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Medical difficulty

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JSt0rm

Lifer
Sep 5, 2000
27,318
3,856
126
Day 3.

Code Blue right off the bat at 7:35. COVID in the ICU, transferred an hour earlier from another maxed hospital. From the chart: 67F with DM2, CAD, HTN. 5 days of cough and body aches, a little short of breath. She was seen by an ED physician just after midnight two days ago. Within 8 hours she had crashed and required intubation. Multifocal pneumonia with positive COVID. Officially admitted to that ICU 24 hours later. Transferred to our ICU 24 hours after that, and 1 hour later her Discharge Note for the Expired Patient was written.

She marks the first COVID patient I’ve seen die.

The anxiety I felt a couple days ago isn’t so bad now. It’s clear there was no avoiding this mass casualty event. Now there’s just work to do.

The thing about intubating a COVID case is it’s a high risk droplet bomb going off around the guys and gals most needed right now: intensivists, anesthesiologists and those badass ICU nurses who are all needed to tube people whose lungs are filling up with fluid. Hospitalists might be able to pick up the slack, but they haven’t the same muscle memory.

So as I’m watching this woman die in her closed glass box of an ICU room, a grizzled doctor with the swagger of an old intensivist says to no one in particular, “Is that a confirmed positive? Not going anywhere NEAR there!”

A nurse over to my left says, “We shouldn’t have to Code cases like this.” And it’s not with the same tone as “This is pointless,” it’s “This puts us in danger for nothing.” I stay out of the room, the extra manpower of one extra resident won’t be worth the PPE for chest compressions. But my chief resident is in there.

He’s a good guy; hope he doesn’t get sick.

(As I write this, I get a call that one of my patients has died. Non-COVID, was in denial about her metastatic cancer, COPD, CHF progressively worse shortness of breath but still wanted to be intubated. She got her wish and died within an hour or two still.)

Then a Rapid Response at 7:56. Then a Rapid Response at 8:01. Then a Rapid Response at 10:30. That last one was for the patient I just mentioned who passed, we put her on BIPAP and loaded her up with Lasix. Then a Rapid Response again at 12:30, again for my patient, watched the intubation occur. There was a minor discussion of where to put her, since the ICU and CCU were full. We’re in the process of transitioning the SICU into another ventilator bay.

Lunch arrives sometime after 13:00. Here’s one silver lining to all this: the community has gone out of its way to shower us with food. My lunches and dinners (residents know to always raid the hospitalists’ office and grab a plate before heading home to crash) have been Mediterranean chicken kebobs on Sunday, chicken piccata on Monday, and pizza today. It genuinely raises moral.

Another Rapid as I’m talking to some other residents and wolfing down a slice. Most of these Rapids have been for non-COVID cases. The ones that are about COVID cases turn into intubation events.

I was wrong yesterday when I predicted we’d become a majority COVID case hospital in 2 days. We crossed the 51% threshold today.

I was naïve when I thought I could volunteer for the resident-run COVID wing so that one less of my fellow residents would be put at risk. We’re all at risk. So now we have 3 residents and an outpatient attending looking over 10 confirmed COVID cases.

My census of 13 today has 5 confirmed and 1 suspected COVID patients. I wish we could make these cases voluntary, but all we can do now is limit exposure and spread out the cases somewhat.

I get a call that our 87 year old COVID patient is desatting on 6L supplemental O2 via nasal canula. So we put her on a non-rebreather. I get a call that she’s desatting down to the mid-80s when talking in long sentences despite the 100% oxygen she’s receiving via mask. The nurse is spooked, and the current plan is to do a Full Code should she tank. So the patient and I get to have The Talk.

The Talk is basically asking people if they want to receive (often futile) CPR that cracks their ribs as they die, or if they would prefer to be attached to machines when they die. But I don’t put it like that. I say things like “chest compressions” and “a plastic tube down your throat” but made it clear that if she were to be sedated for the intubation, she may never wake up. And despite our plans and treatments, her body is taking actions that will most likely (but we can never say guaranteed) going to end her life. Not today, but it’s a good time to put things in order.

The patient said her daughters want everything to be done for her, but she doesn’t want to be on machines when she dies. I said that was reasonable. She asked me what I would do, and what I would want for my mother.

I’m not proud of this next part.

