Synchronicity

           As I wrote in a previous post, Covid 19 isolation has me cleaning out closets. I found a clipped article from Shambhala Sun, a Buddhist magazine, from November, 2000, written by Rachel Naomi Remen, MD, who in the 2000 magazine is listed as a clinical professor at UCSF School of Medicine and medical director of the Commonweal Cancer Help Program. She has written a very entertaining book called "My Grandfather's Blessings: Stories of Strength, Refuge and Belonging, published by Riverhead. In this article she talks about the strange coincidences that occur in our lives that seem as though they have some outside guiding hand and often serve to awaken us or guide us in some fashion. In this time of great travail, I was moved again by rereading this article. I especially found her opening moving and reproduce it here for your edification.

     "Glimpse of a Deeper Order:  According to the Buddhist understanding of auspicious coincidence, all circumstances can be brought to the spiritual path.  Everything that happens in our lives, whether positive or negative, can serve to awaken us to the nature of the world. But occasionally, events cluster in particular ways that give us a glimpse of the deeper structures of reality, and suggest that time and linear causality may not be the ultimate way in which the world is ordered..

     "There are many possible responses to such happenings, which Jung called synchronicity. Some people give them a highly individualized meaning, finding guidance in a personal decision they are facing or confirmation of a direction they have already chosen. But perhaps the real meaning of synchronicity is more universal than personal, with every instance simply pointing to the possibility of a hidden pattern underlying the events of this world. 

     "Either way, these events offer us a certain reassurance, and they also have the power to awaken us. A common response to such an acausal happening is a sharpening of attention, a sense of the closeness of something unseen. Startled awake, we may listen for the direction in which the universe is moving, and discover a wish to participate in it.

     "Synchronicity often takes us unaware and may restore us to ourselves."

     The author goes on to tell about an experience during the Christmas season when she was so busy with her work that she had no time to prepare for the holiday and especially to do one thing she always did which was add an angel to her many years of collecting angels to honor those who had died that year in her medical practice. She dealt with End of Life care and thus was often placed inside another human being's crossing into whatever lies beyond. She met a lady on an airplane who sensed her troubled state of mind and gave her an angel which that fellow traveler's grandmother had just given to her. What a coincidence or was this occurance the definition of a synchronicity?

     Dr. Remen writes further "I suppose one might call this coincidence and perhaps it is. But it felt as if whatever it is that we really serve when we serve others had reached out and shaken me awake, saying 'You get on with the work...I'l take care of the small stuff.'

     "This is the sort of event which Jung meant by synchronicity, a meaningful coincidence which thumbs its nose at linear causality. At a certain level, synchronicity suggests there is more to life than we realize, and that we and all others may not be alone, I regard such a happening as a blessing. Such things may happen at any time, but in the years I have worked with people facing death and those who survive them I have heard many such stories. Perhaps such things are either more frequent at these times, or perhaps in some way every death is a bridge between worlds, and allows us to see things differently for a little while.

     "Synchronicity is always an experience of the unknown. Events such as these do not really prove anything. They are simply a reminder to wake up and pay attention because the mystery at the heart of life can speak to you at any time."

     When I reread this little article, I felt a few moments of expansiveness which some people of the Buddhist bent have called "kensho."  As a physician, I have certainly experienced what Dr. Remen is talking about and these episodes certainly do seem to occur around death. Many of my patients have told me stories of "coincidences" or "synchronicity" that happened around the time of a death in their family. Some of these stories also seem to involve a "ghost" or "seeing" the deceased again in a very life like way. I will tell a little story about just such an experience in a later post.

 Curious about synchronicity. Here's a starting reference:

 https://lonerwolf.com/synchronicity/https://lonerwolf.com/synchronicity/

Closets, Crocus, and helebores

          This elderly couple is about 3 weeks into our "Safer at Home" policy in Wisconsin. the pandemic surges on. In Wisconsin seems somewhat behind many other regions. Of course, this means that we will probably be at this isolation longer than other places because we started earlier and we will still have to go through the peak and the trough before may people are able to return to work. And then there is, of course, our age and our comorbid conditions that I think means we will have to continue at home even after many populations can return to work.

        The first thing I did was to clean a closet. I missed an opportunity in that I should have taken a before and an after photo of my hall linen closet. This is a large double door closet with 5 very deep and long shelves. I can only describe to you the mess that it was. heeps of unnecessary and unused linens which still sit packed in bags to take to the Goodwill Store as a donation when it reopens. Mixed in with all these linens were very non linen type items such as photo albums from a couple of our trips. I think they got put there because it was handy and other closets were full. There were some automatic plant watering systems consisting of beautiful glass bulbs that you fill with water and put in the plant's soil.  They never worked very well for long trips. I found several nice children's gifts that never got gifted. At 13 and 10 years old, the two older grandsons have outgrown them. But I now have a 2 year old grand daughter and will soon have a baby grandson. I saved those gifts. They may still find a child's home. Of course, there is always my own antique toy collection if I save these long enough. One real itme of interest that made my younger son laugh: a paper grocery bag full of one particular sample drug, folders with 4 small diamond shaped blue pills in each. I am known in my family and among friends as a prepper. Well, these were certainly prepping for a different situation. In case you are having trouble guessing what these pills are, there is a photo at the end of this particular blog.

