[FRIAM] bad covid story

Mon Dec 27 12:42:40 EST 2021

This relates to a disagreement I had with Nick.   What is the value of empathy above and beyond the ability to anticipate feelings and the consequences of feelings?    When Bill Clinton "feels your pain" but perhaps actually doesn't, what difference does it make provided he was persuasive?   If he passes the emotional intelligence Turing test, he passes.

My sympathy is to the doctors and nurses who have a technical task to perform under pressure and one that may threaten their own safety.   They shouldn't also need to perform the task of helping people manage their own emotions.   That is not a scalable approach.  It means that the people (here, doctors) who can keep it together become more and more burdened by people who cannot.   I don't just mean in a crisis, but in general.   A citizen has the job of keeping it together.  It helps no one to start lowering the bar on that.  Lean on me until you don't need to, and then please stop.   It isn't the Gen-Z or the Millennials to blame for all the conspicuous neediness and instability, but increasingly it seems be a cultural problem.

Marcus
________________________________
From: Friam <friam-bounces at redfish.com> on behalf of Eric Charles <eric.phillip.charles at gmail.com>
Sent: Monday, December 27, 2021 10:18 AM
To: The Friday Morning Applied Complexity Coffee Group <friam at redfish.com>
Subject: Re: [FRIAM] bad covid story

I certainly didn't say there weren't reasons why the events unfolded as they did. Everything that happens has reasons. I was pointing out that the situation is unnecessarily bad in more ways than just the ones that people already seemed to fully understand and be responding to.

I have spent plenty of time in emergency rooms, and brought people for plenty of surgeries. I have sat with one dying person in hospice, and with a few people who might have died in an ICU but who luckily didn't. I also recognize that if I'd loaded my kids into a car and driven to see my dying wife, and had been turned away for a reason that everyone knew existed before I was asked to come out, and then someone came up to me in the parking lot to tell me she had died while we were being kicked out, there's a reasonable chance I'd at least shove him out of frustration. That's about as escalated and stressful a situation as I can imagine, short of it being one of my kids who was dying in the hospital. If that exact person had repeatedly told my wife "I won't let you die", a punch would be virtually guaranteed.

I'm not saying I'm a good person because that would be my response, I'm saying it would be VERY predictable and VERY understandable. And if the guy thought it was "lucky" that I was still there to be told by him-in-particular in person, while I'm still ramped up about being kicked out of the hospital with my kids, then he needs to work on his thinking skills.

The frustration of the family and it's manifestations are totally understandable. They are wrong, but they still deserve our sympathy. They were frustrated about aspects of the situation that it is completely reasonable to be frustrated by; they lost their husband/father. Even if, by the time the story starts, he was going to die no matter what happened, the process by which that happened could have been much less cruel. The system itself, the structure of laws and statutes and practices, creates, at times, situations that are borderline dystopian and that are cruel to patients and their families. There might be very rational reasons why the system exists in that state, but reasons-existing doesn't magically erase the cruelness.

I know you (Glen) don't particularly care about labels, but as several on this list do: To not be able to understand and be sympathetic with both the doctor and the family in this story is fundamentally illiberal. If you, for whatever reasons, desire to self-identify as "liberal", you should go back and read it again with that in mind.

<mailto:echarles at american.edu>

On Mon, Dec 27, 2021 at 10:54 AM glen <gepropella at gmail.com<mailto:gepropella at gmail.com>> wrote:
Wow. This reads like you've *never* spent any time witnessing hospital operation. Surely that's not true. Surely you've spent time at an ICU bed side, waiting for someone to not die, right? Or, perhaps you've taken a friend to the emergency dept for some reason (like smacking their head on the pavement)? Maybe, at least, you've visited someone in a typical room recovering from surgery or somesuch?

If you've done any of that, surely you'll recognize that a) there are laws these people (nurses, doctors, administrators, whole hospital systems, etc.) have to follow or they'll be severely punished for violation of those laws. Right?

And on top of the laws, there are various statuses that hospitals have (e.g. Trauma 3 vs 1) for which there are fairly strict policies and procedures, where, if violated, people will be severely reprimanded and the hospital may lose its status. Surely you realize that, too. Right?

And on top of that, there are standard safety practices, standard materials used, "algorithms" by which such systems are, if not optimized, made as efficient and effective as possible. (Do you know how much disposable plastic and paper would be used to, say, roll a dying man out into the fvcking parking lot? Never mind that act of rolling them out there would open them to accusations of murder.)

Then, add to that the fact that these humans are doing their level best to help people, under extremely stressful situations. Renee' comes home crying many days simply because a patient she's familiar with by their health record *alone* (i.e. never having seen the person face to face) has died. Perhaps you're so immune to empathy that you would maintain a perfect computing inference machine in your head in spite of the people dying in the hallways. But normal people aren't that psychopathic. Cheers to you.