I told the truth. I said that my mom and I have worked in medicine, and she would never want to be intubated if it was a long shot she’d ever recover. I told her I recently only rescinded my own Do Not Intubate order because were I to get COVID and need intubation, I’m a young, healthy guy who could survive it. But were I hit by a truck and braindead, I’d never want to be intubated. She said she’d call her daughter back and explain things.

I get a call later saying this very sharp 87 year old lady has signed the form declaring her Do Not Resuscitate / Do Not Intubate.

Intubation would have been the wrong choice here, I believe that. And I only told the truth (which I usually avoid by saying things like “it’s not for me to make you decide either way.”)
I helped the patient make her personal wishes count at the end of her life so she could die on her terms.

But, in the back of my head, I was also thinking I saved the nurses from having to witness a pointless and traumatic CPR and I saved one likely-inevitable ICU bed and a ventilator.



I don’t feel like writing anymore today.
 

Dulanic

Diamond Member
Oct 27, 2000
9,630
213
116
All this shit is real. My sister works at a hospital and she is pregnant. She is scared as hell that she will get COVID working there. Thankfully, she is a sonographer so her direct exposure should be lower than someone working in the ER or ICU.

I can't imagine being in NYC right now working at a hospital.
 

JEDIYoda

Lifer
Jul 13, 2005
30,663
1,778
126
How many minutes can you go without thinking about Trump? Put some thought into that and then ponder whether it's healthy to be so obsessed.

That "orange shit stain" is exponentially more successful that you'll ever hope to be. One reason is that he doesn't spend his time whining on an Internet forum expecting that it's going to make a difference.
You know you give all new meaning to the term TRIGGERED!!'
So now you equate successful to mean he is a better liar and a better douch nozzle and for that matter a better cheat and self centered? That is what you call a success??
Just to be clear of course he doesn`t spend his time whining on the internet! He spends his time whining on TWITTER!!! Get your facts straight !!
 

JSt0rm

Lifer
Sep 5, 2000
27,318
3,856
126
day4/day5 copypasta



Day 4

“The residents should run the Code Blues, they’re probably better trained than us.”

I’ll start off with what is good.

We’re becoming more adept at treating COVID cases. With a growing census of confirmed COVID positive patients (10 COVID positive in a census of 16 today), we’re getting a better sense of how this bastard virus behaves. There are the easy presentations: 40F w/ no significant PMH presenting w/ a 7 day hx of fever, dry cough, fatigue found to have bilateral ground glass infiltrates, elevated LFTs, lymphocytopenia and even fucking hypokalemia on admission. Might as well not even swab to confirm. (But the ED will, oh yes, because now they’re swabbing everyone and costing us probably 30-40 PPE kits per admission while we wait the 24 hours for the COVID test to result.)

But then there was the subtle one: 73M w/ multiple comorbidities who was diagnosed with simple CHF exasperation and sepsis secondary to a UTI (positive UA and UCx) who was tubed on arrival to the ED, admitted straight to the ICU, found to be COVID negative 3/21. He is taken off the vent within 24 hours and discharged to the floors. Because he’s COVID negative you see. We treat him with antibiotics, work up his NSTEMI which he managed to throw in during his first day admitted and kind of take mild interest in his recurrent fevers. But he’s not coughing and is satting well. Yesterday, my team and I thought “This guy has a normal white count, elevated LFTs and recurrent fevers. Forget the last test, order a repeat COVID.” I do this several hours before speaking with the attending physician. During table rounds, he pointedly asked me if I was aware of the protocols the Command Center had put in place for repeat testing. I say no, as these protocols change every day. (Side note: N95s are now rated for indefinite use, not just 4 days. Hope we didn’t toss all those other ones away for no reason!) “Cancel the test, let’s get Infectious Disease on board and ask them their input.”

I put in for the ID consult, I “forget” to cancel the COVID repeat or inform the Command Center. Busy day as you saw from yesterday. Comes back positive. We know what this bastard virus looks like.

But we spent 2-3 days in his room without our N95s on.

We would have spent more in there had we not tested.

We’re still early, but we know how fast or how slow a case progresses. Our younger patients, the 41F and the 49M might get discharged to home quarantine as early as tomorrow! They’re not reliant on supplemental oxygen and haven’t had fevers for >24 hours. Our older patients aren’t as lucky. No one on our census so far has been intubated. The 73M whose COVID we caught late rapidly progressed to requiring supplemental oxygen and was transferred to the SICU as the last stop before ventilator land.