 

Crocus

We had a couple of nice days and of course, gardener that I am, I had to get my hands in the dirt. I had ordered 12 new hellebores before this whole isolation process began, so on the first nice day I got out and stuck them in the ground, most of them near the house and the rest out in my woods where there are more that have grown over the years. Hellebores are also called the lenten rose because they are certainly among the first flowers to bloom in spring, around Lent. They like shade and are just about indestructible. The blooms lasts for about 3 months and after that the foliage is quite attractive. I wanted some up near the house where I could see them easier since you can't always depend on April weather for a walk in the woods. Here are some photos of the first blooms timed right along with an early crocus near the house.

     Now of course since I was cleaning off some beds near the house, I had to arrange some of my fairy scenes.

   
          During this stay at home time, some of our neighbors started a nice little email group. And I joined another group also that stretches further along the Lake Michigan shoreline, down into Bayside and maybe even up into the next community north. One neighbor got the idea that since this email group has been so active with advise, grocery shopping, and other helpful ideas, she wanted to drink a toast to the organizer. She and her husband left bottles of wine out front and invited people to come up their driveway and drink a toast and then take the bottle home with them.  Since we have some new neighbors with younger children, the next week this same couple put out boxes of animal crackers and invited strollers to come up and take a box. This stimulated the organizer to suggest that since the real zoo was closed, that we create our own neighborhood zoo by putting small toy animals, stuffed or otherwise in the window for the families to walk around the neighborhood and find the different animals. Almost everyone participated, and there was quite a menagerie.

     I have a very large stuffed animal in my toy collection. It is not really a zoo animal but I thought it would work. My oldest son won this at the Wisconsin State Fair when he was a sophomore in high school. He remembers it well. It was a very hot day and he was lucky very early in the day and had to carry this huge animal around his neck for the entire day at the fair. Since he left home, this creature has been sitting in a corner of my toy room. I thought it would fit very well with zoo animals. It is a 4 foot tall stuffed blue performing horse with white mane and tail, and a saddle and golden bridle. He is stuffed tightly with straw, but over the years, he can't stand anymore but sits as though ordered by his trainer into that position. I heard some interesting stories about the horse as the neighbors passed. One neighbor was walking her two dogs and they would not pass the horse. They put up such a barking fuss that she had to turn around and go back toward their home. Another neighbor told of walking her great dane, who also was terrified of the big blue horse. Finally when slowly allowed the length of his leash, he made friends and immediately went around to stiff around the white tail, just as dogs do.  The owner of the dog was seen to absolutely crack up with laughter. So my blue performing horse was a big hit even with the adults and some of the dogs.
   

     Have you figured out what the tresure chest of medical drugs I found in my linen closet? Well here is a big hint. 

April 1, 2020 Some Scientific and Technical Info about Covid 19.

     I previously promised some information about the COVID 19 virus itself. The following website is an excellent source of rather detailed information about this virus and what we have learned since its discovery in December of 2019. For those who want to delve into this science, this is an excellent source of information. Since my undergraduate major was microbiology, I felt I should be able to at least refer you to a good microbiology source.

theatlantic.com/science/archive/2020/03/ and find the article called biographynewcoronavirus.

Your can access this article by going to the above site and type biography (dash) new (dash) coronavirus. My computer's dash is broken so I cannot type that in here. Otherwise you can google Science of Coronavirus and pick The Atlantic article.

I would like to just summarize some of this scientific information here in case you do not want to delve deeply.

