emergency room physician at Bellville Medical Center in Bellville, Texas, about an hour from Houston. “It’s approaching apocalyptic.”
In Texas, state data released Monday showed there were only 319 adult and 104 pediatric staffed ICU beds available across a state of 29 million people.
Hospitals need to hold some ICU beds for other patients, such as those recovering from major surgery or other critical conditions such as stroke, trauma or heart failure.
“This is not just a COVID issue,” said Dr. Normaliz Rodriguez, pediatric emergency physician at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida. “This is an everyone issue.”
While the latest hospital crisis echoes previous pandemic spikes, there are troubling differences this time around.
Before, localized COVID-19 hot spots led to bed shortages, but there were usually hospitals in the region not as affected that could accept a transfer.
Now, as the highly contagious delta variant envelops swaths of low-vaccination states all at once, it becomes harder to find nearby hospitals that are not slammed.
“Wait times can now be measured in days,” said Darrell Pile, CEO of the SouthEast Texas Regional Advisory Council, which helps coordinate patient transfers across a 25-county region.
Recently, Dr. Cedric Dark, a Houston emergency physician and assistant professor of emergency medicine at Baylor College of Medicine, said he saw a critically ill COVID-19 patient waiting in the emergency room for an ICU bed to open. The doctor worked eight hours, went home and came in the next day. The patient was still waiting.
Holding a seriously ill patient in an emergency room while waiting for an in-patient bed to open is known as boarding. The longer the wait, the more dangerous it can be for the patient, studies have found.
Not only do patients ultimately end up staying in the hospital or the ICU longer, some research suggests that long waits for a bed will worsen their condition and may increase the risk of in-hospital death.
That’s what happened last month in Texas.
On Aug. 21, around 11:30 a.m., Michelle Puget took her adult son, Daniel Wilkinson, to the Bellville Medical Center’s emergency room as a pain in his abdomen became unbearable. “Mama,” he said, “take me to the hospital.”
Wilkinson, a 46-year-old decorated Army veteran who did two tours of duty in Afghanistan, was ushered into an exam room about half an hour later. Kakli, the emergency room physician there, diagnosed gallstone pancreatitis, a serious but treatable condition that required a specialist to perform a surgical procedure and an ICU bed.
Daniel Wilkinson
(Courtesy of Michelle Puget)
In other times, the transfer to a larger facility would be easy. But soon Kakli found himself on a frantic, six-hour quest to find a bed for his patient. Not only did he call hospitals across Texas, but he also tried Kansas, Missouri, Oklahoma and Colorado. It was like throwing darts at a map and hoping to get lucky, he told ProPublica. But no one could or would take the transfer.
By 2:30 p.m., Wilkinson’s condition was deteriorating. Kakli told Puget to come back to the hospital. “I have to tell you,” she said he told her, “Your son is a very, very sick man. If he doesn’t get this procedure he will die.” She began to weep.
Two hours later, Wilkinson’s blood pressure was dropping, signaling his organs were failing, she said.
Kakli went on Facebook and posted an all-caps plea to physician groups around the nation: “GETTING REJECTED BY ALL HOSPITALS IN TEXAS DUE TO NO ICU BEDS. PLEASE HELP. MESSAGE ME IF YOU HAVE A BED. PATIENT IS IN ER NOW. I AM THE ER DOC. WILL FLY ANYWHERE.”
The doctor tried Michael E. DeBakey VA Medical Center in Houston for a second time. This time he found a bed.
Around 7 p.m., Wilkinson, still conscious but in grave condition, was flown by helicopter to the hospital. He was put in a medically induced coma. Through the night and into the next morning, medical teams worked to stabilize him enough to perform the procedure. They could not.
Doctors told his family the internal damage was catastrophic. “We made the decision we had to let him go,” Puget said.
Time of death: 1:37 p.m. Aug. 22 — 26 hours after he first arrived in the emergency room.
The story was first reported by CBS News. Kakli told ProPublica last week he still sometimes does the math in his head: It should have been 40 minutes from diagnosis in Bellville to transfer to the ICU in Houston. “If he had 40 minutes to wait instead of six hours, I strongly believe he would have had a different outcome.”