We’re getting better as a team of residents. We’re all more than a little scared. I’ve talked to my favorite resident / current carpool buddy / best second-in-command about my anxiety about this situation. How the adrenaline kicks in when I’m on the floors and makes me feel less afraid and more focused. The crash after work is awful and the anxiety kicking back in takes a drink or two to knock down, but fuck it, I’m better at my work when I’m not terrified.

Oh and the food remains the best part of the day. Thank you, local places that sent great sandwiches for lunch and Greek for dinner. Makes the rest of this easier to write about.
Now on to what’s not good.

The hospital is now greater than 2/3rds COVID cases. The ratio of ventilators for COVID patients to non-COVID patients is 7:1.

We’re maxed out on the capacity of our Intensivists, intensivist PAs, and Anesthesiologists. The sprawl of the traditional ICU has taken over essentially anything that used to be elevated care and we’re still scrambling for beds. A handful of Internal and Family Med Hospitalists are being recruited to act as lieutenant Intensivists overseeing the ventilated. I mean lieutenant in its original definition: "substitute,” “deputy," literally "place holder." They report to the Intensivists directly.

At lunch today, it was declared that due to the sheer number of Rapid Responses and Codes, and due to the overwhelming census of the Greater ICU, Residents responding to Rapid Responses are not expected to get any Intensivist backup.

I’m no stranger to Rapid Responses. You hear the call over the PA and are given a floor, you rush upstairs and enter a room blind with someone either choking, or unconscious, or bleeding, or seizing, or with a heart rate incompatible with life. You remain calm, you ask the patient questions while asking the nurses to give a summary of the patient’s medical background, current admission issues, latest changes, vitals, labs, imaging. Scary, but doable.

During the meeting, the Medical Director said the Hospitalists would be asked to run Code Blues. The Hospitalists balked.

See, Intensivists ran every single Code Blue in the hospital before now. One Hospitalist said, “We haven’t run a Code since residency! The residents should run the Code Blues, they’re probably better trained than us.” The room of a couple dozen full-blown-attending Hospitalists nodded in agreement. I was the only resident there, too stunned to speak up. No final decision was made.

I know the timing of Epi pushes and ACLS algorithms enough that a couple days’ review would cement it pretty well. But the actual pressure of making the call for a defibrillation or a push of atropine or adenosine is so beyond what I’m prepared for.

CPR is a violent, ugly thing with a fatality rate that is 100% for COVID patients with lungs too full of fluid for their heart pumping to matter. Even if I were to run everything perfectly, the person is still going to die. Let alone if I fuck up and make the wrong decision.

I’ve come to terms with the idea that I’m going to see COVID patients die under my care a whole fucking lot.

I don’t want to be forced to watch them die under my care from three feet away while I make a series of life or death decisions that are guaranteed to be utterly pointless.

=====

Day 5

“If you’re going to stroll around here, you’re going to need full PPE”

“Usually takes about 20 minutes, then everyone’s arms get tired”

If this hospital is at war, it’s ceding territory at an alarming rate.

Here’s the layout of the field: we’ve got medsurg wings on the cardinal points of the compass (except 2SW for some reason) in a somewhat random pattern from first floor to fifth: 1N, 2S, 2SW, 3N, 3E, 5E, 5S. The ICU, CCU, CICU, and SICU are floating around the periphery of the 3rd floor.

By the time I started Day 1, 2SW and 5E were already on lockdown and designated as COVID territory. My team alone had a total of two pending and one confirmed COVID cases.

By Day 2, the CICU became a conflict zone and joined 2S and 5E. 5 COVIDS or pendings.

By Day 3, my team had pending tests in 5S as well. 6 COVIDs or pendings.

By Day 4, the 5th and 2nd floors were entirely given over to COVID. 3E still had some non-COVID evacuees waiting to be transferred to the last bastions of 1N and 3N. Everything ending with -CU is overrun by this point.

It’s Day 5. My census stands at 15, of which 9 are COVID positive. There’s talk of clearing out 1N sooner or later even.

The hospital is fairing less well: of the 170 or so inpatients (not counting the 25 or so Greater ICU COVID positive people on vents), 100 are COVID positive, and a third more have pending tests.



So those are the numbers. Actually walking the halls puts the change from Day 1 to Day 5 in starker contrast.

The amount of PPE used per nurse or CNA has steadily increased. On any floor (except the Last Bastion wings), if you squint your eyes all you can see is uniform green paper scrubs with blue hairnets and and blue paper booties and blue paper masks +/- an N95 underneath. If you look further down the hall you’ll see a spray of yellow as one of them gowns up to enter a patient’s room. (The nurses have been using Sharpies to write their names on the paper gowns so people can tell each other apart.)