     The Coronaviruses are a widespread group of RNA viruses. Most are spherical and have spikes on the spherical surface that have what look like small crowns on the end of the spikes; hence the name Coronavirus. Coronaviruses exist rampantly in bats, pangolins, and have been found in civets and camels. Four of the Coronaviruses are human viruses only and cause relatively mild colds much like the common Rhinoviruses. It is thought that they cause up to 1/3 of  common colds.  They have been named OC43, HKU1, NL63, and 229E.  Research on these viruses, both the cold viruses, and the animal Coronaviruses in the past has been few and far between.  Such research has been regarded as sort of boring and backward.  But we have faced two other Coronaviruses in the past which are nothing like the common cold virus. The first of these was called COV1 and caused the first epidemic of SARS Cov in 2003. SARS stands for Severe Acute Respiratory Syndrome. This Coronavirus also rose in China again from animals and then moved to humans. This particular Coronavirus did not transfer very effectively from human to human but it did do this well enough to move to 26 different countries. Fortunately it was not so communicable because its death rate was very high at 15% overall and 50% for those over 64 years old. The second famous Coronavirus to cross into humans was the MERS Cov 2 virus which caused as the name implies, Middle Eastern Respiratory Syndrome which broke out in Saudi Arabia. But again this virus did not transfer well between humans and stayed mostly in the Middle East. The camel was thought to be at least an intermediary vector. However, this virus also had quite a high death rate. So now we have reached the feared point where a deadly Coronavirus has gained the ability to rapidly and easily transfer from person to person. It is also thought that its origin was in bats in China but it is suspected that there was some intermediary animal between bats and humans, possibly an animal that was sold at the wild animal bushmeat markets of China. This virus is fortunately not as deadly as either SARS COV, or MERS COV, but on the other hand it has very effectively evolved to be able to infect humans very easily.

     Just to clear up some confusions, this virus has several names. Some people in the beginning it called it a novel Coronavirus. Then people began to call it COVID 19 based on its origin in ;ate 2019. The Chinese scientists were able to sequence its RNA very early and did indeed supply that information to the world research community. Since this virus acts very much like the original SARS COV1, it is technically now called SARS COV2. But still the acronym COVID 19 is used both to refer to the disease it causes and to the virus itself.

     Microscopically the crown at the end of the spike is really a couple of pincers held together by a lipid and protein bridge. In order for it to hook onto human cells and hold on long enough to break through the cell wall, this bridge has to break letting the pincer action allow the virus to stick to the cell. This virus has accomplished this mechanism. Actually it has adopted to use a small enzyme that the human cells themselves produce called furin. This protein is readily available throughout the human body and it accomplishes that break of the bond between claws on the crown allowing the grabbing of the human cell by a pincer like action.

     Apparently it has evolved to utilize the ACE 2 receptor which is found on many cells in the human body. It seems that pincer actually grabs the ACE 2 receptor protein. The lungs have a particularly high concentration of these receptors as do the walls of blood vessels, and the gut. You may recognize the acronym, ACE. It stands for Angiotensin Converting Enzyme. Some of those of you with hypertension may recognize that you are on a drug called an ACE inhibitor. Such drugs block the protein, angiotensin and its tendency to raise blood pressure in our bodies. So does being on such a drug have any bad or good effects on this virus or the disease that it causes? Well we don't really know. There are anecdotal ideas, some held even among doctors, that one of the reasons that older individuals with underlying conditions often die from the disease is because they are on ACE inhibitors for their high blood pressure, or heart disease. Doctors have noticed this fact among their ICU patients on ventilators. But there are no studies that would prove this or disprove this idea. Since ACE inhibitors are so commonly used in these conditions that affect older people, it is more probable that this is just a coincidental presence of severe COVID 19 disease and the use of these drugs, and there is not a cause and effect relationship. In fact there is one small study that seems to postulate that being on ACE inhibitors may actually protect against the severe disease. We just don't know at this time. At any rate, we know that the virus uses the ACE2 receptor to stick to the cell wall and eventually get into the cell.

     Many respiratory viruses tend to either cause mostly an upper respiratory illness or an infection of the lower respiratory tract. This virus seems to be able to do both. It first enters human cells probably in the upper respiratory tract and is able to infect cells there and proliferate without a lot of symptoms. This may be why people can seem almost or totally asymptomatic. But then once the virus has multiplied more it seems to in some people move down to the lower respiratory system and cause a viral pneumonia. At this stage several mechanisms can lead to worsening of the patient's condition. One problem seems to be that the secretions are very dry and hard to clear with coughing and this leads to portions of the lungs being closed off to good air movement for proper oxygenation. The body tries to mount an inflammatory response to kill this virus but sometimes that response seems to go berserk especially in compromised people such as the old, or those with other severe underlying conditions. This inflammatory over response does a couple things. First there is something called a cytokine storm where the inflammatory response produces a lot of these inflammatory proteins which in smaller amounts attract the white blood cells that produce killing antibodies and help fight off the invader. But if too much of these proteins are produced they make the blood vessels leaky and lots of fluid leaks out of the blood vessels into the lungs adding more difficulty to the breathing and oxygenation, essentially drowning the person microscopically. Also all of these conditions make the lungs open for invasion by bacteria as well and a bacterial pneumonia may occur. Sepsis is the cause of death in many of these patients which causes shut down of many other organs, such as the kidneys and liver.

