Fail, fail, fail, fail, succeed

How Do You Protect the Truth?

It seems as though we live in a post-truth era, as if there is a smorgasbord of truth where you get to pick the one that suits your sensibility.

This idea probably always existed on the fringes of society, but it took the internet to provide the global scaffolding that really allowed it to become mainstream.

To recognize this catastrophe is to realize the limits of free speech. Or at least it seems that way to me. Back in the days of print media, there was no confusing The New York Times at the newsstand with the National Enquirer at the checkout line of your grocery store.

No one saw the headline “Bigfoot Keeps Lumberjack as Love Slave” and actually believed it – and if they did, they kept it to themselves. There was no pretense that this was “the truth.”

But those days are long gone – now, any idea, no matter how outrageous or ignorant or hateful will have a cult of thousands of very loud people enthusiastically posting about it on the internet.

Harmless, you say?

Not when it affects public health.

Sending Your Baby Out Into the World

So let’s say you’ve worked on this thing for a considerable period of time; it might be a piece of music, narrative fiction, a movie, software, an invention of some sort, a process improvement for work, anything really. You keep chipping away at it, looking at it from different perspectives, trying to make it as good as you possibly can.

And then the day comes where you realize it’s not going to get any better. In fact, if you keep fucking with it, it’s only going to get worse.

So that’s the moment.

You’ve got to let it go.

The really scary thing about all this is all internal though – because you can’t fail as long as you’re you’re “still working on it.” Its only once it’s done that it can be judged on its own merits. But here’s the thing: most people never even get to this point. It’s just too hard, and for what? To maybe see that no one cares?

Thinking this is a big mistake: failure is part of success. It’s not only how you get better, it’s your only chance at hoping to be great. Fail, fail, fail, fail, succeed. It’s the name of this blog for Christ’s sake.

Besides, one of the most common cognitive distortions artists have is not being able to separate themselves from their art. Just because someone thinks something you made is shite is no reflection on who you are.

Regardless, I just packed up a baby and sent it out into the world. Now it has to live or die on its own. Bon voyage!

Disconcerting

You know those pictures of the ocean receding that precedes a tsunami? People playing and holding up their cellphones like it’s some kind of freakish low tide – and then the tsunami rolls in, its immense power destroying everything in its path.

That’s what it feels like in ERs all over the U.S. right now – it certainly does in mine. I’ve never seen the census so low, day after day. We still get our COVID patients, but nothing like what we experienced in March and April. And it appears that everyone else is avoiding us like the plague.

Here in NYC I kind of get it – the deaths were widely reported in the media, understandably scaring the shit out of the public. Who wants to sit in an ER surrounded by people dying from a contagious virus?

But it just feels weird. Where are all the heart attacks and strokes? They didn’t just stop – are people really staying home instead of seeking treatment?

To make the whole thing even weirder, my hospital hired a significant number of travelers – nurses who come in for a few weeks to support overwhelmed staff. The problem, however, was that they came in after the first wave had died down (perhaps a poor choice of words). So we went from Armageddon with no staff to a low census with too much staff in a short period of time.

And of course their contracts will soon end, just as the quarantine restrictions begin to loosen. So we know there will continue be a outbreaks in waves. What happens in the fall is anyone’s guess…

All I know is that it makes me feel uneasy. Maybe it’s because of what my ER just went through, or perhaps it’s a bit of PTSD beginning to rear its ugly head.

But I don’t like it. I don’t like it one bit.

COVID Meditation

Can now meditate for 20 minutes in the chapel of my hospital with my N-95 respirator mask on without feeling like I’m suffocating.

This must be some new uncharted level of TM…

Movies That Made Me (Part 3): Godzilla

It appears as though I am starting with movies I saw as a very young child, but hey, I’m not over-thinking this. In my mind, Toho studio’s 1954 classic “Gojira,” marketed in North America as “Godzilla,” is somehow inextricably connected to “King Kong.” This is probably because I saw them both at around the same age (4 or 5), and they both involved giant monsters that man was helpless against. Ok, that last part wasn’t exactly true – King Kong was shot off the Empire State Building, but not before wreaking serious havoc on NYC.

Godzilla, on the other hand, was way more frightening. Kong was a mistreated giant ape that actually liked a human (Faye Wray), while Godzilla was a true existential threat. Nothing could stop him – he seemed to have no purpose other than to destroy. And if his giant size and destructive power weren’t enough – he could exhale a concentrated beam of radioactive fire that burned everything in its path to a cinder. I couldn’t get enough of it!

