This week on the show, Mike and David discuss the life and times of the late Rep. John Lewis. They also talk about the new wave of incoming Black politicians into Congress and the need for a new radical Black politics. Tune in below.
ares加速器中文名字是什么
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ares加速器中文名字是什么
Run It Black Podcast · Making Sense of the Moment We’re in
2023 has been a year unlike any for most of us. From coronavirus to the national movement against police violence, it feels like we’re in a moment that could best be described as tectonic. This week on the show, Mike and David explore recent protests over the killing of George Floyd, Breonna Taylor, and Ahmaud Arbery. They also address criticisms of uprisings taking place all over the country and discuss the larger issue of policing. Tune in.
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ares加速器中文名字是什么
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Whether or not these policies become reality is dependent on much more than presidential politics. Congressional elections will have an important impact, as will state and local elections. Building the strength of the labor movement is a must. So is the growth of independent alternatives to corporate media. Social justice advocates must continue to organize, wage effective issue campaigns, re-envision Democratic institutions, and increase the membership of promising grassroots organizations that have begun to wield power, including the Democratic Socialists of America and the Sunrise Movement.
But presidential politics still matter, and while no progressive-minded person would consider voting for Trump, there are three distinct presidential election strategies social justice advocates may embrace. Those strategies, along with their pros and cons, are summarized below.
No matter how we weigh any individual strategy’s tradeoffs, it is essential to understand its rationale and stand in solidarity with social justice advocates who pursue it. Attacking each other over strategic disagreements only undermines our common agenda; there is much more that unites people who supported Sanders (or Elizabeth Warren, for that matter) in the primary than that divides us.
Vote Blue No Matter Who
This strategy, embraced by Sanders himself, centers the threat posed by a potential second term for Trump. Sanders, like many of his supporters, maintained since he entered the race that he would ultimately support any Democratic nominee – no matter who it was – because of the importance of defeating the man he believes to be “the most dangerous president in the modern history of our country.”
It’s not hard to understand the rationale for this strategy: Trump, beyond his bigoted rhetoric, sub真正免费的加速器, and disregard for political norms, has pursued the standard GOP policy playbook while in office. His administration has worked to sub网络加速器官网下载, 旋风sub加速器, roll back environmental regulations, and chip away at the Affordable Care Act. He has appointed a plethora of privilege-defending judges to the federal bench, including two on the Supreme Court. Trump has also SUB外网加速器 the emoluments clause of the Constitution, using his presidency to personally enrich himself and his family, and seriously bungled America’s response to the coronavirus.
Social-justice-minded proponents of this strategy acknowledge that Biden has a long history of condoning millions of people’s oppression. They don’t deny that, over the course of his career, Biden has stymied school integration, helped engineer mass incarceration, worked to deregulate the financial industry, spread racist stereotypes used to deprive poor people of cash assistance, voted against LGBTQ equality, championed the Iraq War, fought reproductive rights, enabled abuses of immigrants, and 旋风app加速器 deficit panic. They recognize that Biden frequently lies, has been accused of sexual assault, and sub真正免费的加速器 opposes urgently needed policy, like Medicare for All and a Green New Deal, that would threaten the profits of his corporate donors. But while that may be true, vote-blue-no-matter-who proponents point out, Biden would surely appoint Supreme Court justices better than Brett Kavanaugh. He also surely wouldn’t use a pandemic as cover for helping employers bust unions. In the short run, social justice advocates will undoubtedly have a better chance of successfully pushing their agenda – and preventing as much of the serious harm a president can cause as possible – with Biden than with Trump in the White House.
Still, there is a clear downside to pledging unconditional support for the eventual Democratic nominee: it deprives social justice advocates of considerable long-term power. If Democratic party leaders and their allies in the media know you will support a Democrat in the end no matter who that Democrat is, what incentive do they have to cover and push the issues and candidates you care about? Isn’t it perfectly logical for party elites to ignore you and the millions of people their policies hurt and cater instead to groups whose support is conditional upon the pursuit of their interests, like corporate America and affluent White suburbanites? The Democratic Party has for decades done just that, relying on social justice advocates’ fears of Republicans instead of actively trying to court social-justice-minded voters.