     There are a number of ways to attack this virus. Corticosteroids are used to suppress this immune over reaction called the cytokine storm. Now plasma from persons that have been infected and now recovered is being used in the very ill. There is one study from France with a relatively small group of patients who were given the antimalarial drug, hydroxychloroquine, and there seemed to be a good response that was statistically significant. But this was just one study. Currently studies are being done and this drug along with zithromycin are being used actively in the field against this virus, as long as the results are part of an organized study.  Antivirals that have been used for influenza, HIV and other diseases are being tried. Various labs around the country now have live virus and are using those live virus to infect cell colonies and then measuring what various drugs do when added to these small human cell colonies. All of this work is done by robots and is observed microscopically. One drug seems to hold some promise so far, called remdesivir. This drug has been used to fight another very lethal respiratory virus called the Nipah virus which has caused outbreaks in Bangladesh and in Kerala, Inda. Studies are ongoing for this drug. There maybe new drugs that could be effective and perhaps are being safely used for totally different diseases. If any of these drugs have benefit in the lab, they could be introduced to human populations with COVID 19 fairly quickly because their general safety is already known.  Such is the case for hydroxychloroquine and thus it is already being employed to some degree.

March 31, 2020: A View of This Pandemic from the Healthcare Perspctive

 
    Photo from Twitter.    

     I am a medical doctor and have been retired 11 years. I don't have a medical license anymore so I am not helping with this pandemic. And my knowledge has certainly waned in those 11 years. But my son is an MD. He is Chief of General Surgery in a large Midwestern University Healthcare Organization. He works very hard normally and I often worry about him and all of his responsibilites as a busy general surgeon, director of various sub departments of the Surgical Dept, as active member of multiple national surgical organizations, and as Chief of the Department. Well, now he has a huge burden on top of all that mentioned above. Elective surgery of course has been stopped so a large source of his income has dried up. Now he just does emergent surgery. That means every surgical case is an unknown and big risk. The patient is very sick, otherwise surgery would not be necessary. This makes every case much more anxiety producing. Add to that COV 2. The patient might be infected which until recently would be unknown to the surgeon and his staff. He was looking forward to a short test that can give a result in 15 minutes. He has that now but that does not take away the risk of doing surgery on an infected patient. There is some indication that for fear of causing aerosols of infected material in the OR, electric cautery should not be used. This increases the risk and the time of the surgical operation with more bleeding risk as well.  On the phone recently he told me he operated on a patient that morning and that patient's test had been negative. He was doing another surgery later on Sunday and didn't yet know the COV 2 status of that patient.

     Remember that this man and all his surgtcal colleagues and staff go into the hospital every day where dozens of infected patients are entering the ER, being evaluated and many of them being admitted to the hospital, to ICU, etc. My son enters all of these regions to see sick patients of his own whom are pre op or postop for other reasons. Think of the level of his exposure to this virus every day. My son is 49 years old and at the peak of his surgical career. But he has Type II diabetes mellitus. He is just on a single medication, metformin, and he follows his diet, exercises, and controls his blood sugar meticulously. His usual Hemoglobin A1C is 6.3 which is very good for a diabetic. Still we know that just having diabetes does add some risk of complications should he get the disease. He knows this every day as he enters the hospital, or his office, or the ER, or the OR.

    On top of all this anxiety, he is the Chief and has to direct the 35 or so surgeons that are in his department. He has to think about all the ramifications of this pandemic on his department. And he has to participate in hospital meetings that try to plan for the surge, as they are calling it now. In his city, the surge is expected in about 2 weeks, but they already have a lot of ICU beds taken up by COVID 19 patients. There has been the usual shortage of Personal Protective Equipment, (PPE). The hospital had already taken enlightened steps to preserve N95 masks, by limiting each individual worker in the number used and were trying to sterilize the masks by exposing them to UV light for a period of time. My son made the comment that because of the high costs of medical care in this country, he as the Chief of Surgery had benn encouraged to cut costs again and again. One of the ways this could be done was to decrease the inventory of PPE. The hospital had done a good job of this. Now there was a shortage and no storage to back up the new intense needs. I am sure that the meetings of the leaders of this hospital are very intense, and there is no doubt discussion of the worsening spread and the increase of patients that will appear deathly ill with COVID 19.

     There is no doubt that the job my son has loved and has devoted his whole life to without any other interests beside his family, has now become a daily source of anxiety and despair. The pandemic situation has not spared my son's homelife. His two sons, 13 and 10, are home from school and trying to engage in some degree of virtual learning. But they are missing their school friends and cannot participate in sports and music lessons, and other activities that basically define these young boys at this stage of their life. My daughter in law teaches pharmacy at a local college and is now teaching virtually from home. She is also trying to manage her son's studies, and to manage the household. In addition, she has just gone through a trauma. Her stepfather has died from a fall and head injury leaving her slightly demented mother alone and unable to take care of herself. She has made 4 or 5 trips down to the south of the US to the funeral, and to visit the family. And after arranging by phone a nursing home for her mother, she had to drive down to the south again this past week to get her mother admitted and moved in. Her mother, with some agitational mental issues, will have to be quarantined in her room for 2 weeks. My daughter in law has no idea how this will turn out.