Of course as a child the whole “monster as metaphor for the atomic bomb” thing went right over my head. But rewatching it as an adult makes the film much more interesting. It’s a fascinating post-WWII artifact made only nine years after Hiroshima and Nagasaki – a potent example of art as a response to trauma.

The fact that most of the film was shot in Japan and badly dubbed only made it weirder. Even as a little kid, it was clear that the Raymond Burr parts were added for the American markets. I didn’t know what film stocks were back then – all I knew was that the “American” parts didn’t look like they were in the same movie.

While Kong was created with stop motion animation, Godzilla was a man in a rubber suit. What made it work was two things: the graininess of the film itself, but more importantly the incredibly detailed miniature sets. Toho built models of Tokyo for Godzilla to crush and burn down, and they looked good – good enough to suspend belief and think this shit might be possible, at least if you’re a little kid.

See, my home life as a child was violent and unstable. I wanted Godzilla to come in and burn it all down. I spent many years fantasizing this would happen, knowing all the while it wouldn’t.

But it gave me some great daydreams.

Secondary Crisis

Emergency responders administer help, they don’t ask for it. It’s part of our culture that’s not healthy. I’m afraid there’s going to be a lot of psychological fallout for EMS, docs, and nurses in NYC after this pandemic. Dr. Breen’s suicide was a pretty obvious red flag.

See, we take pride in our ability to deal with the worst possible emergency’s while remaining calm and knowing what to do. And although this is a highly developed skill, it’s not a superpower. We are still vulnerable whether we choose to admit it or not.

Part of the problem in treating COVID patients was this: because it had never been seen before in humans, there were no algorithms for how to treat it. There were no case histories to guide us, so everyone was figuring it out in real time. And although the knowledge base is increasing daily, it left everyone who responded to the first wave navigating dangerous currents without a map. With so many dying, it left everyone responding feeling helpless in the face of an existential threat. But feeling helpless is exactly what we aren’t trained to do.

Because NYC was the perfect storm, the virus’s spread was exponential, overwhelming everything in its path. Books will be written on this pandemic and everything that went wrong, but right now I worry about my colleagues.

We all have to seek help – this is not a sign of weakness.

It’s a sign of strength.

End-Stage Capitalism?

The United States of America. That already sounds like an oxymoron, doesn’t it? I’m 63 years old, and I think I can remember a time when I thought that was true – but maybe I’m just remembering a line of bullshit that a naive little kid bought into because he didn’t know any better.

Nothing’s ever really united when the fuel that powers the engine is greed, is it?

So I guess this is it – we’re seeing the end game of how this grand project plays out – and it’s not pretty, is it? The ultra-rich just keep getting richer while everything else descends into chaos. Who needs to plan for a pandemic when you can ride it out behind the walls of your sequestered, bought-and-paid-for world?

Except, of course, this isn’t how life works. Sure, the poor and the working class will get it first, but eventually the virus will find the oligarchs too.

The cynic in me thinks it’s only then that money will be allocated for research and the supplies needed for healthcare workers to tend to the sick and dying, since that will now include the rich. And you can bet attention will be paid if the economy comes crashing down.

I don’t want to be a cynic, but when you look around it’s hard to feel optimistic. In an attempt to find humor in this grim mess we call “The United States,” I’ll quote one of the greatest comedians of the 20th century.

“The upper class: keeps all of the money, pays none of the taxes. The middle class: pays all of the taxes, does all of the work. The poor are there… just to scare the shit out of the middle class.”

– George Carlin

The joke sounded funnier when George said it.

Putting Together a New Normal

This is where I am right now – trying to reassemble a life, because the one I knew for 63 years is gone. Let me be clear – I know I am not alone, and my heart breaks for everyone who lost a loved one, as it breaks for all those unemployed.

But my grief over taking part in so much death while feeling helpless to stop it, and then losing my medical director to suicide, has left me feeling numb. Add to that the fact that I somehow have to keep getting up and going into work knowing I am vulnerable to the virus that has killed so many people right in front of me. The only way it seems possible is to turn your humanity off, which doesn’t seem like a healthy response. I don’t even know what a healthy response is.

How do you get through this shit? Yesterday I finally looked at the memorial page my union put up recognizing all the frontline healthcare workers who died in NYC and it’s fucking heartbreaking. Of course most of them were younger than me.

Am I just supposed to go to work like it’s a game of Russian roulette? No, that analogy is ridiculous and dramatic. Unless you saw what I’ve seen. I keep telling myself the reality is that no where is safe, at least until they come up with a vaccine.

I’m just in this weird interim limbo where I feel like I’m not really living. I’m either working in the ER or recuperating at home, unable to focus on anything.

