It is the 5th week of essential lock-down for our family. We started social distancing prior to the general order in California and our city. I had been following the COVID-19 MD Facebook groups closely. Before most were social distancing, we had cancelled our early March vacation and cancelled Mr. Plastic Picker’s parents trip to New York. Thank goodness, as New York is now the epicenter of COVID-19. California has done remarkably well, but even with hundres of thousands of cases averted and thousands of deaths prevented – we have many dissenters. Probably there are not many, but they are taking up a sizeable share of the blogsphere. I had a high school friend post on facebook COVID-19 misinformation. I replied but didn’t have the energy to have a prolonged facebook discussion. I ended it with let’s just be grateful that we in California are doing okay.

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April 12, 2020

by drplasticpicker

It has been a wet spring in Southern California, and our rain barrels have been overflowing. The country is still under COVID-19 quarantine orders, but I have been gratified that this blog has seen an uptick in traffic – hopefully providing everyone with some entertainment. This has motivated me to keep on writing. Anyway, our rain barrel makeshift collection system caught 395 gallons of water yesterday. My mother-in-law will use it over the course of the next few weeks to water her garden. Her garden is truly a work of wonder where in the normal sized front yard she is able to yield enormous amounts of lettuce, kale, onions, tomatoes, lemons, and different varieties of squash.

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April 11, 2020

by drplasticpicker

I’ll be blunt here. Physicians are not for the large part good stewards of their own money. Physicians often think other fields are easier than our own work. I hear this a lot. Some of my colleagues think there is easy money in real estate investing, yet rarely do those same people have actual real estate outside of their primary home. It’s kind of a minor insult to true real estate professionals, just like a parent telling you they could drain an abscess better than you could with a sewing needle and exacto knife.

To actually support a middle-class or upper-middle-class family solely through the real estate boom and bust cycles of the market is not easy. Like performinig surgery, real estate investing requires a very specific skill set. It requires negotiating, managerial skills interacting with skilled laborers and tenants, having good accounting skills and being able to take on financial risks. You need to know about the specific tax laws, termite inspections, cost by the square footage of decking material and on and on. It also requires time and focus and attention to detail.

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April 8, 2020

by drplasticpicker

There is much to be hopeful for Wednesday. In the end we will never know what the death toll would have been if we had not #flattenthecurve and #stayhome. But as an outpatient MD following along, I do believe it would have been in the order of 500,000 to 1,000,000 lives lost. We still have at least a month left of mandatory quarantine, but we should recognize that the community accomplished many hundreds of thousands of lives saved by pulling together already. I thank our state and local leadership for putting in shelter in place orders early. It has been a remarkable thing to see how well California has done. Still a lot of work to do, but this Golden State, that embraced our immigrant family even before my birth and formed me as a person, has made me so proud. I have always and continue to be even more so proud to be from California!

With that, there is hopeful news for the environment. I wanted to highlight today how the practice of medicine can be more sustainable after COVID-19. We have learned that we can practice effective medicine and environmental stewardship. I apologize for skipping last week’s Hopeful Wednesday post. I was feeling down last Wednesday, but today I am happy.

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April 6, 2020

by drplasticpicker

This blog series is monthly. This month I am 5 days late. Forgive me as there is this thing called a pandemic going on. But in all seriousness, I am so happy to be forced to write a non-COVID19 post. When I started this blog called Dr. Plastic Picker, I really wanted it to be more about Plastic Picker – but it’s become more about Dr these days. I try to deny it, but I am one and am doing my due dilligence these days to be a competent one. In fact, I held the On-Call COVID Pediatric walkie-talkie for our large outpatient building today. I decided my code name is Dr. Spock and I asked the nursing manager to call me that when she needed me. This is why this series is so important, because it keeps my tangential brain on earth and not in outerspace. This series keeps me accountable for making real changes in our lives that are good for the environment. I am responsible for reporting out monthly 15 changes that I have made in our daily lives that help the environment.

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April 5, 2020

by drplasticpicker

Chris was my anatomy lab partner during our first year of medical school. We had the right side of the cadaver of a 90-something-year-old woman, and across from us was Felipe and Andrew. Felipe was the son of a Nobel Prize winning chemist. He was always a more morose soul, and would disappear after class. He made it through and I believe is an internist in New York. Andrew was very slim and handsome, and dated a fellow student who was beautiful and smart. They broke up before the Residency Match as they were applying in very competitive fields. I believe the beautiful girlfriend is an ophthalmologist now. Andrew stayed at one of the teaching hospitals as an academic specialist. It is ironic because he used to talk about the stock market and money a lot.

