Cowboy Who?

Tonight's comic is cooking a lot more lately.

Pregnant resident doctor
who is participating in virtual care
Internal Medicine
Resident Physician,
Brigham and Women’s Hospital
Boston, MA

This essay is part of our new series, Flattened By the Curve, which features the voices of doctors, nurses, healthcare workers, and others on the front lines against COVID-19. For information on how to submit, click here.

A man is screaming. He’s pulled out his breathing tube. You want to calm him, to assess his breathing, but you can’t even see him.

You are at home. Watching ICU rounds through the unblinking eye of an iPad.

On max volume, your headphones pick up all the sounds. Heart monitors beep and screech. Ventilators purr and hum. Twenty different clinicians having twenty different conversations. It’s an orchestral din. An unusual agony.

Until you realize you’re still here, at the dining table strewn with cookbooks and yesterday’s crumbs. Cool quartz under your elbows. A shard of shy Boston sunlight sneaking in behind you. Here, in your home without COVID, lucky to be safe. And, sheltering inside you, a baby who has just learned to kick.

You go where your colleagues take you, a camera wheeled along on an IV pole. You are a disembodied voice. A shared screen. A virtual assistant.

Your view of your colleagues is Picasso-like. Here, a triangle of nose and left eye. There, a blue gown and three fingers of fist clutching a stethoscope’s diaphragm. It fills you with pride to see them. It scares you to know them to be vulnerable.

The patient on your screen cries again. The team assembles: an intern gowns up, steps in to offer relief. In the shuffle, your view through the looking glass is momentarily lost. You breathe in. The hospital is in your ears but not your nostrils—where’s the sharp disinfectant, the sweat, the sterile air? A sudden pang of longing for the humid Indian summers of your childhood, soaked in cha and the warm smells of cumin, dust, fresh marigolds. You remember snatches of a melody your grandmother used to hum. What lullabies will you sing when your baby stirs? The intubated patient’s trembling has been soothed to stillness. His squirming, his will to live, not unlike what you feel beneath your stretched skin.

Everything smells like cheese. Your back hurts, but you’ve also been sitting still for hours.

These feelings you’re having of terror, and guilt, and ache for the safety of others. Pregnancy or pandemic?

You take notes in a small column; the tasks pile up like steps on a staircase to somewhere impossible. Check blood gas. Follow up liver ultrasound. Broaden antibiotics. Update family. You’ve never felt so helpless when you know there’s so much to do. How to provide care without your own hands in the room? How to give shape to comfort when the screen is flat?

One day, during rounds, you make pancakes. Whole wheat flour dribbled into liquid butter and tired eggs. Blueberries explode. The griddle hisses to greet the batter. Three perfect coins, submerged in syrup. Outside, a family of squirrels has taken shelter in your neighbor’s rain gutter. The Prudential Center is shrouded in fog. You listen to a presentation about kidney failure between bites. You hear about a man withdrawing from alcohol; he is shaky and hallucinating. And a young woman whose lungs are failing her, and each day the team fiddles with the delicate settings for pumping air into them. You wonder how suffering can at once feel so near and far. You don’t make pancakes again.

After rounds, you spend a few hours on your laptop writing meticulous summaries of the patients you heard about. “Hospital courses” are medical narratives stripped of human drama. Tedious to write, yet crucial for insurance and billing. This is the only role you can fill from afar. When you are done, you play chess obsessively with your husband; it’s the only game where the rules haven’t changed. You feel the weight and curve of each piece in your hand as it advances. You can predict the positions and calculate the losses. A pawn is a pawn; a king is a king.

Pregnancy or pandemic?

I cannot tease them apart. Hands on belly, I succumb to another kick.

Amrapali Maitra is a resident physician in Internal Medicine and an anthropologist in Boston, MA. She writes about care, culture, and the human experience of medicine. She has never baked bread but hopes to, someday.

Family medicine resident
Bronx, NY

This essay is part of our new series, Flattened By the Curve, which features the voices of doctors, nurses, healthcare workers, and others on the front lines against COVID-19. For information on how to submit, click here.