But I know I’m resilient and I’ll get through this. I don’t yet know how, but I’ll do it. I’ve been through some hard shit in my life – I will survive, or at least that’s what I keep telling myself.

It may not be that great, but for the moment, that’s my story and I’m sticking to it.

Gaining Insight From Tragedy

It was my sister’s suicide that forced me to acknowledge the reality of my childhood.

It was Dr. Breen’s suicide that forced me to acknowledge the reality of my ER.

The question then becomes: What do you do with that insight?

Pandemic Phase II (Part 1)

In phase I of any emergency, you don’t overthink – you just respond. This is the part where you are focused on surviving and performing your job, and if you’re well trained you go on automatic pilot. If you overthink you won’t be able to function because you’ll be paralyzed by fear.

So you wake up, put on your uniform, and go to work. Then you come home, go to bed, and get up and do it all over again. This goes on as long as necessary until the emergency is resolved. Whether you’re a soldier in a war or a nurse in a pandemic, you do what you’ve trained for.

Then at some point, the initial emergency is over, but your brain doesn’t understand it yet. So there’s a period of time where you’re a little lost. The pandemic/war analogy is a good one, because in both you know you could die at any time. In both, you see so much death that you become numb to it. In your world, you’re either alive or you’re dead. Your lizard brain has been in fight mode so long it doesn’t know how to turn it off and return to normal.

The really fucked up thing about the viral pandemic is that you know it won’t end until there’s a reliable vaccine. So this could go on for years. It creates an untenable state.

Soldiers are trained for the chaos of battle. Emergency nurses and doctors in a first world country are trained to respond to mass casualty events, but they expect the supplies they need to respond will be there. When they aren’t, it creates a powerful internal trauma. They begin to feel helpless yet are still expected to do their job, so that’s what they try to do. There is not a single colleague I am aware of that didn’t feel like they wanted to be there for the sick and for their peers.

Right now, for the moment, in NYC it appears to have plateaued, so for the first time there’s a pause to reflect. But your brain has trouble switching into reflection mode because it still thinks you might be killed at any moment – and truthfully, it’s right.

But now in Phase II, you begin to reflect on all of the first responders who died, and it’s overwhelming. There are the deaths from the disease, and then there are the suicides from responders so traumatized by what they saw they couldn’t bear it.

And while you’re trying to put your prefrontal cortex back in charge, you realize that as soon as the quarantine is relaxed, it’s all going to start up again. And if you didn’t get sick, you have no idea whether your body built up any antibodies to protect you, so until there’s a vaccine your brain has to stay in fight mode indefinitely.

A couple of days ago one of my younger peers who has a military background and took part in active combat was in the locker room getting ready to go home. Casually, while getting his gear together, he said something that stopped me in my tracks: “This is scarier than anything I saw in Afghanistan.”

It’s going to be a long road ahead.

RIP Lorna M. Breen, MD

The first time I met you I was so intimidated. A new ER nurse who felt like I knew nothing, working with the medical director of an ER that was part of a well-respected NYC teaching hospital. I was eager to learn, and you were imposing but patient in teaching me, never making me feel stupid because I didn’t know something. And there was so much I didn’t know. I came from a med-surg background, which I would soon learn has very little overlap with emergency medicine.

I’d always wanted to be an ER nurse, but right out of school it seemed crazy to go into that environment without some experience, so I worked for four years with stroke and traumatic brain injury patients before finally getting my first ER job – where I ended up staying for ten years.

I had the privilege to work with you as an ER doc and then as a friend. You were always there to listen, teach, and mentor me. When I became focused on implementing a new program for a nursing procedure in the ER, your support and guidance allowed me to start and eventually write a new hospital policy supporting this change, something I would never have been able to do without you. In fact, my whole grand idea came from a code I did with you where you asked me to do something and I didn’t know how to do it. I was determined not to let that happen again, and you patiently supported me as I struggled years to see it through. When I finally succeeded you just smiled as if you knew I’d get it done all along. I was never quite that sure, but you gave me confidence.

Your door was always open, and whenever I spoke you would look at me intently like whatever I was saying was the most important thing in the world. Invariably, within minutes whatever problem I was struggling with would be solved. You always seemed like the smartest person in the room.

I remember hanging out with you last year at our annual ER party, laughing and having cocktails on a boat we’d all rented to cruise around New York’s harbor. You seemed so happy to be with your crew, the nurses and all the rest of the staff who make our ER run. You were our boss and we wanted to make you proud.

You will always be in my heart, and I wish you knew how many lives you made better.

RIP my dear friend and esteemed colleague. You are gone but will never be forgotten. I wish I could tell you that as devastated as our ER was by the COVID pandemic, it would have been much worse without you at the helm.

