Month: March 2020

Are you anxious?  Depressed?  Scared? Bored?  Angry?  If you are not, you’re probably insane.  The world has changed, and no one can tell you if it will be normal ever again.  

If you can work from home, you are one of the lucky ones.  If the shelter in place order has shut down your business, if you’ve been fired/laid off, then you are scrambling to figure out how to pay your bills and put food on the table.  

In a way, my illness shut down my office and sent me home permanently.  I can’t even pitch in to help my former colleagues during this crisis.  I understand, firsthand, how threatening a sudden disruption in your income stream is.

Luckily, Renee and I are not at each other’s throats. Trapped in the house on an emotional rollercoaster can wreak havoc on a marriage.  Cabin fever, the above listed emotions and those that I’ve failed to list can add up to divorce or worse.  There is a great picture on Facebook of a woman knitting a noose. 

So, what do you do?  Obviously, you now have time for lots of sex.  That’s probably why the above-mentioned woman was knitting a noose.  I know what I’m doing.  I’m relearning how to meditate.  To help, I use Dr. Ruth Naperstak’s Guided Imagery program and have just started to work with a program made by Balance and found in the App Store on your phone.

Meditation can be a very useful tool.  Today, on www.ZdoggMF.com, I listened to a 1 hour Podcast on dealing with anxiety. While it was rather long and somewhat technical, it was excellent. 

My patients never seemed to have time to learn to meditate.  Unfortunately, the only thing that most of us still have is time.  It’s time to learn to meditate.  

Renee, I’ve done my meditation, it’s time for more ……

As I promised yesterday, today deals with a similar but, in many ways, worse scenario.  Assume that you have had extensive end of life discussions with your spouse.  Your spouse agrees to honor your wishes not to be placed on a ventilator and knows when to invoke your DNR orders.  Also imagine that you have not discussed any of this with your children.

Afterall, discussing end of life issues with your children would be awkward and upset them.  Right?  WRONG!

Your 26-year daughter, Amanda, and your spouse come to see me the week after you are buried.

Spouse – “Doc, Amanda won’t talk to me.  She thinks I killed her mother.  I tried to explain to her . . .”

Amanda – “You did kill her.  Had you let the docs intubate her and breath for her she might be alive today.  I can’t stand being in the same room with you.  I thought you loved her.”

Spouse (crying) – “If you won’t listen to me, listen to Dr. Segal.”

Doc – “I know losing your mom came as a surprise.  Covid-19 hit her hard.  Her cancer treatments were also taking a toll on her.  Your mother, father and I had multiple, lengthy conversations about your mother’s wishes.  She did not want to be intubated under any circumstances, She signed DNR papers at her last office visit.  That was before Covid-19.”

Doc – “She also did not want to discuss any of this with you or your brother.”

Amanda – “My brother is furious.  He wouldn’t come today.  He can’t understand why you and dad did not fight harder to prolong mom’s life.  To give her a chance to beat the virus.”

Doc – “Your father and I honored your mother’s wishes.  Your father didn’t want to but had promised her he would not keep her alive mechanically.  She was very sick.  The cancer treatments were horrible.  She told me the only reason she didn’t go on hospice is that you and your brother were not ready to let her go.  The Covid-19 pneumonia made everything 10 times worse.  Your father did what she wanted.  He did not kill your mother.  He loved her enough to let her go.”

Unfortunately, the above conversation is not fictional.  I’ve heard it too many times in the past.  It is far better to have end of life conversations with your children (if they are mature enough) than to leave it to the surviving spouse.

The father depicted above just lost his wife.  He came close to losing his children.  Had they not openly discussed their feelings, the belief that he took away the only chance their mother had to survive Covid-19 would have destroyed their family.

Make sure your children know what you want if catastrophe strikes you.  Every few years, reaffirm your beliefs and wishes.  Should your spouse or children ever have to take you off of life support they will know what you want. They will be able to console each other and give the acceptance and loving support each survivor will need. 

Losing one’s parent or spouse is hard enough.  Losing ones loved one and then forever questioning if you could have saved them is a type of living hell.  As a doctor, I preached preventative medicine.  Everyone agrees, it is better to prevent illness than to treat it.

Mr. “P’ is the perfect example of a spouse suffering intense emotional pain that could been prevented.  The following is a real conversation that was all too common in my practice.

Mr. “P” – “Doc, did I kill my wife?  I think I killed her.  I can’t sleep.  I cry all the time.”

Doc –” P” you know you didn’t kill her.  The cancer took her from us.  She fought hard and, in the end, went peacefully.”

“P”- “I can’t help but wonder if I should have kept her on the ventilator another week or two.  She might have gotten better.  I shouldn’t have turned it off.”