I’m in my last year of family medicine training. In normal times, my residency program cares for nineteen hospitalized patients, half a hospital floor, mostly patients from our outpatient clinics. We share our floor with palliative care, which means the nurses we work with know about dying. As residency progresses, we learn about dying too.

My first patient who died, died of AIDS complications. Many of our nurses came from the Caribbean Islands during the AIDS epidemic, when there were not enough U.S. nurses who would care for people with HIV. Many of them still work the night shift. Unlike the physicians I work with who are over 65 — and thus not reassigned to the hospital as part of the surge preparing for COVID — many of the nurses and attendants, regardless of age, are expected to continue coming to work. As residents, we trend younger. Except for those who are immunosuppressed, we all got deployed.

The palliative care doctors have been sent to the Emergency Room. Our residency program has taken responsibility for a total of six hospital teams, or, 73 patients. I work a very piecemeal schedule: a few nights, a few days, a day off. I live in Chinatown, on the last stop before Brooklyn. My hospital is the last stop of the same train in the Bronx, over an hour each way.

After my first string of nights at the start of COVID, my housemates told me they think it’s too unsafe for them if I come home. I couldn’t disagree. I moved into my uncle’s empty apartment. Hertz gave me a free rental while a friend worked to fix my rusty 1985 Benz. My mechanic has gone back to the Islands.

The work requires blinders. We don our dirty, reused personal protective equipment and focus on the most urgent next task. Tubes go in; tubes come out. All night long the overhead voice announces that hearts have stopped. I put my phone in a ziplock bag and Facetime my patients’ families. I build a stand for my phone when I can no longer stay to hear the many ways this person was loved. I have learned enough about death to help the dying come without suffering. I wrap my hair in a plastic bag. I brush my patients’ hair back from their faces. I find no beauty in the work.

When the computer system occasionally alerts me of a hospital admission of one of my primary care patients, before their status is changed to deceased, I go visit when my shift is over. I use my phone in its foggy ziplock to FaceTime the families. I ziplock my face shut.

I drive my rental back to Manhattan and cry into the steering wheel. A pandemic makes you feel small. A pandemic makes you feel nothing at all. The streets are strewn with flowers. The little green leaves are unfurling.

Nell Baldwin is a third year Family Medicine resident at a hospital in the Bronx, NY.

Since I am working from home right now, I have set up shop in what we call “the library.” Most of the stuff in this room are books, pictures, and some miscellany from family. This room is more for reading and not working. However, I wanted to keep library work separate from my other stuff, so I used this room so I could spread out.

We have a LOT of books in this room. Most of the time, I don’t pay attention since I mostly read library books. I can’t remember the last time I looked at titles in here. Combine this with the fact that I turned 60 last month, and we have known people that have been sick – and in some cases died – from COVID-19, I had a literal Swedish Death Cleaning moment. I am not planning to die soon, but I have decided that it’s time to get rid of our detritus throughout the house, starting with this room.

Home libraries are unique to the owner. They don’t have collection development policies. I wrote about some book people that were upset about Marie Kondo’s advice about paring down one’s library. I think there is merit in paring down one’s personal library. So with this in mind, I will be sharing, from time to time, some special items from my home library. I am going to start with the easy stuff. So let’s kick this off!

By the way, if any of you are in a similar situation and are weeding through some of your household items and books, please share your finds with us. I am sure all of us have stuff in our possession that begs the question: “Why do I have this?”

A History of a Free People
Bragdon, McCutchen, and Cole
1974 printing

My first example is this gem. I believe this is my high school American history text. Since it is in my possession, I can only assume I must have walked off with it, and probably owe my high school some money. Why I have it is a mystery to me.  Since it is 50 years out of date and I am not having any nostalgic moments, I think this will find its way into the circular file.

Mary

The post Library Death Cleaning appeared first on Awful Library Books.