With much love and respect.

An Immensely Tragic Day in my ER

It’s late after a long, emotional, and disorienting day in the ER. What I want to write is going to require some thought and time, so it will have to wait until tomorrow.

Suffice to say, there will be a lot of casualties and PTSD after this acute phase ends.

I guess it’s beginning now.

You Think You’re Getting Off Easy?

Not so fast buster – there are some things you can’t unsee. You might be thinking I’ve got this shit covered but boy would you be wrong.

Things have a way of surfacing in the most inopportune times. You might find yourself inappropriately emotional and wonder What’s going on?

What’s going on is simple. You can’t keep pretending you’re invincible forever. That 800 pound gorilla you think you can keep ignoring? I’ve got news buddy.

He’s going to kick your motherfucking ass.

It Exploits the Weak

That’s what the virus does – it finds the weakness in everything. Your immune system, the moment you let your guard down. Then it moves in.

Our healthcare infrastructure; it looks for its weakness and exploits it. The impoverished, the uninsured, the unhealthy. Finding holes and systematically breaking them down.

It exploits the ER’s weakness – its chaotic environment, its disorganization – and methodically breaks the whole thing down.

Weak leaders and the weak minded – dropping them in one fell swoop, like taking candy from a baby.

Unprepared virologists and infectious disease experts, made to look like bumbling school children.

Helen Ouyang said it best: It does what it wants.

The Setup

He didn’t see it coming – no one ever does. Sitting there in the clothes he thought made him look good, but I guess that’s what we all do. We never see ourselves the way other people do. Why is that?

It all made perfect sense to him, at least the way she told it. Her eyes never seemed to lie, and god knows he wanted to believe her. But men are such saps, always falling for the dumbest shit. Especially the dumbest shit – they just need to want it to be true.

That’s how life works, isn’t it? We all tell ourselves the story we want to believe, even if it’s one where we lose. All he knew was that right now, he wanted to believe more than anything.

He’d been around though. Enough to know he was probably wrong.

But what’s the harm in pretending?

Another Powerful COVID Diary Written by a Colleague

Maybe I’m prejudiced, but I think ER docs are a special breed, and I have been fortunate to work with many brilliant ones. Jason Hill is a good example; smart, compassionate, quick to respond, and always willing to teach.

Buzzfeed just published his COVID diary – if you want to know what’s been going on in NYC ER’s (more specifically mine) for the last six weeks or so, this is a good place to start.

It’s been an honor to work with all of my colleagues responding to the pandemic. Docs, nurses, EMS, PAs, NPs, ERTs, respiratory therapists, radiology, security, nursing management, volunteers, and everyone who came from other areas of medicine and nursing to help. I am humbled by their strength.

I will forever mourn all of those we lost.

Movies That Made Me (Part 2): King Kong

Although I don’t want to do this in any kind of chronological order, the original 1933 version of King Kong, directed and produced by Merian C. Cooper and Ernest B. Schoedsack, absolutely blew my mind when I saw it on my parents black and white TV as a young child. It’s certainly one of the first movies I can remember seeing, so I’m guessing I was around four or five-years-old at the time.

Jesus – I’m going to sound fucking ancient here, but this was one of those films that would be shown once a year on television (I have no idea why). I think it goes without saying – after the first time, I would do my best to never miss it.

At first, I probably thought it was real, which only added to its appeal. A giant gorilla rampaging in NYC! Tossing around subway cars like toys! Crushing people underfoot! Ripping what looked like some kind of dinosaur’s head apart on Skull Island! Throwing men around like dolls! Seriously – I thought it was the coolest thing in the world and was one of my first experiences of the power of film.

Of course, at some point, I realized it wasn’t real – but that didn’t diminish my love for it; instead, I became even more fascinated. How was this possible? This would have been in the early 1960s, so it was almost 30 years old then, but its age gave it an even weirder sense of other-worldliness like it was some secret artifact from a time when these things really happened.

I could have given two shits about Faye Wray or any of the other people in the film for that matter. For me, it was all about Kong and the world he inhabited, whether on Skull Island or in NYC – both of which seemed pretty exotic. When I finally realized it was done with this thing called stop-motion animation, I became obsessed.

Willis O’Brien was responsible for creating this world, and the job he did with Kong was quite a magic trick – somehow, through his mastery and vision, he imbued the 18-inch rubber creature with a metal armature covered with something that looked like fur into a living thing that had emotions. The final sequence where the single-engine airplanes shot him down off the Empire State building was heartbreaking.

It was one of the first times I realized what assholes people could be.