     As you can imagine, when my son comes home from his work, things are not calm and easy at home either. He worries about all that his family is going through at this time as well. When I spoke with him, on Sunday, I heard the stress in his voice. He has always been a very hard worker, and I have always worried about him taking on too much for one doctor, for one human being to handle. But I had never heard the tone in his voice that I heard on Sunday. He spoke softer than ever, and there was a note of despair in his voice. My second son had talked to him a couple days before and had been told that this brave doctor had lost 12 pounds since this pandemic had hit our country. His anxiety was preventing him from sleep. He had only been getting 2 hours of sleep a night for various reasons, but no doubt largely from worry. When he spoke with his brother, he had finally been able to sleep a couple of nights for 6 hours. He had taken the time to organize and get all the family finances in order to have it prepared for his wife in case something would happen to him. He is certain that he is going to get this virus and he is deathly afraid it will cause complications because of his diabetes. I tried to tell him that he had only had diabetes for a couple years and not like me and others of my age, it had not taken a toll yet on his body. Also he maintains meticulour control of his blood sugars as I have said. But all of this weighs greatly on his mind. I am worried that he is almost at the breaking point.

     Then I see nurses on TV crying about their experiences in the ER and in taking care of the very sick COVID 19 patients. Our death rate rises. And the number of infected and therefore the number of very sick continues to rise. There is not really an end in sight yet for our healthcare workers, and our first responders. I just wanted to present to the public a view of what life is like in a doctor's or for that matter any hosptal worker's role right now. These are people with the bravery of the first line infantry soldier on D day.  We will never repay them for what they are doing in every city in our country.

      Please God, bless them and help them do their job, and protect them not only from the virus but also from the worry and despair that sits next to them every minute of every day and of some nights. Please provide the support and calm that only you can supply. Amen

    

March 27, 2020  "Safer at Home"

     Our Governor Evers has locked us down a little more. He has recommended that all non essential workers stay home, except for trips to the grocery store or to pick up take out, the former ideally only every 2 weeks. Grocery stores are making time in the morning of some days entirely for elderly and those with preexisting conditions who still remain the most vulnerable to this disease in terms of death rates. We now know that young people also get the disease and end up in the hospital with it but they still seem to withstand the deadly effect on the lungs better. Essential workers are healthcare workers, pharmacy and drugstore workers, food supply workers at stores and at restaurants who do take out, first responders, goods transport, gas stations, energy workers, certain manufacturing workers making things necessary for safety, life, and supplies for all things needed in this emergency, home repair, news reporters and radio and TV workers,  mass transit, airlines, cleaners and maintenance as well as waste management and garbage handling, and infrastructure. These businesses vary somewhat from state to state. For example, the production and sale of marijuana is deemed essential in California. Basically each state has decided what they deem essential for the safety of people's lives, and maintenance of their ability to stay safely in their homes.

     New York state and especially New York City and surrounds are the epicenters currently in our country and our country now leads all countries in numbers of cases.  It should be noted that we hold this record, mostly because we are dong more testing than any other country. And yet we still are probably missing the vast majority of the cases.. The actual number of infected is probably a multiplier of 5 or even 10 times this number of confirmed cases. Italy still leads the death toll and it is still mysterious why Italy has such a high death rate. We now have over 137,000 cases in the US and 2400 deaths. Every state has cases. Other highly effected areas are Florida, Louisiana, Washington State, and California. Chicago is also effected heavily. All of these areas are on different time lines toward their peak of cases based on how much they were seeded by travelers early and then how soon they began to close down schools, large events, and businesses.

     Testing has advanced and not only can tests be pretty easily done, there is now a rapid test that gives a result in 15 minutes. My son, who is Chief of General Surgery at a large Midwestern University Health system, was especially anxious for that. He felt that without knowing whether a surgical patient was COVID 19 positive or not would endanger the entire operating room staff. To speed surgery electric cautery is widely used to stop bleeding during surgery, but this creates an aerosol that could be very infectious. On a COVID 19 positive case, perhaps cautery would not be used and this would lengthen the surgical time often dramatically and make for more surgical risk. Also testing now can be done by the patient in their drive through car, utilizing mostly just the anterior nose and throat which would induce less coughing and sneezing. Therefore the collecting healthcare worker doesn't need to wear as much Personal Protective Equipment (PPE), saving it for in hospital and clinic workers.