As I continue to search for my overdue stimulus check, I instead find a worn-out handwritten letter in my mailbox, with a postmark dated 2006. It reads:

Hello, I’m Keanu Reeves in the 2006 movie The Lake House. What’s up?

Hello, Keanu Reeves in The Lake House. Do you know anything about where my stimulus check is? Apparently they were delayed because President Trump wanted to put his name on it, can you believe that? So here I am just checking my mailbox obsessively, hoping it’ll finally get here. You know, if I’d gotten my tax return via direct deposit, I’d have gotten this check already. But I was too lazy to get up to find the routing number on my checkbook. Anyway, any word on where this is?

I don’t know anything about a stimulus check. But what did you say about the president? Their name’s Trump? Like the reality show guy? That’s funny. And why are you expecting a stimulus check?

Oh, yeah. Sorry to break it to you. It’s the same guy. He’s president now and is killing us all. He fired the U.S. pandemic response team in 2018, and you’ll never guess what happened. There’s a pandemic! The country’s in quarantine, they’re using Tom Hanks’s blood to find a cure, and everybody’s losing their jobs. So now we’re getting a stimulus that’ll cover like half my rent. So, all fixed, right? Wait, what’s The Lake House?

Wait, you didn’t see The Lake House?

No.

Are you sure? Me and Sandra Bullock, we rent the same lake house two years apart and start sending time-traveling letters back and forth? It’s a romantic drama, really strong script…

Yeah, no definitely doesn’t ring a bell, but that does help explain why I’m getting letters from 2006 Keanu Reeves. I was beginning to wonder.

You were only just starting to question that?

Listen, a lot’s going on, OK? The president is telling people to inject disinfectant and I’ve been locked up for two months. I’m so concerned that my plant’s planning a coup that I started loudly watching chopped salad recipe videos to keep it in line. For all I know, I’m hallucinating and this is just my bank statement.

So just to circle back, The Lake House is not a hit?

That doesn’t appear to be the case, no. Something’s Gotta Give definitely holds up though.

Yeah?

Oh, definitely.

That’s a relief.

Hey, just throwing it out there. You said Sandra Bullock was in this movie too; is she able to send me letters? I want to tell her not to do All About Steve.

No. If you had seen The Lake House, you would know that my character can send letters to the future and her character can only send letters to the past.

Ah. Why?

Because… I don’t know, the mailbox is magic or something. Just watch the movie.

It just doesn’t seem very plausible to me, that’s all.

Do you hear yourself? You’re telling me America made a game show host president who’s telling people to shoot up Clorox during a pandemic, and MY story doesn’t sound plausible?

Alright, Keanu Reeves, calm down. Hey, here’s an idea: you have all that Matrix money, how about you just send me my $1,200?

Yeah, whatever, might as well. Should I wire it through Western Union?

No, absolutely not. I guess Venmo wouldn’t work either. Please just send a check or cash… I wonder if this time travel thing takes into account inflation?

Alright, here you go. Since I don’t know what my financial situation is when you are, and don’t want a check from 2006 to bounce, I just sent cash.

Awesome, thanks. I don’t think you needed to worry about the check bouncing, though. Just say yes when someone comes to you about doing something called John Wick. I didn’t really imagine that I was more likely to get my federal stimulus money from 2006 Keanu Reeves than the government, but here we are, I guess.

May the 4th be with you!

I roasted you some fresh coffee beans. Yes. You. There is no ulterior motive here.

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While the rest of us are fretting about the pandemic, a couple of state agencies are busy with big, unrelated stuff. Government never stops.

The Texas Department of Transportation decided to use the agency’s $3.4 billion discretionary fund on an Interstate 35 expansion through Austin, a long-term project starting during what the state comptroller predicts will be a loss of billions of dollars of state revenue due to the coronavirus-spurred recession in Texas.

Meanwhile, the Texas Railroad Commission is set to vote Tuesday on a proposal to order a cut in the amount of oil produced in the state, a serious bit of regulatory intervention designed to cut supply to match drops in demand. The plan has found unexpected welcomes from some struggling oil companies that ordinarily bridle at any hint of intervention from Austin or Washington. Those voices are hardly unanimous, but they’re out there.