But, yeah, it's fine. Nothing to worry about, here. Blame the doctor. Blame the hospital. Blame Fauci. Blame the victims. It's standard practice, I guess.

Wow ... just wow.

On 12/27/21 07:12, Eric Charles wrote:
> It's weird how many ways this can be dystopian all at the same time. Under the assumption, that it is obvious what Nick replied "Yuck!" at, let me add:
>
>   * It is pretty easy to explain to people that ICU's require masks regardless of Covid, that a cold could kill some other ICU patient who is immunocompromised in some other way, and that it was a rule pre-Covid. Don't fight with the family about special Covid rules, talk them through making the decision to see their loved on. Just tell them it's for the kid doing chemo one room over.
>   * Whatever the situation, if they won't wear masks in the hospital, there should be the option to bring the father to see them outside. If, given the choice, he would prefer to be removed from all machines and wheeled outside to see his kids one last time, that should for sure be a choice the patient and family can make. It is horrific to have him die alone with his family right there. Mind-bogglingly horrific.
>   * It really isn't necessary to say things like "we won't let you die" to patients who you are almost assuredly going to die under your care. It is, if anything, immensely cruel. The aside from the doctor "although I never said we might not have any choice in the matter" makes that interaction worse, not better. What's he going to tell the family "Oh, yeah, I said we won't let your husband die, totally. But, you see, technically speaking, I never said we wouldn't let the virus kill him, so, like, No Lies, am I right?"
>   * It is pretty easy to give someone vitamin C and D. You can buy them at any drug store for a few bucks. Let the family give him mega-doses of vitamins if they want. Why would you ever stop that?
>   * Hydroxychloroquine and/or ivermectin are also pretty easy to get, and not too expensive, and there's also no evidence that they increase risk. At the least the family should have had the option to pay for them, and have them administered. If there is someone the doctor has essentially given up on, and the family wants to bring in a shaman to perform rituals involving goat guts and sacred flowers - and the shaman is willing to wear a mask - then the idea of denying that is crazy. "I'd rather continue a course of treatment that will definitely result in death, instead of letting people try random stuff that's unlikely to work" is NOT a moral position. This is worse than denying a visit from the family minister.
>   * If you go out to confront a grieving family --- a mother who you had drive in, with their children, and who you then turned away at the door --- to tell them that their loved one just died while you were turning them away, then you should expect some severely negative reactions, up to, and including, the possibility of physical violence. I have no idea how to explain how obvious that is, other than just stating it. I can't imagine what was going through the physician's head if they went out there and then were surprised to get shoved, or hit, or even to have the patient chase them around the parking lot with their car. Especially if it is the exact physician who unreasonably denied all the requested treatments. Especially if you turned them away for a reason that you knew would happen when you begged them to drive all the way there. Completely unnecessary and completely daft.
>   * To emphasize that last part: You could have not had any of this happen, if you had just NOT had them drive in only to be turned away, and simply followed the normal procedures for informing someone over the phone when a death occurs. The physician went out of his way to arrange the situation that he is complaining about, every aspect of which happened in an unsurprising fashion.
>   * To try to hit that nail even harder: When the author says "Fortunately, they had not left", I could only think "Fuck you." That was before I read the next paragraph and learned what the wife's reaction was. This physician's thinking about the whole situation is so unbelievably screwed up in its self-righteous martyrdom. "Fortunately, they had not left." Are you serious? "Fortunately" you have a chance to tell a frantic, legitimately angry, flustered, and frustrated mother, in front of her three children, that her husband died alone, only a hundred yards away, while his whole family was standing in our parking lot? Fuck you dude. Eight ways to Sunday. He has every right to be frustrated by having to deal with patients and families who made choices he disagrees with, but the continuous cruelty and better-than-thou posturing is really, really, really problematic, and if you didn't catch any of that in the story, that's a problem.
>
>
>
> <mailto:echarles at american.edu<mailto:echarles at american.edu>>
>
>
> On Tue, Dec 21, 2021 at 2:19 PM glen <gepropella at gmail.com<mailto:gepropella at gmail.com> <mailto:gepropella at gmail.com<mailto:gepropella at gmail.com>>> wrote:
>
>
>     https://old.reddit.com/r/QAnonCasualties/comments/rakxun/my_career_of_treating_patients_has_ended/ <https://old.reddit.com/r/QAnonCasualties/comments/rakxun/my_career_of_treating_patients_has_ended/>
>
>      > After more than three decades as a physician, the Q maniacs have succeeded in driving me out of providing care to patients. I, like many of my colleagues, am moving into medically-adjacent work, where we can continue to apply our training and decades off knowledge without ever having to come in contact with sick people.
>      >
>      > I've been able to deal with the years of patients who attended Google Medical School, and the hours wasted explaining things such as why cinnamon cannot be used to treat diabetes, or that garlic and beetroot can't treat HIV. And Lord save me from essential oils.
>      >
