Brief Snapshot #1

work was worky

Hey there, it’s Cassie, sorry it has been a bit between posts! Both L’Erin and I were swamped with work and general malaise.

I got my second vaccine shot last weekend. Felt out of sorts for a few days, unsure whether that was my shot, work, my mother's continuing poor health (due to her having covid), or being an American, heh.

My mom went back to the hospital a few days ago and they X-rayed her, found out she'd gotten pneumonia and a UTI. They've blasted her with antibiotics since, and she feels better again. I hope it sticks. (For the record she's been fighting this since Christmas...and I can't say I TOLD YOU SO until she's all the way better, heh.)

I had a friend ask recently if you could still be infected with covid after you're vaccinated.

Unfortunately, yes.

ALLLLLLL the vaccines do is make sure that the severity of your reaction to covid is such that you're unlikely to be hospitalized from it. It just really tamps shit down.

But you can still be an asymptomatic carrier, alas. Which is why I gotta keep my A game going until my husband (and everyone else I know) get vaxed. That’s really going to be the hardest stage of this (after all the deaths, obvs) — people aren’t going to want to hear that getting vaccinated isn’t magic, and they’ll let their guard down (even more.) I’ll probably write something more official about that up in the future.

We had a bunch of tragic deaths this past week at work, mostly because they're people who we'd worked a long time on. It's such a roller coaster ride once you're ICU level (far more downs than ups, alas). We had this patient my age, we'd been taking care of them for over a month, they seemed to get better, got downgraded, and then their lungs just punked out.

The NP pulled up their CT scan for us, because we'd all taken care of them, but not all of us had been there when they’d died. They just had 'honeycomb' lungs (which is when the tissue in there was all scarred up.)

Here’s an example of that from Radiopaedia.org (which is a pretty rad site — RAD SITE. GET IT?! GET IT?!?! lol) —

Here’s a normal lung cross section for comparison, also from Radiopaedia::

Once you get all that stiff scar tissue in there (as in the 1st pic, above) you lose the compliance/elasticity/functional lung tissue you need to take effective breaths for oxygen transfer.

(As an aside, I got to look at an xray of a patient post feeding tube insertion this past week, and they were normal, and it was so bizarre to me -- like...wtf was all that open space? I haven't seen a normal lung xray in so long!)

Yesterday I had a patient’s family want me to put the iPad for the facetime like 6 inches from the patient’s face, so they could all shout at them for 90 mins trying to see if they would do something or move or anything, really.

They're all worried about their brain (which is gone, the patient doesn't even have a cough or gag reflex) when their O2 sats are 70% (normal air is 21%) and their PEEP is 12 (normal lungs, 5, max possible 16-20) -- like even if they did miraculously wake up (after having been on heavy narcotics and paralyzed for the better part of a month) Their Lungs Are Still Likely Trash And They're Not Gonna Get Better.

One of my coworkers walked by yesterday in the morning singing, "Another daaaaaay taking care of deaddddd peoplllllleeee."

We're all feeling it. And by 'it' I mean 'the absolute futility of ongoing care in so many of these cases'.

More soon,

Cassie