Refuse to Support Corporate Democrats
The social justice voting bloc is big enough that the Democratic Party cannot beat Republicans without it. If that voting bloc were to uniformly and credibly pledge to withhold support from corporate Democrats like Biden in general elections, less social-justice-oriented Democrats who want to win general elections above all else would have no choice but to support candidates social justice advocates support – like Sanders – in primaries. This strategy is about destroying the electability argument that won Biden and Hillary Clinton the last two Democratic nominations.
To be clear, corporate Democrats’ electability arguments have lacked evidence for years. But they have nonetheless convinced Democratic primary voters, in no small part because their logic makes a certain sense. If the only swing voters are moderates, people who want to win general elections against Republicans would naturally maximize their chances to do so by nominating candidates who appeal to this narrow swing constituency. Social justice advocates who refuse to support corporate Democrats increase their leverage by becoming a swing constituency themselves.
The goal of refusing to support corporate Democrats, in the long run, is to achieve one of two outcomes: pulling the Democratic Party in a social justice direction or creating the conditions for the emergence of a viable third-party alternative to the Democratic Party. For the millions of people who are incarcerated, bombed, deported, and/or mired in poverty due to policies corporate Democrats support when they’re in power, it is crucial that one of these outcomes occurs as quickly as possible. The likelihood of that happening through the strategy of withholding support from corporate Democrats is uncertain, but what is certain is that, all else equal, it is much higher than the likelihood of achieving these long-run objectives through the vote-blue-no-matter-who strategy.
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The Wait-and-See Approach
Some Democratic voters have yet to declare whether they will support or refuse to support Biden in November. These voters do not hold as much power to influence Democratic primaries as those who vow never to support corporate Democrats, but when a corporate nominee like Biden emerges from a primary victorious, they are well-positioned to influence that nominee’s agenda.
第一波5G手机扎堆发布！但今年上市毫无意义 | 5G手机将 ...:2021-3-3 · 原标题：首批5G手机2021上半年开始上市，但真正的竞争2021年上半年开始一年一度的MWC已经开展，5G无疑是MWC2021的主题。无论是芯片、5G设备供应商，还是运营商和移动终端厂商都争相展示自家最新的5G进展。5G手机的集中发布伍及MWC上随处可见的 ...
There are tradeoffs involved in figuring out how to approach this negotiation. Ask for rhetorical overtures without staffing commitments and you’re essentially deciding to vote blue no matter who. Insist on Nina Turner as Vice President, Naomi Klein as Energy Secretary, and Rashida Tlaib as Secretary of State and you’re effectively refusing to vote for Biden. Demand Pedro Noguera as Education Secretary, Lori Wallach as Trade Representative, and Matthew Desmond as Secretary of Housing and Urban Development and maybe you have a shot at getting it.
Because the wait-and-see approach can apply to fundraising, voter outreach, and other forms of activity in addition to votes, it is not mutually exclusive to voting blue no matter who or refusing to support corporate Democrats. Someone who has already committed to voting for Biden may only donate or phonebank under certain conditions. Likewise, the frequency and intensity with which Biden is critiqued by people refusing to vote for him may change in response to who he selects as his vice president or promises to appoint to key positions. In addition, these strategies complement each other. People who refuse to vote for corporate Democrats stretch the Overton Window, making other social justice advocates seem less radical in comparison. The potential to bring other social justice advocates along is the carrot that vote-blue-no-matter-who proponents offer the Democratic Party in internal negotiations, while the potential to pull other social justice advocates away is the external stick wielded by those who refuse to pledge unconditional support to the party’s corporate Establishment.
Debate the Strategies, Unite Around Goals
Vigorous debate about how to weigh the pros and cons of each of the above strategies and when to engage which strategy is healthy; joining corporate Democrats in pillorying Sanders supporters who adopt different general election strategies is not. If we are to be successful in achieving the Sanders movement’s central aim – improving millions of people’s lives through the social justice policies a majority of Americans support – we must remember who our allies are. And no matter who is ultimately elected president, we must continue the down-ballot work, movement building, and on-the-ground activism essential to advancing our shared vision.