     The shortage of this PPE has been a problem across the entire country. My son told me that their hospital was reusing N95 masks and using a period of UV light exposure to sterilize the masks inside a plastic bag. Multiple companies, especially garment makers have retooled to make N95 masks. 3M, the largest producer of these masks has hugely increased its output and is teaching other companies how to make them. Various local people here and there are making cloth masks and even stuffing them with feminine hygiene pads or coffee filters and providing them for some protection, not meeting hospital standards, but useful in other sites where there is required exposure to a large number of people. Small distilleries are using wasted amounts in their drinking alcohol production to produce hand sanitizers and are delivering them to local hospitals and other places that are in need. Various large manufacturers are retooling to make more venilators which are always in short supply

     One thing that President Trump and his team have done very well is to involve the private sector in answering the many shortages and needs of the pandemic. Now private labs have stepped up to make rapid testing kits. Already the virus has been RNA sequenced and within 2 months the first group of people have gotten a vaccine for its first trial, totally skipping trial in animals. It also has been found that antimalarials may help treat this disease. Someone noted that countries or areas in Africa and in South America where people are on antimalarials don't seem to have many cases. A study was done in France that is very promising. These drugs are already being used and our government is allowing this as long as these patients are part of a study to get the data as the drugs are used. There is also a new antiviral, called remdesovir, ?sp. Many individual people and small groups of people have started to make masks and sew full body suits that protect our health care workers. Individuals and very small companies even with just s single 3D printer are making face shields. In other words, the movement against this virus and protection against it has been a combination of government management and gathering of the most up to date and wisest knowledge, of the private capitalistic production abilities of our big companies, and the small but just as dedicated efforts of tiny businesses and individual people. This massive effort though not making itself effective just yet on the illness numbers, will in the end defeat the virus. Our form of government and current leadership combined with our capitalistic economy will win in the long run.

     The former paragraph sounds very positive and it is. But there is no doubt that we are taking a big hit both in illness which is overwhelming our healthcare system and has at least temporarily destroyed our economy. It is going to take a long time to come back from this. And my husband and I are no doubt going to be isolated in our home for many months even after others are going back to a more normal life because we are at so high a risk that we cannot take a chance on becoming infected.

     One of the interesting things that has made a lot of news is the run on toilet paper. Why was that the one item that people hoarded and worried so about not having enough? This is still a mystery and will remain so, I guess. Another run on goods was the dramatically increased sale of guns and ammunition. There is certainly more reason behind this buying spree. This pandemic has led the prepper like me and many other people in addition to worrying about the disease and how to protect against getting it and the economic loss the mitigation of the disease has caused, to begin to think about what this combination could cause if it advances much further in society. That fear is that we would have a breakdown in society and great civil unrest. Preppers worry about protecting what they have gathered to weather this pandemic from those who might come to take what they have. Hence people want to buy a gun.

     I am a prepper and I admit it. Some people laugh at this fact about me. If they could see me not worrying about getting to a grocery store now and just digging into my supply of freeze dried food, they would laugh less. But one thing I did not have was a gun. I did join a range club, take two courses on shooting, one for beginning shooters and one for learning about Conceal and Carry. I have shot two different hand guns a few times at the range, but I had never taken the step to buy a gun. I decided this was the time to do that. However, I had waited a little long, Many stores were out of 9 mm handguns. Then I tried to get some ammo and at least two gun stores that I called had none on their shelves. Finally I found a range and gunstore down in Racine, WI and was able to get a gun held for me as well as 2 boxes of 9 mm ammo, though I had only one choice there. The more expensive copper or brass coated shells were sold out. I just had to take metal jacket which I think is nickel. Then I could not take the gun with me that day, because there was a backup at the Department of the government that ok's background checks. I waited in the store a short time but the background check was put on delay. Two days later it had passed and I had to drive back down to Racine to pick up my gun. Soooo...... though I had planned to buy a gun all along, like many others, I was affected by the mass fear and effects of mob mentality and I went out and bought a gun. I didn't buy any toilet paper though so I didn't totally lose rational judgement.

     I am going to do a little research on the drugs that might be useful for COVID 19, and on the vaccines.  In the next report here I will try to give you some up to date info. There is some hope there. It is just gong to take some time to accomplish this.

     Stay safe out there and practice the hygiene and physical distancing from others recommended by all health scientists. But don't practice social distancing. Call your loved ones. Call those you haven't talked to in years. Send emails, texts, and even snail mail cards to raise other spirits. And we will get through this.

March 20, 2020:  The Pandemic

   
Notice the above date. An interesting combination of numbers. Maybe our numerology expert can give us some information on their significance. Well, we are certainly right now as I write this and as you read this experiencing a fantasmagoric event which shall be forever recorded in history. We are experiencing a very frightening pandemic of the Coronavirus Covid 19.