Even before medical school, Mr. Plastic Picker and I were already together and had been dating for 3 years in college. We were planning our lives together. I studied harder in the last few years of college so I could attend the same medical school as Mr. Plastic Picker. Life worked out. He was initially a year ahead of me at school, and when I was starting my first year of medical school – he purposefully took an extra year of research so that we could be in sync during our training. He was having a relatively relaxed time driving around putting on event monitors on volunteer study subjects with varying Bostonian accents. His lab was studying the effects of air pollution on cardiovascular events. He was there to support me, and talk me through the first year.

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April 4, 2020

by drplasticpicker

It is good to have a rhythm to the month, and blogging has given me this structure in life. There is a world-wide pandemic going on, but let’s leave that somewhere else for a bit. I did pick up ocean bound plastic at the beginning of the month so at least I have something to report out for March. Now that I am reviewing my notes, I was really doing a lot of litter picking at the beginning of March – and I’m glad I did because for various reasons that everyone knows, there was not much litter picking or beach cleaning from mid month. I expect April to be really nothing since the beaches are closed. I think I could do it safely, but I don’t want to set a bad example and someone copies me and doesn’t wear the right protection and then gets sick. Dr. Dear Friend https://drplasticpicker.com/drplasticpicker-goes-to-the-aap-national-conference-in-new-orleans-and-tries-to-use-less-plastic/ is cleaning her office, which is a great idea for April. I’m thankful for this blog series, because I’m accountable to report out to our readers even if the total is 0. This is the entire purpose of this blog! I have to be accountable to you and the environment.

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March 31, 2020

by drplasticpicker

Dr. Plastic Picker knows a lot more about cortisol than the average outpatient pediatrician. I did two years of pediatric endocrine fellowship, and here is the blogpost that explains why I left in good standing https://drplasticpicker.com/covid-19-social-distancing-is-like-bedrest-dr-plastic-picker-understands-but-this-time-you-stay-home-and-i-get-to-do-something/. Cortisol is a stress hormone and is often referred to as almost how doctors in the 1700s would speak about “humours” that would float in the body. This is before we knew about germ theory. It’s somewhat accurate though, because we refer to cortisol in general but to actually get an accurate cortisol level is very difficult. It fluctuates through the day, and to really get an accurate level of one’s cortisol level one has to admit a patient short-term to do an ACTH stimulation test. The cortisol or “stress humors” are running rampant in your body right now if you are in healthcare. In the end of the day, Dr. Plastic Picker is still a middle manager and I’m hearing all about it. I’m calling in the Great Freak Out. Yes, you are all freaking out about COVID-19.

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March 29, 2020

by drplasticpicker

Today the politicians are again arguing about who is to blame for the skyrocketing COVID-19 cases. But in California, there is a glimmer of hope. We began mandatory quaratining relatively early, and in our community our local leaders have been working together across the aisle to help our homeless communities and provide rent relief to our population. Beaches are closed and our local friends the Police were driving calmly up and down the beach telling our relaxed San Diegans to disperse. I was born and raised in San Diego, and I have a great love for my homeworld (Star Trek reference). In this increasingly polarized world, there is still a sense of civic responsibility and engagement in my hometown. I am hoping this helps us #flattenthecurve. Looking at the prediction models, it looks like we will likely have enough ICU beds for our county. So I am still vigilant but hopeful. I wrote yestserday that the best way I can help, is by doing the job I am qualified to do – a general outpatient pediatrician who middle-manages a department and is responsible for a few actual outpatient clinics https://drplasticpicker.com/be-like-a-tree-during-the-covid-19-cytokine-storm/.

So in that vein, I will be an outpatient pediatrician and give general advice about eczema! This is such a common problem and I hope this gives you some relief since we are trying to keep these “minor” issues at home. But minor issues are important to deal with as well.

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March 28, 2020

by drplasticpicker

The COVID-19 pandemic has definitely proven how powerful Facebook physician groups are. There are three main COVID-19 MD-only Facebook groups, and the clinical discussions, mutual assistance and advice is phenomenal. These are doctors helping other doctors, because we are all trying to save our communities. I was Zoom chatting with engineers from Hewlett Packard yesterday, and they were asking for information on what designs and equipment the medical community needed. I honestly told them, everything is on these Facebook groups. CNN is at least 48 hours behind these groups.

But one of the primary COVID-19 MD Facebook groups has 21,000 members! It can be a whirlwind of journal articles, posts, tutorial videos on how to make PPE and comments. There are journalist on the fringes, friends or spouses of members, and suddenly a post will receive a few comments and is then featured on a major news outlet. This is usually with permission of the commenters of course. You can see the pandemic coming toward you, as MDs from the current hot spots give us a preview of what is to come. One post that has been shared and copied multiple times has mentioned that on “Day 10 of illness Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours,” wrote the internist.

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