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ares加速器中文名字是什么
This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.
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I’m interested to see who comprises the volunteer corps because there is a wide variety of people in the Delaware Valley that suddenly have nothing to do. There are retired physicians, nurses, medical students (suddenly without any clinical duties), as well as people not at all involved in medicine who just want to help. Everyone is eager and energetic. You couldn’t tell there was a pandemic about to make its way to Philadelphia and the people that are most concerned they have an infection are driving to your current location.
There are multiple large white tents set up to receive cars to drive through. Each tent has the capacity to test about 100 people per day. The decision on how many tents to open each day is dictated by the number of volunteers available and the weather. On my first day it’s windy—very windy in South Philly. So windy in fact if you dropped a glove or a face shield you better start running because it would be 10 yards away before it hit the ground. Mornings start with huddles of teams where we begin the process of assigning volunteers to different stations and assign roles for the day. A woman in a vague military ensemble and standing up perfectly straight, presumably from FEMA, calls our medical director over after our huddle. There is a line of about 30 cars waiting for the entrance gate to the parking lot to be lifted to signal we’re ready to start testing. We typically start at 1pm on the dot but today things are dragging along. The Medical Director slowly walks back to the “swabbers” tent, facemask in hand, and dejectedly says that we have to close the operation today due to high winds which are anticipated to become worse as the day wears on. This is because the specimens may blow over and be scattered in the wind, putting Philly on the map as the first city to accidentally infect its own citizens with coronavirus. We have to go car by car to notify the inhabitants that if they are truly sick they should go to the nearest ED or come back at a future date. Demoralizing indeed.
Our positive rates with the nasal swab at the testing site are between 25% to 30%. If we had tested only 200 people that day, that’s still at least 50 people we would have identified as being COVID-19 positive. Who knows how many had to take off from work to come in or might not get the chance to come in tomorrow. The volunteers are pretty disappointed.
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最新翻译的官方 PyTorch 简易入门教程:2021-1-10 · “PyTorch深度学习:60分钟快速入门”为PyTorch官网教程，网上已经有部分翻译作品，随着PyTorch1.0版本的公布，这个教程有较大的伋码改动，本人对教程进行重新翻译，并测试运行了官方伋码，制作成JupyterNotebook文件（中文注释）在github予伍公布。（黄海
It won’t be a surprise that our lives will be markedly different in the coming months and most likely years. For the foreseeable future, society will no longer run as “business as usual” following the first wave of the pandemic. The way our healthcare system functions is something I’m most looking forward to seeing evolve as people realize that our employer-based model leaves millions behind is not equipped for delivering the most care to the most people. A new awareness of what we find important in life will also develop. This may entail rethinking the significance of the local community and each person’s role. We’ll be forced into introspection – things like where we get our food how we view work, and how we spend our free time will require reflection and evaluation – whether we like it or not.
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ares加速器中文名字是什么
This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.
Monday, April 6th
Aside from the very real concerns over lack of personal protective equipment (PPE), ICU beds, and ventilators, I believe that the biggest cause for anxiety among healthcare professionals is not having answers. Traditionally, the public has turned to physicians during public health scares as they purportedly know how to approach all ailments. This virus is demonstrating that given all of our progress in the medical field from state-of-the-art imaging modalities to treatments utilizing personal genetic properties, we still can’t answer many basic questions about this new disease.
Philadelphia has a geographic advantage over many other regions in relation to the viral spread. We have an up-close view of the damage that the virus has wrought in New York without having nearly the number of cases or hospital burden at this time. The delay it takes for the virus to move westward globally and down I-95 not only allows us to stock up on PPE, prepare the hospitals, and practice social distancing, it also gives us the opportunity to analyze the studies that have come out of places like China and Italy. Although hospital beds in Philadelphia are now filling up with COVID-19 patients, it’s the barrage of images in the media of trashbag-wearing nurses, overflooded hallways and pleas from staff urging more supplies or more assistance that make this even more terrifying. The answers to our questions will come, but during the quarantine when each day feels like a week, data collection isn’t necessarily the issue — interpreting the data is.