Maybe you’ll spot a Resident in a long white coat rush by.

And by every single door on wheeled tables usually topped with hospital food are boxes and boxes of blue gloves and yellow gowns. Might be my imagination, but the boxes of face masks are disconcertingly not as ubiquitous.

The Greater ICU is less colorful. Just window after window of people on vents. Walk the whole length of it and count maybe one person who’s conscious. Most don’t look like our usual ICU clientele of the cachectic elderly. These are mostly men (my imagination?) ranging from their 50-70s.

I made the mistake of asking who the youngest intubated COVID patient on the unit was.

Younger than me.

So we finish at the ED. It’s not chaotic like a Saturday night. Sure there are a few beds in the hallways, but that’s nothing new. I walked the length of it too. Some people on oxygen here and there, wider variety of ages.

Lots of people getting gowned up to enter rooms though. And I know we’re supposed to take them off at the door of the patient’s room, why are people walking around-

“HEY! If you’re going to stroll around here, you’re going to need full PPE. With an N95 on!”

The ED is now considered COVID home territory.



I don’t feel like a soldier. I don’t feel brave for showing up to my job. I most certainly don’t feel like a hero.

I feel like the tide came in way too fast and everything around me is starting to go underwater.
 

Dulanic

Diamond Member
Oct 27, 2000
9,630
213
116
All this shit is real. My sister works at a hospital and she is pregnant. She is scared as hell that she will get COVID working there. Thankfully, she is a sonographer so her direct exposure should be lower than someone working in the ER or ICU.

I can't imagine being in NYC right now working at a hospital.
So just to add on to this, one of my sisters patients was positive but they won't test her per CDC directions because she isn't showing symptoms yet. Great directions right? She's been clearly been exposed, but no test because we don't have enough tests and possibly spread it to other patients.

She wears a mask, but as other have read and heard, they get 1 mask all day. THIS is just 1 of the reasons the US has blown past all other countries at this point in # of cases. And /w our limited testing it has to be MUCH higher than we know.
 
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VRAMdemon

Diamond Member
Aug 16, 2012
3,606
2,290
136
Don’t Worry, America, Jared Kushner Is Going to Save You From COVID-19

Wednesday, during the latest installment of his daily briefings that have become must-see TV, New York Gov. Andrew Cuomo said he spoke with Jared Kushner. You know Kushner—the president’s son-in-law. The president's son-in-law is a member of the president’s COVID-19 taskforce, but he is not a doctor or an elected official. In fact, Jared has no experience handling pandemics, or any medical background whatsoever. Jared Kushner doesn’t know about science or medicine but Cuomo must appeal to him for help from the federal government.

And that’s not the only place the president’s son-in-law has popped up the last few days. One of the biggest questions we've all been puzzling over is, why won’t the president invoke the wartime Defense Production Act to force companies to make ventilators?

He “signed two executive orders citing provisions of the Defense Production Act” but then refused to use those provisions. Later it was revealed that Trump refused to use the wartime law “reportedly after corporations successfully lobbied his top adviser and son-in-law, Jared Kushner.” Meanwhile, Cuomo holds continual pressers that have the same refrain again and again: “We need the federal help, and we need the federal help now.”
 

cytg111

Lifer
Mar 17, 2008
11,875
2,981
136
So just to add on to this, one of my sisters patients was positive but they won't test her per CDC directions because she isn't showing symptoms yet. Great directions right? She's been clearly been exposed, but no test because we don't have enough tests and possibly spread it to other patients.

She wears a mask, but as other have read and heard, they get 1 mask all day. THIS is just 1 of the reasons the US has blown past all other countries at this point in # of cases. And /w our limited testing it has to be MUCH higher than we know.
Someone in my neck of the woods have come up with a new test concept that takes 1½ hours, is cheap and dont involve the big machines form Roche etc. I think we will hear more about it in the coming days.
 

JSt0rm

Lifer
Sep 5, 2000
27,318
3,856
126
Day 6

“There’s another Anesthesia Stat. Don’t know where we’re gonna put that one.”

55M with PMH of uncontrolled DM2, HTN, CKD3. Admitted 5 days ago for fever, SoB, dry cough, you get it. COVID positive on Day 1. Went to a COVID medsurg floor, experienced worsening hypoxia on NC, and started on nonrebreather. By Day 5, transferred to the newest territory grab of the Greater ICU, the Post-Anesthesia Care Unit - the PACU. We’re not doing surgeries anymore, so no anesthesia, so that’s free real estate to park the intubated.