      It started in China in probably December but the Chinese Communist Party hid its presence from the rest of the world. We did not learn of it until the very end of December, 2019. Now there were two previous Coronavirus epidemics that were not so bad. In 2001 to 2002, SARS, Severe Acute Respiratory syndrome, started also in China and did spread around the world but not to any great extent. It seemed to peter out on its own and did not harm economies of the world. Then in 2012 to 2014, MERS, Middle Eastern Respiratory Syndrome, started in Saudi Arabia and might have had something to do with camels. It stayed mostly in that area, though there were two cases in the US in 2014. But fortunately that one also died out. In the beginning, the hope was that this novel Coronavirus would act the same way. However, China was hit very hard especially in the province in which it started. Then we heard of cases spreading in South Korea and elsewhere in southeast Asia. Our President, Donald Trump, made a fairly early decision to shut down the US to Chinese travelers especially from this province but also in general. Our west coast particularly receives large numbers of Chinese nationals daily and the fear was that this would rapidly import the virus to our country. Indeed, Trump faced harsh criticism for doing this so early. He was called racist, xenophobic, and even Nazi, for this decision. However, he went on to make light of the risk to our country. There is no doubt he was trying to reassure and calm the American people, but he was blamed for being slow to mount an all out protective and aggressive war on this disease. The problem was complicated by the fact that for the last 30 years, much of our manufacturing has been moved to China and we depend on them for all sorts of parts, and indeed large percentages of our pharmaceuticals, and even our hygienic protective gear like face masks. Meanwhile, the virus hit Italy dramatically because they had not shut down their borders. We have continued to close our borders, but the virus is here, as it is all over the world. It is a health, economic, and worldwide disaster. At this point in time, none of us know what will happen from here.

Since one week ago today, there have been hourly changes in our status in the US. Currently everything is closed: all sports activities, schools, gym, restaurants and bars, and many many non essential businesses and services. The State of California is on a modified lockdown, with people only going out for food, or health care. Likewise New York City is locked down in the same way. In addition, there are hot spots in New Jersey, Florida, Washington State, and the Los Angeles and San Francisco area. Wisconsin is just starting the climb of cases with our first 3 deaths in the last 2 days and with about a thousand confirmed cases. This disease seems to be at least 3 times as contagious as Influenza, and it especially become lethal for our seniors and those with underlying health problems. Those are the ones who mostly die, but young people can also get sick enough to be hospitalized. Yet many young people get a relatively mild cough and cold but with fever. There is evidence that some almost don't realize they have this disease but shed the virus, a very dangerous situation. 

      Well, to try to avoid what is happening in Italy and Europe, and Iran, as well as China and southeast Asia, our economy is being closed down. The stock market has lost almost a third of its value from 3 weeks ago. And it is expected that there will be many more cases that are beginning to overwhelm our supply of ventilators and our protective health gear for the first responders and health care workers. There is huge debate about how to handle this. I feel that some good things are being done: the private sector is being called in to replace and add to the manufacturing of these health items that are in short supply. Hospital ships and even the possibility of cruise ships being moved to New York, San Francisco, LA, and maybe Miami to provide more hospital rooms. But our health care workers without enough protection are going to get sick themselves and there will be no one to staff these ships. Car companies are saying they can retool to make ventilators, but that will take some time. The Federal Reserve is doing what it can with interest rates, and Congress is slowly passing bills to provide money, to stimulate the economy and help people who are out of work. Tax day has been postponed to July 15. Prisoners who are due for release are being let out of prison because the virus is getting into the prisons. Meanwhile fear of civil unrest has made most gun shops sell out and ammunition is no where to be found. Well, I can't even  begin to log here all the effects of this virus and our government's response to try to save lives.

     Well, I guess I would like to chronicle my reaction to all this. It think it is very typical of the average person over 65 in this country. We began to hear a lot about this about 10 days ago. Still we had no confirmed cases in the Milwaukee area and no evidence that there was community spread. All cases to that time had been tied to either international travel, or to national travel to hotspots in the US. These cases were still being isolated and their contacts were still being traced and self quarantined at home. A week ago Wednesday I drove by the grocery store and the parking lot was full. There was an obvious panic buying spree going on. I joined the panic a little bit though I had stocked up a few days before. The comical portion of this whole event was that people were wheeling cartloads of toilet paper to their cars. We have never discovered what that was. Hand sanitizers, disinfectant wipes, and rubbing alcohol were to next to fly off the shelves.

     That was the first sign to me that we were in big trouble, much worse than just a normal flu season. It was being emphasized so strongly that we oldies were so much more at risk for lethal complications. No one knew entirely why, but statistics seemed to prove this. And Italy being one of the oldest countries in the world, citizen age wise, had death rate running very high, maybe 8 to 10 per cent.