As the pandemic ramps up in our region, the ever-present fear of not knowing which patients entering the hospital with upper respiratory infection symptoms are positive is anxiety-producing, not only because these patients can become sick quickly, but because it’s easy to let your guard down. When you 网友网络加速超速器 your patient is infected you know to be extra cautious. Also, determining whom to test prior to admission, given the tests’ continued scarcity, remains an issue, even as our own institutions’ guidelines continuously evolve.
In an ideal world we’d screen everyone and it would be an accurate test. However, right now we cannot screen everyone and we know the test has a high rate of false-negatives. Let’s say we do identify a COVID-19 patient through testing but who doesn’t require hospitalization. Our guideline for duration of self-isolation is just a recommendation as we simply don’t know if they are still infectious post-isolation. We can’t even tell patients that tested positive whether or not they are susceptible to getting re-infected, and if it will return in autumn; we can only posit given what we know about other viruses in these situations. Lastly, we don’t even have a proven treatment plan, only what experts surmise is the best approach given the information we have. Hydroxychloroquine, among many other proposed treatments, is still in the nascent stages of evaluation but the public wants answers quickly. This is not typically how the peer-review process works in academia as it often takes months to years to evaluate therapies. In this case public expectations need to be grounded to a reality in which even when expedited, implementation of new practices moves at a seemingly-glacial pace.
Residents get daily updates regarding our own institutional policies as well as new relevant findings that could be practice-changing. It’s amazing seeing the sausage being made, but it’s also terrifying because the Attendings and veteran physicians that we as trainees look to for answers are now looking to each other for answers and opening the floor to all ideas.
The good news is that while we don’t have the answers yet (and we may never have all the answers), we can take comfort in knowing that we are in the golden age of data- and knowledge-sharing. Pooling the resources of physicians, epidemiologists, researchers, and statisticians internationally has allowed us to make great strides in our understanding of COVID-19 in a relatively short time, and work toward mitigating our greatest fear – the unknown.
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ares加速器中文名字是什么
This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.
Wednesday, April 1st
Medicine residents work in the hospital as well as the outpatient office. Cleared to go back to work, I’m scheduled to see some of my patients in the office. In an effort to limit the exposure to coronavirus for both the patients and the office staff, as many appointments as possible have been converted into telemedicine visits. These are essentially video-chat appointments using a HIPAA-compliant app where I can talk to a patient, ask about their symptoms and have them show me any relevant physical exam information, like using the camera on their phone to show me the back of their throat. I complete the online training modules that all providers have to pass and I think I’m as ready as I’ll ever be.
Something is off as I arrive at my clinic prior to my shift. First, it’s nearly empty, no front desk employees are there to wave to, and there are new standing hand sanitizer dispensers everywhere. Magazines from February populate the waiting room tables which may not be alarming for most businesses, but for my clinic, not having new editions of Philadelphia Magazine on display is shocking and noteworthy. No patients in the waiting room and doors to individual offices are closed, preventing natural light from gaining entry to the normally well-trafficked hallways. This place definitely feels more bunker-like than I remember. The few staff and attendings that are present are all wearing scrubs and face masks. Recognizable but unfamiliar, the pandemic has now officially warped and invaded every facet of my life and there is no sanctuary for normalcy.
Previously, only a small portion of physicians were utilizing telehealth visits. Fewer than 1% of Medicare beneficiaries used it prior to the pandemic. Presumably because there is a learning curve on both the provider and the patient’s end, you have the opportunity to be more thorough during an in-person visit, and the big one: it wasn’t fully reimbursed by Medicare. Recently, under the Stafford Act and National Emergencies Act, Centers for Medicare & Medicaid Services (CMS) announced its beneficiaries will now be able to use telehealth to access their PCP for non-routine visits. Important to note, this is only 旋风app加速器, as once the crisis is over (whatever that means), CMS will go back to its prior payment structure. Notably, other providers like social workers, psychologists, dieticians, etc. that are also integral to a person’s overall well-being will be covered.