One other thing. The PACU was never meant for anything longer than a few hours’ stay and has only drapes between beds. No doors or walls means this is COVID home turf. You have to completely PPE up to even enter the unit.

This newest long walk of ventilated COVID patients is kept alive by 2nd string equipment. No modern touch screens, no real time graphs, just an aged-beige box with some dials and digital-clock-red settings. It does the same job - you can set the PEEP, FiO2, RR, AC/PSV just as precisely as the modern machines.

Even the third tier stuff never intended to serve as ventilation for the 10-14 days of ventilation COVID patients may require works well. These are the surgical ventilators the anesthesiologists used to use back when we did surgeries. They have been liberated to serve the Greater ICU. We’ve even drafted the ad hoc ventilators of the local community of outpatient docs to act as reserves.

Code Blue called on the 55M gentleman above. The team rushes up and I am deeply relieved that it’s not a Code I have to run. By the time we get our PPE on (takes about 3 minutes), he’s already being intubated. No chest compressions required. We put in some orders, we watch the Veteran Attendings tube their first patient of the day. It is only about 8AM.

”Anesthesia Stat to the ED” heard on the overhead PA means someone is getting intubated essentially right after they enter the door. The Intensivist sighs and wonders out loud where they’re going to place this next intubated next.

The Greater ICU is quickly becoming The Empire of the ICU, as more unused departments get swallowed up by the need to house the intubated.
 
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skyking

Lifer
Nov 21, 2001
18,495
311
136
My niece is in the thick of it in a Seattle ER, but she does not have the time to write about it. I called her mother and she was sobbing about it. She sees PTSD and suicides in the future over this. I can't blame her.
 
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shortylickens

No Lifer
Jul 15, 2003
73,375
7,235
126
My niece is in the thick of it in a Seattle ER, but she does not have the time to write about it. I called her mother and she was sobbing about it. She sees PTSD and suicides in the future over this. I can't blame her.
That's the most depressing part about all this: the fallout.
When we finally get the disease under control we'll have to face a lot of hard truths about ourselves as people and how we run our country.
 

cytg111

Lifer
Mar 17, 2008
11,875
2,981
136
Shit is about the get real ... from our friend over at sa

"“We’re going to need to start making decisions on who gets care, and no one is stepping up. No one wants to cross that line."

In case some of you have not kept up, this is the scenario where the death percentage takes a major turn for the worse.


-------------------------------
Day 9

“We’re going to need to start making decisions on who gets care, and no one is stepping up. No one wants to cross that line."

“I don’t want to go this way.”


The Story of You

You're a reasonably healthy guy in your mid 50s.

Sure, you had a health scare when you were in your mid 30s, a pretty big scare come to think of it. You had some chest pain whenever you worked too hard and went to a heart doctor and after a bunch of tests wound up getting some kind of mesh tube in your heart. Or something. Doesn't matter. You see your heart doctor every year and he tells you you're fine. Maybe lose a couple pounds. Here's a pill you should take for your blood pressure. Maybe you know the name of it, maybe you don't. But you still see your heart doctor, even two decades later, because you want to be healthy.

Your other doctor worries about your sugars. He tells you to take a different pill. Metformin. You know that one's name. Your other doctor also tells you to lose some weight. And he says he doesn't like how high this blood test number is. But you feel fine. It doesn't hurt like the chest pain you had.

Maybe you work at a gas station. Maybe you're a public notary, doesn't matter. You're definitely blue collar. Hair's thinning and mostly grey, you keep it buzzed pretty close to the scalp. You haven't shaven for the past week or so it seems, because you got sick.

You come down with the flu. Fevers that leave you sweating and chills that put you under the extra blankets you keep on the top shelf of your closet. You don't take a temperature though. You just feel awful. And the cough keeps you up at night. You're not coughing up any goo though, so that's good. Right?

You put up with it for a week. The fevers aren't going away. What's more worrying is that it's getting harder to breathe. Not the kind of hard to breathe when you had your heart issue, no, this is taking the wind from you when you walk the length of your room to go take a wiz. So you overcome your stubbornness and go to an Urgent Care.

This new doctor says he doesn't like the sound of your lungs and orders a chest Xray. Your new doctor says you have pneumonia and gives you two more pills to take. Antibiotics. They'll help you start breathing better again.

