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.
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.
Did the picture above catch your
attention? The large Pokemon bean bag belongs to my children. The other object
is a plastic bag I made from plastic scraps. I know it’s weird, but I have
embraced my off-kilter personality as Dr. Plastic Picker. Our children consume
enormous amounts of clementines. Clementines come in orange plastic mesh bags. I am now master of the glue-gun which is how
I make trash art. With my glue-gun, I reuse bits of plastic. I reuse the orange mesh bags as my base. I
make pretty sturdy bathroom trash liners! Every time I finish one, I show it to
my in-laws, children and sometimes husband.
They all exclaim at how marvelous my bags are.
I bring up making these trash liners
because I understand everyone’s anxiety over the COVID-19 crisis. It’s easier
to DO SOMETHING rather than to be asked to sit at home and social distance. I
have been a student of medicine and human nature for 20 years. It is so hard to
be asked to do nothing, even when that nothing can save lives.
We have two children. The two beings
that eat all those clementines. I was on
bedrest for both pregnancies for 8 weeks apiece. I was placed on strict bedrest
for cervical incompetence. Having your cervix called incompetent is hard even
though it’s your cervix and not your brain. I did not feel pain. Yet ultrasounds showed a shortened cervix.
There was less than 0.5cm of cervix keeping these still not viable fetuses in.
I think there are more treatment modalities than just asking a pregnant woman to
lay flat, but 15-years-ago I did just that for 8 weeks and got up only to go to
the bathroom and shower occassionally. But mostly I was flat on my back.
COVID-19 social distancing is like
bedrest. You don’t see the danger when you look out the window. The weather
looks fine and the sky is clear. There are not gasping senior citizens on the
street. But health officials are telling you that the signs don’t look good. Soon there could be catastrophic social
change as the most vulnerable of us could die if we don’t #flattenthecurve.
They are asking you to stay home. The high-risk Ob-Gyn doctors asked me many
years ago did I want to terminate my 18-week-pregnancy or did I want to to save
it? Was I ready to go on bedrest without any guarantee of how this baby would
turn out? I opted to try bedrest. At that time my body felt fine. I couldn’t actually see the danger but I
trusted my Ob-Gyn doctors.
When I went on bedrest it was one of
the hardest things I ever did. Everyone thinks bedrest is easy. It’s horrible. This was pre-social media. I had to lay on my
back and dwell on jumbled thoughts of the possibilities of how life may or may
not end up. One painfully sees the world go about its rhythms while one just
lays there. I did finish one scientific paper while on bedrest. But my other
grand ideas about brushing up on foreign languages did not happen.
But I made it through bedrest
because I am an analytical person. I
wanted each of those babies however they came. I did what many of you are doing
now holed up at home. I made schedules. I did ankle and arm exercises. I talked
to my family. I read medical articles. I
was upset. I had taken care of other
people’s babies. Why couldn’t I just
have a little girl of my own? What got
me through the hardest times was my analytical brain. I had calculated out
roughly that for every minute I stayed on bedrest, a certain number of alveoli
(the end-unit of respiration where there is gas exchange at the capillary level
in the lung) were opening in the fetal lung. Every day the baby stayed it had a
better chance for the baby. It was due to lung maturity. When I wanted to give
up, I would sing to myself “pop pop pop.”
I knew alveoli were opening up.
To all of you who are having a
difficult time with social distancing, I realize that you want to do something.
Just like my making the plastic bag with my glue-gun because I want to do
something about the plastic pollution crisis. You want to do something, so you
are hoarding toilet paper and reposting crazy conspiracy theories. You are
reacting to this abstract existential threat. But my advice is to instead think
of (1) every hour you stay in and every human contact you do not make by social
distancing and think of (2) the breath of a grandmother or the tap of an
elderly friend’s cane as they make their way down the nursing home hallway
still alive. Think of that incremental life and human moment you are saving by
For me though, I have been on bedrest. My two children did not require prolonged intubation. Enough alveoli popped open. The world is in a similar situation. You have to social distance. I feel your hardship. But now I am a doctor and my uterus is voluntarily closed for business. I get to go to work and help save the world. I am lucky to be a bit player in this historic moment. But for you friends who are not in healthcare, who are brilliant attorneys, educators and engineers, I know you want to DO SOMETHING. But the best thing you can do is do nothing. Social distance and stay home. You will be saving lives by slowing the spread and #flattenthecurve. Think of the sound of your grandmother’s breath or the tap of an older friend’s cane. Tap tap tap. Whoosh whoosh whoosh.
*I am grateful that KevinMD accepted this blog post to be published among the academic COVID-19 articles. It was an interesting and useful exercise, as I had to edit the original blog which was almost 2500 to 1000. Mr. Plastic Picker helped quite a bit as he used to be the editor of magazines at the Pingry School and Harvard College back in the day.