>      > COVID and Q finally proved to be the one of amateur "experts" that was too much for me. The horrific deaths are beyond what you might imagine. They emerge almost unrecognizable to their families. Since June, I have never seen a horrible case of someone who was vaccinated. I have seen people struggling to breathe through lungs that have hardened to near uselessness, begging us in their ignorance to give them the vaccine now. We can tell, almost without fail, which ones will die when they come through the door of the ICU, but we do everything in our power to keep them alive - BIPAP, ECMO, ventilator - knowing we are stretching out the inevitable. We use paralytics with ECMO and ventilators, then ease them off to see if they can function. And as the drugs wane, the look of terror emerges, the tears. We try to calm them, to swallow our desire to scream at them: This is your fault! This didn't have to happen! Often, their spouse or their uncle or neighbor is nearby, dying
>     along with them. And we work hard for those rare cases where we can pull them back from the edge.
>      >
>      > I could deal with all of that. What I can no longer handle is the screaming, not from the patients, but from the families. They are not screaming in anguish, or in recognition of how their foolishness has led them to this point. No, they are screaming at me. Because, you see, I am part of the global conspiracy to commit genocide. If only I would give 10,000 mg of Vitamin C - even though the body can only absorb a maximum of 100 mg a day, with the rest creating the world's most expensive urine - they would be saved. Or hydroxychloroquine. Or ivermectin. Those have never been studied, they assure me, and when I tell them they have been, they snap that I don't know what I'm talking about. I want, oh god I want, to tell them that if we are the ones responsible for killing their loved ones, then why the hell have they brought them to the hospital? Why throw them into our clutches? I know the answer: They know it is all lies. But their egos are so huge they cant bring
>     themselves to admit it.
>      >
>      > My breaking point came three weeks ago. I dealt with a particularly horrible case. This was a husband and father, 38 years old. A wife, two daughters, one son. All of age to get vaccinated, none vaccinated. If you could have seen his face, and the ravages left by both COVID and the time he spent prone on his stomach. An enormous clot kept reforming in his leg, and we had been forced to amputate his foot in hopes of keeping him alive. When he was awake, the look of terror in his eyes, the crying, the pain. It was nothing new. But the begging, over and over, "Don't let me die." And "Give me the vaccine." All I could tell him is "We won't let you" - although I never said we might not have any choice in the matter. And I told him, repeatedly, it was too late for the vaccine.
>      >
>      > He begged me to bring in his family. A nurse called them, because they had never come to the hospital. They refused to wear masks, and so would not be admitted. The nurse told the wife that her husband was likely dying, and was begging to see them. All she cared about was masks. She would only come if she and her daughters didn't have to wear any.
>      >
>      > The nurse came to me and told me the wife wanted to speak to me. I got on the phone and she ordered me to cure him with ivermectin and vitamin C & D. I explained to her, those do not work, they have been extensively studied and the amount of ivermectin needed to treat even mild COVID would kill a human being. Once again, I was told I was ignorant. I asked her to come down to the hospital, to bring her children, to at least wait outside. Somehow, she agreed.
>      >
>      > The nurses were all busy, and I took over the role they usually perform, comforting the dying. I sat beside the man's bed. Through tears, he rasped out sounds I could vaguely understand as a question. I guessed at what he was asking, and assured him that yes, his family was coming. He was so frightened, and I could tell he knew death was unavoidable. I'm not religious, but I knew he was, and I talked about the comfort of Jesus as I held his hand. About a minute later, he coded. We tried to save him, but there was nothing to be done. He died.
>      >
>      > Twenty minutes later, I heard from a nurse that the family was here, that they had made a ruckus down in the lobby demanding to be let upstairs without masks, and had been thrown out of the hospital. I consulted with a few colleagues who agreed to cover me so that i could speak to them in the parking lot. I took the elevator down, and asked security to point out the family that refused to wear masks. Fortunately, they had not left.
>      >
>      > I stepped outside, went to the wife, and identified myself. I told her that I was sorry, that we had done everything we could, but her husband had passed a few minutes earlier. I did not manage to get the words of the sentence fully out of my mouth when I felt the fist strike my face and heard the screamed words "You murderer!" I fell backwards, tripped, and plopped onto the pavement, the back off my head striking asphalt. I vaguely heard the words being screamed about ivermectin and hydroxychloroquine and god knows what else. I heard "you could have saved him if you listened!" I tasted blood from the top of my lip. It took a moment to know it was seeping from my nose, which she had broken. My mask was getting wet, and thus useless. Security grabbed her. They were getting ready to call the police, but I knew if they did, I would become the next national target for the Q maniacs. I told them to just put her in her car. I wasn't going to press charges. I went back to the
>     hospital.
>      >
>      > I started looking for a new job the next day. I will never treat a patient again.
>      >
>      > Thank God.
>

--
glen
Theorem 3. There exists a double master function.

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