But you don't start breathing better. And the fevers only go away for a little when you take Tylenol. And you're having to breathe faster now even in bed. You wait three more days, taking the antibiotics which were supposed to fix you, until you're scared enough to head to the Emergency Room. Because you can't breathe.

You're seen by the first new doctor in the afternoon. The nurses put some tubing under your nose and now you don't have to breathe so hard. He's wearing a lot of stuff your other doctors never wore. It's hard to hear him as he speaks through two masks. He probably says something about that virus that’s going around. The COVID virus. And you're shocked because you thought it was the flu, and you haven't been around any sick people. You don't know where you got it from.

Four hours later a different doctor comes by (also wearing a lot of masks and a yellow dress) and says you're heading upstairs. He asks you even more questions. By this time, you had to switch to a face mask to get enough oxygen to breathe ok.

You spend the night in the hospital. You're woken up at 11PM, 1AM, 2AM, and 5AM for a nurse to come take your vitals. If you take your mask off for even a minute, you feel like you've just run up 2 flights of stairs.

Your newest doctors (there's a few of them) wake you up around 8AM. They listen to your lungs, look at the monitor next to your bed that beeps sometimes, and frown. You can tell even under the masks. They say you're going to get different pills. One of them isn't usually used to treat the COVID, but you're desperate to breathe and you agree to it.

Your nurse keeps coming into your room to check your monitor a few times in an hour. You're breathing just as fast as you were at home, even with the mask of oxygen on.

Suddenly there's a lot of talk outside your room. Maybe you can make it out over the sound of the whooshing air into the mask and your own breathing, maybe not. Doesn't matter.

If you were listening, you'd hear an anesthesiologist asking why he was called stat to the room when a decision hasn't been made yet to intubate or not. (Intubate. Do you know what that word means?) You hear a different doctor ask why they weren't called earlier to first evaluate the patient before the anesthesiologist was called. After a minute or two you see a tall doctor enter your room, again with the masks, and the yellow dress.

Things start to move faster now.

He speaks quickly but seemingly without worry in his voice. "How are you feeling?" (Did he even pause to introduce himself? You can't remember.) You answer in clipped words. "It's not hard to breathe," you say, "but I just can't catch my breath."

He explains that your oxygen is too low despite the mask. And he says the only way to help you keep breathing is to stick a plastic tube down your throat and hook you up to a machine. He explains you'll be asleep while it's in. You agree, because why the hell wouldn't you?

He exits just as quickly as he came in. Again, if you're listening closely, outside the door you hear him say to some people you can't see, "We don’t need to intubate in the room, we've got a good five or ten minutes before he goes south. Get him to the sick you."

You probably didn’t hear that last thing right.

You're rolled out of your room in your stretcher to an elevator. You go up and are wheeled into a busy room of other people in beds but with tubes down their throats, with only drapes to separate them, filled with dozens of people in yellow dresses and masks and plastic windshields on their face. There's more of those same dings and bells you heard from your own monitor, but they're all over the room echoing off the floors and walls and ceiling.

Another doctor says you're going to go to sleep. You look scared. You don’t ask any questions, you just keep breathing. The monitor behind you keeps dinging.

You don't even realize they pushed the medicine into your veins in the two seconds it takes for you to stop feeling or hearing anything.



Maybe you remember being in a fog as the medicine wore off a little. Maybe. You choke on the thing in your throat. Your eyes well up. Then you go back to sleep less than a minute later when you're given more medicine. You hope you don’t remember that.

Now you're wherever we go when we sleep.

You hope you wake up.
 
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skyking

Lifer
Nov 21, 2001
18,495
311
136
My niece is in the thick of it in a Seattle ER, but she does not have the time to write about it. I called her mother and she was sobbing about it. She sees PTSD and suicides in the future over this. I can't blame her.
I called my sister Sunday and her daughter had the first day off in many in a row. They could call her back but it looked like she got a day at least.
 

cytg111

Lifer
Mar 17, 2008
11,875
2,981
136

cytg111

Lifer
Mar 17, 2008
11,875
2,981
136
No that cant be right.
Donald said repeatedly it was no big deal.
And thats why you went on spring break right? .. And went to service afterwards to confess your sins...

That makes me think for a second, if the true believers have promoted Trump to the second coming of Christ, then ehm, when asking for forgiveness ... who are you asking? Exactly?
 
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