At this point, the conversation goes one of two ways.  The first way is if his wife had advanced directives and she had discussed her wishes with him.  The second, and more common way is when the two of them never had discussed her wishes.

Response to option one:

Doc- “”P”, you didn’t turn the respirator off.  Despite your wanting to keep her alive, you did the hardest thing you could do.  You honored her wishes!  She made her wishes perfectly clear.  She did not want to be on a ventilator.  You did not kill your wife!  You honored her wishes!”

Responding to option number two is not as easy.  No matter what I say, Mr. “P” questions whether he should have kept her alive and hoped for a miracle for the rest of his life.

With thousands of people dying from Covid-19, it’s time to make your wishes known to your family and your doc!  Tomorrow, I’ll address a similar but more complex problem.

My doctor called me yesterday seeking my opinion on a new hospital policy.  We have worked together for over 20 years, so I was not surprised when he called.  I was shocked, dumbfounded, enraged and saddened by what he told me.  I slept poorly last night.  It’s like we are all trapped in the same nightmare, and it keeps getting worse.

First, you need a little background information to fully understand my flood of emotions.  One of the hardest decisions I ever had to make was when I realized that I’d have to give up inpatient hospital care.

When you are hospitalized is when you need your doctor the most.  You need to know that your caregiver knows you, cares about you and that, in turn, you know him/her.  Unfortunately, as I aged, seeing patients in the hospital and office (working 14-16 hours a day) became too much.  Rounding at 6 am and 7:30 pm was difficult.  Being awakened at all hours of the night by nurses seeking orders for sleep aids, indigestion, labs, IV solutions, etc. became impossible.

My solution was to start using the hospitalist as my in-house resident and follow my patients by phone and computer.  I got to sleep through the night and my patients were, whether they knew it or not, remotely supervised by me.  If there were any problems, I would show up at the hospital.

Flash forward to today.  Apparently, the new hospital policy is to admit all Covid-19 positive patients to one of three hospitalist who work for a large group of hospitalists.  At a time when your life is threatened by an unseen terrorist, you no longer will be under the care of the doctor you know and trust.  You will be isolated, in the hospital, ALONE since family and friends will not be allowed to visit.  Yes, your worst possible nightmare is now real.

To make matters even worse.  Your family will be communicating, over the phone or by text, with a total stranger.  As an adult patient, you will have to cope with seeing a stranger, being without family, friends and your doctor.  When I try to imagine how a five-year-old patient is supposed to cope with this, all I can do is cry!

Covid-19 has brought madness into our world!  So, what can we do?  SHELTER IN PLACE!  IF YOU FEEL SICK, CALL YOUR DOC.  HELP YOUR ELDERS.  

If you are admitted to the hospital, demand to see your own doc (assuming that he is on staff and still cares for inpatients).  If hospital regulations preclude you from seeing your own doc, hire him/her as a consultant.  Share this blog with friends and family.

Once upon a time, my opinion not only mattered, but helped to form hospital policy.  Now, the Press Ganey report on patient satisfaction drives hospital policy.  Let your local hospital administrator know that you want your private doc to care for you if you are hospitalized, especially if you have a life-threatening disease. I certainly would want Dr Bianchi at my bedside if I was admitted with Covid-19.

While you are sharing my nightmare, there is one more task you should do.  Make sure your family knows how aggressive you want your doc to be if you should need to be placed on a ventilator or resuscitated.  Your spouse and children should have a clear picture of what you want.

Tomorrow, I’ll explain why your children should be in the know!

Thanks, Jack!  I was out of things to say until I read “It seems we are fighting two pandemics: Covid 19 and Stupidity.”  Whoever said that is right on.  It also seems there is no cure for stupidity either.

Lynn shared the following:  “You thought dogs were hard to train.  Look at all the humans that can’t even sit and stay.”  Damn it, I sit and stay!  If you sit and stay, you’ll get a treat.  You’ll get to live. If you’re really good at obeying the shelter in place order, you’ll have time for other treats.  RENEE, I’ve been really good!

On the lighter side is: “Dear single friends, Stay positive and optimistic.  After 3 weeks of lockdown there will be plenty of divorces and new opportunities.  Unfortunately, many of the females will be newly pregnant.  Top names for the newborns will be Charmin, Angel and Scott.”

Last and the most important is: “The virus doesn’t move, people move it.  We stop moving, the virus stops moving, the virus dies.  It’s that simple.”  Conversely, we keep moving and socializing and perhaps we give the virus to a few grandparents and their children and friends.  Perhaps we get away with murder!  Perhaps you actually kill the doc and nurses taking care of grandma to.