Many of my appointments for the day involved patients interested in COVID testing. There’s an algorithm providers are to follow to determine who should be tested given the scarcity of tests. Mainly if the patient has symptoms, has other elevated risk factors such as coming into contact with a known COVID positive person, or recent travel to a coronavirus “hot spot”, they should be tested. This doesn’t cover a lot of other vulnerable people or others who should be tested, but the algorithm is designed to only catch the most likely positive cases at this point. The rapidity with things like which screening tests are performed and whom to test are just part of the equation in this constantly developing situation. Someone who is not eligible for testing one week, very well may be eligible the next.
I’d never performed a telehealth visit but the obvious problems that come to mind, like poor internet connection and not being able to get a gestalt on a patient that you can by an in-person exam, were apparent. In my first session I immediately encountered an issue with a patient which our staff couldn’t get in touch with to see if they could convert their in-person appointment to telehealth. The patient’s partner had lost their job and couldn’t pay their cell phone bill so they were splitting the phone and the voicemail-box was full. The current economic crisis will of course exacerbate issues like this. Additionally, most commercial insurance as well as CMS will pay for audio/video calls but not necessarily only an audio (traditional telephone) call. My next patient actually was having difficulty accessing the proprietary HIPAA-compliant app on his phone, necessitating a phone call appointment which ultimately won’t be billable. Other appointments went smoothly and were unremarkable but already it’s clear there will be growing pains in moving patients to telehealth.
I’m a big believer in the future of telemedicine for many reasons but primarily because it provides a lower threshold for patients to access their providers, and this will be beneficial to delivering healthcare. These next few months will be telling if we can make it work nationally from a logistical standpoint. I’m not as convinced from a reimbursement standpoint as I’m sure there will be many kinks to work out. If my first foray into telehealth has shown me anything it’s that for my patients telehealth is a generally welcome idea in theory– many of whom did not grow up with cell phone technology– but in practice it’s a different story. Since the beginning of the quarantine, there’s been a surge in popularity of video and teleconferencing software connecting co-workers and friends alike. This current crisis will hasten the public’s comfort with interacting over the internet. We’ll see how long it will take to successfully adopt and integrate into daily medical practice but the test has arrived regardless of whether insurance, the public, or providers are prepared.
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ares加速器中文名字是什么
This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.
Sunday, March 29th
Although I’m a resident and I’m able to access my own medical chart through the electronic medical record, I’m not allowed, per hospital policy. I’m relegated to waiting for my results once “released” to me. While waiting for results in self-isolation, at a certain point you don’t really care whether it’s positive or negative, you just want to know something. Unfortunately, we still don’t know if being coronavirus positive prevents you from getting infected again so I’m not at the point where I would prefer to be positive just to get it over with.
Finally, five days after having the back of my throat swabbed I get an email saying my results are back: SARS CoV-2—undetected. Whew, negative. I was able to isolate for 5 days while my wife worked and took care of our baby simultaneously. Many other households aren’t that fortunate and either the other parent would have to take unpaid time off from their job (if they are able) or the person in quarantine would have to watch the kids and therefore expose the entire family to coronavirus. This is problematic for many obvious reasons.
A picture of me and Jack at the tail-end of my quarantine. I still smiled under the mask for some reason.
The responsiveness from the government to obtaining and manufacturing tests was 5G版Mate 30系列驾到！Link Turbo助力EMUI10实现疾速体验 ...:2021-11-1 · 图片来自华为官网 而在5G版Mate 30系列身上，借助SA 5G网络的疾速下行速率，再结合Link Turbo技术技术能带来快到难伍置信的速度。比如5G下载速度为1424Mbps，WiFi下载速度为575Mbps，那么Link Turbo技术带来的“聚合网速”就高达1900Mbps。 Quick turnaround time for testing is beneficial for giving patients a diagnosis promptly and is beneficial for epidemiologic prediction models that guide how much a region will be impacted and which locations that will be hit hardest next.