Did the picture above catch your attention? It’s a bit odd. The large stuffed animal/bean bag animal is some kind of anime/Pokemon formerly loved object my millenial brother dropped off at my house. His 2-bedroom-2-bath downtown condo was getting too filled, and he passed this on to us. It’s an interesting piece of human artifact. Honestly, I did it more to keep it out of the landfill. If you want it , it’s in excellent condition so just let me know and I’ll clean it up (it’s pretty clean) and send it over after the COVID-19 crisis if you have kids who will love it. The other object is a plastic bag I made from scraps of plastic I save. I know it’s weird, but I have embraced my off-kilter personality. The Plastic Picker children consume enormous amounts of clementines now known universally as cuties. They actually do have fiber. My daughter and son pointed out to me about 1.7 grams per clementine https://drplasticpicker.com/squeasy-gear-1-tackling-the-pediatric-fiber-deficit-with-real-fruit-and-not-plastic/. But those cuties come in this god-awful orange plastic mesh bags with an elongated plastic product label strip that is a third the size of a piece of paper. Every time we throw these away, I have this irrational sense of guilt. I think it’s having picked up now 178 bags of ocean bound plastic. I’m not sure how a peditarician who picks up trash and pays my taxes and has not ever had an extramarital affair and never fake-called in a sick-day feels guilt? Not sure what my parents did to me when I was young.
I had purchased these rain barrels about 3 years ago. There was a major discount or rebate when I got them for almost 50% off. I forget the actual numbers. They are also made from 100% recycled plastic. They have served us well and with every downpour they catch gallons of rain that we later use to water the garden. Lettuce, tomatoes, lemons and many other organic delicious vegetables are the result. What I love about these rain barrels is that they were an investment that keeps on generating food and money savings. I just bought the rainbarrels, and my mother-in-law has taken them over and is so eager to use the water she catches as she says it’s better for her garden. I get to benefit from her garden’s bounty.
Wow. The world is in a panic. The White House gave an address that just caused more confusion. Yes a pandemic is something to take seriously but there is nothing to panic about. There is nothing to panic about because doctors just want you to stay at home as much as you can, wash your hands especially when you are out in public and in contact with other people, don’t gather in large crowds and certainly don’t go on flights or cruise ships if you can help it. If we all did this, called social distancing and understanding why we need to all pitch in to #flattenthecurve, then we’ll do okay.
Dr. Plastic Picker is a little bit worried about COVID-19. Like everyone else I was touting hand-washing,which is the best way to contain the spread, and social distancing, which means stay home if you don’t absolutely need to go somewhere. I am worried not because I am worried about getting Coronavirus, which is a cold virus and given my age and no underlying comorbidities, I will likely have a mild illness. I am worried because I know human nature, and the health care system will only continue to run if health care workers think of ourselves as ESSENTIAL and quarantine ourselves if we need to and to show up to work when we are healthy.
COVID-19 is here. There is a cruiseship docked off the coast of Oakland with several infected persons and in our area there was 1 case at a local AT&T store. Dr. Plastic Picker worked at the CDC offices during the HIV/AIDS epidemic in the early 2000s, but the CDC today is not what it used to be. Messages are coming down from public health, but this lone pediatrician out on the blogsphere is skeptical of our public health leadership and I work as a front-line pediatrician at a large HMO now. I have some infectious disease chops as I did some heavy lifting to stop a Measles case last summer. During that case, I had to panic as Measles is highly infectious and unvaccinated infants were at risk. COVID-19 I am not as panicked since it is spread through contact, and I wash my hands. Also I am a pediatrician and my patients are not the ones at increased risk of death. But we have grandparents with underlying medical conditions so we do want to keep them safe.
Just like I think everyone should all pick up their own litter and maybe an extra 3-10 pieces on the beach, I can’t wait for the federal government or the CDC to mandate things. When I saw the plastic pollution along our beach, I went to the beach and I pick up trash and it makes me feel like I’m doing my part. Now that COVID-19 is here, I know that we all need to practice “social distancing” and I am not waiting until public health tells us to do so. We know how this will spread, by people fanning out to different locations from epicenters. Some travel is necessary. Most is not. The Spanish Flu moved slow throughout the world via train mostly. COVID-19 can spread fast. But our family will not contribute to this spread.
People are really in a panic regarding Covid-19. There are at least twice daily email updates it seems from upper echelon management about the policies and procedures. The most relevant item is that if one physician is potentially exposed to Covid-19 than that person has to be isolated for 14 days. So it seems prudent not to have physicians meet in large groups as we have to mobilize in case there is a real outbreak. We want to keep our physicians out of isolation. The reality is that if I get isolated, I’d probably just be surfing the internet and blogging and eating oatmeal and having a great time and getting paid. But it’s not good for patient care, as I can see up to 30 patients in a normal workday. I am a cog in a large efficient health care organization.