Not only do we need to find a cure for Covid 19, but we need to find a cure for stupidity and selfishness.  

What the hell is wrong with our leadership?  We are being attacked by a new virus.  It’s wreaking havoc worldwide.  The solution, social isolation and shelter in place, is financially destroying the bulk of us.  The news, depending on which station you watch, is doom and gloom.  Anxiety is at an all-time high.

Making everything worse is the inability of our leadership to agree on anything.  Today, the pundits promise that the democrats and republicans are very close to making a deal.  It seems that both sides have lost sight of the trouble this country is in.  We are no longer the United States of America.  We are at war.  It’s the democrats vs. the republicans vs. Trump.

It’s pitiful!  We are all going to suffer if our leadership continues to fight, further splintering an imperfect union.  I can’t imagine how bad it must feel to sit at home, out of work, bills coming in and having these jokers screw around with a relief package.

I know how it feels to have my retirement threatened.  Hell, my very existence is threatened by Washington’s war.  It’s time to call a truce.  It’s time for our leaders to represent the country, not their parties.  It’s also time to vote these people out of office come November.

Believe it or not, I’ve run out of words. On the news this morning, I saw a report about a man making protective face shields on his 3D printer in his basement.  As you know, I’ve been really worried about my fellow docs’ health and this report offered a ray of hope.

I’ve been calling my old patients looking for assess to 3d printers but came up dry.  Actually, one of my patients told me that the schools in the area most likely have 3D printers, but I haven’t been able to find anyone in charge of the local schools.  If you know anyone in the local school districts, please contact them and see if they would consider making protective gear for our local hospitals.  Apparently, the specs for printing a faceguard are open sourced.

So much for the bright side of things.  If there is anything in particular that you would like me to write about, feel free to contact me.  Stay home!  Don’t kill your spouse.  Renee showed me a picture of a woman knitting a noose.  She thought it was funny.  I’m just glad we don’t have any yarn in the house.

Maybe I do have one or two words left.  Humor is a great way to, at least momentarily, relieve pressure.  I appreciate the jokes and videos ya’ll are sending and would share them with you if they weren’t so raunchy.  I never realized how raunchy you guys were.

I will continue to post articles on this blog as often as there is something new for me to address and will resume daily articles when my writer’s block clears or I can be more upbeat.  

The other day I wrote about the roller coaster of emotions I’m experiencing.  Well, I want to get off this roller coaster but can’t.  Every time I turn on the TV, I’m bombard with opinions, facts and outright lies and its pissing me off.

The solution is obvious.  I just shouldn’t turn on the TV.  For some strange reason, I can’t help myself. The thing that’s eating at me is the fact that my friends and colleagues who work at our local hospitals are really in peril.  Without proper personal protection gear, every patient they see may be a suicide bomber, armed with a potentially lethal virus and ready to take the docs, nurses, staff and their families out.

This situation is outrageous.  Why hasn’t the President and national health authorities remedied this situation?  Calling healthcare workers heroes does nothing to protect them and their families.  Promising that masks, gowns and tests are coming just doesn’t cut it!  Yes, while the docs who took the Hippocratic Oath knew what they signed on for, their families did not.  If I was still an ER doc, I’d be afraid to go home.

I’ve talked to some of my colleagues and, in fact, they are afraid to go home.  We are at war and the enemy has broken through the lines and is attacking us from within.  What can we do?  If you know someone in manufacturing, ask them if they can retool and make protective gear for our healthcare providers.  If you are hoarding masks, donate them to your doc and the local ER.  If you are hoarding sanitizers, share them with your neighbors and friends. If you are hoarding toilet paper, I hope you suffer constipation.

Most of all, obey the shelter in place rules.  If we stay away from others, the virus will not be able to spread.  If you are a know-it-all and think that this crisis is being blown out of proportion by the government and press, obey the rules anyway!  It’s ok to be outraged at the situation no matter how you envision it.  It’s not ok to unknowingly pass the virus about your community.  The sooner we shelter in place, the sooner this is over.

Finally, I’m stress eating and that’s not good.  Are you?  Sitting at home 24/7 is maddening and eating relieves some of my anxiety and stress.  Eating too much of the wrong things combined with limited exercise actually weakens you.  It’s time to enroll in boot camp and prepare for a long battle.  Now if I only had a drill instructor to rein me in!  Oh yeah, I do.  Betsy, help!!!!!!! As for exercise, Renee, can you think of a way to get my pulse up for a while?

OMG, I hate rollercoaster rides.  While I can tolerate the majority of coasters, I know they only last minutes and promise to return you to where you got on, safely! The current rollercoaster we are on is miserable and promises to last months.