There are two main testing locations. In-patient testing for those that are hospitalized, where the test is performed in the hospital’s own microbiology labs (“in-house”) which have continuously improving turnaround times. Once the tests became available to hospital labs across the country, waiting times went from 48 hours down to about 4 or 5 hours (and in some hospitals turnaround is under an hour). The other main testing sites are commercial labs (LabCorp, Quest Diagnostic, etc.), where your test would be performed if your outpatient doc sent in a referral or if you went to a screening center. Unfortunately wait times are getting much longer as the public demand goes up for testing, and along with it, any part of the supply chain that is lacking—from swabs to reagents to protective gear for the providers—will back up everything.
The answer to better prediction models and better care isn’t just faster turnaround time for tests. The media has really honed in on getting quick results as a major issue in the epidemic because the news can show a long queue waiting to be swabbed or interview people frustrated by the lack of knowing their status. Arguably just as important is the accuracy of these tests. Swabs of the nose and throat are analyzed by something called polymerase chain reaction (PCR), which is designed to multiply the virus genetic material—RNA in the case of coronavirus—and detect the presence of the virus itself. A couple of problems arise from PCR as there have been reports of high rates of false negatives—meaning getting an inaccurate “undetected” reading when in fact, one is coronavirus positive. This is called low sensitivity in a test.
Because PCR looks for the virus itself from the swab, there have been studies in which essentially, if you go lower down the trachea (“wind pipe”) and obtain a sample closer to the lungs there are higher concentrations of virus located there so you will get a better sample and potentially provide more RNA material to amplify and detect with PCR. The issue with going down the trachea, in addition to being very unpleasant, can cause more of the virus to be coughed up during the procedure potentially infecting more people. So it seems not only possible, but likely that the swab going to the back of the throat either by way of mouth or nose just doesn’t pick up enough virus to be amenable to detection in many instances.
A blood test was recently approved by the FDA under Emergency Use Authorization which will test for antibodies (our own immune system response to the virus). These tests are already in use in China and other countries and can return results in under an hour. The benefit is that these tests aren’t dependent on obtaining an adequate swab and they could potentially tell us if someone’s been exposed in the past. It will also lead to more data regarding immunity to future infections with SARS CoV-2. The downside is that the test may not be accurate either and potentially detect non-COVID-causing coronavirus like CoV-1. There also arises questions like: is it better to know with 80% accuracy with one method vs 70% accuracy with another but it takes half the time to get the results back? There are no clear-cut answers because there are pros and cons to both.
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At our institution there have been patients that we’ve been so sure are COVID positive that we’ve performed multiple PCR tests yet have all returned negative. Unfortunately, the answer to those that are so sure they are positive with coronavirus but have received negative testing is to assume the test is wrong. Given the rapidity with which this is all developing there just isn’t enough data regarding how accurate these tests are and how they should be employed.
I finally received a call from occupational health telling me the test results and to go back to work. Typically I’d be starting on outpatient weeks at this time, meaning I would be seeing patients in the office and go to morning and afternoon conferences with other residents. The pandemic has disfigured outpatient life for a resident, so now I start with telemedicine appointments and we’re given strict instructions to stay away from the hospital until it is our turn again—I’ll gladly oblige.
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ares加速器中文名字是什么
This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.
Friday, March 27th
I’m not having any symptoms at all at this point, really itching to get back to work. All residents have been instructed to check their temperatures before and after every shift since last week, in the hopes of catching any early signs of infection. We were not supplied any thermometers by the program, local drug stores are all sold out, and checking online the cheapest thermometers that will arrive in fewer than 4 days are all over $50. Luckily, I have my son’s infant forehead thermometer but I’m pretty sure doesn’t really work—I use it anyway and consistently have a temperature below 95 degrees, whatever that’s worth. I hadn’t felt feverish so I continued to go in to work at the hospital.