Another difference with the latest surge is how it’s affecting children.
Last year, schools were closed, and children were more protected because they were mostly isolated at home. In fact, children’s hospitals were often so empty during previous spikes they opened beds to adult patients.
Now, families are out more. Schools have reopened, some with mask mandates, some without. Vaccines are not yet available to those under 12. Suddenly the numbers of hospitalized children are on the rise, setting up the same type of competition for resources between young COVID-19 patients and those with other illnesses such as new onset diabetes, trauma, pneumonia or appendicitis.
Dr. Rafael Santiago, a pediatric emergency physician in Central Florida, said at Lakeland Regional Health Medical Center, the average number of children coming into the emergency room is around 130 per day. During the lockdown last spring, that number dropped to 33. Last month — “the busiest month ever” — the average daily number of children in the emergency room was 160.
Pediatric transfers are not yet as fraught as adult ones, Santiago said, but it does take more calls than it once did to secure a bed.
Seth Osborn, the 12-year-old whose appendix burst after a long wait, spent five days and four nights in the hospital as doctors pumped his body full of antibiotics to stave off infection from the rupture. The typical hospitalization for a routine appendectomy is about 24 hours.
The initial hospital bill for the stay came to more than $48,000, Nathaniel Osborn said. Although insurance paid for most of it, he said the family still borrowed against its house to cover the more than $5,000 in out-of-pocket costs so far.
While the hospital system where Seth was treated declined to comment about his case because of patient privacy laws, it did email a statement about the strain the pandemic is creating.
“Since July 2021, we have seen a tremendous spike in COVID-19 patients needing care and hospitalization. In mid-August, we saw the highest number of patients hospitalized with COVID-19 across the Cleveland Clinic Florida region, a total of 395 COVID-19 patients in four hospitals. Those hospitals have approximately 1,000 total beds,” the email to ProPublica said. “We strongly encourage vaccination. Approximately 90% of our patients hospitalized due to COVID-19 are unvaccinated.”
On Sunday, The Washington Post reported that a hospital in Alabama called 43 others across three states before finding a bed for Ray DeMonia, a critically ill heart patient who later died. In his obituary his family wrote: “In honor of Ray, please get vaccinated if you have not, in an effort to free up resources for non COVID related emergencies. ... He would not want any other family to go through what his did.”
Today, Seth is mostly recovered. “Twelve-year-old boys bounce back,” his father said. Still, the experience has left Nathaniel Osborn shaken.
The high school history teacher said he likes to stay upbeat and apolitical in his social media musings, posting about Florida wildlife preservation and favorite books. But on Sept. 7, he tweeted: “My 12-year-old had appendicitis. The ER was overwhelmed with unvaccinated Covid patients and we had to wait 6+ hours. While waiting, his appendix ruptured and had to spend 5 days in hospital. ... So yeah, your decision to not vaccinate does affect others.”
It was retweeted 34,700 times, with 143,000 likes. Most comments were sympathetic and wished his child a speedy recovery. Some, though, went straight to hate, apparently triggered by his last line. He was attacked personally and accused of making up the story: “Good try with the guilt, jerk.”
Osborn, who is vaccinated, as are his wife and son, told ProPublica he only shared Seth’s story on Twitter to encourage vaccinations.
“I have no ill will towards the hospitals or the care received at either hospital,” he said this week, “but had these hospitals not been so crowded with COVID patients, we wouldn’t have had to wait so long and perhaps my son’s appendix would not have burst.”
Have you experienced or work for a hospital that is rationing care due to COVID-19 overcrowding? Contact Jenny Deam at jenny.deam@propublica.org.
By the 1960s, the neighborhood’s business core was gone, replaced by newly constructed Interstate 94. Homes that had been a short walk to the shops now overlooked a six-lane highway shuttling commuters between the Twin Cities of Minneapolis and St. Paul. Homes and businesses were seized and destroyed under eminent domain. The neighborhood was split in two.
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