How any of us are going to stay sane is beyond me.  My emotions are all over the place. Right now, I’m happy and content.  Today is my 42^nd anniversary and I’m home with my bride of many years.  We feasted on steamed Maryland crabs, Facetimed with our children and grandchildren and got literally 100s of good wishes from friends and patients.

In a few minutes, I’ll crash into depression and abject fear.  This virus is blowing my mind.  I worry about my patients and am sad I’m not there to care for them.  I worry about my colleagues: doctors, nurses, clerks, lab techs, x-ray techs, etc.  They are on the front line and, if you believe the news, are running out of protective gear and flying by the seat of their pants.

I’m worried about my children and grandchildren who will inherit the current disaster’s aftermath.  I’m worried about financing my retirement with the market collapse and being stuck with two homes.  OMG, no one is going to tour a stranger’s house with the current virus lurking behind every corner, waiting to get you.

I have mixed feelings about not being able to practice medicine.  If I was physically able, I’d be volunteering my services at the local hospitals.  Working as a doc would put my family and me at risk but it’s what I trained for.  On the other hand, I’m actually glad that I can’t work and therefore will not run into the fire.  

All of this rambling would sound ridiculous to a sane person.  Since most of you are on the same ride I’m on, I’m sure you understand.  How do we survive this upheaval?  One thing is to look at it as being at war.  Isolating ourselves is like going into a bomb shelter and waiting out the bombardment.  To fight off the fear, be assured that the best medical minds in the world are looking for treatment options and vaccines.  They will find them, and the war will end.  Until then, hug your loved ones and keep them close.  If you are hording N95 masks, donate them to the docs in your local hospital.  If you are hording toilet paper, shame on you.  Some of us are running low and that’s just one more “mess” to contend with.

While I’m cycling through emotions, I end up madder than hell.  We’ll find a vaccine and prevent future outbreaks.  Won’t we?  I’m mad because I know the anti-vaccine lobby will fight being vaccinated and serve as fertile ground for this and other diseases, new and old, to attack us.  What a pity!

Time to be happy again.  Renee, let’s play hide and seek.  You go hide and I’ll find you and . . .  Aren’t you glad you are trapped in the house with me? What else can we play?

Wow!  I never would have believed that I, Stewart Segal MD, would endorse the use of Telemed.  Not in a million years could I have imagined telling patients to avoid seeing their docs in person.  Coronavirus has changed everything.

If you are ill, do not go to your doctor’s office, immediate care center or ER.  Call your family doc for instructions.  Expect to wait a long time for a response as most of your docs’ patients will be calling him/her. If you don’t have a family doc, call a hospital-based urgicare center.

The real question is do you have the Coronavirus or not.  Testing for the Coronavirus is not readily available.  If you get sick, assume you have Coronavirus and isolate yourself from the rest of the world as much as possible.  Initial treatment of the Coronavirus is the same as for any other virus.

Rest, lots of fluids, acetaminophen or ibuprofen, combined with prayer are my treatment of choice and is what the phone doc is most likely to prescribe. The real dilemma is discerning when it’s time to go to the ER/hospital.  Shortness of breath and difficulty breathing are your two big indicators that will trigger an urgent call to your doc or a trip to the hospital.

Once you’ve determined that you or a loved one has a worsening respiratory tract infection that is probably Covid-19 and you’ve discussed it with your doc, you are off to the hospital for definitive testing and oxygen.

Yesterday I wrote about the stubborn spouse.  What do you do when your sick spouse is having trouble breathing and refuses to follow the docs instruction and will not go to the ER.  The following conversation is one I’ve had too many times in my life.

ICU Waiting Room

“Mrs. “X,” I’m Dr Segal.  Your husband is on a respirator and stable.  His condition is critical.  If only he would have come in earlier.  What happened?”

Mrs. “X” – “He has been sick for a week.  He started having shortness of breath yesterday.  I knew you were busy, so I called the ER and they told me to bring him in.  He can be a real jerk!  He told me he wasn’t going to the hospital as it was just a bad cold. When I told him he was either going to the hospital or I’d call the paramedics, he told me that “IF YOU CALL THE PARAMEIDCS, I’LL NEVER TALK TO YOU AGAIN!  So, I didn’t call the paramedics until he became so weak, I thought he might die.”

Dr Segal – “Did it dawn on you that if he died, HE WOULD NEVER TALK TO YOU AGAIN? In the future it is better to have a pissed off spouse than a dead one.”

For all of you married to a stubborn spouse, God bless you.  I hold meetings of the Cursed Spouse Married to a Stubborn Person (CSMSP) on the first Thursday of every month.  Stubborn spouses are welcome but will never come.