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Residents are at an even higher risk of burning out at this time because all “non-essential” employees are not permitted in the hospital and they are limiting the number of employees for the essential roles as a way to decrease overall exposure. Medical students typically make discharge appointments, obtain outside hospital records, and other vital tasks—but medical students are no longer permitted in the hospitals because in many ways they’re paying for the privilege of being there. That topic in and of itself could be another blog post. Gone or restricted hours also apply to many case managers, social workers, patient transporters, nutritionists, physical therapists, drug or alcohol rehab representatives, etc. The burden of caring for patients and providing a safe discharge now falls more squarely on the remaining, smaller medical teams, which includes residents (and more specifically the interns—first year residents). This is time-consuming and no doubt will hasten burnout. In our program we’ve been fortunate enough to be able to take certain measures to mitigate this, like shorter duration spent on COVID teams for residents, but we may not have that luxury in the coming weeks.
Is this what we signed up for as trainees? My institution for now has been remarkable in being able to accommodate residents that are particularly vulnerable or have vulnerable household members; others may not be so lucky. Hospital administrations have to make the decision as to who to put in harm’s way. It’s not always cut-and-dry—should we protect older attendings or younger trainees? Is the duty to provide the best care for these current patients or to minimize exposure of budding physicians who will be practicing for decades to come? We have no idea if there are any long-term repercussions to the lungs or any other organ systems in people with asymptomatic coronavirus, and they may confer a higher rate of complications not seen for years or decades—we just don’t know. The vast majority of residents and clinicians in Internal Medicine are very hesitant to jump right in, and understandably so. Initially no med students, interns, or residents were to take care of COVID patients. As the epidemic grew into a pandemic more and more hands needed to be on deck. But still, the decision regarding which specialties will be taking care of these patients is growing. The public may not realize it either, but some residents and even attendings from subspecialties that don’t have much clinical patient exposure (e.g. Radiology) may have to dust off their stethoscope and start taking care of loved ones in your hospital.
Similarly to reports about physicians having to decide which patients get a ventilator, we are also making the decision as to which providers get greater amounts of exposure, which is a morbid endeavor. In Philadelphia, we’re fortunate enough that we haven’t had the same patient burden as New York so it hasn’t been all-hands-on-deck, but we may have to start asking which residents can handle more exposure than others, sooner rather than later. Does taking care of an elderly family member, or a child at home come into consideration? What about providers with immune system issues? Where does my duty to provide for my patients trump my duty to keep my family’s risk of exposure at a minimum? Is it moral to ask a young, healthy, single resident to have repeated exposure or is it better to spread it out over several residents but lessen their daily exposure?
Although I personally hope to continue to be at or near the front lines, I understand those that are in a compromised position, and they shouldn’t feel bad for wanting to protect themselves or their family. There is no portion of the Hippocratic oath that implicitly or explicitly states that physicians have a duty to patients above their own safety. This is a nuanced situation that doesn’t have a blueprint in place. There are many features that as a society we’re having to figure out in real-time, which is just adding to our collective anxiety.
Healthcare workers are put in an awkward situation in these times. We need to be discussing this openly, with transparency about the treatment of healthcare workers, especially nurses and residents. How to improve the healthcare system is an important topic that hopefully will not be able to be ignored after we pass the emergency of the pandemic. It will not be easy to address this because the goals of the industry are not aligned with the goals of the public or those providing care. Even though we’re in the midst of the pandemic it’s a beneficial practice to reflect and think about the way we can improve the safety and efficacy of those delivering care.
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Filed under coronavirus, Health Care and Medicine, Pandemic, Residency
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This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.
Wednesday, March 25th
Today was my first day of quarantine and now I feel like I’m a part of society. In the prior weeks, working on the general hospital floor I was constrained by daily ritual –nothing said on the news or by the government about isolating or “staying home” applied to healthcare workers, or residents, more specifically. Those working in hospitals are in the thick of it, but we have a completely different experience because we have to continue to go to work and do our jobs while everyone else has just had drastic changes dictated for their daily lives. I was working long hours every day so I didn’t observe any special social distancing; my daily routine recently had been to come home and only have about an hour before turning in for the night so I wasn’t doing much socializing. Now home and quarantined, I found out quickly how fast things could change as I spend most of the day sequestered in our bedroom away from my family and where they typically are during the day.
