Covid Has Made Practice Difficult

I’ve been away from this blog for a while.   

Prior to attending medical school, I was a Physics major.  Physics and Math are very different from Biology and Medicine.  In Physics and Math, if something is known to be true, you can use that truth to figure out other truths, often long before you can experimentally verify these truths.  It leads you into interesting directions and reveals things that can seem impossible to believe.  It is one of the reasons I loved Physics.

Medicine and Biology, however, are very different.  First, what you believe to be true is often not true.  Systems are so complex, what you understand is merely a tiny piece of a complicated process.  In fact, you never really understand the whole process.  If you take experimental evidence you believe to be true and extrapolate it to predict other truths, you will totally run off the rails.

Simple example:  A high HDL Cholesterol usually means low cardiovascular risk.  A low HDL means higher risk.  So, for years we assumed we could make a drug that increased HDL and decreased cardiovascular risk.  For literally decades, despite drug trials to the contrary, we KNEW this would be true.  Except… it wasn’t and all of these drugs actually increased risk.  Take just about any area of medicine and you will find similar examples.  Medicine is not a Math problem.  Medicine does not let you use the logic tools you use in Physics.  It simply does not work that way.  Time and again, we think we are smart and then we are proven to be dumb, dumb, dumb!

Enter Covid.  It was a mystery from day one as it appeared to ravage China and take down its economy.  It did not help that China was so secretive.  But, we could deduce some things as we watched from far away.  China was shutting down its country to try and control the outbreak.  It was doing so at great economic cost.  This is a country that regularly chooses to wreck the environment rather than do anything which might slow its economic machine.  Yet, here China was grinding its massive economy to a halt.  Bottom line: This looked really bad and really scary.  It was not “just the flu.”

Since those early months, we’ve been all over the place.  The world is watching medical personnel deal with a bad and quickly evolving virus in real-time.  Some really stupid things have been said in the past twenty months and they’ve been said by a lot of smart people.  Welcome to medicine.  In medicine, all of us are dumb.

More than 40 years ago, when I sat in my first medical school lecture, the dean said: “You’re going to learn a lot in the next four years and by the time you graduate, half of it will be wrong.”  He was exaggerating, but not by much.

Back in January 2020 as the world watched China and wondered about a plan, we should have told the public: “You’re going to be told a lot about Covid in the next couple of years and more than half of it will be wrong.  It’s not a conspiracy.  It’s just the way it is.”

I get stomach aches when I think back to March and April 2020.  Occasionally, I will see a  picture of Joe Exotic from “Tiger King” and feel an overwhelming wave of nausea and headache.  It’s the same thing you feel when a song plays that was a hit when you were going through very bad times. It is visceral and it is unpleasant.

Spring 2020 was terrible.  I cannot defend the choices everyone made.  We were trying to find our way in a very difficult time.

The anger now is still so strong.  Can we tone it down a bit?  Two weeks ago, I went to see DEVO live in Las Vegas (a religious experience!) and then to the National Parks in Utah.  Talk about whiplash!  Ten miserable hours in travel, thanks to the marvel of flight cancellations, all in a mask.  In Las Vegas, I accidentally neglected my mask when I walked into a store and was surrounded by security within eight seconds. Concert admission required a digital vaccine passport.  Yet, the next day, we entered Utah and it appeared masks were forbidden.  In a small store in Utah, my wife was refused service because she wore a mask.

Do masks help?  Maybe a bit.  Are they worth the insane level of aggressiveness either way?  Definitely not.

If you come into our office, you have to wear a mask.  If people are having trouble with the mask, I tell them to take it off in the less exposed realm of the exam room.  It was a decision we made and it is our office.  If patients don’t like it, there are other places they can go.  Yet, this has provoked amazing anger from patients.  Some are so threatening and fierce that our staff has felt real fear.

Every day, we see patients with Covid.  Last week, we were seeing eleven new cases per day.  We’ve lost too many patients to count. None of those who died were vaccinated.   Meanwhile, every day, unvaccinated patients enter our office.  They ask us our opinion about the vaccine and their questions often initially appear honest.  We tell them  “Get it now!”  and we tell them why.  Then, the fight begins.  It is quickly apparent their real intention was to have an argument about vaccines and ivermectin.  There was a time when I tried to have an honest exchange on the topic, but this hope is an illusion.   I try my best to avoid the fight and just say I respect their choice. That’s not what they want.  They want a fight. I try to end the visit, but it still runs overtime.  It will be one of many fights in the day. 

…And we are so tired of fighting.

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