The pandemic scattered most state government workers to their homes, like the rest of us. That doesn’t mean they’re all working on responses to the spread of coronavirus. In fact, both agencies are in the business now they’ve always been in, regulating oil and gas and building roads.

The energy business is in a tailspin that’s only partly attributable to the pandemic. Producers are putting out more product than the world wants, pushing prices down. Mixed with a dreaded virus that stalled the economy and, with it, a large amount of that already insufficient demand, oil prices fell below zero, into negative dollars.

That prompts a classic economic debate in the conservative oil patch: Do you prefer free markets or government control of production?

The latter was the Texas model for decades. The Texas Railroad Commission, which regulates energy in the state (it’s a long story), was the original oil cartel, turning the spigots off and on to balance supply with demand and keep prices up.

That’s no longer how it works; the agency stopped “proration” more than 40 years ago. But the machinery is still in place, and lame-duck Commissioner Ryan Sitton, who lost his reelection primary this year, wants the agency to order a 20% cut in production. The chairman, Wayne Christian, wrote a lengthy “no” in an op-ed in the Houston Chronicle this week, setting the stage for a tiebreaker at the next RRC meeting. The third commissioner, Christi Craddick, hasn’t said publicly whether she’s with Sitton or Christian, but she’s widely believed to be against proration.

It’s a big fight, though, and it’s not about social distancing or testing or the other things dominating the state’s attention right now.

TxDOT isn’t looking at changing course — not because of the pandemic or the economy. Commissioners there voted 3-1 Thursday to use all of the agency’s discretionary funds on the I-35 project, which adds lanes to the highway in Central Texas and which, according to agency officials, will eliminate 11 of the 12 worst “choke points” on state highways.

They drove past objections from state Sen. Robert Nichols, R-Jacksonville, (a former TXDOT commissioner) and state Rep. Terry Canales, D-Edinburg, the respective transportation committee chairs in the Senate and House, who wrote the commissioners in mid-March seeking a delay.

The lawmakers cited “immense volatility in global financial markets, a near collapse in the oil market, and a threat of potential recession” as reasons to “postpone adoption until more financial certainty is available.”

The state’s economic problems have escalated sharply since they wrote that letter. Comptroller Glenn Hegar, watching rapid declines in sales taxes from a flagging economy and oil prices that signal drops in severance taxes, has warned state officials that they’ll have billions of dollars less to spend in the current budget than he forecasted a year ago.

One commissioner, Alvin New of San Angelo, also wanted to tap the brakes. He was the lone vote against the proposal.

“Now, I want to be really clear here,” he said before the vote. “I am not against this project. I am not speaking from a metro versus rural perspective. I am not speaking to protect or debate any one region of the state. That's what I am not doing. I am not against this project. However, the pandemic and its effect on our economy and revenue sources have me wanting to slow down and be more cautious with expenditures.”

Commission Chairman J. Bruce Bugg Jr. pushed to stay the course, saying the vote to proceed isn’t a promise the project will be built, but it commits those funds to the agency’s plans. The discretionary funds would cover a little less than half of the total $7.5 billion price tag, most of which the commission previously approved.

“The COVID-19 environment we are living through today has had historic impacts on the world economy and our economy in Texas,” he said. “But we know the sun will once again shine on Texas. In the meantime, it is the responsibility of this commission to look ahead to the future needs of Texas.”

Disclosure: The Texas Comptroller of Public Accounts has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

Belgian households typically eat one serving of fries per week. The head of the national potato processing association says one more won't hurt consumers or their health, and will help producers.

(Image credit: Teri Schultz for NPR)

NASA astronauts Bob Behnken and Doug Hurley are ready to make history as they prepare to become the first two Americans to launch from U.S. soil since 2011.

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Slowly, Taco Bell became the punchline to every episode of SMBC.