My wife’s mother watches our son but we’ve collectively decided that while I might feel fine, because of my high risk exposures it would just be best for her to not come until things cool off. We’re lucky that we have the opportunity to actually have this option as many families in our situation would either have to choose exposing a loved one to potential coronavirus or have the parent take time from work to watch their kid. I fully appreciate we’re privileged enough to even have that possibility.
I look out my closed bedroom window and think it’s a shame that the weather’s so nice as I’m sure everyone is itching to be outside. Spring is in full swing even on our street, as the trees are approaching full bloom, and I’m pretty sure a bird’s nest is being built in our gutter as I hear constant chirping with rustling of leaves and tin behind the upper corner of my bedroom. I can hear neighborhood kids outside playing. I look down and see groups of 4 or 5 parents awkwardly try to stay 6 feet apart on our narrow street. I’d like to kindly remind them to keep their distance, but like Jimmy Stewart in Rear Window, I just gaze at them from the safety of my newly shuttered life.
Hearing the kids play, I wondered, what are they thinking is going on? How much have their parents told them? I don’t know what age you go from being elated you’re off from school to being worried about whether or not you and your family will survive. Do they think this is a normal occurrence and something they’ll have to deal with frequently in their lives? This must have a major impact in many different ways on kids of varying ages. I remember getting talks at school about fire safety and going home every night and practicing an escape plan with my family because I was so terrified. I don’t know what 8 year old me would be feeling about the invisible yet much more real confrontation with a virus. I couldn’t imagine having a 2 or 3-year-old that doesn’t understand that they can’t go outside to play with friends and then have to keep them entertained throughout the day. Then do it again the following day indefinitely.
I’m now realizing there will be so many unforeseen consequences, namely impacting those on the lower socioeconomic scale. When you work in healthcare during a crisis all you care about is how it impacts you and your patients. When suddenly removed, I’m forced to take a step back and come to grips with how this affects literally everything and everyone else in society. Maybe it’s because I now have my own child to look out for, but children have been on the forefront of my thoughts related to the pandemic. They may not be medically the most vulnerable in this case but they are in terms of long-lasting impact. Every facet of their lives are being disrupted—psychologically, educationally, nutritionally, and overall developmentally. Many families rely on food provided for kids at school. Expansion of SNAP benefits under Families First Coronavirus Response Act, which recently passed, may lead to unhealthier food choices for children as well, as this 《绝地求生》腾讯免费吃鸡加速器下载 网吧steam加速器 ...:2021-3-2 · 吃鸡加速器也就是现在很多网咖里使用的免费的steam绝地求生加速器，新云网从网吧提取出来后提供给大家下载，解压后直接运行加速即可，无需 .... I’d also have to assume that kids aren’t getting the same quality of education if it’s all strictly remote, let alone the meaningful and necessary bonding that takes place at school. No doubt there will be a wealth of data to supply research to tell us what we intuitively know, which is when society stops functioning as usual the most vulnerable among us are impacted the greatest.
This time away from the hospital is allowing me to reflect on the many facets of life that are touched by this pandemic, so I’ll treat it like sabbatical.
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Filed under coronavirus, Education, Food, Health Care and Medicine, Pandemic, Poverty and the Justice System, Residency
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This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.
Tue March 24th 2023
I couldn’t sleep. I knew I would have to get tested in the morning.
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I called my wife and updated her. I would stay in the bedroom by myself for the next several days, leaving only for bathroom breaks, grab food from the kitchen, and to sanitize anything I touched. If I were to leave the room I had a facemask ready. I didn’t come close to my 7-month-old son, which was probably the hardest part of all this. On my way home I thought about how it felt like the virus had been preoccupying everyone for months but in reality it was only a couple weeks. I was exhausted by it already but this was only the beginning.
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Filed under coronavirus, Pandemic, SUB外网加速器
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