     One night last week, I lay awake thinking about what I would do if one of us got sick. I have somewhat of a special case. My husband is mild to moderately demented  and would not be able to take care of me if I got the disease. I am having trouble explaining to him how we need to keep the outside out of the house and not contaminate surfaces in the house with things that have come from outside. I will say that he is washing his hands more than usual. If he got the disease, first of all he is at high risk for complications and severe disease because he is 83 years old, and has moderate renal failure in addition to the dementia. How would I take care of him without getting the disease myself. I began to run through some things I could do in my mind: use separate bathrooms, separate bedrooms, keep our areas apart, continue to wipe down all surfaces even more than I am now. I would be totally isolated in my efforts with no family in the area and no one to turn to. All of these thoughts kept me from sleeping.

     In addition, coincident with this, perhaps because of me being on my feet more and running more errands to try to get ready for this event, I developed worse left sided back pain with radiation of an
intense ache into my lateral left thigh and upper left calf. Clearly I had a pinched nerve in my back. I went to see my internist who agreed with me and gave me a Medrol dosepack. Great! Now I was on an immunosuppressive dose of prednisolone while a lethal disease is beginning to run rampant. At my Spirit Mind body group a week ago Thursday, I didn't hang around afterwards and on Friday at my water aerobics class I participated well away from others in the water and refused to play Canasta. After all, playing cards for 3 hours passing these cards from person to person without touching our faces, seemed very unhealthy to me. The next day, Saturday, I decided we would self quarantine except for having to go out to get groceries, or gas. I also have had to go out to get a prescription for gabapentin for my back when the Medrol Dosepak gone, my pain began to come back. When I go out for these necessary trips, I wear an N95 mask I have saved since my retirement 11 years ago, and I wear plastic gloves. Of course, being a physician, I understand sterile precautions and so I try to wipe down the inside of the car and door handles, and leave the packages that I can sit in the cold garage for 24 hours so  that any virus particles on the paper bags can disappear. I handle the plastic bags and plastic wrap with care and dispose of it with care and wash my hands all the time. When I come into the house I wipe off  the doorknobs and take off my coat and put that one aside for 2 to 3 day and use a different coat to go outside the house the next time. I immediately wash my hands then.

    When I have to go to the bank, I just drive through. I use some alcohol in my car and cotton balls to wipe down the air tube carrier and to wipe down my ID after if I have to put that in the air tube container. If I use my credit card in a store I wipe it down with alcohol afterwards. It really becomes exceedingly anxiety producing to remember the order in which to do all this. I have no idea if I am exercising over kill for this virus or not, but I know that we just cannot get this bug. I could not handle it emotionally within our little household. Suddenly I know how a pathological germophobe feels.

     Our sons and their families are also going through some sort of hell. My younger son has a 2 year old and his wife is 5 months pregnant and very nervous about all this. They live in California, which is a hot spot. They are practicing all these safe practices as well and my son is reading all about whatever new info comes out. Sometimes this might be a little encouraging but mostly it just adds to the fears. My oldest son is of course Chief of General Surgery at a midwestern University Hospital and is in the thick of things. He predicted last week that all elective surgery would be curtailed to preserve ventilators, hospital beds, and supplies and indeed that has happened.  This will mean a great reduction in income, and he will likely have to go into the trenches to care for the sick.  His wife teaches pharmacy and though the school is closed, she may be called in to deal with pharmaceuticals in the hospital. Their two boys at 13 and 10 are home alone and dealing with that. I worry about all of them.

     No one can predict in any reliable fashion how long this will go on. It is true that our country is behind others in the onset of this spread here. That is because we closed our borders early. But we are having logarithmic increases in the infected and in deaths now. On an optomistic side, most agree with how the President is handling this and government in combination with the private sector are stepping up to help out. All of our experts and our President and Vice President are thinking outside the box to try to think of thousands of ways to help contain the virus and its spread, help the economy, and to help all those who have been sidelined at home and have no income coming in due to that fact. We are seeing thousands of little acts of kindness and ways to help people. Since many churches are closing, one priest held drive through confession in the parking lot. Everything is being done electronically and more and more ideas are coming forth to supply more electronic help. We have a new neighborhood hotline on our phones and people are volunteering to make runs to some of the few drive through restaurants to pick up food  for anyone in the neighborhood to help support those restaurants. Perhaps we can maintain some degree of perspective and also hope that this will be over soon.

     I plan to start posting every day or so describing our life under these circumstances. If nothing else I think it will have historic interest for readers who find my work many years later. That probably will be one little old lady like me who is interested in genealogical work and wants to know what her ancestors' lives were like during this historic time.